💓 Savvy NurseOpen the app

📋 Management of Care · Lesson 6 of 7 · 6 min

SBAR, Handoffs and When to Climb the Chain of Command

📞 It is 0300. The client is deteriorating. The resident says, 'Watch and call me if it gets worse.' You believe it is already worse. What happens in the next two minutes is a classic exam question.

💡 Key idea

SBAR organizes the call; read-back confirms the order; the chain of command is how you advocate when the first answer is unsafe.

🧠 Why it matters

SBAR structures urgent communication: SITUATION (who you are, who the client is, what is happening now), BACKGROUND (diagnosis, relevant history, recent changes), ASSESSMENT (your interpretation and the vital signs), RECOMMENDATION (what you want: an order, an evaluation at the bedside, a transfer). Read back verbal and telephone orders and have the provider confirm. HANDOFF reports at shift change must be thorough and uninterrupted and include pending tasks, abnormal findings and what to watch. When a provider's response leaves a client unsafe, use the CHAIN OF COMMAND: the charge nurse, then the nursing (house) supervisor, then the attending or chief, following facility policy. Document the times, the people contacted and their responses, factually. Advocacy sometimes means being the person who keeps calling.

🏥 In the real world

🧗 A nurse reports a post-op client's rising heart rate and falling blood pressure. The resident orders a fluid bolus and says to reassess in an hour. Thirty minutes later the pressure is lower. The nurse calls back, is told to wait, and then calls the charge nurse and the attending surgeon. The client returns to the operating room with a bleeding vessel. The nurse's documentation lists four calls with times. That timeline is the difference between a near miss and a tragedy.

📌 Takeaways

  • Situation, Background, Assessment, Recommendation
  • Read back every verbal or phone order
  • Unsafe response: go up the chain and document every step

📖 Terms in this lesson

SBAR: Situation, background, assessment, recommendation: the structure for reporting a client problem to a provider.

✅ Test yourself

In an SBAR call, 'Client's heart rate is 128, BP 86/50, and the abdomen is distended and rigid' belongs to which part?
  1. Situation
  2. Background
  3. Recommendation
  4. Assessment

Answer: D · Assessment

Assessment is your findings and interpretation. Situation states the immediate problem; recommendation states what you want done.

A provider gives a telephone order for a new medication. What must the nurse do?
  1. Ask the pharmacist to confirm instead
  2. Wait for the written order before doing anything, regardless of urgency
  3. Read the order back and obtain confirmation before carrying it out
  4. Write it down and give the medication

Answer: C · Read the order back and obtain confirmation before carrying it out

Read-back and confirmation prevent transcription errors. Telephone orders must then be signed per policy.

The on-call provider refuses to evaluate a client the nurse believes is deteriorating. What should the nurse do next?
  1. Notify the charge nurse and go up the chain of command
  2. Document the refusal and wait for the day team
  3. Call the client's family to intervene
  4. Give a medication the nurse thinks will help

Answer: A · Notify the charge nurse and go up the chain of command

Client advocacy requires escalation through the chain of command, with documentation of each contact.

Start this lesson free →

NCLEX-style questions, XP and streaks in the app. No sign-up needed.

More in Management of Care

🔗 Related lessons