Management of Care · 3 min read
The Advocacy Role · Prioritization of Care · Resource Management
Nurses advocate by speaking on behalf of clients who cannot speak for themselves and by supporting clients who can express their own needs. Advocacy protects client rights, promotes informed decision-making, and ensures access to needed services. Effective advocates know client rights, institutional policies, and available resources; communicate assertively while maintaining respectful relationships; and use cultural competence to advocate across diverse populations.
Client Rights
Receive information about diagnosis, treatment options, and prognosis in understandable terms
Participate in care planning and refuse recommended treatment
Privacy and confidentiality of all health information
Designate surrogate decision-makers and create advance directives
Access their medical records and request amendments
Use complaint mechanisms without retaliation
Participate in research only with full understanding of its purpose, procedures, and risks, and withdraw at any time without affecting standard care
Advocacy Actions
At the bedside, nurses communicate client preferences to the team, question orders that appear inappropriate, and intervene when safety is threatened, documenting their actions. At the system level, they address policies that create barriers to care through quality improvement, ethics committees, and professional organizations, and political advocacy influences health legislation. Cultural advocacy ensures care respects client values: arranging qualified interpreters, accommodating dietary restrictions, and incorporating cultural healing practices when appropriate and safe.
Use a qualified medical interpreter, not a family member or child, for consent, teaching, and assessment. When an order seems unsafe or conflicts with the client's documented wishes, the advocate's first move is to clarify it with the provider.
Prioritization Frameworks
Maslow's hierarchy of needs guides prioritization by addressing physiological needs before safety, love and belonging, esteem, and self-actualization. Within physiological needs, the ABCs (airway, breathing, circulation) provide a systematic order: airway obstruction is treated before breathing problems, and circulatory compromise follows respiratory stabilization.
Growth, fulfillment
Recognition, independence
Family, support systems
Injury prevention, protection from harm
Airway, breathing, circulation, fluids, nutrition, elimination
Priority-Settingrulesofthumb
| HigherPriority | Before |
|---|---|
| Acuteproblems | Chronicconditions |
| Unstableclients | Stableclientswithexpectedfindings |
| Actualproblems | Potentialproblems unlesspreventioniscritical , |
| Unexpectedfindingsforthecondition | Findingsexpectedwiththediagnosis |
| Physiologicalneeds | Psychosocialconcerns |
Triage Principles
Emergency triage sorts clients by illness severity and available resources. In mass casualty incidents, triage aims to do the greatest good for the greatest number.
| Category | Tag | Description |
|---|---|---|
| Immediate | Red | Life-threatening injuries that need lifesaving intervention within minutes |
| Delayed | Yellow | Seriousconditionsthatcanwaitfortreatment |
| Minor | Green | Non-urgent conditions ("walking wounded") |
| Expectant | Black | Unsurvivableinjuriesordeceasedinamasscasualtysituation |
Telephone triage uses standardized protocols: the nurse gathers subjective data systematically, gives appropriate recommendations, refers high-risk symptoms for emergency care, and documents the encounter thoroughly.
Clinical Decision-Making
Clinical reasoning integrates assessment data, nursing knowledge, and client preferences. Critical thinking evaluates the quality of information, identifies assumptions, and considers alternatives. Time management maximizes efficiency: clustering activities reduces interruptions, anticipating needs prevents delays, and delegation extends the nurse's capacity to manage several clients.
Adequate staffing and safe nurse-to-
Par levels set minimum supply
Electronic health records and clinical
client ratios reduce mortality,
quantities, and just-in-time ordering
decision support provide information
medication errors, and hospital-
reduces waste. Malfunctioning
and alerts at the point of care.
acquired infections. Orientation and
equipment is removed from service and
Evidence-based resources guide
continuing education maintain
reported. Cost-effective care uses
decisions, secure messaging protects
competency; performance
generics, appropriate length of stay,
information, and structured handoffs
management includes feedback, annual
and complication prevention without
maintain continuity during transitions.
evaluation, recognition, remediation,
compromising quality.
and progressive discipline.
Sbar:Astandardformatforhandoffsandforreportingachangeincondition
➜
➜
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What is happening now
Relevant history and context
The nurse's findings and concern
What the nurse needs or
suggests
The RN keeps accountability for every delegated task.
The provider explains the procedure; the nurse witnesses and verifies understanding.
Assessment, initial teaching, care planning, and evaluation are never delegated.
Airway, then breathing, then circulation; acute and unstable before chronic and stable.
Malpractice requires duty, breach, causation, and damages.
Use a qualified interpreter, never a child or family member.
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