SBAR Examples for Nursing Students: How to Structure Clinical Communication

SBAR gives you a script for the moment students find hardest: telling a senior colleague that something is wrong. It was developed in the US Navy’s nuclear submarine service, adapted for healthcare by Kaiser Permanente in the early 2000s, and is now embedded in escalation policy almost everywhere.

Its value is not just clarity. It gives a junior person permission to state an assessment and make a request, which is the part hierarchy tends to suppress.

The four components

S — Situation. Who you are, where you are, who the patient is, and what the immediate concern is. Ten to fifteen seconds.

B — Background. The clinical context needed to interpret the situation. Admission reason, relevant history, current treatment, recent changes.

A — Assessment. What you think is going on. This is the component students skip.

R — Recommendation. What you want the other person to do, and by when.

Why students skip the Assessment

Two reasons. First, a belief that offering a clinical opinion is above their station. Second, genuine uncertainty.

Neither justifies omitting it. You do not need a diagnosis. “I think this patient is deteriorating and I’m concerned about sepsis” is an assessment. So is “I’m not sure what’s causing this, but the change from two hours ago is significant and I’m worried.”

Uncertainty stated clearly is more useful than no assessment at all, because it tells the receiver how urgently to respond. A call that reports observations without interpretation forces the receiver to guess how worried you are, and they will often guess low.

Worked example: deteriorating patient

Situation: “Hello Dr Okafor, this is Sam Whitfield, third-year student nurse on Ward 12 with Nurse Ellis. I’m calling about Mrs Bennett in bed 6. Her NEWS2 score has gone from 2 to 7 in the last hour and I’m concerned about her.”

Background: “She’s a 74-year-old admitted three days ago with a community-acquired pneumonia, on IV co-amoxiclav. She’s been stable until this morning. History of COPD and type 2 diabetes.”

Assessment: “Her respiratory rate is 28, up from 20. SpO₂ is 89% on 2 litres, down from 94%. Temperature 38.6, heart rate 118, blood pressure 96 over 58 — that’s down from 124 over 70 this morning. She’s more confused than baseline. I think she may be becoming septic.”

Recommendation: “Please can you come and review her now? In the meantime, would you like us to increase her oxygen, take blood cultures, and start a fluid challenge? We’ve already sent bloods including a lactate.”

Note the structure of the Recommendation: a clear request with a timeframe, plus an offer of what can be started immediately. That second part converts a phone call into simultaneous action.

Worked example: medication concern

Situation: “Hi, this is Priya Raman, student nurse on the surgical unit, calling about Mr Doyle in bay 3. I have a concern about his enoxaparin dose.”

Background: “He’s 82, admitted for a hemiarthroplasty two days ago, prescribed enoxaparin 40mg daily for VTE prophylaxis. His creatinine has come back at 186 today, up from 112 on admission, and his eGFR is 24.”

Assessment: “With an eGFR under 30, the dose usually needs reducing. I don’t think the prescription has been reviewed since the renal function changed.”

Recommendation: “Can you review the prescription before this evening’s dose is due at 18:00? I’ve held it pending your review and documented that.”

Worked example: handover

Handover SBAR is compressed and often uses a written proforma.

Situation: “Bed 4, Joseph Ntanda, 56. Day 1 post laparoscopic cholecystectomy. Currently stable, main issue is pain control.”

Background: “Admitted yesterday with biliary colic, uncomplicated procedure. PCA morphine, regular paracetamol. No significant comorbidities. Mobilising with one assist.”

Assessment: “Pain has been well controlled overnight, scoring 3 to 4. Wound sites clean and dry, no signs of infection. Passing urine, no bowel movement yet. He’s anxious about going home tomorrow with the drains still in.”

Recommendation: “Continue current analgesia and step down from PCA today if pain remains controlled. He needs the discharge conversation about drain care — I’ve asked the surgical nurse practitioner to see him this afternoon. Please monitor for bowel sounds.”

Using SBAR in written assignments

SBAR appears in coursework in three ways, and each wants something different.

As a documentation exercise. You write an SBAR for a scenario. Marked on completeness, clinical accuracy, appropriate prioritisation, and whether the Assessment and Recommendation are actually present and specific.

As the subject of a reflective essay. You reflect on an escalation you were involved in, using SBAR as a lens. Here the analysis should engage with the literature on structured communication, hierarchy, and speaking up — the evidence base for SBAR is mixed and worth engaging with honestly rather than treating the tool as self-evidently effective.

As part of a care plan or case study. Embedded to demonstrate the communication element of your care.

For the second of these, be aware that studies of SBAR show inconsistent effects on hard outcomes, and that implementation quality varies enormously. An essay that acknowledges this is stronger than one that treats the tool as unambiguously proven.

Common mistakes

Burying the concern. Two minutes of background before saying why you called. Lead with the concern.

Omitting the Assessment. Covered above, and the most consequential error.

Vague Recommendations. “I thought you should know” is not a recommendation. Say what you want and when.

Reciting the whole chart. Background is what the receiver needs to interpret this concern, not everything you know.

Not stating your name and role. The receiver calibrates their response partly on who is calling. It matters.

Not documenting. Every escalation goes in the notes: time, who you spoke to, what you reported, what was agreed.

A note on escalating when you are not taken seriously

SBAR helps but does not guarantee a response. If your concern is dismissed and you remain worried, most organisations have a graded assertiveness framework — approaches like PACE (probe, alert, challenge, emergency) or the two-challenge rule — and a defined route to escalate beyond the person who dismissed you.

Knowing that route before you need it is worth more than any communication tool. Ask about it on your first day of placement.

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