Using SBAR with a Difficult Physician Interaction

Scenario

It’s 3 a.m., and your post-operative patient’s potassium returns at 2.8 mEq/L.
You call the on-call physician, who responds curtly:

“It’s fine — I’m tired. Just recheck it later.”

The patient’s heart rate is 110 bpm with occasional PVCs on the monitor.

Question: How do you handle the situation while maintaining professionalism and ensuring patient safety?

Best Practice Answer

1. Maintain Composure and Focus on Patient Safety:
   Regardless of tone or frustration from the provider, your priority is objective, safe communication.
   Do not match irritability — remain calm, respectful, and precise.
   Use a structured approach like SBAR to guide the conversation and prevent emotional escalation.

2. Deliver Information Using SBAR Framework:

   • Situation:

     “Dr. Smith, this is Nurse Lee from 3 West. I’m calling about Mr. Jones, who has a critical potassium of 2.8 on post-op day one.”

   • Background:

     “He’s on D5 ½ NS with 20 mEq KCl at 100 mL/hr. No additional replacement has been given yet.”

   • Assessment:

     “He’s tachycardic at 110 bpm, showing PVCs on the cardiac monitor, and appears slightly diaphoretic.”

   • Recommendation:

     “I recommend starting IV potassium replacement per hospital protocol and ordering repeat labs in four hours.”

3. Stay Assertive but Respectful:
   If the provider dismisses your concern, calmly reinforce the clinical significance and policy standard:

   “I understand it’s late, but per our critical lab protocol, a potassium of 2.8 requires immediate replacement and provider notification. I’m concerned about his cardiac rhythm.”
   This phrasing communicates advocacy without confrontation.

4. Escalate if Patient Safety Is at Risk:

   • If the provider refuses appropriate action and the patient remains at risk, escalate per chain of command:
     • Notify the charge nurse, supervisor, or medical director on call.
   • Document both your SBAR communication and escalation steps factually (no emotional language).

5. Documentation Example:

   “0300: Critical K+ 2.8 reported. Physician notified via SBAR — declined replacement at this time. Charge nurse informed. Will continue cardiac monitoring and recheck labs at 0400.”
   Thorough documentation protects both patient safety and nursing accountability.

6. Reflect and Report Professionally (if pattern persists):
   If provider hostility is recurrent or impedes care, report through appropriate professional channels (e.g., Nurse Manager, Quality/Safety Committee) without personalizing the issue.

Real-World Application

This question tests your ability to handle stressful interpersonal dynamics without compromising clinical standards.
Effective SBAR use under pressure demonstrates:

• Emotional control
• Structured communication
• Advocacy for patient safety
• Understanding of escalation protocols

This scenario is frequently used in behavioral and leadership interviews, especially for charge nurse or critical-care positions.

Tip: When interviewing, use phrasing like —
“Even if the provider is frustrated, I stay calm, follow SBAR, and escalate if safety is at risk. My goal is always to protect the patient, not win an argument.”
This conveys professional assertiveness, sound judgment, and maturity under pressure — exactly what interviewers seek.