Nursing Prioritization and Delegation: ABC, Maslow, and Scope of Practice

Prioritization and delegation questions appear throughout the NCLEX and represent some of the highest-stakes clinical decisions a nurse makes in practice. Answering them correctly requires a systematic framework, not a gut feeling. This guide breaks down the most reliable prioritization models and explains which tasks can be safely delegated to LPNs and UAPs.

The ABC Framework: Airway, Breathing, Circulation

The ABCs remain the foundation of nursing prioritization. When multiple patients or problems compete for your attention, the one posing the greatest immediate threat to airway, breathing, or circulation takes first priority.

• Airway: Any obstruction, stridor, or inability to maintain a patent airway is your highest priority
• Breathing: Respiratory distress, oxygen saturation below 90%, or respiratory rate outside normal range comes next
• Circulation: Signs of hemorrhage, shock, or severe cardiac compromise follow

Apply the ABCs to both individual patient assessment and multi-patient triage. The patient with the least stable airway always comes first, regardless of how complex another patient’s situation may be.

Maslow's Hierarchy in Nursing Priority

After life-threatening physiological threats are addressed, Maslow’s Hierarchy of Needs provides a secondary prioritization framework:

1. Physiological needs — pain, nutrition, elimination, rest (addressed after ABCs)
2. Safety and security — fall risk, infection prevention, medication safety
3. Love and belonging — social isolation, family support
4. Esteem — patient dignity, self-care capacity
5. Self-actualization — coping, meaning, and growth

On the NCLEX, if two patients are both physiologically stable, the one with the greater safety concern (fall risk, altered mental status, risk for self-harm) takes priority over one with only psychosocial needs.

The Safety and Instability Rule

A useful NCLEX heuristic is: unstable before stable, acute before chronic. Consider these comparisons:

• A patient with a new onset of chest pain takes priority over a patient with chronic stable angina asking for discharge teaching
• A postoperative patient with a sudden drop in blood pressure takes priority over a patient who has been on the unit for two days with a healing wound
• A patient whose condition is changing takes priority over a patient whose condition is unchanged, even if the unchanged patient appears sicker overall

Change and instability signal immediate reassessment need. Stability, even at a low baseline, indicates the patient can wait briefly.

RN vs. LPN vs. UAP: Scope of Practice for Delegation

Delegation questions hinge on understanding what each role can legally and safely do:

Registered Nurse (RN):

• Completes initial and ongoing assessments
• Develops and updates the nursing care plan
• Administers IV push medications and blood products
• Performs patient teaching and discharge planning
• Delegates tasks and retains accountability for outcomes

Licensed Practical/Vocational Nurse (LPN/LVN):

• Performs ongoing (not initial) assessment of stable patients
• Administers oral, subcutaneous, and intramuscular medications
• Provides wound care and catheter insertion
• Contributes to the care plan but does not independently develop it
• May administer IV medications in some states — always follow your state’s practice act

Unlicensed Assistive Personnel (UAP/CNA):

• Measures and records vital signs on stable patients
• Assists with activities of daily living (bathing, grooming, positioning)
• Collects urine, stool, and sputum specimens
• Performs basic care tasks that do not require nursing judgment
• Never interprets data, makes clinical decisions, or performs invasive procedures

The Five Rights of Delegation

The American Nurses Association identifies five rights that must be satisfied before delegation is appropriate:

1. Right task — the task is within the delegatee’s scope and competency
2. Right circumstance — the patient’s condition is stable enough that the task is safe to delegate
3. Right person — the specific individual has demonstrated competency in this task
4. Right direction and communication — clear instructions including expected outcomes are given
5. Right supervision — the RN monitors the outcome and is available for questions

If any of the five rights cannot be satisfied, the RN should not delegate the task. Delegation is never used to offload work that requires nursing judgment — it is used to optimize team efficiency for tasks that fall within an assistant’s verified scope.