The "R" in SBAR......nope

SionainnRN · Oct 23, 2014

A quick answer is: always know what you want when you call. If the pt is hypotensive and you've given the doc all the pertinent info the R is for what you want. Do you think they need some fluids, or they're possibly anemic and you want to run labs. It just helps you to remember to have suggestions ready. That way you can prompt the doc, whether they do what you suggest or not, it helps get the ball rolling.

GypsyNinja · Oct 23, 2014

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?

loriangel14, RN · Oct 23, 2014

SBAR is never a waste of time. You want to have all the facts in front of you before you call that doctor. Ypu are wasting his time and yours if you don't have the facts so you can answer any questions the MD will have about the patient or the situation. Being prepared to offer a suggestion does not mean you have to be a med student. Many doctors that I work with will discuss a plan of action with the nurses and consider our input and suggestions.It's not crazy.

K+MgSO4, BSN · Oct 23, 2014

Ok let's break it down.

1 you are a first year student. We don't expect you to know the answer or the R. You are being conditioned to use a specific language almost. SBAR or ISBAR is an almost universal way of addressing issues within health care. As you progress through your study and work as a nurse this will become more useful.

2 although you may not be able to prescribe the fluids, you are assessing the pt and identifying the need for fluids BP low, skin tugor, dry mouth, low urine output, concentrate urine, feeling dizzy. This is what you need to be discussing in the conversation with the doc- not just pt BP is 90/50.

3 the doctor can have multiple pts with multiple issues, you as a nurse are prompting her or him to respond to a current issue. They will be dealing with multiple problems. You only have your couple of pts that you are with for 8 or 12 hrs they may of seen them at 8 am for 5 min on the round.

4 yes it gets easier over time.

GypsyNinja · Oct 23, 2014

Thanks guys and girls!

LoveMyBugs, BSN, CNA, RN · Oct 23, 2014

Definitely easier over time. The R becomes really important when you find yourself working with residents, who are still learning.

For example I had a kid who had a jaw fx, scheduled for surgery in the AM.

The resident wrote for fluids, NPO and all PO meds.

I called hoping to get IV meds, cause the kid was NPO. He had open fx to his jaw.

The resident didn't want him on IV meds.....I understand, however it has been my experience that when I give kids oxycodone on an empty stomach they tend to get nauseous. My concern is if he were to vomit with open fx in his mouth, not only will it cause him more pain his infection risk goes up.

The resident didn't consider taking pain meds on an empty stomach would make the patient nauseous.

He was focused on the surgery itself.

Not always is SBAR going to be for low H&H or hypotension, but something simple that you as the nurse feel the patient needs.

Like a sleeping pill because the patient is so stressed with being hospitalized they can't sleep. Or an antiemetic or diet orders or activity orders or........

llg, PhD, RN · Oct 23, 2014

In real life, you are not required to know the best medical thing to do. (though sometimes, nurses do make specific recommendations -- particularly to residents and other inexperienced physicians) But that doesn't mean you can't ask for something. e.g.

1. I thought you would want to know so that you can address this problem ... or reconsider his medications ... etc.

2. Could you come and see this patient, please?

3. Is there anything you would like to order?

etc.

The SBA part of SBAR enlightens the other person about what is going on. The R part gets into the "and what are we going to do about it" part of the conversation. You shouldn't have to lead the doctor by the nose by recommending a specific strategy. You just need a way to move the conversation forward into talking about actions to be taken.

StudentOfHealing · Oct 24, 2014

OP, that attitude is what will continue to oppress the nursing profession.

The fact is YOU'RE the one with the patient. Not the doctor. YOU have the best view and you know the patient best. As an RN you continually assess without even thinking about it. So you end up knowing a patient pretty well, this is why YOUR input is often appreciated. You are not telling an MD how to do their job, you're working WITH the MD to get the job done and have a patient's health and comfort restored/maximized.

psu_213, BSN, RN · Oct 24, 2014

That way you can prompt the doc

Especially helpful in the middle of the night!

SionainnRN · Oct 24, 2014

Especially helpful in the middle of the night!

Ha ha yeah especially if they fall back to sleep when on the phone with you!!

psu_213, BSN, RN · Oct 24, 2014

I believe you are over-thinking the "R" part. You are not suggesting emergent chest tube placement nor suggesting some obscure lab test that detects some genetic disease that only 0.001% of the population have. You are there and most likely the doc is not. Your recommendations (with some SBA thrown in here) can be as simple as "he does not have an antiemetic, can we do Zofran 4 mg"; "he is having swallowing difficulties, can we switch his pain meds to IV?"; "his BP is 90/48…do you want a fluid bolus? What about a CBC and BMP?"

You are correct that it is not your place to know it all, and it is not your place to recommend every possible test/intervention that has to be ordered by a doc. However, you certainly can get the doctor to think about something he/she has not considered or was not aware of…maybe they did not know that the pt. did not have a Zofran order.

It will get much easier in time. As you continue through school and once you enter in to practice you will realize what needs to be addressed in phone conversations with physicians and you will have more of a sense of what needs to be ordered in various situations.