A client expresses suicidal ideation with a plan and means available. What is the priority nursing action?

Suicide risk with PLAN + MEANS is a psychiatric emergency requiring immediate intervention. Risk assessment (SAD PERSONS or other tools): higher risk with (S)ex (male higher completion), (A)ge (older), (D)epression, (P)revious attempts, (E)thanol/drug use, (R)ational thinking loss, (S)ocial support absent, (O)rganized plan, (N)o spouse, (S)ickness. Immediate actions for suicidal client with plan and means: (1) DO NOT LEAVE THE CLIENT ALONE — 1:1 observation by trained staff until risk reassessed; (2) NOTIFY — charge nurse, provider, psychiatric consultation team; (3) REMOVE MEANS — secure access to medications (especially the client's own), sharp objects, cords, belts, plastic bags; window restrictions; vehicle keys; (4) DOCUMENT — exact statements, behaviors, interventions, who was notified; (5) THERAPEUTIC COMMUNICATION — direct, non-judgmental questions ('Are you thinking about killing yourself? Do you have a plan? Do you have access to means?'); listen actively; do not promise to keep it secret; (6) SAFETY CONTRACT (controversial — limited evidence but sometimes used) — verbal or written agreement to not self-harm and to alert staff if urges arise; (7) MENTAL HEALTH EVALUATION — typically required for involuntary or voluntary psychiatric admission per state laws; (8) FAMILY/SUPPORT NOTIFICATION — with client permission when possible. Asking about suicide does NOT increase the risk — research consistently shows direct questioning is appropriate and reduces stigma. Once safety is established, ongoing care includes treatment of underlying conditions, safety planning, follow-up.