SBAR for Student Nurses: Clear, Safe Clinical Communication on Placement

Someone asks you to phone a doctor, escalate a deteriorating patient or give a concise handover. You know the patient well, but deciding what the receiving clinician needs to hear first can still be difficult.

That is the problem SBAR is designed to help solve.

SBAR stands for Situation, Background, Assessment and Recommendation. It provides a predictable structure for communicating clinically important information so that the person receiving it can quickly understand what is happening, what context matters and what response is being requested.

For student nurses, SBAR is not simply a handover acronym to memorise. Used well, it helps you organise clinical information, communicate concern and escalate deterioration safely.

Where did SBAR come from?

SBAR is generally described as having developed from structured communication practices associated with high-risk military environments, including the US nuclear submarine service. The framework was subsequently adapted for healthcare in the early 2000s, particularly through work at Kaiser Permanente involving Dr Michael Leonard and colleagues including Doug Bonacum and Suzanne Graham.

The exact history is sometimes described differently across publications, so it is more accurate to think of SBAR as a healthcare adaptation of concise, structured briefing principles rather than as an acronym with one single, perfectly documented point of origin.

The underlying problem is highly relevant to healthcare: important information has to move quickly and accurately between people who may have different roles, experience and levels of authority. A shared structure can make it easier for the speaker to organise information and for the listener to identify the immediate concern.

SBAR has subsequently been used across NHS settings as one approach to structured clinical communication, including handover and escalation. Local organisations may use variations such as ISBAR, so students should follow the communication framework and escalation policy used in their placement area.

Why structured communication matters

Clinical communication is a patient-safety skill. Important information can be obscured when a handover is vague, excessively long or does not make clear why the speaker is concerned.

SBAR gives both people a shared structure:

• Situation: What is happening now?
• Background: What relevant context does the listener need?
• Assessment: What have you assessed and found?
• Recommendation: What response, review or action is needed?

The framework can support urgent escalation, routine handover, referrals and transfer of care. It should support professional judgement rather than become a rigid script.

S: Situation

Start with the immediate problem. The listener should understand within the first few sentences who you are, which patient you are discussing, where the patient is and why you are contacting them.

For example:

“Hello, I’m Amira, a student nurse on Ward 4 working with my supervising registered nurse. I’m calling about Mr Patel in bed 6. He has become acutely more breathless over the last 20 minutes and I’m concerned about him.”

That is more useful than beginning with the patient's entire admission history.

Include

• your name, role and clinical area;
• appropriate patient identification in accordance with local policy;
• the immediate clinical problem;
• why you are concerned.

If the situation is urgent, communicate that urgency clearly.

B: Background

Now give the relevant context. Background should help explain the current problem, not reproduce the entire patient record.

Relevant information might include:

• reason for admission;
• important diagnoses or recent procedures;
• relevant medical history;
• important medicines, allergies or current treatment;
• baseline observations or oxygen requirements;
• recent changes related to the current concern.

For example:

“He was admitted yesterday with community-acquired pneumonia. He was previously maintaining his prescribed target oxygen saturation on 2 litres via nasal cannulae and has become progressively more breathless this afternoon.”

The key word is relevant. Too much background can hide the information the listener actually needs.

A: Assessment

This is where you communicate what you have assessed and found.

For a deteriorating patient, this may include findings from an ABCDE assessment, current observations, NEWS2 where applicable, changes from baseline and other relevant clinical findings.

For example:

“His respiratory rate is 30, oxygen saturation is 88% despite his current oxygen therapy, heart rate is 116 and blood pressure is 98/62. He is more drowsy than earlier. His NEWS2 has increased and I am concerned he is deteriorating.”

Use exact observations when you have them. Trends and changes from baseline are often more informative than one isolated value.

Do not invent information simply to complete the SBAR structure. If an assessment has not been performed, be clear about that and obtain appropriate support. As a student nurse, work within your competence and involve the registered professional supervising the patient's care.

What if the patient simply looks wrong?

Clinical concern matters. A patient may deteriorate before every abnormality is captured neatly by a scoring system. If you are worried, explain what has changed: appearance, behaviour, work of breathing, skin colour, responsiveness, pain, urine output, observations or another relevant feature.

NEWS2 supports the recognition and response to acute illness, but it does not replace clinical judgement or local escalation procedures.

R: Recommendation

This is often the part students find most difficult because asking a more senior professional for a specific response can feel uncomfortable.

Recommendation does not mean diagnosing the patient or prescribing the treatment. It means making clear what you need from the person receiving the communication.

You might say:

“I’m concerned he needs an urgent medical review. Could you please review him now?”

or:

“Could you advise what you would like us to do next while you are on your way?”

Where appropriate, confirm the agreed plan, clarify anything you have not understood and ensure the relevant registered practitioner knows the outcome.

Putting the whole SBAR together

Imagine you are escalating a patient whose condition has changed.

Situation:
“Hello, I’m Leah, a student nurse on the acute medical unit working with my supervising nurse. I’m calling about Mrs Khan. She has become increasingly drowsy and hypotensive and I’m concerned she is deteriorating.”

Background:
“She was admitted today with suspected sepsis from a urinary source. She has received the prescribed initial treatment and had been alert earlier in the shift.”

Assessment:
“Her respiratory rate is 26, oxygen saturation is 94% on room air, heart rate 122, blood pressure 86/52 and temperature 38.7°C. She is now responding to voice rather than being fully alert. Her NEWS2 has increased.”

Recommendation:
“I’m concerned she needs urgent senior clinical review. Could you come and assess her now? Is there anything you would like us to do while you are coming?”

The listener receives the immediate problem, relevant context, current assessment and a clear request without having to extract those points from a long narrative.

SBAR and ABCDE are not the same thing

This distinction is worth learning early.

ABCDE is a systematic approach to assessing and treating a critically ill or deteriorating patient.
SBAR is a framework for communicating relevant clinical information.

In a deteriorating patient, findings from the ABCDE assessment can therefore form an important part of the Assessment section of SBAR.

A useful sequence is:

Recognise deterioration → call for appropriate help → assess and intervene using ABCDE → communicate using SBAR → confirm the plan → continue reassessment.

In an emergency, these steps may overlap. Do not delay calling for help while trying to complete a perfect assessment or SBAR.

SBAR and NEWS2: how they fit together

NEWS2 and SBAR do different jobs.

NEWS2 standardises the recording of key physiological observations and supports recognition of acute deterioration in adults in relevant NHS settings.

SBAR helps you communicate the clinical situation.

A NEWS2 score can therefore be useful information within an SBAR, but the score is not the entire Assessment. The patient's symptoms, appearance, ABCDE findings, trends and your clinical concern still matter.

Always follow the NEWS2 response thresholds and escalation arrangements used by your organisation. Some patient groups and clinical environments require additional or alternative approaches.

SBAR is not only for doctors

SBAR can support communication between nurses, doctors and other members of the multidisciplinary team. It can also be used during shift handover, referrals and transfer between clinical areas.

The framework should be adapted to the purpose of the communication. A two-minute urgent escalation call and a planned transfer-of-care handover will not require exactly the same amount of detail.

Common SBAR mistakes

• Starting with too much background: say why you are calling first.
• Giving every detail you know: select information relevant to the current problem.
• Reporting observations without context: explain what has changed and why you are concerned.
• Forgetting the recommendation: make clear what response you need.
• Guessing missing information: be explicit about what you know and what you do not.
• Using NEWS2 as the whole assessment: the score supports clinical assessment; it does not replace it.
• Delaying urgent help to complete SBAR: patient safety comes first.
• Finishing without confirming the plan: clarify instructions and ensure the relevant registered professional knows the outcome.

Before you make the call

If the situation allows, organise the information you are likely to need. Have the patient's relevant record available, know the current observations and NEWS2 where applicable, review recent trends and use the four SBAR headings as prompts.

Before ending the conversation, use closed-loop communication where appropriate: repeat back important instructions, clarify uncertainty and confirm who is doing what next. This reduces the risk of assumptions or misunderstood instructions.

In an emergency, however, do not delay escalation simply to produce a perfect SBAR.

What if the person you call does not respond?

SBAR structures the communication; it does not replace an escalation pathway.

If you believe a patient is deteriorating and the response is delayed or inadequate, tell your supervising registered nurse and follow the organisation's escalation policy. Depending on the setting and urgency, this may require escalation to a more senior clinician, critical care or emergency response team.

Do not repeatedly wait for the same response while the patient's condition worsens. Continue appropriate assessment and reassessment while help is being obtained.

What if you are “just a student”?

You are not expected to manage clinical deterioration independently, but you are expected to recognise concerns, communicate them and practise within your competence under appropriate supervision.

The NMC Code requires registered professionals to communicate clearly and effectively, share information to reduce risk, work cooperatively, recognise and act on deterioration, ask for help when needed and raise concerns when patient safety may be at risk. These principles are directly relevant to learning safe escalation as a student.

If you notice deterioration, inform the registered professional supervising the patient's care promptly and follow local escalation procedures. SBAR gives you a structure for communicating the concern; it does not change your scope of practice.

Try it yourself: a short practice scenario

You are caring for an adult patient admitted with a lower respiratory tract infection. Thirty minutes ago they were alert, respiratory rate 20 and oxygen saturation 95% on their prescribed oxygen. They now look distressed. Respiratory rate is 32, oxygen saturation is 89% despite the same oxygen therapy, heart rate is 124 and they are becoming confused.

Before reading on, try to organise the information into SBAR.

Situation: What is the immediate change and why are you concerned?

Background: Which parts of the admission and previous oxygen requirement matter?

Assessment: Which observations and changes from baseline should you report? What else would you assess using ABCDE while appropriate help is being obtained?

Recommendation: What response do you need, and how urgently?

A reasonable escalation would make the deterioration clear immediately, give only the relevant respiratory background, report the current observations and change in mental state, and request urgent clinical review. There is no need to produce one memorised 'perfect' script.

Your quick SBAR prompt

S — Situation: Who are you? Who is the patient? What is happening now? Why are you concerned?

B — Background: Why are they here? What relevant history, baseline or recent treatment explains the situation?

A — Assessment: What have you found? What are the relevant observations, trends, NEWS2 and ABCDE findings?

R — Recommendation: What do you need from the person receiving the SBAR? How urgently? What is the agreed next step?

One final point

A good SBAR is not the one containing the most information. It is the one that allows the receiving clinician to understand the problem and respond safely.

With practice, SBAR becomes less like four letters to remember and more like a natural clinical sequence:

Here is the problem. Here is the relevant context. Here is what I have found. Here is what I need.

References and further reading

NHS Institute for Innovation and Improvement (2010) SBAR: Situation, Background, Assessment, Recommendation. Implementation and Training Guide. Coventry: NHS Institute for Innovation and Improvement.

Nursing and Midwifery Council (NMC) (2018, updated 2025) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: NMC. Available at: NMC Code 

Resuscitation Council UK (2024) The ABCDE approach. Available at: Resuscitation Council UK 

Royal College of Physicians (2017) National Early Warning Score (NEWS) 2: Standardising the assessment of acute-illness severity in the NHS. London: RCP. Available at: Royal College of Physicians NEWS2 

Shahid, S. and Thomas, S. (2018) ‘Situation, Background, Assessment, Recommendation (SBAR) communication tool for handoff in health care: a narrative review’, Safety in Health, 4, 7. doi:10.1186/s40886-018-0073-1.