A typical teaching hospital may have more than 4,000 handoffs every day, according to a Joint Commission Sentinel Event Alert. That means a handoff is not a small end-of-shift formality. It is one of the most repeated safety moments in healthcare.

A good nursing handoff does more than “give report.” It transfers the patient story, the current risk, the plan, the uncertainty, and the responsibility for what happens next.

That is why SBAR still matters.

SBAR gives you a simple structure: Situation, Background, Assessment, Recommendation. Used well, it keeps report short enough to follow and complete enough to protect the patient.

What is a nursing handoff report?

A nursing handoff report is the structured communication used when one nurse transfers patient-care responsibility to another nurse or care team.

This can happen during:

  • End-of-shift report
  • Bedside shift report
  • Unit-to-unit transfer
  • ED-to-floor admission
  • PACU-to-floor transfer
  • ICU downgrade
  • OR-to-PACU handoff
  • Break coverage
  • Charge nurse updates
  • Rapid response or code follow-up
  • Phone calls to providers
  • Discharge planning or care transitions

AHRQ’s handoff guidance says handoffs include information about uncertainty, response to treatment, recent changes, circumstances, and the care plan, including contingencies.

Official sources:

Why nursing handoff reports matter

Handoffs are high-risk because important information can be lost, delayed, softened, or misunderstood.

The Joint Commission’s Sentinel Event Alert on handoff communication notes that failed handoffs are a longstanding patient-safety problem. It also states that The Joint Commission’s Provision of Care standard requires the handoff process to provide an opportunity for discussion between the giver and receiver of patient information.

AHRQ PSNet similarly emphasizes that safe handoffs require both written and verbal communication, an environment with fewer interruptions and distractions, active listening, and discussion when needed.

Official source:

SBAR: the easiest structure for nursing report

SBAR stands for:

  • S — Situation
  • B — Background
  • A — Assessment
  • R — Recommendation or Request

AHRQ describes SBAR as a structured communication framework that helps teams share information about a patient condition or issue that needs attention. IHI describes SBAR as an easy-to-remember, concrete mechanism for framing critical conversations and fostering patient-safety culture.

Official sources:

How to give a nursing handoff report using SBAR

S — Situation: the 15-second headline

The Situation is the opening line.

It should answer:

  • Who is the patient?
  • Where are they?
  • Why are they here?
  • What is their current status?
  • Why does this matter now?

What to include

  • Your name and role, if needed
  • Patient name or approved identifier per policy
  • Room number
  • Age
  • Primary diagnosis or reason for admission
  • Current stability
  • Main issue for the next shift

Situation sentence starter

This is report on [patient], room [number], a [age]-year-old admitted for [reason/diagnosis]. Current status is [stable/unstable/watch closely] with the main concern being [priority issue].

Example

This is report on Maria Lopez, room 412, a 64-year-old admitted with acute CHF exacerbation. She is currently stable on 2 L nasal cannula, but the main concern is trending oxygen need and strict diuresis overnight.

B — Background: the context that changes decisions

Background should not be a biography.

Include the details that help the next nurse understand risk and plan care.

What to include

  • Relevant medical history
  • Allergies
  • Code status
  • Isolation status
  • Brief hospital course
  • Procedures or surgeries
  • Important consults
  • Baseline mental/functional status
  • Relevant home situation if it affects care
  • High-risk meds or special precautions

Background sentence starter

Pertinent background: [history]. Hospital course: [brief course]. Allergies: [allergies]. Code status: [status]. Important precautions: [isolation/fall/aspiration/seizure/suicide/etc.].

Example

Pertinent background includes COPD, heart failure, and CKD stage 3. She was admitted yesterday for dyspnea and fluid overload. Allergic to sulfa. Full code. She is on fall precautions and strict I&O.

A — Assessment: what you see, what changed, and what worries you

Assessment is where you share the current clinical picture.

Do not just list random data. Organize it so the receiving nurse can follow the patient’s risk.

What to include

  • Vitals and trends
  • Neuro status
  • Pain
  • Cardiac status
  • Respiratory status
  • GI/GU
  • Skin and wounds
  • Mobility and fall risk
  • Lines, drains, airways
  • IV access and pump settings
  • Labs and imaging
  • Intake/output
  • Patient or family concerns
  • Your nursing concern or impression

Assessment sentence starter

Assessment: Vitals are [trend]. Neuro [status]. Respiratory [oxygen/device/work of breathing]. Cardiac [rhythm/edema/drips]. GI/GU [diet/voiding/bowel/drains]. Skin/mobility [status]. Lines/drains [status]. Labs/imaging [key results]. My concern is [priority].

Example

Vitals have been stable: BP 132/78, HR 92, RR 22, SpO2 94% on 2 L. Alert and oriented x4, pain 2/10. Lungs have bilateral crackles, improved from this morning. Sinus rhythm on tele. Voiding with PureWick; urine output 1,200 mL this shift after IV Lasix. Left forearm 20-gauge is patent. Potassium was 3.4 and replaced. My main concern is oxygen need and potassium after diuresis.

R — Recommendation: the next-shift action plan

Recommendation is where many handoffs get weak.

Do not end with “that’s it.”

Tell the next nurse:

  • What is due soon
  • What is pending
  • What needs follow-up
  • What to monitor
  • What thresholds require action
  • Who has been notified
  • What the contingency plan is

What to include

  • Meds, labs, treatments, or assessments due soon
  • Pending tests, results, consults, or orders
  • Escalation criteria
  • Provider notifications already completed
  • Family communication needs
  • Discharge or transfer plan
  • Patient-specific safety risks

Recommendation sentence starter

Recommendations for the next shift: [tasks due]. Follow up on [pending item]. Watch for [risk]. Call/notify if [specific threshold]. Plan is [next step].

Example

Recommendations for nights: give IV Lasix at 2200, continue strict I&O, and follow up the 0400 BMP. Watch potassium and oxygen requirement. Notify the provider if SpO2 stays below 92% on 3 L, RR is over 28, urine output drops below 30 mL/hr, or potassium is below 3.2.

SBAR nursing handoff example: pneumonia patient

Scenario

A 72-year-old patient admitted with community-acquired pneumonia has worsening oxygenation.

S — Situation

This is report on Mrs. Davis, room 305, a 72-year-old admitted for community-acquired pneumonia. The main issue is that her oxygen saturation has been dipping below 92% on 2 L nasal cannula.

B — Background

History includes heart failure and hypertension. She was admitted two days ago with cough, fever, and shortness of breath. DNR/DNI. Allergic to sulfa. She is on IV antibiotics and fall precautions.

A — Assessment

Current vitals: BP 140/88, HR 105, RR 24, temp 101.2 F, SpO2 91% on 2 L. She is alert but fatigued. Crackles are worse in the right lower lobe. She is using mild accessory muscles with activity. Urine output has been adequate. No chest pain reported.

R — Recommendation

Dr. Evans was notified. Stat chest X-ray was ordered, and IV Lasix was given. Titrate oxygen to 3 L to maintain SpO2 above 92% per order. Please follow up the chest X-ray and notify the provider if RR goes above 28, SpO2 remains below 92% on 3 L, work of breathing increases, or she becomes more somnolent.

Bedside shift report: what to verify at the bedside

Bedside report can improve shared situational awareness, but it must be done thoughtfully.

Use bedside report to verify:

  • Patient identity
  • Allergies
  • Code status, according to policy and sensitivity
  • Oxygen device and setting
  • IV lines and pump rates
  • Central line or arterial line status
  • Drains, tubes, and wounds
  • Fall risk and bed alarm
  • Restraints or sitter status
  • Pain level
  • Skin risk or visible safety issues
  • Call light, bed position, and immediate needs
  • Patient or family questions

Bedside report script

Hi, I’m [Name], the nurse taking over until [time]. [Off-going nurse] is giving me report. We’re going to verify your IV, oxygen, pain level, safety needs, and plan for the next few hours. We’ll keep this brief, and then I’ll ask what questions you have.

How to involve the patient without losing control of report

Say:

Before we step out, is there one concern you want to make sure I know for this shift?

This invites patient participation without turning report into a full care conference.

What not to say at bedside

Avoid:

  • Blaming previous staff
  • Discussing internal conflict
  • Sharing sensitive history loudly
  • Debating the plan in front of the patient
  • Using jargon the patient cannot understand
  • Giving uncertain information as fact
  • Ignoring patient questions completely

The 60-second pre-report micro-audit

Before giving report, scan your patient list and update the items that most often get missed.

For each patient, check:

  • Most recent vitals
  • New labs or critical results
  • Pain score and last pain med time
  • Oxygen setting and trend
  • IV access and fluids/drips
  • Lines, drains, tubes, and dressings
  • Code status
  • Allergies
  • Isolation status
  • Fall risk or sitter/restraints
  • Intake/output if relevant
  • Due meds in the next hour
  • Pending tests or consults
  • Provider notifications
  • Discharge or transfer plan
  • Escalation thresholds

Nursing report sheet: printable SBAR template

Copy this into your notes app or print it as a brain-sheet template.

PATIENT:
Room:
Age:
Admit date:
Diagnosis / reason for admission:
Code status:
Allergies:
Isolation / precautions:
Provider / team:

SITUATION
One-line summary:
Current stability:
Main issue for next shift:

BACKGROUND
Relevant history:
Hospital course:
Procedures / surgery:
Baseline mental/functional status:
Diet / activity:
Family or discharge context:

ASSESSMENT
Vitals / trends:
Neuro:
Pain:
Cardiac / rhythm:
Respiratory / oxygen:
GI:
GU:
Skin / wounds:
Mobility / fall risk:
Lines / drains / airways:
IV fluids / drips / pump rates:
Labs:
Imaging:
Intake/output:
Patient or family concerns:
Nursing concern:

RECOMMENDATION
Meds due soon:
Treatments due:
Labs/tests pending:
Consults pending:
Discharge/transfer plan:
What to monitor:
Escalation triggers:
Provider already notified:
Questions for oncoming nurse:

SBAR phone call script for providers

SBAR is not only for nurse-to-nurse report. It is also useful when calling a provider, rapid response, or another department.

Before calling

Write down:

  • Patient name, age, room
  • Diagnosis
  • Current vitals
  • Relevant history
  • Current assessment
  • What changed
  • What you have already done
  • What you need
  • Callback number
  • Orders to read back

Provider-call script

S: Hi, this is [Name], RN on [unit]. I’m calling about [patient], room [number], a [age]-year-old admitted for [diagnosis]. I’m concerned because [current problem].

B: Relevant background: [history, recent procedure, code status, allergies, current meds/treatments].

A: Current assessment: [vitals, focused assessment, labs, changes, what you have already done]. My concern is [your concern].

R: I’m requesting [specific order/evaluation/action]. Would you like [labs/imaging/medication/assessment] now? Please clarify when you want to be notified again. I’ll read back the order.

Provider call example: chest pain

S: Hi, this is Jamie, RN on 4 West. I’m calling about Robert Hill, room 418, a 59-year-old admitted for pneumonia. He is reporting new 7/10 chest pressure.

B: History includes CAD with stent, hypertension, and diabetes. Full code. Allergic to penicillin. He is on telemetry and IV antibiotics.

A: BP 162/94, HR 112, RR 24, SpO2 95% on 2 L. Tele shows sinus tach. Pain started 10 minutes ago and radiates to the left arm. I placed him on oxygen per protocol, obtained vitals, and asked another nurse to get the EKG machine.

R: I need you to evaluate him now. Would you like a stat EKG, troponin, aspirin, nitro, or rapid response activation? Please clarify the chest-pain protocol orders.

How long should nursing report take?

Report length depends on acuity, assignment size, and unit workflow.

Patient typeReasonable target
Stable routine patient60-90 seconds
Stable patient with active plan2-3 minutes
Complex patient with multiple issues3-5 minutes
ICU or unstable patientLonger as needed; focus on safety, devices, drips, and contingencies
New admission or transferLonger; include arrival status, initial assessment, orders, and pending items

Common nursing handoff mistakes

1. Giving a biography instead of a safety-focused report

Weak:

He had his gallbladder out 20 years ago, and his daughter lives in Ohio...

Stronger:

Relevant history is CHF and CKD. The key issue tonight is diuresis, oxygen need, and potassium monitoring.

Weak:

Vitals are stable.

Stronger:

BP has trended down from 118/72 to 94/58 over the last 4 hours, HR is up from 88 to 112, and urine output is dropping.

3. Reporting tasks without timing

Weak:

Antibiotics are due.

Stronger:

Vancomycin is due at 2100. Trough was drawn at 2000 and is pending.

4. Leaving out pending results

Weak:

They went for CT.

Stronger:

CT abdomen was completed at 1830. Result is still pending. Provider wants to be notified if it shows obstruction or perforation.

5. No escalation criteria

Weak:

Keep an eye on his breathing.

Stronger:

Call if RR is over 28, SpO2 stays below 92% on 4 L, work of breathing increases, or mental status worsens.

6. Hiding uncertainty

Weak:

Everything is fine.

Stronger:

He is stable right now, but I am not fully comfortable with the new confusion. UA is pending, and the provider is aware.

7. Ignoring receiver questions

A safe handoff includes time for questions. The receiving nurse may catch something you missed.

Say:

What questions do you have?

or

What do you want to verify at bedside before I leave?

Specialty-specific nursing handoff examples

ICU handoff

Include:

  • Airway and vent settings
  • Sedation and RASS goal
  • Pressor/inotrope doses and titration goals
  • Arterial line and central line status
  • Drips and concentrations
  • Neuro status and pupil checks
  • Hemodynamics
  • I&O and urine output trends
  • Labs: ABG, lactate, electrolytes, CBC, coags
  • CRRT or dialysis settings if applicable
  • Tube feeds and residuals per policy
  • Skin, turns, pressure injury risk
  • Family updates and goals of care
  • Code status
  • Escalation thresholds

ICU mini-script

This is report on Mr. Chen, 58, septic shock, intubated on AC/VC 18, TV 450, PEEP 8, FiO2 40%. RASS goal -2 to 0; currently -1 on propofol 20 mcg/kg/min and fentanyl 75 mcg/hr. Norepi is at 0.08 mcg/kg/min to keep MAP above 65. Lactate improved from 4.1 to 2.3. Urine output is 35-45 mL/hr. Watch MAP, urine output, lactate, and potassium. Provider wants to know if norepi exceeds 0.15 or urine output drops below 30 mL/hr.

ED-to-floor handoff

Include:

  • Chief complaint and working diagnosis
  • Triage acuity
  • What has been ruled out or not ruled out
  • Vitals and trends
  • Tests completed and pending
  • Meds and fluids given
  • IV access
  • Isolation or safety concerns
  • Pain/nausea control
  • Mobility
  • Why admission is needed

ED mini-script

This is ED handoff for Ms. Patel, 46, admitted for pyelonephritis with fever and tachycardia. CT showed no obstruction. Blood cultures and urine culture are pending. She received 2 L normal saline, ceftriaxone at 1700, acetaminophen, and ondansetron. Current vitals are BP 118/70, HR 104, temp 100.8, SpO2 98% room air. She has a 20-gauge left AC. Please monitor fever, pain, urine output, and culture results.

Post-op / PACU-to-floor handoff

Include:

  • Procedure and anesthesia type
  • Surgeon or proceduralist
  • PACU course
  • Airway or oxygen needs
  • Pain and nausea control
  • Incision or dressing
  • Drains
  • Foley or voiding status
  • Activity restrictions
  • Diet orders
  • Anticoagulation or bleeding risk
  • Post-op orders and timing

PACU mini-script

This is PACU report on Mr. Allen, 67, post-op laparoscopic cholecystectomy under general anesthesia. He arrived to PACU at 1510 and is now awake, oriented, and on 2 L nasal cannula with SpO2 96%. Pain is 4/10 after hydromorphone 0.4 mg IV at 1600. Nausea improved after ondansetron. Four lap sites are clean, dry, intact. No drains. Due to void by 2200. Clear liquids ordered, advance as tolerated.

Psych handoff

Include:

  • Safety status
  • Suicide or self-harm risk
  • Violence/agitation risk
  • Observation level
  • Triggers
  • De-escalation strategies
  • PRN meds and effectiveness
  • Restraint/seclusion history this shift
  • Sleep, appetite, group participation
  • Med adherence
  • Legal status if relevant
  • Discharge or placement plan

Psych mini-script

This is report on Jordan, 29, admitted for suicidal ideation with plan. On q15 checks, denies current intent but remains high risk due to recent attempt and limited support. Main triggers are loud conflict and feeling cornered. PRN hydroxyzine at 1500 helped anxiety. No restraints or seclusion this shift. Ate 50% dinner and attended one group. Watch for isolation and increased agitation after phone calls with family.

Maternity / labor handoff

Include:

  • Gravida/para and gestational age
  • Reason for admission
  • Membrane status and time
  • Cervical exam and time
  • Contraction pattern
  • Fetal heart tracing category
  • Pitocin rate
  • Epidural status
  • GBS status and antibiotics
  • Blood type/Rh if relevant
  • Preeclampsia or hemorrhage risk
  • Provider plan
  • Delivery or OR readiness concerns

L&D mini-script

This is report on Ana, G2P1 at 39 weeks, admitted for induction due to gestational hypertension. Membranes ruptured at 1430, clear fluid. Last exam at 1800 was 5/80/-1. FHR Category I with moderate variability and accelerations. Pitocin is at 8 milliunits/min. Epidural is working well. GBS positive; second dose of penicillin due at 2100. Watch BP and notify for severe-range pressures or Category II tracing that does not resolve with interventions.

Pediatrics handoff

Include:

  • Weight in kg
  • Caregiver present
  • Diagnosis
  • Baseline behavior
  • Weight-based meds
  • IV access reliability
  • Intake/output
  • Feeding or hydration status
  • Pain scale used
  • Safety concerns
  • Parent education needs

Pediatrics mini-script

This is report on Leo, 4 years old, 18.2 kg, admitted for asthma exacerbation. Mom is at bedside. He is on 1 L nasal cannula with SpO2 95%, mild retractions with activity, and albuterol q3h. Last dose was 1800. Drinking small amounts; urine output adequate. IV right hand flushes but is positional. Use FLACC for pain/distress. Notify if SpO2 drops below 92%, work of breathing increases, or he needs treatments more frequently.

For medication calculation review, see NurseZee’s med math for nurses guide.

HIPAA and privacy during nursing handoff

Handoffs often require patient information. The goal is not to avoid necessary communication. The goal is to use reasonable safeguards.

HHS guidance on incidental disclosures gives examples of reasonable safeguards, including speaking quietly when discussing patient conditions in public areas, avoiding patient names in public hallways and elevators, and using security such as passwords for computers with personal information.

Official source:

Handoff privacy checklist

Do:

  • Lower your voice in shared spaces
  • Use approved identifiers according to policy
  • Avoid hallway gossip
  • Lock screens before and after report
  • Keep report sheets secure
  • Shred report sheets according to policy
  • Avoid visible PHI on whiteboards unless policy allows it
  • Share sensitive details in a private space when possible

Do not:

  • Discuss patients in elevators or cafeterias
  • Leave brain sheets in pockets, bathrooms, printers, or break rooms
  • Text patient information through unapproved channels
  • Use photos or screenshots outside approved systems
  • Give detailed sensitive history loudly at the bedside

New nurse handoff tips

1. Use the same structure every time

SBAR reduces panic because you do not have to invent the order of report.

2. Keep a running brain sheet

Update it during the shift so report is not a memory test at 1900.

3. Practice one-line summaries

For every patient, write one sentence:

Admitted for ___, current issue is ___, next shift needs to ___.

4. Ask experienced nurses what they want first

Some units prefer diagnosis first. Others want code status, drips, or overnight risks first. Learn local expectations while keeping SBAR logic.

5. Do not apologize for being structured

If you are nervous, say:

I’m going to go through this in SBAR so I do not miss anything.

6. End with questions

What questions do you have?

or

What should we verify together before I go?

7. Learn from your report mistakes

After a rough handoff, ask:

  • What did I forget?
  • What was unnecessary?
  • What should I move earlier next time?
  • What safety item did the next nurse ask about?
  • What should go on tomorrow’s brain sheet?

Charge nurse handoff: what to include

Charge nurse report is different from bedside nurse report because it focuses on unit risk and flow.

Include:

  • Census and staffing
  • High-risk patients
  • Unstable patients
  • Pending admissions
  • Pending discharges/transfers
  • Sitters/restraints
  • Isolation rooms
  • Falls or safety events
  • Rapid responses or codes
  • Staffing gaps
  • Equipment or supply problems
  • New orders affecting staffing
  • Family conflicts or security concerns
  • Any escalation already made

Charge report script

Unit census is 28 with 2 open beds. Staffing is 6 RNs, 2 techs, no unit clerk after 2300. High-risk patients: 412 on increasing oxygen, 418 confused with bed alarm and sitter request pending, 426 post-fall CT negative. We have one ED admission assigned to 409, ETA unknown. Two discharges likely tomorrow morning. Security is aware of family conflict in 420. Main overnight risks are staffing for sitter coverage and oxygen escalation in 412.

Handoff checklist for patient transfers

When transferring a patient to another unit or facility, add:

  • Reason for transfer
  • Current level of care
  • Transport mode
  • Stability during transport
  • Oxygen and airway needs
  • Monitoring requirements
  • Drips and pump compatibility
  • Lines/drains/tubes
  • Medications due during transport
  • Code status
  • Isolation status
  • Pending labs/imaging
  • Belongings
  • Family notification
  • Receiving nurse name
  • Time report was given

Frequently asked questions about nursing handoff report

What is a nursing handoff report?

A nursing handoff report is the structured transfer of patient information and care responsibility from one nurse or team to another during a shift change, break, transfer, or change in care setting.

What does SBAR stand for in nursing?

SBAR stands for Situation, Background, Assessment, and Recommendation or Request.

How do I give a good nursing report?

Use SBAR. Start with the patient’s situation, give only relevant background, share your current assessment and trends, then end with the next-shift plan, pending items, and escalation triggers.

What should be included in shift report?

Include diagnosis, code status, allergies, relevant history, current assessment, vital trends, oxygen, pain, lines/drains, IV access, drips, labs, imaging, meds due, pending tests, safety risks, plan, and what to watch for.

How long should nurse handoff take?

Stable patients may take about 60-90 seconds. More complex patients may take 3-5 minutes or longer. Critical patients take as long as needed to transfer responsibility safely.

What is bedside shift report?

Bedside shift report is handoff at the patient’s bedside. It allows the off-going and oncoming nurse to verify safety details such as patient ID, allergies, lines, drains, oxygen, fall precautions, pain, and immediate needs.

Is bedside report always required?

It depends on facility policy and patient situation. Some information is better shared privately before or after bedside report, especially sensitive social, behavioral, or diagnostic details.

What is the biggest mistake in nursing handoff?

One of the biggest mistakes is leaving out the “R” in SBAR: recommendation. The receiving nurse needs to know what is pending, what to monitor, and when to escalate.

What should I say when calling a provider?

Use SBAR: introduce yourself and patient, state the problem, give relevant background, share your assessment and what you have already done, then make a clear request.

Can handoff include patient names under HIPAA?

Handoffs for treatment require patient information, but nurses should use reasonable safeguards. Follow facility policy, lower your voice, avoid public hallways/elevators, secure report sheets, and keep screens locked.

What should new nurses use for report?

New nurses should use a standardized SBAR brain sheet, update it during the shift, practise one-line summaries, and close report by asking what questions the oncoming nurse has.

How do I stop rambling during report?

Start with the one-line situation, limit background to relevant facts, organize assessment by system, and end with the plan. If a detail does not change the next nurse’s care, it probably does not need to be said in report.

Final thoughts

Nursing handoff is a clinical skill, not a personality test.

You do not need to sound perfect. You need to transfer the right information, the right risk, and the right responsibility to the right person at the right time.

Use SBAR when you are tired. Use it when the patient is stable. Use it when the patient is crashing. Use it when you call the provider and when you give end-of-shift report.

A calm, complete handoff helps the next nurse start safely — and helps the patient stay safer after you leave.

Sources and references