What is the first action a nurse manager should take during a sudden patient surge when staffing is stretched?

• A. Do not initiate surge actions until formal approval is received.
• B. Reallocate staff only after the patient census is stabilized.
• C. Address ABCs in daily operations, ignoring surge.
• D. Activate the unit surge plan, reallocate staff, and prioritize patient safety by addressing ABCs.

Answer: (D)

When a sudden patient surge hits with staffing stretched thin, the immediate goal is to mount a rapid, organized response that protects patient safety. The first action is to activate the unit’s surge plan. This isn’t just a formality—the surge plan provides predefined steps, roles, and thresholds that jump-start coordination, communications, and resource deployment. With the plan in motion, staff can be reassigned quickly to where they’re most needed, rather than waiting to figure things out on the fly.

Prioritizing patient safety hinges on addressing airway, breathing, and circulation for all patients. Stabilizing these critical functions establishes a clear, objective stance for triage and care decisions during a crisis. It ensures that those in imminent danger receive attention right away and that scarce resources are directed toward the most life-threatening needs.

Waiting for formal approval delays care, reallocating staff only after census stabilizes is reactive and slow, and ignoring surge altogether leaves patients at risk. Using the surge plan to mobilize resources while prioritizing ABCs provides a proactive, safety-first approach that aligns with how nurses manage crises in real time.