Escalating a concern to a senior colleague on the ward.

You are on a busy ward and you are not happy with a patient’s condition. The challenge is not just the medical situation; it is the communication: you need to be assertive, clear and respectful, especially if the senior colleague is busy or initially dismissive. In this lesson you practise stating concern and urgency explicitly, giving the key facts in a structured way, and making a direct recommendation or request. You will work on language that avoids vague hints, such as clearly explaining what you have observed, what has changed, and why you think it matters now. You will also practise handling pushback professionally: repeating the concern, offering supporting details, and confirming what will happen next. You finish with a short follow-up message or note that records the escalation factually, including who was informed and what action was agreed.

1. Spotting deterioration and deciding to escalate.

You’re on a busy ward and you’ve got that uncomfortable feeling: something isn’t right. In this lesson, we’ll practise how to escalate that concern safely and professionally. The key skill isn’t fancy vocabulary, it’s being clear, specific and time-focused. Seniors are often busy, and if you sound vague, your message may not land. So today we’ll build a simple pattern you can rely on: state your concern, state the change, give the key observations, and make a direct request with a timeframe. We’ll keep the same patient story throughout so it feels like a real shift. As you work, keep patient safety in mind: you’re not “being difficult”, you’re protecting the patient by communicating clearly. In this first block, we’ll set the scene, look at what good escalation sounds like in the first 20 seconds, and you’ll write your own opening lines.

The ward scene (same case all lesson).

You’re working on Bay 3. Your patient, Mr Alan Price (68), was admitted with a chest infection and is on oxygen. Over the last hour, you’ve noticed he looks more breathless and less alert than earlier.

This is exactly the moment where communication matters. You might be thinking:

• “Maybe it’s nothing.”
• “The registrar is busy.”
• “I don’t want to sound dramatic.”

But safe escalation is not drama. It is clear information + a clear request.

What ‘clear’ sounds like in the first 20 seconds.

When you escalate, aim to include four things quickly:

1. Who you are + where you are
2. Your concern (say it plainly)
3. What has changed (since when?)
4. What you want (review now / within 30 minutes / advice)

Here are two versions. Notice the difference.

Vague (easy to ignore)

> “Hi, sorry, he’s not looking great. Could you come when you can?”

Clear and time-focused (harder to ignore)

> “Hi, it’s Priya, staff nurse on Ward 7. I’m concerned about Mr Alan Price in Bay 3. There’s been a change since 14:10: he’s more breathless and his oxygen requirement has increased. I’d like you to review him within the next 30 minutes, please.”

Useful phrases to keep you calm and professional.

You can recycle these throughout the call:

• “I’m concerned about…”
• “I’m not happy with how they’re looking at the moment.”
• “There’s been a change since…”
• “Their observations are…”
• “I’d like a review within the next…”

You are not diagnosing. You are reporting what you can see, and stating what you need.

Micro-skill: name the timeframe.

A timeframe prevents the message becoming a vague “at some point”. Compare:

• “Could you review him?” (unclear)
• “Could you review him within 30 minutes?” (clear)

In the next blocks, we’ll add supporting details and practise handling pushback. For now, let’s get your opening right.

Practice & Feedback

Write your first 2–4 sentences to escalate to the registrar on the ward.

Situation: You are the nurse/clinician looking after Mr Alan Price (68), Bay 3, Ward 7. He looks more breathless than earlier, and you feel uncomfortable.

Include:

1. who you are + where you are,
2. a clear concern phrase (for example, “I’m concerned about…”),
3. a change since a time (you can choose a realistic time),
4. a direct request with a timeframe (for example, “within the next 30 minutes”).

Keep the tone respectful, calm and patient-safe. Aim for 40–70 words.

Quick reference: strong openings.

• “Hello, this is … calling from …”
• “I’m concerned about …”
• “There’s been a change since …”
• “Their observations are …”
• “I’d like a review within the next …”

Avoid.

• “Sorry to bother you…” (you can be polite without apologising)
• “When you have time…” (too vague)
• “He’s not great…” (unclear)

2. Listening to a real escalation call and noting key facts.

Now you’ll hear a short model call from the same ward situation. Your job is to listen like a clinician: pick out the facts that matter and notice how the speaker stays respectful while still being firm. Listen for three things: first, how they state concern early; second, which observations and changes they choose, because you can’t include everything; and third, how they make a request and then confirm the plan. You’ll also hear a bit of pushback, which is extremely common on a busy shift. The speaker doesn’t argue or become emotional. Instead, they repeat the concern, add one or two supporting details, and ask for a clear next step. After the audio, you’ll answer a few focused questions. Don’t worry if you don’t catch every number first time. Aim to catch the meaning and the structure.

Listening task: what a safe escalation sounds like.

In the audio for this block, you’ll hear Priya (staff nurse) calling Dr Hughes (registrar) about Mr Alan Price.

Read these questions before you listen. They will guide your attention.

What to listen for.

A) The structure (mini SBAR on the ward)

Even if you don’t say “SBAR”, the pattern is there:

• Situation: who, where, why I’m calling
• Background: why the patient is in hospital / relevant history
• Assessment: what you’ve observed, what’s changed, key observations
• Recommendation: what you want and by when

B) Language that is assertive but respectful

Notice phrases that sound calm and professional:

• “I’m concerned about…”
• “There’s been a change since…”
• “Just to be clear, my main concern is…”
• “If you’re tied up, who would you like me to contact?”

C) Handling pushback

Busy seniors may respond with:

• “He’s probably fine.”
• “Just keep an eye on him.”
• “I’ll come when I can.”

A safe response is not to argue. Instead:

1. restate the concern,
2. add 1–2 facts,
3. repeat the request or negotiate a safe alternative.

After listening.

You’ll answer questions about:

• the main concern,
• what changed and when,
• the requested timeframe,
• and the agreed plan.

This skill is also perfect preparation for documenting later: if you can summarise the call clearly, you can write a safe note.

Practice & Feedback

Listen to the call once (twice if you need). Then answer the questions in short, clear phrases.

Write:

1. Who is calling, and who are they calling?
2. What is the main concern?
3. Name two observations mentioned (numbers if you catch them).
4. What review timeframe is requested?
5. What plan is agreed at the end?

Aim for 60–110 words total. If you miss a number, write what you understood (for example, “oxygen needs increased”).

3. Making your message specific: change, evidence, urgency.

You’ve heard what a realistic escalation sounds like. Now we’ll sharpen the language so you can be specific without sounding emotional or aggressive. In practice, juniors often say things like “He’s not well” or “She’s worse”, which can be true but isn’t actionable. Seniors need to know: what has changed, compared to when, and what you’re seeing right now. Another key point is safe uncertainty. You don’t need to diagnose. You can say, “I’m worried this could be deterioration,” or “I’m concerned we may miss something time-critical.” That kind of wording is strong but appropriate. In this block, you’ll practise upgrading vague statements into clear, ward-ready sentences using the same patient case. Think of it like turning a foggy picture into a sharp one: time, numbers, and a direct request.

From vague to ward-ready: upgrading your escalation language.

On a busy ward, clarity is kindness. It helps the senior make a safe decision quickly.

Below are common vague phrases and stronger specific versions. Notice how the specific versions include time, comparison, and observable facts.

Examples (using our same patient).

A useful mini-template you can reuse.

Try this:

1. Concern: “I’m concerned about…”
2. Change since: “There’s been a change since…”
3. Key observations: “Their observations are…”
4. Why it matters: “I’m worried this could be…” / “I’m concerned we may miss…”
5. Request + timeframe: “I’d like a review within…”

Safety note: be confident with what you know.

You don’t need to over-explain. Choose two to four high-value facts:

• one breathing measure (sats, oxygen, respiratory rate),
• one circulation measure (pulse, blood pressure),
• one ‘look’ (drowsy, pale, struggling to speak),
• and a time comparison (since 14:10 / in the last hour).

In the next block, we’ll practise what to do when the senior pushes back. For now, we’ll train your sentence-level precision.

Practice & Feedback

Rewrite the four vague lines below into ward-ready escalation language.

Use the same patient context (Mr Alan Price, Bay 3) and include:

• at least one time reference (for example, “since 14:10” / “in the last hour”),
• at least two concrete facts (numbers or clear observations),
• and at least one clear request with a timeframe.

Write 4 upgraded sentences (one for each line). Aim for 80–140 words total. Keep the tone calm and professional, not dramatic.

Vague lines to upgrade.

1. “He’s worse than earlier.”
2. “His obs aren’t great.”
3. “I’m worried but I’m not sure.”
4. “Can you see him when you have time?”

4. Handling pushback without losing professionalism.

Let’s tackle the part that often feels hardest: when the senior colleague is busy or dismissive. This is a real pressure point. You may hear, “Just keep an eye,” or “It’s probably fine,” and in that moment your job is to stay calm and keep the message clear. The goal isn’t to win an argument. The goal is to secure a safe action: a review, a clear alternative, or a named person to contact. A useful technique is the ‘broken record’ approach: you repeat your main concern, add one supporting fact, and then restate your request or offer options. You can also use respectful escalation language like, “If you’re tied up, who would you like me to contact?” That keeps the hierarchy respectful while still moving things forward. In this block, you’ll do a short chat-style simulation, replying to a senior who pushes back.

Pushback on the ward: a professional script you can rely on.

Pushback doesn’t always mean the senior doesn’t care. Often it means they are overloaded and trying to triage their own workload. Your job is to make it easy for them to understand the risk and choose an action.

Three safe strategies.

1) Restate your main concern clearly

• “Just to be clear, my main concern is his breathing has worsened rapidly.”

2) Add one key supporting detail (not a long story)

• “His sats are 90% on 4 L, and an hour ago he was 94% on 2 L.”

3) Make the next step concrete

• “I’d like a review within the next 30 minutes.”
• “If you can’t come, who would you like me to contact for an urgent review?”

Mini-dialogue: how it sounds.

Senior: “He’s got a chest infection. Just keep an eye on him.”

You: “I understand, but I’m not happy with how he’s looking at the moment. There’s been a change since 14:10 and his oxygen requirement has doubled. I’m worried this could be deterioration. I’d like a review within the next 30 minutes, please.”

Senior: “I can’t get there in 30.”

You: “OK. If you’re tied up, who would you like me to contact for an urgent review? In the meantime, I’ll repeat observations in 15 minutes and update you if there’s any further change.”

Why this works.

You are doing three patient-safe things:

• naming your concern,
• supporting it with facts,
• and ensuring there is a clear plan.

In the next blocks, you’ll put this together into a full escalation, then document the escalation factually. For now, your focus is: stay respectful, stay specific, and don’t accept vagueness as a plan.

Practice & Feedback

Chat simulation time. You are you (junior clinician/nurse on Ward 7). Clara will play Dr Hughes (registrar).

Write your replies as short chat messages, 1–3 sentences each. Keep them calm and respectful, but don’t lose your main point.

How to do it:

1. Start by restating your concern about Mr Alan Price.
2. Clara (as Dr Hughes) will respond with pushback.
3. You reply using one supporting fact + a clear request/timeframe, or a safe alternative (for example, contact SHO).

Write your first message now (40–70 words).

Pushback lines you may receive.

• “He’s probably fine. Just keep monitoring.”
• “I can’t come right now.”
• “What do you want me to do?”
• “Call me if he gets worse.”

Useful replies.

• “Just to be clear, my main concern is…”
• “There’s been a change since…”
• “I’d like a review within the next…”
• “If you’re tied up, who would you like me to contact?”
• “Can I just confirm the plan…?”

5. Deliver a full ward escalation with a confirmed plan.

You’ve practised openings, you’ve practised making the facts specific, and you’ve practised handling pushback. Now we’ll do the core performance: a complete escalation that is structured, time-focused, and ends with a confirmed plan. Think of it as a short, safe ‘mini SBAR’ adapted to the ward. You’ll be given the patient details on the screen, and you’ll write what you would actually say in a call or face-to-face escalation. Aim for clarity over length: a senior should be able to understand the situation in under a minute. Your message must include: your concern, the change, key observations, what you think it might indicate in cautious language, and your recommendation with a timeframe. Then, crucially, you’ll finish by confirming responsibilities: who will do what, and when. That final confirmation protects the patient and protects you.

Integrated task: one complete escalation (same patient).

Below is your ward data for Mr Alan Price (68), Bay 3, Ward 7. Use it to deliver a structured escalation.

Patient snapshot (use these facts).

• Reason for admission: chest infection
• Change: more breathless and drowsier since 14:10
• Observations at 15:05:
• RR 28
• SpO₂ 90% on 4 L (was 94% on 2 L at ~14:05)
• HR 112
• BP 98/60
• Clinical look: pale, struggling to complete sentences

The structure to follow (keep it short).

1) Identify + purpose

• “Hello, this is… calling from…”
• “Is now a good time for a quick update?”

2) Situation + concern

• “I’m calling about…”
• “I’m concerned about…” / “I’m not happy with…”

3) Change + key evidence

• “There’s been a change since…”
• “Their observations are…”

4) Assessment in cautious language

You are allowed to be concerned without diagnosing:

• “I’m worried this could be deterioration.”
• “I’m concerned we may miss something time-critical.”

5) Recommendation + timeframe

• “I’d like you to review within the next…”

6) Confirm the plan

• “Can I just confirm the plan: you will…, and I will…?”

Mini rubric (self-check).

Before you send your message, check:

• Did I state concern early?
• Did I include time + comparison?
• Did I make a clear request + timeframe?
• Did I end with a confirmed plan?

Next, you’ll write the follow-up documentation. But first, let’s make your escalation strong enough that a busy registrar can act on it immediately.

Practice & Feedback

Write a complete ward escalation script for a phone call or face-to-face update to the registrar.

Use the data on the screen for Mr Alan Price. Your script should be 120–170 words and sound like something you could say naturally.

Must include:

• a clear concern statement,
• the change since a time,
• 3–4 key facts (numbers/observations),
• a cautious assessment phrase (for example, “I’m worried this could be…”),
• a request with a timeframe,
• and a final line that confirms the plan (“Can I just confirm…?”).

Keep it respectful and direct. Avoid long background stories.

Helpful phrases (you can copy and adapt).

• “I’m concerned about…”
• “I’m not happy with how they’re looking at the moment.”
• “There’s been a change since…”
• “Their observations are…”
• “I’m worried this could be…”
• “I’d like a review within the next…”
• “If you’re tied up, who would you like me to contact?”
• “Can I just confirm the plan: you will…, and I will…?”

6. Write a factual escalation note with time and agreed actions.

Strong communication doesn’t end when the call ends. On a ward, you also need a short, factual record: who you informed, what you reported, and what was agreed. This protects continuity of care, especially when teams change over, and it reduces risk because the next clinician can see the timeline and the plan at a glance. In this final block, you’ll write a brief escalation note based on the same case. Keep it objective: observations, actions, and agreed next steps. Avoid emotional language like “doctor didn’t listen” or “patient terrible”. Instead, document the facts: “Registrar informed”, “review requested”, “plan agreed”. Also include timeframes: “repeat obs in 15 minutes”, “SHO to review now”, and what you will do if there is further deterioration. If you can do this well, you can escalate and document safely on a real shift.

The follow-up: documenting an escalation safely.

A good escalation note is short, dated, and factual. It answers:

• When did you escalate?
• Who did you speak to?
• Why did you escalate (main concern + change)?
• What facts did you report (key observations)?
• What plan was agreed (who will do what, and by when)?
• What will you do next (monitoring + update plan)?

Model note (example).

Below is a model you can follow. Notice the style: neutral verbs, clear times, clear responsibilities.

> 15:07 Escalated to Dr Hughes (med reg) re: Mr Alan Price (Bay 3) due to increased SOB and drowsiness since 14:10. Obs at 15:05: RR 28, SpO₂ 90% on 4 L (was 94% on 2 L at ~14:05), HR 112, BP 98/60. Pt pale, struggling to speak full sentences. Requested review within 30 mins. Dr Hughes advised: repeat obs in 15 mins, calculate NEWS2, contact medical SHO for urgent review now. Dr Hughes to review ASAP when free. Will continue close monitoring and update if further deterioration.

Style tips (B2 and patient-safe).

• Use past tense for what happened: “Escalated”, “Informed”, “Advised”.
• Use accepted neutral wording: “re:” (regarding), “due to”, “requested”.
• Keep uncertainty safe: you can write “concern for deterioration” without diagnosing.
• Keep it readable: one short paragraph is enough.

Your final performance.

Now write your own note for this exact case. Imagine you are writing it for the oncoming team: they should immediately understand the concern, the timeline, and the plan.

Practice & Feedback

Write a brief, factual escalation note for the patient record.

Context: Same case: Mr Alan Price (68), Ward 7, Bay 3. You escalated because of worsening breathing and drowsiness since 14:10.

Write 90–140 words in a neutral clinical style. Include:

• time of escalation,
• who you informed (role/name),
• key observations (2–4 facts),
• what you requested (review + timeframe),
• what was agreed (who will review, repeat obs, NEWS2, etc.),
• what you will do next and when you will update.

Keep it factual and clear. Use times and numbers carefully.

Phrase bank for documentation.

• “Escalated to … re: … due to …”
• “There has been a change since …”
• “Obs at …: RR …, SpO₂ … on … L, HR …, BP …”
• “Requested review within …”
• “Plan agreed: … to review …; repeat obs in …; update if …”
• “Will continue monitoring and update if any further change.”