Planning and Implementation
What to know
Planning turns assessment data into measurable goals and individualized interventions. Know SMART goals, prioritization frameworks (ABCs, acute before chronic, unstable before stable, actual before potential), evidence-based bundles, medication reconciliation, patient education with teach-back, and safety practices such as fall and infection prevention. Implementation includes ongoing reassessment, not just task completion. Delegation follows the nurse practice act and the "five rights": right task, circumstance, person, direction/communication, and supervision. The RN retains assessment, teaching, evaluation, and clinical judgment.
Traps
- Delegating assessment, patient teaching, or evaluation to unlicensed assistive personnel.
- Selecting an intervention before identifying the problem.
- Ignoring patient preference, health literacy, or readiness to learn.
- Treating a stable patient's routine task as more urgent than an unstable patient's ABC problem.
- Forgetting to document the intervention and the patient's response.
Worked example
An RN has a new admission with shortness of breath, a stable patient requesting a shower, and a UAP available. First assess and stabilize the breathing patient; the shower can wait or be delegated for the stable patient. A UAP may obtain vital signs and assist with ambulation for a stable patient but cannot assess breath sounds or teach inhaler use. Rule: delegate tasks, not judgment.