N496 Module 4 assignment: effective communication and interprofessional collaboration paper, a full sample

The Call That Did Not Land: Structured Communication, Assertive Speaking Up, and Interprofessional Collaboration on a Surgical Unit

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RN to BSN Program, Aspen University

N496: Nursing Leadership and Management

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Month Day, Year

The Call That Did Not Land: Structured Communication, Assertive Speaking Up, and Interprofessional Collaboration on a Surgical Unit

Communication failures are among the most common contributors to patient harm in hospitals, and most of them are not dramatic. They are calls that ramble, concerns that are hinted at rather than stated, and handoffs in which the one important fact is buried. This paper examines workplace communication through a composite night-shift call on a surgical unit, explains three strategies that address the failures it reveals, structured communication with SBAR, assertive speaking up, and interprofessional collaboration practices, and closes with what a nurse leader can do to make these strategies routine.

A Composite Call at 2 a.m.

The following situation is a composite. At 2 a.m. a nurse on a surgical unit calls the on-call surgical resident about a 67-year-old man one day after bowel surgery. The nurse begins with the patient's name and room, describes his surgery, lists his medications, mentions that he "seems a little off," reports a blood pressure of 94/58 mmHg and a heart rate of 112, and asks whether the resident wants anything. The resident, covering four units and half asleep, hears a long history and no clear request, orders a fluid bolus, and says to call back if anything changes. The nurse hangs up uneasy but does not call back. At 5 a.m. the patient's pressure is 78/40, his urine output has been minimal for four hours, and a rapid response is called. He is found to have an anastomotic leak with early septic shock.

Nothing in the call was false. The problem was structure and assertiveness: the key findings were scattered through a long narrative, the nurse's concern was stated vaguely, and no specific request or timeline was made. The resident's response was reasonable for the call he heard, and not for the patient in the bed.

Strategy One: Structured Communication With SBAR

SBAR organizes a clinical message into four parts: situation, background, assessment, and recommendation. Its value is that it puts the problem first and ends with a request, which is exactly what the 2 a.m. call lacked. A systematic review of studies on SBAR found moderate evidence that the tool improves patient safety, particularly when it is used to structure telephone communication between nurses and physicians, although the studies were heterogeneous and many used before-and-after designs (Müller et al., 2018).

One pre- and post-intervention study in a Belgian hospital illustrates the potential. After SBAR was introduced, all four elements were documented far more often when serious adverse events occurred, nurses rated communication with physicians more highly, unplanned ICU admissions rose, and unexpected deaths fell from 0.99 to 0.34 per 1,000 admissions (De Meester et al., 2013). The rise in ICU admissions is the telling result: clearer calls led to earlier escalation of patients who needed it.

Rewritten in SBAR, the 2 a.m. call becomes: "Situation: I am calling about Mr. T. in room 12, day one after bowel resection; his blood pressure has dropped to 94/58 and his heart rate is 112. Background: his pressure was 128/76 at 8 p.m., and he has had 60 mL of urine in four hours. Assessment: I am concerned he may be septic or bleeding. Recommendation: I would like you to come and evaluate him within 30 minutes, and I would like to send a lactate and a complete blood count now."

Strategy Two: Assertive Speaking Up

A structured message still depends on the nurse's willingness to state a concern clearly and to persist when it is not acted on. Assertiveness means expressing one's views directly and respectfully, as distinct from passivity, which leaves concerns unstated, and aggression, which states them in ways that attack the listener. Passive-aggressive communication, such as complaining about a physician to colleagues rather than raising the concern with the physician, combines the costs of both and fixes nothing.

Team training programs provide simple tools for assertive speaking up. TeamSTEPPS, a federal team-training program built jointly by a health services research agency and the military health system, teaches the CUS words, three escalating statements that move from voicing concern, to voicing discomfort, to declaring a safety issue, as a signal that the team must stop and listen, and a two-challenge rule, in which a concern is voiced at least twice and, if it is still unresolved, carried to the next person with authority (King et al., 2008). In the composite case, a nurse using these tools would have said, "I am concerned he is getting worse," and, when the concern remained at 3 a.m., would have called again or contacted the charge nurse and the attending surgeon rather than waiting.

Tools alone do not make nurses speak. Whether a nurse raises a concern at 2 a.m. depends heavily on what happened the last time that nurse did. A nurse who was mocked for a "soft" call learns to wait until the numbers are undeniable, which is often too late. A nurse who was thanked for calling early, even when the patient turned out to be fine, learns that early calls are welcome. That history is what researchers and leaders call the psychological safety of a team: the shared belief that it is safe to speak up, ask questions, and admit uncertainty. It is built one interaction at a time, and physicians and nurse leaders shape it as much as the nurse making the call.

Strategy Three: Interprofessional Collaboration Practices

Many communication failures begin before the night call, in the absence of a shared plan. Structured interdisciplinary rounds, in which nurses, physicians, pharmacists, and other team members meet daily at the bedside or in a huddle to agree on goals and concerns, give each profession a chance to hear the others and set expectations for the night, such as which findings should prompt a call. A shared plan makes a 2 a.m. call easier because both clinicians already know what the team is watching for.

Closed-loop communication reinforces this. The receiver repeats back an order or key information, and the sender confirms it, which catches misunderstandings before they reach the patient. Mutual respect underlies all of these practices. Nurses are more likely to call and to persist when they expect to be heard without ridicule, and physicians are more likely to respond fully when calls are concise and clinically focused. Collaboration is therefore not only a set of tools but a relationship each side builds through repeated good-faith interactions.

What a Nurse Leader Can Do

A charge nurse or manager can make these strategies routine rather than optional. First, the unit can adopt SBAR as the standard for all calls to providers, with a pocket card and a brief practice session in orientation and annual competencies. Second, leaders can model assertive speaking up and respond visibly and positively when staff escalate a concern, even when it turns out to be unfounded, because the response to the first false alarm teaches the whole unit whether speaking up is safe. Third, the unit can work with medical leadership to establish daily interdisciplinary rounds and agree on explicit call parameters for postoperative patients.

Leaders can also address the other side of the call. Many residents cover several units overnight and receive calls in a steady stream; a unit that consistently uses SBAR, batches nonurgent questions, and saves calls for true changes in condition makes each call more likely to be taken seriously. Some hospitals hold brief joint sessions in which nurses and residents practice difficult calls together through simulation, and hearing the call from the other end often changes behavior faster than any policy. A charge nurse can also offer to join a call when a newer nurse is worried, both to support the message and to model how to make it.

Finally, leaders can review communication in every rapid response and serious event, asking not who failed but where the message lost its shape. Over time, those reviews show whether the strategies are taking hold and where further coaching is needed.

Conclusion

The 2 a.m. call failed not because either clinician lacked knowledge but because the message lacked structure and the concern lacked force. SBAR gives calls a shape that puts the problem and the request first, and evidence associates it with earlier escalation and fewer unexpected deaths. Assertive tools such as the CUS words and the two-challenge rule help nurses persist when a concern is not heard, and interprofessional practices such as structured rounds and closed-loop communication build the shared plans and mutual respect that make both work. Nurse leaders turn these strategies into habits by setting standards, modeling the behavior, and responding well when staff speak up.

References

De Meester, K., Verspuy, M., Monsieurs, K. G., & Van Bogaert, P. (2013). SBAR improves nurse-physician communication and reduces unexpected death: A pre and post intervention study. Resuscitation, 84(9), 1192-1196. https://doi.org/10.1016/j.resuscitation.2013.03.016

King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2008). TeamSTEPPS: Team strategies and tools to enhance performance and patient safety. In K. Henriksen, J. B. Battles, M. A. Keyes, & M. L. Grady (Eds.), Advances in patient safety: New directions and alternative approaches: Vol. 3. Performance and tools. Agency for Healthcare Research and Quality.

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 Open, 8(8), Article e022202. https://doi.org/10.1136/bmjopen-2018-022202