GypsyNinja

I see what you're saying. Definitely more efficient to use SBAR in that scenario. Was SBAR hard for you to grasp when you first learned about it as a student? You all seem so CLEAR and CONCISE with your SBAR's and not redundant or awkward like mine....It's great to see all of these awesome examples and I must admit I'm a bit envious! I hope my SBAR's will look as good as all of the other examples you guys have given me. It really makes me want to keep trying. Thanks for the encouragement!

Ok, so knowing things like lab values (hematocrit, hemoglobin, CBC, etc.) would be the Clinical Knowledge, and the Critical Thinking would be something like.....my pt has coffee grounds in her emesis. So, I could ask myself what the cause could possibly be, (maybe a GI bleed)?. Then assess her VS and she has a fever. Could I look at the lab results as part of the assessment? Like, if she has a high WBC count? Then assess current meds, (I think Coumadin is a high risk one so lets say she's taking that). Could the R then be something like "What do you think of switching her Coumadin to something else?" (Or is that overstepping my bounds?) Or, could I recommend an x-ray or some diagnostic test for GI bleed? Am I closer? I feel like I'm understanding it a bit more but it still feels really sloppy or out of order when I do it.

"Personally, I'm used to doing SBAR in a slightly different order: RASB. That way is essentially what I want, why I want it, and the evidence/info that led me there." AkulahawkRN, as a nurse who has much more experience than I do with report techniques, do you think RASB is more efficient than SBAR? Also, do you think writing a SOAP note before contacting the provider using SBAR/RASB would be helpful? (just for practice, while in school, I'm not sure if nurses actually have time to do both once they are in the field...).

"Simply put, if you've got a patient that's vomiting a lot, what does your patient need? 1) to stop vomiting. How? Antiemetic. Ask for it. 2) Fluid replacement. PO isn't going to do it until the antiemetics kick in... so, IV bolus? Ask for it. 3) protracted vomiting can cause metabolic problems... how do you find out if something's brewing? Get some labs. Ask for it..." Thank you SO much! This is really helpful. I'm copying this part to my notes so that I can have a clear summary of SBAR if I get lost again!

Do you want to be an RN who can collaborate with the provider, or who is blindly dependent on others to tell her what to do? Here. I. Stand. Thank you for your input and for giving me some great examples from your practice for me to chew on. I definitely don't want to be blindly dependent on others to tell me what to do, thank you for putting that in perspective for me! I really want to get better at SBAR, and do everything I can to be as clear and concise as possible for my future patients. It seems like S+B = A, and the R is dependent on the A. Am I on the right track?

Sorry to break it to you......but expressing opposition to something, albeit temporarily, because I'm frustrated, and can't wrap my head around it, does not make me an oppressor of the whole nursing profession. Can you imagine if nurses never questioned things? If we only did what has always been done instead of using EBP? Many students, and nurses, express opposition to concepts, and some never make room for other points of view. Also, as a student nurse, I begin to represent the nursing profession? Why? Because you say so? You don't get to have a monopoly over any unspoken laws of the nursing world just because you're a nurse instead of a student. And even if you did, so what? I don't find anything wrong with the way I have represented the profession, thus far. I have absolutely no problem questioning things, especially when said things don't make sense to me. If there is this given rule that every single nursing student represents the profession as soon as they begin learning, than I'm proud to do so by questioning things instead of blindly following what my professors say. If I didn't care about being the best nurse I can be, I wouldn't have been so upset at feeling lost. If I didn't care about learning everything I can to be a great nurse, I wouldn't have posed the question in the first place. You really come across as a know-it-all by saying things like "this attitude will do this to the profession" and "you have nooooooo idea what eating young is". I've seen nurses eat their young. I used the phrase in my response to you to make a point. I'm a student, but I'm not that naive. You did not merely make a suggestion. You presented your opinion as fact.

LOL Oh dear..........! Has this actually happened?!

I hear ya :) It definitely is easier to focus on the SBA for now, in order to get more comfortable with the R, eventually!

What attitude? The sarcasm part? If that were true, god help the nursing profession because nursing students will get frustrated and feel lost. If you're referring to something else that I said, maybe you should reread my original post and realize that I'm a student. Not a nurse, yet. And just because you may be a nurse, doesn't mean you know what will and will not "continue" to oppress the nursing profession. I doubt that students who get frustrated with hard concepts that they are still learning, and expressing these feelings in a place where it's supposed to be safe to do so, will oppress the nursing profession. It's not like I'm going into work every day saying how xyz doesn't make sense and is insane, again, because I'm not a nurse yet. If you think a first year nursing student's attitude is a predictor for what their attitude will be like for the rest of their career, or that a first year student's attitude has the power to oppress a whole profession, you should probably consider taking yourself less seriously. Or, you can continue to give credence to the whole "they eat their young". I get that the nursing field does not need to be degraded more than it sometimes is. I'm not contributing to that.

Thanks guys and girls!

I understand that the R is what I want but I have no idea how I'm supposed to know what I want. I'm a first year nursing student, if the pt is hypotensive, I don't think I can automatically know that my pt may need fluids or that they're anemic. If its something I can do independently as a nurse, I can't help but see SBAR as a waste of time. Especially if the MD has the option of not doing what I suggest! That seems crazy! I'm not sure why I have to prompt the doctor. I find it scary if a doctor needs prompting and I have to tell her what to do/how to do her job. Is this something that gets easier over time?

I'm really not understanding the recommendation part of SBAR. I understand what it is that I'm supposed to do (tell the attending provider what my recommendations are), but I have no idea how to go about doing this. I think it's because I'm a nursing student. Not a medical student. (Sarcasm, sorry, I'm frustrated). How am I supposed to know every single diagnostic test? Somebody please shed some light on this. I am starting to think I'm just not smart enough to be a nurse.

Thank you so much, Cara! You have really inspired me!

Thank you, RN010101 :)

Thanks, traumaRUs :)