Before We Start
Why unstructured communication causes patient harm
Poor communication between healthcare providers is one of the leading causes of preventable patient harm. A nurse calls a physician at 2am, nervous and disorganized, provides information in a rambling order, and fails to clearly state what they need. The physician, half-asleep and missing context, makes a decision without the full clinical picture. The patient is harmed.
SBAR was originally developed by the U.S. Navy for use in nuclear submarines — environments where clear, structured communication under pressure is literally a matter of life and death. The healthcare system adopted it because it solves the same problem: how do you communicate complex information quickly and completely to someone who needs to act on it?
The Joint Commission has endorsed SBAR as a patient safety tool. Most hospitals require it for nurse-to-provider communication. Learning it now means you will be a confident, effective communicator from day one.
The Four Components
SBAR — what goes in each section
S — Situation
What is happening RIGHT NOW — lead with this
The Situation statement gets the listener's attention immediately and tells them why you're calling. It should be brief — one to two sentences maximum. State the most urgent fact first.
Include:
• Your name and location
• The patient's name and room number
• What is happening right now (the reason for the call)
• The level of urgency
Examples:
• "This is Nurse Williams on 4 North. I'm calling about Mr. Garcia in room 412. His blood pressure has dropped to 82/50 and he's becoming confused. I'm concerned he may be going into shock."
• "This is Maria, RN in the ED. I'm calling about Ms. Chen who came in with chest pain — her 12-lead shows ST elevation in leads II, III, and aVF. I think this is an inferior MI."
💊 Lead with the problem — not with "sorry to bother you" or background information. The provider needs to know immediately what they're dealing with.
B — Background
Relevant context — what the provider needs to know
Background provides the clinical context that makes the Situation make sense. It should be focused and relevant — not a complete chart review.
Include the relevant subset of:
• Why the patient is admitted (primary diagnosis)
• Relevant medical history
• Current medications (especially those relevant to the situation)
• Allergies (if relevant to anticipated orders)
• Recent labs or test results
• What has happened clinically since admission
Focus on what matters for THIS situation. A call about blood pressure doesn't require full psychiatric history. Provide what helps the provider understand the situation and make a decision.
💊 Keep background to 30–60 seconds. The provider doesn't need the full history — they need the context that explains why you're calling and what options exist.
A — Assessment
YOUR clinical judgment — what do YOU think is happening?
This is the section new nurses find most intimidating — and the most important. Assessment is where you share YOUR clinical impression of what is happening. You are not just reporting facts. You are offering a clinical interpretation.
The provider wants to know: What does the nurse — who is AT THE BEDSIDE and has seen the patient — think is going on?
Examples:
• "I believe his hypotension and confusion may be early septic shock related to his ongoing pneumonia."
• "I'm concerned this may be a pulmonary embolism — her risk factors include recent surgery and she's been immobile."
• "I think the patient's pain is not adequately controlled with the current regimen."
It's okay to say: "I'm not sure what's happening, but I'm concerned because [specific finding]." Uncertainty is acceptable. Failure to communicate concern is not.
💊 "I'm concerned this patient may be..." — Your assessment matters. You are at the bedside. The provider is not. Your clinical impression is valuable information. Share it.
R — Recommendation
What do YOU need — be specific
Recommendation is where you tell the provider what you think needs to happen. You are not demanding — you are requesting. But you should be specific about what you need.
Examples of clear recommendations:
• "I'd like you to come and assess the patient."
• "Can we get a STAT chest X-ray and blood cultures?"
• "I think the patient needs an order for additional pain medication."
• "I'd like to initiate the sepsis protocol — can I get your order?"
If you're unsure what to recommend: "I'm not sure what the next step should be, but I feel this patient needs to be seen. Can you come evaluate?"
Read-back: When orders are received verbally, repeat them back to confirm accuracy. "I'm reading back: Morphine 2mg IV PRN every 4 hours for pain. Is that correct?" This is a required safety step.
💊 "What do you want me to do?" is a weak recommendation. "Can you come see the patient? I'm worried about him" is a specific, assertive recommendation. Ask for what you need.
🏥 Full SBAR Call — Put It All Together
It is 0230. Mr. Torres, 67 years old, admitted 2 days ago for a COPD exacerbation, has had a significant change in condition. You are calling his physician.
S
Situation: "Dr. Patel, this is Sarah, RN on 5 West. I'm calling about Mr. Torres in room 524. He's become increasingly short of breath over the past hour and his oxygen saturation has dropped to 84% despite being on 4L nasal cannula. I've increased his oxygen to 6L but he's still at 88%. He's working hard to breathe and I'm concerned he may be deteriorating."
B
Background: "He's a 67-year-old admitted two days ago for a COPD exacerbation. He's on scheduled albuterol and ipratropium nebs, prednisone 40mg daily, and azithromycin. His baseline SpO₂ is 90–92% on room air. Tonight his vitals are: BP 148/92, HR 108, RR 28, Temp 38.4°C, SpO₂ 88% on 6L. He was at 94% on 4L at my last assessment two hours ago."
A
Assessment: "I'm concerned he may be having a worsening COPD exacerbation or possibly developing a pneumonia on top of his COPD. His fever is new since this evening and his work of breathing is significantly increased compared to earlier today. He's using accessory muscles and I can hear expiratory wheezes bilaterally."
R
Recommendation: "I'd like you to come and assess him. In the meantime, can I get an order for a STAT chest X-ray and ABG? And I'd like to have respiratory therapy at the bedside — can I initiate that? If his SpO₂ drops below 88%, would you like me to apply a non-rebreather mask?"
Dr. Patel: "Yes, get the CXR and ABG now. Call respiratory. I'll be there in 15 minutes. If his sat drops below 86%, apply NRM and call me immediately."
Nurse: "I'm reading back: STAT CXR and ABG, respiratory therapy consult, NRM if SpO₂ below 86%, and you'll be here in 15 minutes. Correct?" Dr. Patel: "Correct." → Documented with time, provider name, orders received, read-back completed.
SBAR for Handoff
Shift-to-shift report using SBAR
SBAR applies to more than physician calls — it's the framework for shift handoff report as well. When giving report to the oncoming nurse, use SBAR for each patient to ensure complete, organized transfer of care.
Bedside handoff — best practice
The safest handoff happens at the bedside, with both nurses and the patient present. This allows:
• Visual verification of the patient's current condition
• Patient participation in their own care transition
• Immediate identification of any discrepancies between the chart and the patient's actual state
• Introduction of the incoming nurse to the patient
Use SBAR as your framework: Situation (why they're here, current status), Background (history, relevant events during your shift), Assessment (your impression of where they are), Recommendation (what needs to happen next shift, pending tests, concerns).
📌 NCLEX Application
SBAR is tested on NCLEX as both a communication tool and a safety concept.
Key NCLEX rules:
• Always identify yourself, the patient, and the situation first
• Read back ALL verbal orders — required safety step
• Document: time of call, provider name, information reported, orders received, read-back completed
• SBAR is used for nurse-to-provider calls AND shift handoff
• Bedside handoff with the patient present is evidence-based best practice
Chain of command: If you call the provider with a patient safety concern and don't get an appropriate response, escalate — charge nurse → nursing supervisor → medical director → hospital administration. Document every contact. Never ignore a patient safety concern because one person didn't respond.
⚠️ The Trap — Leaving Out Your Assessment
New nurses often skip the Assessment component of SBAR — they provide Situation and Background (the facts) but leave out their own clinical impression. This is the most valuable component to the provider, and the one most often omitted.
Providers want to know what the nurse at the bedside thinks. You have information the provider doesn't have — you've seen the patient, assessed them, watched the trend. Your assessment is not an opinion to be embarrassed about. It is clinical data.
"I don't know what's wrong — I'm just giving you the numbers" is less useful than "I'm not sure what's causing this, but something has changed and I'm worried." The second statement tells the provider how urgently to respond.
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