Platform 4: Working in Teams

What does the SBAR communication tool stand for?

• ASymptoms, Baseline, Action, Response
• BSafety, Behaviour, Assessment, Referral
• CSituation, Bloods, Action, Review
• DSituation, Background, Assessment, Recommendation✓

Answer: SBAR structures a clinical handover or escalation call: what is happening now, the relevant background, your assessment of the problem, and what you are asking for. It is designed so that urgent information is not lost in an unstructured conversation.

A registered nurse asks a nursing associate to take a set of observations on a patient who is deteriorating. The nursing associate finds a NEWS2 score of 6. What should they do?

• ARepeat the full set of observations in 30 minutes to confirm the score is genuine before reporting it to anyone
• BAsk a healthcare assistant to keep an eye on the patient while they finish the round
• CEscalate the score to the nurse immediately and follow the escalation pathway, rather than waiting for the round✓
• DRecord the score in the notes and report it to the registered nurse at the next planned handover of the shift

Answer: A NEWS2 score of 5 or more requires an urgent response; the nursing associate reports it straight away so the registered nurse and medical team can act. Delaying to re-check or to the handover leaves a deteriorating patient without review.

A student nursing associate is working alongside a qualified nursing associate. What is the qualified nursing associate's responsibility towards the student?

• ATo support and supervise their learning while remaining accountable for the care that is delivered✓
• BTo leave the student to work independently for the shift so that they build confidence in their own judgement
• CTo delegate their own workload to the student so that the student gains experience of taking full responsibility
• DTo assess and sign off the student's competencies as their practice assessor

Answer: Registrants have a duty under the Code to support students' learning and to supervise them appropriately, while accountability for care remains with the registrant. Formal assessment is the role of an allocated practice assessor rather than every colleague.

During a handover a colleague gives information about a patient that contradicts the notes. What should the nursing associate do?

• AAccept the verbal information, since a colleague's spoken account is likely to be more current than the written notes
• BQuery the discrepancy openly and check the record so that the correct information is carried forward✓
• CNote the difference privately and raise it with the ward manager once the shift has finished and the colleague has gone home
• DIgnore the verbal information and rely on the written notes alone

Answer: Handover exists to pass on accurate information; a discrepancy is checked there and then so that the next shift acts on the right facts. Silently choosing one version, or leaving the question until after the shift, risks care being based on an error.

A nursing associate disagrees with a doctor's decision to discharge a patient who they believe is not ready. What is the most appropriate action?

• ARaise the concern directly with the doctor and the nurse in charge, giving the specific reasons, and record the conversation✓
• BSay nothing, since discharge decisions are medical decisions and it is not the place of nursing staff to question them on the ward
• CTell the patient privately that they should refuse to go home until they themselves feel completely ready to manage on their own at home
• DDelay arranging the patient's transport home so that the discharge cannot go ahead that day and has to be reviewed again

Answer: Every member of the team has a responsibility to speak up when they have a concern about a patient's safety, through the proper route and with evidence. Undermining the decision covertly, whether by coaching the patient or by obstruction, is not professional practice.

Which of these is an example of good delegation by a registered nurse to a nursing associate?

• AAsking the nursing associate to delegate the task onwards to a healthcare assistant
• BChecking the nursing associate is competent and willing, giving clear instructions, and being available for support✓
• CHanding over a list of tasks at the start of the shift and reviewing them at the end
• DDelegating a task because the nurse is too busy to do it, regardless of the nursing associate's experience

Answer: Safe delegation requires that the task is appropriate, the person is competent and agrees, the instructions are clear, and supervision and support are available. Delegating under pressure without checking competence, or without follow-up, is unsafe.

Why is it important for a nursing associate to introduce themselves and their role to a patient and the team at the start of care?

• ABecause it is a legal requirement under the Health and Social Care Act
• BSo that everyone understands who is providing care and what that person is able to do✓
• CSo that the introduction can be recorded in the notes as part of the care plan
• DSo that the patient can request a different member of staff if they prefer

Answer: Patients and colleagues need to know who is caring for them and the scope of that role; the 'Hello, my name is' approach also builds trust. Clarity about role matters particularly for nursing associates, whose scope differs from a registered nurse's.

A nursing associate notices a colleague appears to be under the influence of alcohol at work. What should they do?

• AReport it to the nurse in charge straight away, since patient safety is at risk✓
• BWait to see whether the colleague's work is actually affected before saying anything
• CMention it to other colleagues so that they can help cover the person's work
• DSpeak to the colleague privately and agree to keep it between them

Answer: The Code requires action to protect patients from any risk, including a colleague who may be unfit to practise. Reporting immediately to the person in charge lets them assess the situation; waiting for harm or covering it up puts patients at risk.

A nursing associate is asked to give a verbal handover for four patients at the end of a shift. What information is most important to include?

• AA full chronological account of everything that happened to each patient during the shift
• BThe nursing associate's own opinion of how the shift went and which patients were difficult
• CEach patient's current condition, any changes, outstanding tasks and what the next shift needs to watch for✓
• DOnly the patients' names, ages and diagnoses, since the details are in the notes

Answer: Handover exists to keep patients safe across the change of staff, so it prioritises current status, changes, outstanding actions and risks — usually in an SBAR-type structure. A blow-by-blow narrative buries the important points and personal opinions are not handover content.

A healthcare assistant asks a nursing associate for help with a moving-and-handling task. What is the first consideration?

• AWhether the task has a current risk assessment and whether the right equipment and number of staff are available✓
• BWhether the patient can be moved quickly enough to be finished before the next task on the list is due to start, so the round is not delayed
• CWhether the healthcare assistant has asked a registered nurse for permission first, since only nurses may authorise a move
• DWhether the patient's relatives can help with the move

Answer: Safe moving and handling starts with the risk assessment and the equipment and staffing it specifies. Rushing the task, insisting on a nurse's permission for a routine move, or involving untrained relatives all introduce risk.

A doctor gives a verbal instruction over the phone during the night to change the dose of a medicine that is already prescribed. What should the nursing associate do?

• AFollow the local policy for verbal orders: repeat the instruction back, have it witnessed if required, and ensure it is written and signed at the earliest opportunity✓
• BRefuse to act on any verbal instruction whatever the circumstances, and wait until the doctor is physically on the ward in the morning to write the prescription up properly
• CWrite the instruction on the chart yourself in the doctor's name, noting that it was given by phone, so that the medicine can be given now and the doctor can countersign in the morning
• DAdminister the medicine straight away on the strength of the phone call alone, since the doctor has given the instruction and is the person responsible for the prescription

Answer: Verbal medication orders are a known source of error, so most organisations allow them only under strict conditions — read-back, a witness, and prompt written confirmation. Acting without those safeguards, refusing altogether, or forging the prescription are all unsafe.

Which of these best describes the role of a nursing associate in a multidisciplinary team meeting?

• ARepresenting the patient's family's wishes on their behalf, since relatives are rarely able to attend the meeting
• BAttending only to take notes for the registered nurse
• CContributing observations about the patient's day-to-day care, needs and responses to treatment✓
• DChairing the meeting and deciding the overall treatment plan, since the nursing associate knows the patient best

Answer: Nursing associates bring valuable knowledge of the patient's daily care and progress to the team's decisions. Leading the plan sits with the responsible clinician, and the family's views are best given by the family or through advocacy.

A student nursing associate tells you they were asked by a busy nurse to give a medication they have not been signed off for, and they did so. What should you do?

• ATell the student not to mention it to anyone, since the medication was given correctly and no harm came to the patient as a result
• BReport the student to the university for practising outside their scope
• CTake no action yourself, since the responsibility rests entirely with the nurse who delegated the task and not with the student
• DEnsure the patient is safe, support the student to report the incident, and raise it with the nurse and the education lead✓

Answer: Both the delegation and the acceptance were unsafe, and the system needs to learn from it. Patient safety comes first, then supportive reporting; hiding it, blaming only the student, or ignoring it all leave the risk in place.