Nursing Leadership and Management

Nursing Leadership and Management
Chapter 1: An Overview and History
A key part of the success of the healthcare system is how well healthcare workers can talk to each other. Communication is important because it affects the ties between nurses, patients, doctors, families, and the people in charge of the hospital. Effective communication is important for important parts of quality care, like making patients safer, lowering death rates, and reducing the number of times they have to go back to the hospital. The majority of health care workers are nurses. They talk to patients and doctors all the time to make sure they get good care. In these ways of communicating, nurses are active in handing off care from one shift to the next. The way information is passed from the outgoing team to the new team at shift change is a big problem that causes problems with patient care. (Bukoh & Siah, 2020). In the emergency room, it can be hard for nurses and doctors to talk to each other, especially during consultations and when patients are being admitted to the inpatient rooms. Communication between nursing teams and between nurses and doctors in the emergency room needs to get better.

The emergency room is the busy part of any hospital, and effective service delivery can be improved by setting up good ways for people to talk to each other. Every day, care teams and doctors see hundreds or even thousands of patients. To avoid mistakes and save time, they should make sure information is passed on correctly. When people don’t talk to each other well, healthcare workers have to take more time to ask questions or call coworkers, which wastes time. Because of this, people have to wait longer in the emergency room, there are more mistakes with medications, treatments take longer to do, and patients aren’t fully evaluated. Also, because admitted patients depend on information from the emergency room, bad communication can make it harder for them to get the care they need. When people don’t talk to each other well, it can lead to disagreements between nursing teams and between nurses and doctors.

In the healthcare business, collaboration depends on people being able to talk to each other well. When healthcare workers can’t talk to each other well, it hurts their ties with patients and makes the services they give less good. Studies and proof from the Joint Commission show that almost 60% of medical mistakes happen because doctors and nurses don’t talk to each other well. (Amudha et al., 2018). In the emergency room, the lack of a full guide for the transfer of care between nursing teams is the biggest problem. This has led to longer wait times for services and more mistakes when giving medications. Since almost a year ago, the emergency room has seen a rise in medication mistakes. This is mostly due to poor documentation and communication of care during shift change. Also, it seems like the nurses and doctors in the ED’s admitting room don’t get along because they can’t talk to each other. The doctors are upset that the right questions aren’t asked at the right time and that they don’t have enough knowledge about the patient to make important decisions.

Satisfaction scores from both employees and patients show that there is a problem with communication in the area. Recent polls done in the department show that nurses aren’t happy with their jobs because they feel like they’re under a lot of pressure and get most of the blame when mistakes happen in the unit. The last year’s patient happiness scores show that there are problems with how patients and nurses and patients and doctors talk to each other. More polls show that the number of ER patients who have to go back to the hospital has gone up because services aren’t being given well and patients are being sent home too soon. Doctors often make choices about their patients, but nurses do most of the care for them. These groups need to work together by using a good plan for communication, which can lead to better service performance. By making it easier for the two teams to talk to each other, the admission unit can do a better job of serving people in the ER.

Problem Statement

Communication that is accurate and quick is a key part of giving people high-quality care. Poor communication is one of the main reasons why healthcare services are often not very good. Communication between nurses and doctors and between different nursing teams is a big problem in the healthcare business I work for. This is a problem in both the emergency room and the unit where people are admitted, and it has major effects on both patients and healthcare workers. The biggest problem is getting information from one nurse to another when one leaves and another comes in. Also, there are gaps in how information about regular care for patients in the ED is passed from the doctors to the nurses through the admitting unit. Because of this, there are more mistakes with medications, more people coming back to the unit, and services aren’t given as quickly, so people have to wait longer. These changes have had a big effect on how happy both patients and employees are. Patients in the unit can get better care if there is a quality improvement program that helps nurses and other health care workers talk to each other better.

Changes in practice, improvements in quality, or new ideas

More and more evidence shows that when healthcare teams talk to each other and work together, the standard of care improves. There are many ways to improve dialogue, and the best one should be chosen based on the organization’s goals. To improve communication, many businesses have done things like train their teams, change their culture, and use technology. Evidence-based practices, on the other hand, show that structured tools can help nurses talk to each other and other healthcare workers better when they change shifts or talk to them regularly. The SBAR (Situation, Background, Assessment, and Recommendation) method of conversation has helped healthcare teams give better care. The suggested answer is to make a quality-improvement plan that uses the SBAR handover checklist to help the nurses talk to each other better.

Improving dialogue in healthcare is a multidisciplinary task that needs input from all of the staff in each unit. The suggested way to make the SBAR handover checklist focuses mostly on the nurses in the emergency room and the nurses in the unit where new patients are admitted. Each part of the situation will be represented by a structured piece on the list. Every time a nurse changes shifts or gives a report on patient care, the assessment, background, and advice will be filled out. The current state of the patient and the working diagnosis are shown in the “situation” part. The background shows the patient’s experience, such as past illnesses and the medicines the patient takes. The examiner’s evaluation of the patient’s health or treatment is shown in the assessment section, while the plan of care and expected changes to the patient’s treatment are shown in the recommendation section.

The SBAR method has helped nurses talk to each other in a clear and easy way during the change of care. The Institute for Healthcare Improvement (IHI) gives details that must be included in SBAR communication. The SBAR checklist will have predetermined points that will be checked for clarity during shift changes to make sure that each part is followed. In the dialogue part of SBAR, for example, the nurse describes the situation by naming himself, the patient, and other members of the healthcare team. The doctor then goes on to explain the patient’s problem and give more details about his or her sickness. For the tool to be used well, it will have to be shown that all parts of each SBAR component were fully covered during information sharing.


By focusing on giving good care to patients, the SBAR communication technique can help a group do better at what it does. This method makes sure that nurses and other health care workers talk to each other in a more organized way. It makes it possible for information to be passed on in a clear and concise way, both verbally and in writing, using the electronic record tools. (Wang et al., 2017). The goal of the quality improvement program is to make it easier for nurses to talk to each other. This can lead to safer patients, happier patients, and lower costs.

Safe and successful care for patients depends on how well they can talk to each other. When thinking about how important better communication is, patient safety is one of the most important reasons why hospital departments need good communication lines. 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. Using SBAR dialogue in the emergency room can make sure that these things are done to keep patients safe.

To encourage joint care, the way the emergency room and the admitting unit talk to each other needs to change. Good communication between healthcare providers makes it easier for them to work together and encourages multidisciplinary methods to patient care. (Muller et al., 2018). 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. The new practice change of using SBAR communication will help nursing teams and other healthcare workers work together better.

Healthcare groups are moving toward providing high-quality care in order to get more patients and meet government requirements. People have noticed that how groups start and keep changes has a lot to do with how happy their patients are. To make sure these things happen, healthcare providers must communicate well and figure out how to use the patient’s knowledge to solve their problems. (Vermeir et al., 2015). 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. The suggested change will make sure that nurses in the emergency room and the unit where patients are admitted talk to each other well, which will make patients happier.

Sources You Can Trust

Evidence-based practices in healthcare are put into place based on study data and national guidelines that back up the data. Improving how nurses and other healthcare team members talk to each other is a topic that has been the subject of many study articles and practice change guidelines from reputable organizations. Appendix A is a summary of the data from 30 reliable sources that look at communication in healthcare, the use of SBAR communication tools, and how important it is to improve communication in healthcare. Different research methods have been used by the sources to figure out how the SBAR communication checklist improves the level of care given to patients. All of the reliable sources that were combined are research articles found in databases like CINAHL, Cochrane, and Pro-quest. The only exception is the national guidelines on SBAR communication from the Institute of Healthcare Improvement (IHI).

Best Practices

Teaching and Learning

The main reason for more mistakes in healthcare is bad communication, and the SBAR dialogue tool can help improve the situation. Today, every healthcare organization follows the standard shift-change routine, which includes the use of communication tools. However, they don’t have the training they need to get the best results. (Shahid & Thomas, 2018). When things are really bad, nurses and doctors don’t pay attention to important parts of patient care, which leads to more mistakes and pointing fingers. Studies show that this practice could be made better by using education and the SBAR communication tool together. (Wang et al., 2017). Different ways, like role-play simulations and lectures, are suggested to help healthcare workers improve their SBAR communication. Even though there are well-established rules for how to use the SBAR checklist in healthcare facilities, poor communication has happened because people don’t know how to use it well enough or don’t have the right skills.

Practice Working Together

In the last few years, interprofessional cooperation has become a way to solve problems in health care. The use of the SBAR tool for dialogue in healthcare is closely linked to how well different healthcare teams work together. During the process of putting the evidence-based practice into place, communication, a lack of collaboration between professionals, and the culture of the business were found to be the biggest problems. Even though the SBAR tool might help nurses speak well during shift change, they are also required to give detailed information to doctors when they report cases. Bonds (2018) says that standardizing handoff communication can only be done when people from different units work together. Also, the increased use of technology like phones and EHR documentation makes it important for professionals to work together for effective care contact. (Kostoff et al., 2016). So, the success of nurses using SBAR communication is also tied to other management factors that should be carefully watched.

Summary of the Proof

Tools for talking to each other

During shift change, information about a patient is passed from one healthcare worker to the next. This keeps care for the patient consistent. Studies show that this information can only be shared if the two parties are able to talk to each other in a clear way. (Bonds, 2018). Because each person is different, there are different tools that can be used to quickly send information from one healthcare worker to another, no matter what their role is. The SBAR tool is recommended for patient handoffs by the Institute for Healthcare Improvement (IHI) and other professional groups like AHRQ and the Joint Commission. (IHI, n.d.). Another study that looked at how communication tools are used in healthcare found that team training, multidisciplinary structured work shift evaluation, and the use of electronic SBAR templates are the most popular ones. (Wang et al., 2017). The SBAR communication tool seems to work better than the others, especially when it comes to helping nursing teams talk to each other better.

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. 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.

Using the SBAR tool to communicate

Written communication is still the most common way for healthcare workers to talk to each other. (Veimer et al., 2015). Effective communication has always been the most important part of giving people good care in our complex and changing healthcare system. The SBAR communication tool is used to make it easier for people to share information between shifts. This is true in any business where communication breaks down. Research on the effect and quality of written communication in healthcare shows that communication is only important when well-known tools are used. (Panesar et al., 2016). The experts also show that when SBAR is used, whether through electronic documentation or paper forms, there is more information sharing between healthcare teams, especially between nurses and doctors.

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 find out how well nurses could pass on care from one person to another. 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.

SBAR and Patient Safety in Communication

SBAR has been mentioned as a way for doctors and nurses to talk to each other without getting confused. When there isn’t clear dialogue, a patient’s safety is put at risk, which can lead to injuries, longer hospital stays, or even death. For example, the Joint Commission says that poor dialogue is a cause of more than 60% of all bad things that happen in hospitals. (Muller et al., 2018). A systematic review was done to find out how dialogue and the tool SBAR for handing off a patient affect patient safety. Researchers looked at several studies and found that SBAR communication makes patients safer, especially when it’s used to structure phone calls. (Muller et al., 2018). Blom et al. (2015) agree with this study because they found that using SBAR as a structure makes patients safer.

A lack of good handoffs between nurses is without a doubt the main cause of bad affects. A study of nine studies, called a systematic review, found that structured handover formats like the use of SBAR help reduce medication errors and other bad things that happen. (Bukoh & Siah, 2020). The results of this study are similar to the results of an experiment that showed nurses’ understanding of how to communicate care between different teams had improved. (Castelino & Latha, 2015). Patient safety depends on how happy people are with their jobs and how well they work together. A study with some experimental elements that was done in Jordan found that SBAR dialogue makes nurses happier at work. (Dalky et al., 2020). This makes sure that nurses keep in touch with other workers and talk to them well, which improves safety and the quality of care.


When nurses switch from the emergency room to the inpatient unit, if they don’t talk to each other well, it can hurt the patient’s health and cause more medical mistakes and less patient happiness. Communication between nurses and doctors and between different nursing teams is a big problem in the healthcare business I work for. This is a problem in both the emergency room and the unit where people are admitted, and it has major effects on both patients and healthcare workers. The Institute for Healthcare Information suggests using the SBAR communication tool to improve how accurate, clear, and consistent information is passed. (IHI, n.d.). The tool makes it easy and clear to set standards for what and how team members will talk to each other. This is important for building teamwork and creating a culture of patient safety.(Dalky et al., 2020). The idea for this project’s answer is to make an SBAR handover checklist that nurses can use to talk to each other better.


Amudha, P., Hamidah, H., Annamma, K., & Ananth, N. (2018). Effective communication between nurses and doctors: Barriers as perceived by nurses. J Nurs Care7(03), 1-6.

DOI: 10.4172/2167-1168.1000455

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 Care, 9(3), 63-68.

DOI: 10.22038/EBCJ.2019.40897.2078

Bonds, R. L. (2018). SBAR tool implementation to advance communication, teamwork, and the perception of patient safety culture. Creative Nursing24(2), 116–123.

Blom, L., Petersson, P., Hagell, P., & Westergren, A. (2015). The SBAR model for communication between health care professionals: A clinical intervention pilot study. International Journal of Caring Sciences, 8(3), 530-535.

Bukoh, M. X., & Siah, C. J. R. (2020). A systematic review on the structured handover interventions between nurses in improving patient safety outcomes. Journal of Nursing Management28(3), 744-755.

Castelino, F., & Latha, T. (2015). Effectiveness of protocol on Situation, Background, Assessment, Recommendation (SBAR) technique of communication among nurses  during patients’ handoff in a tertiary care hospital. International Journal of Nursing Education, 7(1), 123-127. DOI : 10.5958/0974-9357.2015.00025.2

Dalky, H. F., Al-Jaradeen, R. S., & AbuAlRrub, R. F. (2020). Evaluation of the situation, background, assessment, and recommendation handover tool in improving communication and satisfaction among Jordanian nurses working in intensive care units. Dimensions of Critical Care Nursing : DCCN39(6), 339–347.

Institute for Healthcare Improvement. (n.d.). SBAR tool: Situation-Background-Asssessmnet-Recommendation. Retrieved from

Kostoff, M., Burkhardt, C., Winter, A., & Shrader, S. (2016). An interprofessional simulation using the SBAR communication tool. American Journal of Pharmaceutical Education, 80(9).

Müller, M., Jürgens, J., Redaèlli, M., Klingberg, K., Hautz, W. E., & Stock, S. (2018). Impact of the communication and patient hand-off tool SBAR on patient safety: A systematic review. BMJ Open8(8), e022202.

Panesar, R. S., Albert, B., Messina, C., & Parker, M. (2016). The effect of an electronic SBAR communication tool on documentation of acute events in the pediatric intensive care unit. American Journal of Medical Quality : The official journal of the American College of Medical Quality31(1), 64–68.

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. Retrieved from

Vermeir, P., Vandijck, D., Degroote, S., Peleman, R., Verhaeghe, R., Mortier, E., … & Vogelaers, D. (2015). Communication in healthcare: A narrative review of the literature and practical recommendations. International Journal of Clinical Practice69(11), 1257-1267.

Wang, Y. Y., Wan, Q. Q., Lin, F., Zhou, W. J., & Shang, S. M. (2017). 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.


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