A client comes to the emergency department after disclosing suicidal ideation to a friend. The nurse's FIRST priority is:

INITIAL SUICIDE RISK ASSESSMENT is the first priority because it determines the immediate safety response. ELEMENTS OF ASSESSMENT: IDEATION: Passive ('I wish I were dead') vs. active ('I am planning to kill myself'); PLAN: Specificity of plan (vague vs. specific date, method, location); METHOD: Availability and lethality (firearms are highest lethality, most impulsive methods); INTENT: Level of commitment and desire to act; PROTECTIVE FACTORS: Reasons to live (family, pets, religious beliefs, future plans); PRIOR ATTEMPTS: History of attempts is the strongest predictor of future attempt; SAFETY ENVIRONMENT: Are there firearms in the home? PN ROLE vs RN ROLE: RN leads initial crisis assessment; psychiatry or psychology consults for formal evaluation; the RN does not defer assessment while waiting for psychiatry. IMMEDIATE SAFETY MEASURES: Remove or secure potentially lethal items; constant supervision (1:1 for highest risk); communicate level of risk clearly to team.