Leadership and Management in the Field of Nursing

Leadership and Management in the Field of Nursing
Patient safety is the most important thing in health care, and communication mistakes are the most common cause of bad things happening to patients. Today, healthcare groups are trying to improve the quality of care while still meeting regulations. Improving communication can help a lot with reaching these goals. Research shows that good communication takes being aware of the situation, and the SBAR (Situation, Background, Assessment, and Recommendation) technique is known as a good way to talk about the patient’s handoff. (Beigmoradi et al., 2019). Through better communication, fewer medical mistakes, better relationships between providers, and a focus on patient safety, this method has been shown to improve the level of care in hospitals. Even though the SBAR method can be used to improve the way healthcare is given, an SBAR report checklist is needed to keep track of the process and give feedback to colleagues.

Clinical/Organizational Problem

In many health care organizations, nurses make up the biggest group of care givers, and they are at the forefront of improving the quality of care. Quality care means that the nursing team, other health care workers, patients, and their families all talk to each other and work together. Because care is coordinated and services are delivered on time, patient satisfaction goes up when contact channels are set up. (Spiridonov, 2017). My healthcare group seems to have trouble getting doctors and nurses to talk to each other, especially in the emergency room and the unit where new patients are taken in. The SBAR communication plan has been in place for five years to help healthcare teams share information about patients and change how they care for them. However, it doesn’t seem to be working very well.

The problem with communication in the company has made it harder to coordinate care, led to more medical mistakes, and made patients less happy. During shift changes, the nursing team doesn’t interact well, and important information about the patients is missed. Even though the emergency room is the busiest part of the hospital, the SBAR method can help improve care transition and save time if it is used well. Second, nurses seem to have trouble communicating with the physician team when they want to report cases or ask for more information. Because of this, there are more mistakes with medications, treatments take longer in the ED, and patients aren’t fully evaluated, which can cause problems with admission and make patients unhappy. The doctors say that the right questions aren’t asked during phone calls, and the nurses say that the doctors don’t reply quickly when asked. To fix the problem with communication in the unit, an SBAR communication plan needs to be used to make sure that all parts are covered when nurses talk to each other and to the physician team.

Explaining the Problem

Sharing health information about a specific patient during a nursing shift change and during regular multidisciplinary care requires being aware of the situation. Situational awareness means knowing the patient’s medical state, how they are being treated now, and where they are headed clinically. Loss of social awareness is a big problem for health care because it makes it harder to give good care and can lead to mistakes. (Shahid & Thomas, 2018). Sharing information between healthcare workers is the key to solving the problem because it makes sure that everyone knows the same things about the patient, like the care plan and expected results. Administrators, managers, researchers, and regulatory bodies always talk about communication problems and the risks they pose to the safety of patients. The main problem in my company is that the SBAR method doesn’t leave much room for better communication, even though it should be the tool for that. Even though there are attempts to improve situational awareness, there are more medical mistakes and the patients aren’t happy with the care they receive.

The emergency room gives people surveys to find out how happy they are with the services and how good the services are. In the past, the department has gotten good results because of how well care was coordinated and how it used quality improvement methods like SBAR communication. But because of bad communication, the number of satisfied patients in the hospital keeps going down. The unit hears a lot of complaints about delayed entry, longer wait times, and more bad things happening. When the scores for how well nurses and doctors talk to patients are compared to those of other areas, the ED does not do well. This problem has also caused the general HCAHPS scores of hospitals to go down, and if nothing is done right away, it could affect how much Medicare and Medicaid Services will pay hospitals.

Safe and successful care for patients depends on how well they can talk to each other. Care for patients requires clinical accuracy, such as making the right diagnosis, doing procedures correctly, and handing care off to coworkers. Research shows that organizations with good communication improve the health of their patients, while organizations with bad communication hurt the health of their patients. (Shahid & Thomas, 2018). Better communication is a way for institutions to save money, run more efficiently, and keep people safe. When thinking about how important better communication is, patient safety is one of the most important reasons why hospital departments need good communication lines. Also, good communication makes it easier for health care providers to get along with each other and encourages multidisciplinary methods to patient care. Effective communication makes it possible for coworkers to work together, which is a strategy for solving problems and improving the level of care. By putting in place the National Patient Safety Goal to improve communication, the Joint Commission hopes to provide healthcare that is safe, quick, effective, patient-centered, and fair.

Communication in healthcare has a direct effect on how happy a patient is. When it comes to patient-system interactions, people need to tell healthcare workers about their health. In the same way, healthcare workers need to be able to communicate well and figure out what the patient is saying in order to address their concerns effectively. Also, health care workers must give patients and coworkers enough knowledge to help them make healthy decisions that lead to the expected results. Poor communication makes it harder for patients to be happy because treatments take longer, there are more mistakes, and quality services aren’t given. To make patients happier, healthcare organizations must set up clear ways for all areas to talk to each other. Better patient happiness can have a positive effect on reimbursements, which can help the institution’s finances.

Causes Broken Down

If you can’t communicate well, you can’t give good care. This is because bad communication leads to bad results, such as higher costs for groups. Communication problems have many sides and can be affected by how an organization handles patients, how material is designed, people’s cultural backgrounds, their level of education, and how the organization is set up. In healthcare, poor communication is likely to happen if the top management is not careful to encourage conversation and use tools to improve the practice. For example, institutions that use the SBAR communication approach are likely to do better than those that don’t because of how well they coordinate care. (Shahid & Thomas, 2018). The second reason for bad communication is that healthcare teams don’t work well together. Having a sense of authority can make it hard to work together, especially between doctors and nurses. Sometimes, the doctor team might not listen to what the nurses say because the nurses have more power when it comes to making decisions about how to treat patients. This makes it hard for people to talk to each other, which hurts the quality of services.

The way teams in healthcare talk to each other can be greatly affected by how equal they are. There is no special group of health care workers who should think their work is important for safe and high-quality care. Spiridonov’s (2017) study found that the main reason why people don’t get along with their coworkers and healthcare teams is that they are all different. When one healthcare team is treated differently than the rest, dialogue doesn’t work as well. (Spiridonov, 2017). A difference in the amount of education between healthcare teams can also make it hard for them to talk to each other. Because of their level of schooling, some people might find it hard to report patient data and explain some details. When some information is missed, it hurts patients a lot because the mistakes and bad things that happen can cause death or make healthcare more expensive.

Poor communication in healthcare is caused by things like the number of staff members and the number of people who need care. (Spiridonov, 2017). When there are a lot of patients and a lot of work to do in a busy healthcare area like the ED, it can be hard to talk to each other. Low staffing levels mean that nurses and doctors will have too much work, which will make it hard for them to talk to each other. Even if the department has good communication tools, providers might not have time to use them, which could lead to mistakes in communication. Another common reason for bad communication is not following the rules, which can be due to ignorance or personal reasons. Every health care worker needs to keep an eye on how their coworkers communicate and report any problems that come up.

Stakeholders Needed to Be Found

Improving communication in healthcare is not something that can be done by one person. Instead, it is a group effort that involves both internal and external parties. On the inside, dialogue can be made better by getting the doctors, nurses, and patients involved. These people have a direct hand in putting tools and monitoring methods in place to make sure there is good communication. From the outside, payers and regulatory bodies may want to make sure there is good contact so that the standards are met and quality is reached.

The hospital administration’s job is to keep an eye on how things are done and make sure that projects to improve quality are carried out. One of the ways to reach the goals and make sure everyone on the healthcare team knows about the QI projects is through good communication. The administration’s main job will be to set up a quality improvement project to make it easier for nurses, doctors, and patients in the emergency room to talk to each other. The team will also make sure that the project is finished, that policies are made about the change, and that everyone on the healthcare team follows the new rules.

Most of the time, nurses are with patients and other providers, so better conversation can do a lot to build relationships at work. The job of nurses is to talk to patients about their care and work with doctors to make sure that patients are getting good care. Also, nurses have to write down what they find in order to make sure that care stays the same. The suggested change will involve the nurses, and it will be their job to tell patients, other nurses when they switch shifts, and doctors about care. The doctors and nurses work together to give patients good care, which requires good contact between them. During patient intake and regular care, the nurses and other health care workers often talk to the doctors. The doctors’ job will be to handle information well and make good choices about how to care for their patients. During the process of making things better, the team will also talk directly with the patients and nurses.

Patients and their families are important parts of improving quality because they are the ones who get care. These people will be a part of the team that will make sure the change is successful by giving comments on the process. Also, the patients will say how happy they were with the care they got, which will be used to judge how well the project went. By looking at patient satisfaction numbers, outside groups like payers and regulatory bodies will judge the quality improvement process. Communication is a big part of the HCAHPS results, and nurses and doctors are expected to talk to patients about their care and help them quickly.

Talk about Stakeholders


In many health care systems, there are ways to get different people involved in making choices about hospital services. The hospital managers are always in the lead when it comes to making decisions about changing policies and making things better. These people have the power to accept project ideas and come up with new ways to improve quality. Second, the managers have the power to make rules about the new change and punish people who don’t follow the rules of the hospital. Aside from being able to make rules, managers want to improve the quality of care in the facility and get workers involved in making decisions that can help patients. The administration can have an effect on the suggested project by showing support for better communication, which can change how employees react to projects that aim to improve quality. If the project doesn’t get enough help, it will be hard for nurses and doctors to deal with the new change.


When it comes to improving policies and processes in healthcare, the nursing team and nurse leaders are very important team members. They speak up for the patients and work to make sure that projects are done in a way that helps the patients. (Malfait et al., 2017). The suggested project will be carried out by the nursing team in the emergency room. This team has the power to accept or reject the change based on strong evidence. Nurses are the most important part of the health care team, so they can change how people talk to each other in the unit to keep patients safe. The nurse leaders and the rest of the nursing staff can give an idea of what the nurses are interested in. The people in charge of nursing care want to make decisions that can improve the level of care and save money for the patient. On the other hand, trained nurses want to use methods that improve the patient’s experience while causing the least amount of harm. If the nursing team backs the idea, other members of the healthcare team, like the doctors, are more likely to agree to the change. Also, the nursing team can have an effect on how the institution’s management deals with process improvement and policy changes.


Multidisciplinary methods are used to improve healthcare processes, and doctors are part of the team that shapes policy. In the new project plan, the doctors will be directly involved. They will talk to the nurses and patients about care. This group has the power to accept the new idea or make changes that could help make dialogue better. Just like the nurses, the doctors are interested in using projects to improve the level of care they give to patients. Also, the doctors are part of the team, and they want to improve the patient experience so that the patient is happy. By taking part, the doctors can affect how the rest of the healthcare team sees the new change, including whether or not the management gets involved in the project.


How well healthcare services meet the patient’s expectations of care is related to how happy the patient is with their care. Today, Medicare and Medicaid Services pay hospitals and other health care facilities based on how happy their patients are. (Malfait et al., 2017). This means that the goal of process improvement should be to involve patients in their care while putting the client’s needs first. Even though patients may not have much say in this project plan, how they feel about communication strategies can change how they are used. The patients and their families are interested in the project because the new change will affect how services are given and how information is shared in the unit. If the new project doesn’t help the patients, they can change how the facility handles contact.

Describe the Project

In recent years, the healthcare system has turned toward interprofessional collaboration, where communication is very important to keep patients safe. Every company tries to improve communication, but process improvement in the facilities needs to be guided by evidence-based strategies and best practices. Also, every member of the healthcare team needs to help improve communication, because good communication is the key to the future of any company. The problem in my company is that nurses and other healthcare teams don’t talk to each other well, which hurts patient safety and makes patients unhappy. The main goal of this project is to set up a quality improvement tool that can help nurses and doctors talk to each other better. The goal of the project is to get more people on the healthcare team involved so that programs can be used to make patients happier and improve communication.

Evidence-based practice (EBP) is making choices about patient care based on the best evidence we have right now. Researchers and professional groups back this approach to improve the way healthcare works because it uses tried-and-true methods for getting good care. In this project, evidence-based practice will be used to improve compliance with the SBAR communication strategy that is already in place in the emergency room. This project will help the group and the patient, but it will also help me grow as a nurse by letting me use nursing research to learn key skills for my job. So, the goal of this project is to show the integration of key professional skills in areas like communication and building relationships, understanding of the healthcare environment, leadership, working with others, and organizational business management. The project will show how nurses, doctors, patients/families, and the staff can work together to improve communication in the chosen unit.

The Solution Suggested

It is known that communication problems can happen when one healthcare worker hands off to another. Because of this, there needs to be good communication to improve the level of services and avoid mistakes that can lead to wrong patient plans, delayed admissions, duplicate tests, and delays in getting the patient out of the hospital. The SBAR communication approach is known as the best way for nurses and other health care teams to talk to each other better. Even though SBAR is used in many places, communication is still a problem because providers don’t report care with all the necessary details. The suggested solution for this project is to use an SBAR handover checklist as a way to keep track of how well nurses and the physician team in the emergency room are using the SBAR method to talk to each other.

Improving dialogue in healthcare is a multidisciplinary task that needs input from all of the staff in each unit. In the suggested method for using the SBAR handover checklist, most of the work will be done by the nurses and doctors in the emergency room and the admitting unit. The goal of the tool is to let observers give their coworkers feedback on how they use the SBAR communication method when handing over a patient. The checklist will have structured questions about each part of the situation, the assessment, the background, and the suggestion. It will be filled out each time a shift changes and when nurses or doctors call to report on patient care. At the end of the process, the person will rate the handover as either very effective, effective, fair, ineffective, or very ineffective. Due to more work in the area, the charge nurse will be in charge of keeping track of the tool, including any calls made to or from the doctors.

Summary of the Proof

Effective information sharing in the health care system is a key part of safe patient care and one of the most important things that needs to be done to improve patient safety around the world. Getting the right information about patients across shift changes is one of the more difficult parts of nursing. Using the SBAR method and a handoff questionnaire, a study was done to test nurses’ handoff skills and see how well they worked. In the observational study, 64 nurses worked in internal and surgical wards where handoffs were done using the SBAR method while an observer recorded the results and rated the nurses’ performance. When the results were looked at, it was clear that nurses focused more on routine parts of patient care and paid less attention to things like reporting clinical knowledge and assessing systems. (Beigmoradi et al., 2019). The study’s conclusion is that SBAR checklists can help find areas of communication that aren’t being handled well, which leaves room for change.

Improving healthcare quality and safety has become a top concern for hospitals all over the world. When talking about quality, it is clear that improving communication is the key to giving safe and trustworthy care. (wang et al., 2017). An integrative literature study was done to find out how nurses and doctors in intensive care units can better communicate with each other. In the integrative review, which used the Medline, CINAHL, and Science Direct databases, there were both qualitative and quantitative research papers. Based on the results of the integrative review, using an electronic SBAR documentation form and other checklist tools together are effective ways to improve communication. It was seen that the tool made people use SBAR contact more often and made it easier for cases to be reported correctly in intensive care units. (Wang et al., 2017). Also, the electronic recording SBAR tools reminded the nurses to keep full and detailed records of how the patient’s state changed.

Communication is important in healthcare, especially during emergencies when action needs to be taken right away. Studies have been done on how to improve dialogue in these times, and the use of SBAR and read-back strategies are at the top of the list. Lee and Kim (2020) did a study to find out if SBAR communication and Read Back (SBAR-R) strategies are linked to how well a team does its job during a simulated situation. The study used 49 teams and trained watchers who used a set checklist to record how the teams talked to each other. After looking at the data, it was clear that SBAR was a good way to improve communication during emergencies. But the checklist showed that most of the information given was in line with the evaluation part of the SBAR method. (Lee & Kim, 2020). By using the watcher method, healthcare organizations can find places where they can improve while using the SBAR method to talk to each other.

Patients who are brought to healthcare settings are cared for by teams of people from different fields, and good communication is needed to reduce bad things that happen. A prospective study was done to introduce and measure how well the SBAR method for improving communication was documented. During shift handover, an SBAR form or checklist was given out, and the team leader wrote down the things that were done according to the standard rules. Analysis of the data showed that important parts of communication like allergies, relevant history, and naming of comorbidities were often left out. (Achrekar et al., 2016). It was also noticed that using the checklist didn’t help the problem at hand but was useful for later debriefing. The results agree with what Shahid and Thomas (2018) found. They found that SBAR gives an organized way to talk to each other, but it’s hard to use in a critical care setting where patients have long and complicated medical histories.

Plan of what to do

The first step in putting the project into action will be to ask the hospital staff for permission to do the study. After acceptance, the second step will be to include nurses, doctors, patients/families, and other members of the health care team in the new change process. The idea will be talked about by the person in charge of the unit in the emergency room. Even though communication is important, I will work with the hospital’s study unit to find proof that the new practice works. During the first meeting with stakeholders, the evidence will be used to explain why change is needed and why the plan is important to both patients and the organization.

In the second phase of implementation, tools will be given out, team leaders will be chosen, and nurses and doctors will be taught how to use the SBAR checklist. For educational purposes, the hospital administration will be asked to provide tools like meeting rooms and monitors. The clinical nurse educator will help the ED nurses and doctors get together to learn about the SBAR technique and why the new plan is important. During the execution phase, the meeting will be used to figure out who will lead each team. In the last step, the SBAR checklist will be used to improve how people talk to each other. The team leaders will meet once a week to talk about their results and solve any problems. At the end of each week, there will be short reviews to check on progress and make small changes.


The planned change will be fully put into place in the emergency room of the hospital in four weeks. In the first week of the project, the team will try to get approval from the administration, collect data about the new change, and tell the healthcare workers about the project. In week 2, needed resources will be assigned and moved, training rooms will be found, and training classes for nurses and doctors will be scheduled. During week 3, the project team leaders will be chosen based on the staff shifts that have already been set. The staff will also be taught how to use schedules and told what the expected results are. During week 4, the plan will be put into action, and at the end of the week, the results will be shared in meetings.

Required tools and Personnel

For the project to go smoothly, the hospital will be a place where healthcare workers can learn and get trained. For the SBAR checklist, you will also need things to write with and papers to print on. The nurse trainer and the nurse in charge of the emergency room will help with the project. The nurse trainer will set up programs to teach providers how to communicate with SBAR and use the SBAR checklist. The ED charge nurse will make sure that care is coordinated within the department and that project leads and staff can talk to each other.

Proposed Theory of Change

Kurt Lewin said that change management is made up of three stages: unfreezing, changing, and refreezing. In the “unfreezing” stage, facts are used to make people aware of the need for change. Lewin said that to make sure people accept the change, it is important to communicate well and get support from leaders. After figuring out that change is needed, the second step is to make it happen. This is done through education, discussion, and giving people support. The last step is to refreeze the water to harden, strengthen, and stabilize the new change. Using prizes and making rules are two ways to keep the money from getting lost.

During the unfreezing stage, the staff will be taught why the new change is important by showing them that patient satisfaction numbers are low. To help workers get used to the new practice, the administration department will be asked to back the change. During the implementation phase, the data will be looked at in weekly meetings and shared with the healthcare team during shifts. The team leaders will tell the nurses of why the project is happening: to make sure that the SBAR communication strategy is followed. During the refreezing stage, rules will be made about how to use checklists to improve communication. The practice will also be strengthened by nurse leaders who keep an eye on the plan all the time.

Problems with Getting Things Done

Due to how busy the emergency room is, time will be the most valuable resource during the project’s implementation. It will be hard for team leaders to keep an eye on SBAR reporting and paperwork during calls and shift changes. Also, based on how bad the patient’s condition is and how busy the staff is, it might be hard for them to handle everything that needs to be done. The second problem that is expected is that healthcare workers will not accept the practice. They might say that they don’t have enough time or staff to make the change.

Achrekar, M. S., Murthy, V., Kanan, S., Shetty, R., Nair, M., & Khattry, N. (2016). Introduction of situation, background, assessment, recommendation into nursing practice: A prospective study. Asia-Pacific Journal of Oncology Nursing3(1), 45. doi: 10.4103/2347-5625.178171

Beigmoradi, S., Pourshirvani, A., Pazokian, M., & Nasiri, M. (2019). Evaluation of nursing handoff skill among nurses using situation-background-assessment-recommendation checklist in general wards. Evidence Based Care9(3), 63-68.

DOI: 10.22038/EBCJ.2019.40897.2078

Lee, K. R., & Kim, E. J. (2020). Relationship between interprofessional communication and team task performance. Clinical Simulation In Nursing43, 44-50. https://doi.org/10.1016/j.ecns.2020.02.002

Malfait, S., Van Hecke, A., Hellings, J., De Bodt, G., & Eeckloo, K. (2017). The impact of stakeholder involvement in hospital policy decision-making: A study of the hospital’s business processes. Acta Clinica Belgica72(1), 63–71. https://doi.org/10.1080/17843286.2016.1246681

Shahid, S., & Thomas, S. (2018). Situation, background, assessment, recommendation (SBAR) communication tool for handoff in health care–a narrative review. Safety in Health4(1), 7. https://doi.org/10.1186/s40886-018-0073-1

Spiridonov, S. I. (2017). Causes for ineffective communication between medical specialists. Journal of IMAB–Annual Proceeding Scientific Papers23(3), 1623-1626. DOI: 10.5272/jimab.2017233.1623

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2018). Interventions to improve communication between nurses and physicians in the intensive care unit: An integrative literature review. International Journal of Nursing Sciences5(1), 81-88. https://doi.org/10.1016/j.ijnss.2017.09.007

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