Investigating stacking: How do registered nurses prioritize their activities in real-time?

Recent nursing graduates often find it challenging to prioritize competing tasks in the increasingly complex hospital environment. In order to develop a normative framework for task prioritization, Registered Nurses from a variety of settings were interviewed about how they prioritized their activities in the workplace. From 30 interviews, 422 prioritization decisions were coded when study participants were confronted with two tasks that could not be done simultaneously. The findings suggest a seven-level prioritization hierarchy of nursing activities: 1) addressing imminent clinical concerns, 2) high uncertainty activities, 3) significant, core clinical caregiving and managing pain, 4) relationship management, 5) documenting, helping others, and patient support, 6) system improvement and cleaning/preparing supplies, and 7) personal breaks and social interactions. Explicitly providing a normative framework for task prioritization during nursing education may help to accelerate learning this skill. For more experienced nurses, we believe that flexibility to deviate from this framework will be important for providing high-quality, personalized care that best matches the particular context.Relevancy to industryNursing personnel comprises a significant portion of the human capital and operating budget for hospitals. Knowledge of what tasks are likely to be shed under severe workload conditions aids with optimizing hiring and allocation of nursing personnel.

► Recent nursing graduates are provided little guidance on how to prioritize competing demands in their complex work setting.
► Experienced nurses across diverse care settings prioritize tasks in a similar fashion.
► Addressing imminent clinical concerns and performing tasks with high uncertainty are usually prioritized higher than standard core work activities.
► Personal breaks and social interactions are usually prioritized lower than other tasks.