New grad survival · 6 min read
SBAR cheat sheet for new grads — give a clean handoff every time
Updated: May 2026
The 4 letters that should run every handoff
Your first few handoffs as a new grad are going to feel like the longest 5 minutes of your career. The oncoming nurse is staring at you, the off-going nurse you're getting from is talking too fast, and you're trying to write down "K of 3.2" while your brain catches up to "wait, is that critical?" SBAR is the framework that pulls all that chaos into a shape — and once it clicks, it clicks for the rest of your career.
What SBAR actually is
SBAR — Situation, Background, Assessment, Recommendation — came out of the US Navy nuclear submarine program in the 1990s, where the cost of miscommunication wasn't a missed lab value, it was a fire on a sub. The aviation industry borrowed it next. Then Kaiser Permanente brought it into healthcare in the early 2000s, after research kept showing that the #1 root cause of sentinel events wasn't bad clinical judgment — it was bad communication during handoff.
The point of SBAR isn't to make you sound smart. It's to put the most important information first, in an order the receiving nurse expects, so nothing gets dropped. Your brain naturally wants to start with the story ("So this guy came in and his daughter was here and..."). SBAR forces you to start with the headline.
The 4 sections, broken down
S — Situation
What to include: Who is the patient (room, name, age, sex), who's the attending, what brought them in, and — most importantly — what is going on right now. If you're calling about something time-sensitive, the situation is "the new chest pain that started 10 minutes ago," not "the CHF admission from Monday."
How long: 1–2 sentences. 10 seconds max.
Good example: "Hi Dr. Patel, this is Britt on 4-East. I'm calling about J.M. in room 412 — 67-year-old female admitted Monday for CHF exacerbation. She just spiked a temp to 101.8 and her HR is 118."
Common mistake: Starting with the background. New grads often launch into "So this patient came in three days ago with..." before naming who the patient is or why you're calling. The provider on the other end is mentally flipping through 20 patients trying to figure out which one you mean.
B — Background
What to include: Admitting diagnosis, relevant PMH, code status, allergies, any recent significant events (procedures, transfers, code activations). Skip the irrelevant — Dr. Patel does not need to know about a cholecystectomy from 2014 if you're calling about a fever.
How long: 2–4 sentences. 20 seconds.
Good example: "She has a PMH of HF with EF 35%, HTN, DM2, and a UTI two days ago that we started on ceftriaxone. Foley was placed on admission and is still in. Full code, NKDA."
Common mistake: Reading the entire H&P out loud. Background is context for this call. Not a chart biography.
A — Assessment
What to include: Vitals, your physical assessment findings, relevant labs/imaging, and your clinical impression. This is the part where new grads freeze because they think "assessment" means they need a diagnosis. It doesn't. It means: here's what I'm seeing, and here's what I think it might be.
How long: 3–5 sentences. 30 seconds.
Good example: "Vitals: 100/62, HR 118, RR 24, temp 101.8, SpO₂ 93% on 2L. Lungs have crackles at the bases bilaterally — same as this morning. Foley draining cloudy, malodorous urine. UA from this AM showed +LE, +nitrites, 2+ bacteria. I'm worried this is urosepsis from her UTI."
Common mistake: Not committing to an assessment. "I'm not sure what's going on, her vitals are just kind of off" is not helpful. Even "I'm not sure if this is sepsis or volume overload, but I'm worried about one of those" gives the provider somewhere to start.
R — Recommendation
What to include: What you want from the person you're talking to. Orders? An evaluation? A transfer? A higher level of care? Even if you're "just" giving end-of-shift report (not a provider call), there's still a recommendation — "watch her temp, the next dose of Tylenol is due at 2200, and if she spikes again I'd consider blood cultures."
How long: 1–2 sentences. 10 seconds.
Good example: "Can we get blood cultures × 2, a lactate, repeat CBC and BMP, and consider broadening her antibiotics? I also think she'd benefit from a fluid bolus — she's been net negative all day."
Common mistake: Stopping at A and waiting for the provider to tell you what to do. They will respect you more, not less, for having a recommendation ready. Even if they overrule it.
Real example: med-surg end-of-shift
Here's a full SBAR for an end-of-shift handoff (not a provider call — slightly different rhythm, same skeleton):
S — Room 412, J.M., 67F, day 4 of CHF exacerbation, Dr. Patel. Full code, NKDA, fall risk. She had a rough afternoon — spiked to 101.8 around 1430 and we worked up urosepsis. Cultures pending, started piperacillin-tazobactam at 1600.
B — Admitted Monday for HF exacerbation, EF 35%. PMH: HTN, DM2, CKD3, recent UTI treated with ceftriaxone — apparently didn't clear. Has a Foley in (POD 4 — needs to come out tomorrow). Daughter is here until about 2100; she's the healthcare proxy and her number is on the front of the chart.
A — Right now: 116/68, HR 96, temp 100.4, SpO₂ 95% on 2L, RR 20. Looking better than this afternoon but still warm. Lungs: crackles at bases, no worse than AM. Foley draining 30–40 mL/hr, still cloudy but lighter. AM labs: BUN 32, Cr 1.4, K 4.1, WBC 14.2, lactate 2.1 — repeating at 2000.
R — Recheck temp at 2000 with the repeat lactate. Next Zosyn dose is at 0000. Lasix 80 IV is due at 2100 — hold for SBP under 100. She has a heparin SQ at 2100 too. Tomorrow she needs Foley out and PT consult is in. Discharge target is Monday if she stays afebrile.
Notice what's there: room number first, code status and allergies up front, the things that changed today, what the next shift actually has to do. Notice what's not there: irrelevant PMH, a recap of how Monday went, anything that's already in the chart and not actionable tonight.
5 mistakes new grads make on handoff
- Telling the story instead of giving report. "So at like 1430 the CNA came in and said she felt warm so I went in and..." Nobody needs the narrative arc. They need: temp spike at 1430, worked up urosepsis, started Zosyn at 1600.
- Burying the lead. Don't save the new chest pain for sentence 14. If it's the most important thing, it goes in Situation.
- Reading labs without trends. "K of 4.1" means nothing. "K of 4.1, was 3.4 yesterday, we replaced 40 mEq" tells the receiving nurse what to think about.
- No recommendation. Especially on provider calls. Even a wrong recommendation is better than a non-recommendation, because it shows you've thought about it.
- Trying to handoff from memory. Use your brain sheet. Read it. Glance at it. Nobody — and I mean nobody — gives a clean handoff from memory after a 12-hour shift.
How to practice when you're not on shift
Handoff is a skill, which means you can train it. A few things that actually work:
- Record yourself. Open your phone's voice memo app and give a handoff for a hypothetical patient. Listen back the next day. You'll cringe — that's where the learning is. Are you starting with the story? Forgetting code status? Mumbling through assessment?
- Practice with classmates or coworkers. Trade hypothetical patients. "Give me a stroke patient on day 3." "Give me a fresh post-op lap chole." Force each other to use the structure.
- Use a free tool. Our Handoff Coach is free for the first three SBARs — you describe the patient and it spits back a structured handoff. Even if you don't use the output, reading it back trains your ear for the rhythm.
- Watch experienced nurses. When you get report from a 15-year veteran, pay attention to the order, the pacing, what they include and skip. Then steal it.