The R in SBAR
As nurses, we use the SBAR tool when we communicate to physicians, when we chart, and even with each other at the bedside. In fact, the language of SBAR infected our nurse brains long before we even used it. Basically my point is...SBAR is second nature to us. My question is... are we using SBAR to the fullest capability?
The art of critical thinking takes time and plenty of experience. Patricia Benner's theory from Novice to Expert abstractly defines the ability to advocate and think critically at the Proficient or Expert level. That's at least 3-4 years into your nursing career. The question is, how can you get there sooner? How can you speak up and advocate for your patients while still learning how to do it? The answer is... trial and error. Just like practice makes perfect with IV's, same goes for practicing using the R in SBAR.
Making recommendations to physicians has been accepted in the culture of nursing for quite some time now. Here are some examples of how to practice making recommendations:
"Pt still hasn't had a bowel movement after given multiple medications for constipation and now they are complaining of increased bloating, nausea, and not passing gas. I recommend a KUB abdominal X-ray."
"I see that this ETOH withdrawal patient has librium ordered pro every hour, however since it's along acting medication, I recommend that it should be changed to scheduled TID until the withdrawal symptoms subside."
"We have tried multiple pain meds to relieve her shoulder arthritis with no success, how about we try a lidocaine patch?"
The act of making recommendations is not only to flex your expertise as a nurse, but to also test the waters to see what truly works and what doesn't work. The trick is to have all of the information collected and previous interventions explained before you make a recommendation. The physicians are just as busy as we are, and we hate paging them as an annoyance, so therefore by having all of the facts and making a recommendation can really help the physician.
I challenge you this week to try and make a few recommendations at the end of your SBAR dialogue, and I assure you that if you do this routinely, over time... you'll step up your game significantly. You will grow as a nurse, and your patients will love you even more than they do now. Worst case scenario, you're wrong and you just try again.
Give it a shot.
Please comment below about your personal strategy for making recommendations!