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# Assigning patients and setting priorities across several patients

- Safe practice

With several patients, the nurse decides who to see first using airway, breathing and circulation, acuity and time-critical tasks, then shares the work safely.

Updated Nov 12, 2026

## Key points

- ABCs first: airway, then breathing, then circulation problems take priority over everything else.
- Acute over chronic, unexpected over expected, actual over potential (risk) problems, as a general rule.
- CURE: critical (act now), urgent (discomfort or safety risk), routine (scheduled care), extras (comfort).
- A change from baseline (handoff, chart, new results) moves a patient up the list.
- Reprioritise whenever new data appear; routine tasks never delay critical or urgent care.
- Assign to others only what fits their scope; unstable patients and tasks that need clinical judgement stay with the nurse.

On this page

- The basics Key points
- What it is
- What it requires
- Components
- How it is applied (and why)
- Who first? Prioritisation cues with made-up examples
- Common mistakes
- Memory aid

- Safety In nursing practice

- Study Test yourself

- Connections Connections

## What it is

A nurse on a ward cares for several patients at once and must keep deciding who needs attention first. Open RN describes a set of tools that work together: the ABCs (airway, breathing, circulation) come first because they keep the patient alive; Maslow's hierarchy puts physiological needs and safety before higher needs; acute, unexpected and actual problems usually come before chronic, expected or potential ones; and a change from the patient's baseline signals a need for prompt assessment. The CURE scale sorts needs into critical, urgent, routine and extras. Acuity (how sick the patient is) and intensity (how much time the care takes) guide fair assignments. Priorities are not fixed: new data, such as a critical lab result, can change the plan in minutes. Assigning work to others follows each person's scope, and the registered nurse stays accountable.

## What it requires

- Know each patient's baseline from the handoff and the chart before seeing anyone.
- Rate acuity and intensity to spread the workload fairly across the team.
- Identify time-critical tasks early: scheduled medicines in their window, fluids about to run out, timed tests and procedures.
- Plan the shift on a written or electronic worksheet and keep it flexible.
- Know what each team member may do under the law and the institution's policy.

## Components

- ABCs: airway, breathing, circulation.
- Maslow: physiological needs, then safety, then belonging, esteem and self-actualisation.
- Data cues: acute vs chronic, actual vs risk, expected vs unexpected, change from baseline, new diagnostic results.
- CURE: critical, urgent, routine, extras.
- Acuity and intensity scores for assignments.

## How it is applied (and why)

- Get the handoff and review charts and new results for every patient: a baseline lets you spot change quickly.
- List the patients by acuity and mark anyone unstable or with a change from baseline: they are assessed first.
- Sort needs with the ABCs and CURE: an airway or breathing problem beats a routine task every time.
- Mark time-critical tasks (medicine windows, fluids running out, timed tests): missing them causes harm.
- Cluster care in each room (assessment, medicines, teaching): fewer trips leave time for urgent needs.
- Assign or delegate within each person's scope; keep unstable patients and assessments with the nurse: accountability stays with the RN.
- If two patients need help at once, go to the critical one and call for help for the other: no one is left without care.
- Reprioritise when new data appear, such as a critical result or a new symptom: priorities change during the shift.
- Check delegated work and patient responses before the end of the shift: supervision closes the loop.

## Who first? Prioritisation cues with made-up examples

| Cue | Usually first | Usually later |
| --- | --- | --- |
| ABCs | New shortness of breath with chest pain | Patient asking for help to the toilet (still a safety need: send help) |
| Acute vs chronic | Sudden severe abdominal pain | Long-standing joint pain at its usual level |
| Expected vs unexpected | Fever in a patient admitted for a planned joint operation | Mild pain expected after surgery, already being treated |
| Actual vs risk | Patient who cannot clear secretions now | Patient at risk of skin breakdown but with intact skin |
| New data | Critical lab value just reported | Discharge teaching for a stable patient |

## In nursing practice

- Before the shift starts, the charge nurse uses the staffing grid and acuity ratings to share patients fairly.
- Assistive personnel can help a stable patient walk but do not give medicines or make clinical judgements such as skin assessment; they report concerns to the nurse.
- Time spent putting on and taking off protective equipment for isolation patients must be counted when planning.
- When the workload is unsafe, say so early through the chain of command rather than silently skipping care.

## Common mistakes

- Seeing patients in room order instead of by need.
- Finishing a routine task while a patient shows a new airway or breathing problem.
- Ignoring a change from baseline because the patient was stable at handoff.
- Assigning an unstable patient or a task that needs clinical judgement to assistive personnel.
- Making a plan at the start of the shift and never revising it.

## Memory aid

CURE: Critical, Urgent, Routine, Extras.

## Test yourself

Think of the answer, then tap the question to see it.

## Two call lights at once: one patient has new chest pain and breathlessness, the other needs help to the toilet and is at risk of falling. Who first?

The patient with chest pain and breathlessness (ABCs, critical). Ask a colleague or assistant to help the other patient so the fall risk is covered.

## What does the CURE scale stand for?

Critical, urgent, routine and extras: needs that require immediate action, needs that cause discomfort or a safety risk, scheduled care and comfort measures.

## Why is an unexpected finding usually given priority over an expected one?

Because it may signal a complication or a change in condition that the current plan does not cover, so it needs prompt assessment.

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## Connections

## Related 5

- [Delegation and the care team: professional nurses, nursing auxiliaries and students](https://durgical.com/en/nursing/delegation-and-the-care-team-professional-nurses-nursing-auxiliaries-and-student/)
- [Handoff and SBAR communication](https://durgical.com/en/nursing/handoff-and-sbar-communication/)
- [Recognising deterioration and calling the rapid response team](https://durgical.com/en/nursing/recognising-deterioration-and-calling-the-rapid-response-team/)
- [Early warning scores (NEWS2) and when to escalate](https://durgical.com/en/nursing/early-warning-scores-and-when-to-escalate/)
- [Managing nursing care: planning, organising, directing and controlling a unit](https://durgical.com/en/nursing/managing-nursing-care-planning-organising-directing-and-controlling-a-unit/)

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Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.

Sources: [Nursing Management and Professional Concepts, 2.3 Tools for Prioritizing](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Management_and_Professional_Concepts_1e_(OpenRN)/02%3A_Prioritization/2.03%3A_Tools_for_Prioritizing) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts edition, 2022); [Nursing Management and Professional Concepts, 2.5 Time Management](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Management_and_Professional_Concepts_1e_(OpenRN)/02%3A_Prioritization/2.05%3A_Time_Management) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts edition, 2022); [Nursing Management and Professional Concepts, 3.3 Assignment](https://med.libretexts.org/Bookshelves/Nursing/Nursing_Management_and_Professional_Concepts_1e_(OpenRN)/03%3A_Delegation_and_Supervision/3.03%3A_Assignment) (Open RN, Wisconsin Technical College System (CC BY 4.0), LibreTexts edition, 2022).

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Representative model, for educational purposes only.

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License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/nursing/assigning-patients-and-setting-priorities-across-several-patients/