Nursing Handover: The SBAR Framework Explained (With Examples)

Handover is the single most dangerous moment in a shift — and the most under-trained. Studies consistently show that poor handover is a root cause of missed deterioration, duplicated work and incidents. The good news: there's a framework that fixes most of it, and it takes one sentence to remember: SBAR.

Why handovers fail

The classic handover failure modes:

• The brain-dump — "Mrs Jones, she's stable, oh and I gave her the antibiotic, and her daughter called, and the wound looks better..." — everything and nothing.
• The assumption — "you know her" / "it's in the notes" — it wasn't, and you didn't.
• The missing safety-critical bit — a new allergy, a withheld dose, a NEWS2 score trending up — buried in a story about the resident's son.
• Interruptions — handover happens in corridors, by the phone, with one eye on the clock.

SBAR exists to make the important stuff impossible to bury.

What is SBAR?

SBAR stands for Situation, Background, Assessment, Recommendation — a structured way of communicating any clinical concern, from a shift handover to a phone call to a GP to an emergency escalation.

S — Situation

What is happening right now? One or two sentences.

"I'm calling about Mrs Jones, room 12. She's become short of breath in the last hour."

B — Background

The relevant context — why they're here, what's been happening, what's been tried.

"She's 84, admitted last week with pneumonia, on amoxicillin. She's normally independent with a walking frame. Her oxygen saturations were 95% on air this morning."

A — Assessment

Your clinical assessment. What do you think is going on?

"I think she's deteriorating — her sats have dropped to 90%, respiratory rate is 26, and she's more confused than this morning. NEWS2 has gone from 2 to 6."

R — Recommendation

What do you want to happen? Be specific.

"I'd like you to review her within the hour. Should I start oxygen and repeat observations in 30 minutes while we wait?"

SBAR for shift handover

The same four beats work for an entire shift handover — scaled up per resident:

• S — why this resident is on your radar today (post-fall, post-op, deteriorating).
• B — key history, current plan, what's been done this shift.
• A — current status: observations, NEWS2, medications due/refused, fluids, behaviour.
• R — what the next shift needs to do: monitor, escalate, chase the GP, review the plan.

Handover is better when it's written down and structured the same way every day. A standardised handover sheet (or an app that generates one) removes the memory dependence entirely — the incoming nurse reads the same fields the outgoing nurse filled in.

The four rules that make SBAR work

1. Say the recommendation out loud. The most common SBAR failure is stopping at Assessment. A handover that ends with "she's not great" has no action.
2. Numbers beat adjectives. "Sats 90%, resp rate 26, NEWS2 6" beats "she's a bit breathless."
3. Flag changes, not statuses. The nurse needs to know what's different since yesterday: new confusion, new drug, refused dose, family complaint.
4. Closed loop. End with "so you'll monitor her sats and call me if..." — confirm the next shift actually heard the action.

SBAR in care homes

In a care home, handover happens twice a day, often between shifts that barely overlap, and the "next shift" may be agency staff who've never met the residents. That's exactly when structure matters most. A written, standardised handover — built from the same resident record the medication round and observations feed into — means the night nurse's escalation concern survives to the morning nurse's actions.

Care home platforms are starting to automate this: the handover sheet is generated from the day's actual records — observations and NEWS2 scores, medications given and refused, incidents, care plan updates — instead of being re-typed from memory at 7pm. The handover stops being a test of recall and becomes a report of fact.

Bottom line

SBAR is Situation, Background, Assessment, Recommendation — and the recommendation is the part most people skip. Use it for every escalation and every shift handover, write it down, and structure it the same way every time. The shift that starts with a good handover is the shift that doesn't start with a phone call at 3am.