Every nurse knows the feeling: too many patients, too many tasks, and not enough time. Staffing shortages are real and are not your fault. But good prioritisation and organisation can make a heavy shift safer and less stressful, and help new nurses build confidence. It’s also a common topic in interviews and exam questions.
Start with a plan
- Use a “brain sheet” (personal worksheet) during handover: one row per patient, columns for times of medicines, observations, procedures, results to chase and discharge tasks.
- After handover, do a quick safety round: see every patient, check the sickest first, and spot anything urgent (pain, IV issues, oxygen, safety).
- Mark fixed-time tasks (time-critical medicines, scheduled procedures) and build the rest around them.
Prioritisation frameworks
ABCDE and Maslow
Airway, breathing and circulation problems come first, then other physiological needs, then safety, then comfort and psychological needs. A patient whose SpO₂ is falling comes before a discharge letter.
Urgent vs important
| Urgent | Not urgent | |
|---|---|---|
| Important | Do now: deteriorating patient, time-critical medicines, chest pain | Schedule: care planning, patient education, wound care |
| Less important | Delegate or batch: routine phone calls, restocking | Minimise or drop: non-essential paperwork duplication |
Acute before chronic, actual before potential, unstable before stable
A useful rule for real wards and for NCLEX-style questions.
Work smarter
- Cluster care: when you go to a patient, do observations, medicines, a skin check and repositioning together.
- Prepare before you go to the bedside: take everything you need.
- Document as you go, not all at the end of the shift.
- Delegate appropriately to healthcare assistants and students, with clear instructions, and check back. You remain accountable for the delegation decision.
- Batch calls and non-urgent tasks.
- Ask for help early. Offer help when you’re ahead.
Handling interruptions
- Protect high-risk tasks such as medication rounds (“do not disturb” tabards where used).
- If interrupted, write down where you were before switching.
- Politely defer non-urgent requests: “I’m giving medicines now; I’ll come to you in 10 minutes.” And then do it.
Take your break
Skipping breaks feels productive but increases fatigue and errors. Hand over your patients to a colleague and take your break.
When the workload is unsafe
- Tell the nurse in charge early, with specifics: “I have eight patients, two with NEWS2 of 6, and I can’t safely give the 2pm medicines on time.”
- Agree what will be prioritised and what will be delayed.
- Document and report through your organisation’s system. Records of unsafe staffing create the evidence for change.
- Your professional code requires you to raise concerns about patient safety.
End of shift
Start preparing your handover an hour before the end. Hand over outstanding tasks clearly rather than staying late to finish everything. Regular unpaid overtime is a sign of a staffing problem, not a personal failing.
Related: Nursing handover · Becoming a charge nurse · Nurse burnout