Digital Repository Masters Theses Spring 2026 Implementation of a Standardized Paging Protocol to Improve Nurse to Provider Communication Jennifer Moore Weber State University Follow this and additional works at: https://dc.weber.edu/collection/wsudoctoral Moore, J. 2026. Implementation of a Standardized Paging Protocol to Improve Nurse to Provider Communication. Weber State University Doctoral Projects. https://cdm.weber.edu/digital/collection/WSUDoctoral This Project is brought to you for free and open access by the Weber State University Archives Digital Repository. For more information, please contact archives@weber.edu. WSU REPOSITORY MSN/DNP Implementing a Standardized SR Paging Protocol Project Title by Jennifer Moore Student’s Name A project submitted in partial fulfillment of the requirements for the degree of MASTERS OF NURSING Annie Taylor Dee School of Nursing Dumke College of Health Professions WEBER STATE UNIVERSITY 4/24/2026 Ogden, UT Date Jennifer Moore, BSN, RN, MSN Student 4/24/26 Student Name, Credentials (electronic signature) Date 4/24/26 MSN Project Faculty (electronic signature) Anne Kendrick, DNP, RN, CNE (electronic signature) DNP, N, CNE MSN Program Director Note: The program director must submit this form and paper. Date 4/25/26 Date 1 Implementation of a Standardized Paging Protocol to Improve Nurse to Provider Communication Jennifer Moore Annie Taylor Dee School of Nursing Weber State University Trish Gibbs MSN Project 03/29/26 2 Abstract Purpose/Aims: This quality improvement project improved nurse–provider communication by implementing a standardized Situation–Recommendation (SR) paging format on a pediatric medical–surgical unit that previously used unstructured paging. The goal was to make urgent messages clearer and more actionable, reduce back-and-forth clarification, and support faster responses to clinical changes. Rationale/Background: In pediatric populations, subtle clinical changes have the potential to progress to significant deterioration if not promptly recognized and addressed. Many numeric pages leave out key details, so providers must ask follow-up questions before acting. That extra back-and-forth slows decisions when time matters. SR keeps pages short but clear by stating what changed and what is needed next. Methods: Lewin’s Change Theory guided implementation through staff engagement, brief education, and reinforcement. A needs assessment and stakeholder review helped ensure SR expectations fit the unit workflow. Deliverables included an SR education PowerPoint, an SR tip sheet with unit-specific examples, and a pre- and post-clinician micro-survey. Results: Pre- and post-survey results were summarized using descriptive statistics and compared pre-to-post to measure changes in clinician perceptions of communication clarity, efficiency, and confidence using SR paging. Findings were shared with unit leadership and stakeholders to guide sustainment decisions and potential spread. Conclusions: Standardized SR paging provided a workflow-friendly approach to urgent escalation communication and supported consistent expectations between nurses and providers. Keywords: nurse–provider communication, situation–recommendation, structured paging, patient safety 3 Implementation of a Standardized Paging Protocol to Improve Nurse to Provider Communication Clear communication between nurses and providers plays a critical role in patient safety, especially in the hospital. Sentinel events in hospital settings continue to be associated with breakdowns in communication (AHRQ, 2023; The Joint Commission, 2023). On many units, numeric paging is still the standard way to reach a provider. Pages may be brief, and providers often must call back before understanding the full situation. When a patient’s condition is deteriorating, there is no time for delay (Lazzari & Rabottini, 2025). SBAR (Situation, Background, Assessment, Recommendation) is a way nurses and providers communicate to ensure information is clear, and crucial details are not missed (Alizadeh-Risani et al., 2024; Etemadifar et al., 2021). SBAR has been used in various settings and has shown to improve communication between providers. Despite this evidence, unstructured paging remains prevalent across many inpatient units, and such communications frequently lack clarity regarding the patient’s status and the specific action required. This can lead to delays due to providers requiring clarification before they understand the situation and can take the appropriate action. The goal of this project is to identify if adding a standardized format impacts how nurses and providers experience communication, especially in urgent situations on the unit. The focus is on hospital-based nurses and providers working in acute care. This project is guided by the following PICOT question: In hospital-based healthcare professionals (P), how does the implementation of a standardized paging protocol (I), compared to traditional unstructured pages (C), impact clinician self-reported communication efficiency (O) during a 3–5-day hospital stay (T)? 4 Statement of the Problem Communication problems continue to be a common factor in adverse and sentinel events in hospitals (AHRQ, 2023). Numeric paging or unstructured messages are often inconsistent and lack clear statements of the situation. This lack of clarity means providers must call back for more information before they can act. That delay can affect how providers prioritize and respond to patient needs (Kochis et al., 2025). Nurses report frustration related to unclear follow-up, and while providers indicate pages frequently lack sufficient detail to support clinical decisionmaking (Kochis et al., 2025). These communication gaps can negatively impact patient safety. If a change in condition is not communicated clearly, care can be delayed. In some cases, this contributes to transfers that could have been avoided, or extended hospital stays. (Lazzari & Rabottini, 2025). Structured communication enhances providers’ ability to accurately interpret clinical situations and identify necessary interventions, therapy improving interprofessional communication between the nurses and providers (Alizadeh-Risani et al., 2024; Etemadifar et al., 2021). While evidence supports this, many hospitals still use unstructured paging as a primary mode of communication. This style of paging disproportionately impacts on the bedside nurses and the providers who rely on paging to coordinate (Kochis et al., 2025). When messages lack structure, key information may be unclear or incomplete. Over time, such inconsistency can compromise patient safety and create delays in workflow. Significance of the Project Improved communication between nurses and providers is associated with higher patient safety (Lee & Jun, 2024). The use of SBAR in paging facilitates clear messages that convey the 5 patient situation and specific action, necessary, especially in urgent situations (Lazzari & Rabottini, 2025). Structured paging can strengthen teams’ dynamics. Both nurses and providers report decreased confusion when communication is more organized (Halterman et al., 2024; Kochis et al., 2025). Further, the Agency of Healthcare Research and Quality (AHRQ), incorporates SBAR as part of TeamSTEPPS 3.0. underscoring its role in promoting effective interdisciplinary communication. Standardizing paging aligns with established frameworks and supports ongoing quality improvement initiatives. The Implementation of a structured paging protocol offers benefits for both patients and providers. Clearer, concise messages may reduce delays in care and augment collaboration among team members. Additionally, a consistent process reinforces core nursing priorities such as safety, efficiency, and patient-centered care. Review of Literature This section examines communication practices between nurses and providers in inpatient settings, with particular attention to gaps that may adversely affect patient care. It also evaluates the role of structured paging, like SBAR, in increasing clarity and actionability of clinical communication. Barriers related to unstructured paging are explored, along with strategies shown to improve clarity and response time. Specifically, this review assesses whether a standardized paging protocol improves clinicians’ perceptions of communication efficiency compared with traditional paging during a hospital stay of 3-5 days. Three main themes emerged from the literature reviewed. The first them centers on communication breakdown and the implication on patient safety. The second examines the use of structured tools like SBAR and how they improve clarity and response time. The third addresses 6 education, leadership support, and sustainability. Collectively, these themes reinforce the need for a standardized paging process and inform the application of Lewin’s Change Theory to guide implementation. Hospitals still continue to report communication failures as contributing factors in sentinel events (The Joint Commission, 2023). Numeric paging, one commonly used modality in hospitals, is limited int its ability to convey urgency, which may contribute to delayed responses (AHRQ, 2023; Kochis et al., 2025). In response to this issue, this project a proposed the implementation of a standardized SBAR paging format to improve communication and patient safety in the inpatient setting. Framework Lewin’s Change Theory (unfreezing, moving, refreezing) is used to organize this project (Lewin, 1951). During the unfreezing theory, staff review the unit examples and highlight the delay in the unstructured pages that are sent. The goal is to build awareness. In the moving stage, nurses practice concise SR messaging with coaching and quick-reference tools. Feedback from leaders helps address early challenges so they can be fixed or addressed. In the refreezing theory, SR language becomes part of policy, documentation, huddles, and orientation. Ongoing reinforcement supports long-term consistency. Lewin’s model fits this project because it offers a simple structure for introducing change and maintaining it in a hospital environment (Lewin, 1951). Strengths and Limitations One strength of Lewin’s Change Theory is that it is straightforward and easy to understand (Lewin, 1951). Its structured approach makes this model particularly well-suited for implementation within the healthcare setting. The model encourages staff involvement and 7 shared responsibility during change. This aligns with the project’s focus on improving nurse– provider communication. It also allows for reflection and adjustment as the process unfolds. Lewin’s model is not without limitations. It suggests a linear process but change in healthcare rarely happens in a straight line (Lewin, 1951). Staff turnover, shifting priorities, and technology challenges can slow implementation. To support consistency, this project includes brief feedback, reminders in huddles, leadership support, and SR cues within templates and policy. These steps help reinforce the process over time. Search Strategies The literature search included CINAHL, PubMed, MEDLINE, Google Scholar, and Weber State University’s Stewart Library OneSearch. Key search terms were “nurse–provider communication,” “SBAR,” “structured communication,” “paging systems,” “sentinel events,” and “patient safety.” Boolean operators (AND, OR) were used to narrow and combine results. Articles were limited to peer-reviewed studies published between 2020 and 2025 that addressed hospital-based communication and patient safety outcomes. Articles were excluded if they were conducted outside of acute-care settings, unavailable in full text, or not published in English. Additional guidance was reviewed from AHRQ, AACN, and AONL to support alignment with national practice standards. The initial search identified approximately 25 articles. After applying the inclusion criteria, seven were removed due to publication date, setting, focus, or methodological concerns, Sixteen studies and relevant guidelines were included in the final review. These sources provide current evidence related to structured communication and support the development of the SR paging approach. The next section outlines key findings that inform the project. Synthesis of Literature 8 A review of the current literature reveals consistent evidence that structured communication reduces patient harm, improves workflow efficiency, and strengthens interprofessional teamwork (Ait Aiss et al., 2025; Kochis et al., 2025; Lazzari & Rabottini, 2025). These findings directly support the implementation of a standardized paging protocol. This research also provide the evidence base needed to guide the development of an SR-focused paging process, aligning well with Lewin’s Change Theory, which emphasizes preparing staff, supporting behavior change, and sustaining improved communication practices. Communication Errors and Patient Safety Hospitals continue to report communication breakdowns in cases of preventable harm (AHRQ, 2023). Unstructured messages can lead to delayed responses or misinterpretation of urgency (Arora et al., 2005; Kochis et al., 2025). Studies of structured communication show clearer messaging and faster response times (Kochis et al., 2025; Lee & Jun, 2024). This evidence supports using an SR paging format to improve clarity and response in inpatient care. Structured Communication Tools and Standardization SBAR has been shown to make communication clearer between providers (IHI, 2021; Joint Commission, 2023). It has been associated with faster response times, fewer errors, and increased provider confidence (Etemadifar et al., 2021; Lazzari & Rabottini, 2025). Comparatively, SBAR demonstrated improvement in communication compared to another handoff model in an emergency department (Alizadeh-Risani et al., 2024). Embedding communication within electronic templates reduces the need for repetitive clarification and enhances efficiency (Kochis et al., 2025). Similarly, I-PASS demonstrated similar improvements in handoff reliability (Ait Aiss et al., 2025). 9 Based on this evidence, adapting SBAR for urgent paging is a logical step. SBAR’s flexible framework has been successfully applied diverse across settings, including non-hospital environments and patient-centered care models (Jean-Baptiste et al., 2022). Education, Training, and Sustainability To sustain structured communication, staff require reminders, examples, and leadership support. Simulation and case-based practice will aid nurses in becoming more proficient and comfortable using structured language when paging (Pazar et al., 2024; Toumi et al., 2024). Consistent use is further reinforced when leaders model expectations and provide feedback, (Etemadifar et al., 2021). Integrating the prompts into the electronic documentation system will help support adoption, particularly among new staff (Kochis et al., 2025). Additionally ongoing SBAR education and periodic review strengthen reliability and contribute to improved safety outcomes over time (Reynaud et al., 2024; Mulfiyanti & Satriana, 2022). Summary of Literature Review Findings and Application to the Project The findings of the reviewed studies consistently demonstrate that communication breakdowns remain a significant threat to patient safety. Structured tools such as SBAR improve clarity and reduce preventable errors (Ait Aiss et al., 2025; Etemadifar et al., 2021; Kochis et al., 2025). Accordingly, adapting SBAR to SR paging represents a logical strategy to improve urgent nurse–provider communication. Lewin’s Change Theory provides a straightforward structure to guide adoption and reinforcement. Overall, SR paging is a realistic and practical approach to strengthening communication in acute care settings. Collectively, the research supports implementing an SR-based paging format in acute care. Across studies, consistent benefits were reported, including clearer communication and 10 safer care. These findings helped guide the development of project components including educational content, application of paging scenarios and audit criteria. (McCarthy et al., 2025). Project Plan and Implementation This project will be on a pediatric 28 medical-surgical unit at a local hospital. The implementation plan builds upon existing evidence and applies Lewin’s Change Theory to guide the rollout. The focus is on clearly introducing the change, supporting staff during adoption, and embedding the process into the routine workflow. The interdisciplinary team involved in implementation includes nursing staff, providers, and unit leadership. Plan and Implementation Process The SR paging protocol will be implemented in phases on a pediatric medical-surgical unit. Where unstructured paging is commonly used for provider communication. Unstructured numeric paging has been associated with delayed responses and reduced message clarity (AHRQ, 2023; Kochis et al., 2025). This project replaces such practices with a simple standardized script that clearly indicates the clinical situation and the action required. At the onset of implementation, unit leadership and the clinical nurse educator will introduce the SR format and present brief unit data related to communication delays. This approach is intended to enhance staff awareness of the need for change and aligns with. s step to Lewin’s unfreezing stage, preparing the team for adoption (Joint Commission, 2023; Lazzari & Rabottini, 2025). Training and skill development will occur next. Nurses will engage in focused education. Delivered during unit huddles and staff meetings. With emphasis on learning and practicing the SR format through both written and verbal format. Quick-reference materials, including example scripts based on common pediatric scenarios (e.g., respiratory distress, medication questions, 11 fever alerts) will be made readily available at each nurse’s station to help reinforce learning and support consistent use. Providers will be oriented to the standardized format concurrently, to ensure shared expectation for communication. This phase with the moving stage of Lewin’s model, as staff receive support while they adopt the new workflow. Once training is complete, the unit will begin using the SR protocol for all non-emergent pages. Nurse leaders and charge nurses will provide real-time coaching and positive reinforcement to help staff remain consistent during the first several weeks. Throughout the implementation process, feedback will be encouraged to identify and address potential barriers early in the process. When the unit demonstrates consistent use of the SR format, the process will be incorporated into unit policy, orientation materials, and standard workflows. This refreezing stage supports long-term sustainability by ensuring the paging protocol becomes part of routine practice for both current and new staff. Interdisciplinary Team Successful implementation of the SR paging protocol depends on the effective collaboration among interdisciplinary team members. Clearly defined roles and shared expectations are essential to achieve long-term sustainability. Evidence indicates that strong team collaboration is linked to a reduction in communication-related errors (Lee & Jun, 2024; SamostWilliams & Thomas, 2025). Nursing Staff. Bedside pediatric nurses will be the primary users of the SR paging format. Nurses are responsible for identifying patient needs, determining the urgency of communication, and sending structured pages. Consistent use of the protocol directly impacts provider response times and patient safety outcomes. Improving nurses’ confidence and clarity in paging is essential to the project’s success (Lee & Jun, 2024). 12 Pediatric Hospitalists and Resident Physicians. These providers receive many unit pages and will benefit from more actionable, concise messages. Clinician engagement helps reinforce expectations for communication and promotes timely clinical decision-making. Provider feedback during the implementation phase will identify areas for clarification and help refine the SR protocol for real-world application (Kochis et al., 2025). Advanced Practice Providers (NPs/PAs). Advanced Practice Providers frequently manage hospitalized pediatric patients and play a key role in improving communication. The participation of advanced practitioners ensures that SR paging is consistently expected across all provider groups, thereby reducing workflow variation. Clinical Nurse Educator. The clinical educator will coordinate training sessions, develop reference materials, and support real-time coaching during the transition period. This ensures that education remains ongoing and that new hires receive consistent instruction during orientation. Charge Nurses. Charge nurses will reinforce protocol adherence during each shift, help troubleshoot communication concerns, and model effective SR paging. The proximity of nurse leaders to clinical workflow positions to support staff and provide immediate guidance. Nurse Manager. The unit manager will oversee progress, monitor staff engagement, and collaborate with leadership to embed the paging protocol into long-term policy and unit expectations. Their support ensures alignment with broader organizational priorities. Quality and Patient Safety Team. This team will assist in evaluating communication outcomes, reviewing incident trends, and ensuring the project aligns with hospital safety goals. Their input will help determine whether SR paging reduces delays, improves handoffs, or decreases pediatric safety events. 13 Information Technology (IT) Support. If templates are created for the SR format, IT staff will be involved in building, testing, and maintaining standardized fields. Their involvement will help streamline the paging workflow and ensure the system supports accurate and consistent communication. Description and Development of Project Deliverables Project deliverables were created based on current evidence to facilitate ease of use of the Situation–Recommendation (SR) paging format during real-time workflow and to support consistent adoption during implementation. Deliverables were created based on evidence supporting structured communication. These resources are designed to enhance understanding and promote effective teamwork following the training. They serve to reinforce key concepts and provide concise, point-of-care cues that are relevant and reflective of real-world practice (Agency for Healthcare Research and Quality [AHRQ], 2023; Etemadifar et al., 2021; Kochis et al., 2025; Lazzari & Rabottini, 2025). SR Education PowerPoint The SR education PowerPoint (see Appendix A) provides a short overview of need for change, the components of SR, and examples of effective SR pages when applied to common pediatric scenarios. The PowerPoint content will introduce and define each step of SBAR in detail, including an explanations what is happening and why it matters now (Situation), and a clear request for action with a specified timeframe (Recommendation). This form of paging will support prioritization and timely responses (AHRQ, 2023; Lazzari & Rabottini, 2025). The PowerPoint created will be shown during huddles and staff meetings. The PowerPoint may be emailed if requested by staff. The inclusion of brief examples will help reinforce the teaching 14 and help reduce variability in how structured communication is used (Etemadifar et al., 2021; Kochis et al., 2025). SR Tip Sheet The SR tip sheet (see Appendix B) is a quick-reference tool meant for point-of-care use. This tool highlights the SR elements, includes wording cues, and provides examples tied to frequent pediatric situations (e.g., respiratory change, fever escalation, pain concerns, medication questions). Quick cues support consistent, actionable messaging and reduce cognitive load during busy shifts (AHRQ, 2023; Kochis et al., 2025). The tip sheet will be posted in highvisibility areas (workstations/report rooms) and shared electronically. Pre- and Post-Clinician Survey A brief survey (see Appendix C) will be conducted before and after implementation to evaluate how clear, efficient, and confident the healthcare team was with SR paging. The preand post-surveys will measure change over time, and the post survey includes two optional openended questions. The purpose of this is to capture and use feedback. Staff perception measures are a practical way to evaluate communication interventions and align with evidence linking communication quality to teamwork and safety culture (Lee & Jun, 2024; Kochis et al., 2025). Timeline The proposed timeline (see Appendix D) is organized in phases to support readiness, adoption, and evaluation of SR paging on the pediatric medical–surgical unit. The early steps will include identifying the gap through a needs assessment followed by an extensive literature review. Next stakeholders’ approval will be obtained prior to finalizing project deliverables. Staff training will be delivered in brief sessions during unit huddles and staff meetings, followed by a defined pilot period that incorporates coaching and reinforcement to support consistent SR 15 use. Project effectiveness will then be evaluated using pre- and post-implementation survey results and an audit of SR elements if feasible. Findings will be disseminated to unit stakeholders and to guide decision-making regarding potential adjustments to support long-term sustainability. Project Evaluation Project will be evaluated using a combination of formative and summative methods to determine feasibility, adoption, and impact on nurse–provider communication. The evaluation plan is designed to align with unit workflow to minimize disruption while supporting data collection. Outcomes measure will focus on determining whether SR paging improves message clarity and reduces avoidable back-and-forth communication. Formative evaluation Formative evaluation will occur during the first weeks of implementation by brief checkins during huddles with the nursing staff, as well as feedback from the charge nurses, providers, and the clinical nurse educator. The feedback will focus on common barriers, such as missing timeframes, unclear requests, and inconsistent urgency wording when paging. This information will be used to adjust SR examples, clarify expectations for urgent versus routine messages, and reinforce consistent SR use in a supportive, non-punitive way. Summative evaluation The summative evaluation will include pre- and post-clinician surveys measuring clarity, efficiency, and confidence with SR paging. Post-survey questions will be used to identify gaps (e.g., missing timeframes, unclear recommendations) and guide improvements. The post-survey will include two optional open-ended questions to elicit feedback aspects that were effective and areas for improvement. Capturing staff perspectives’ provides valuable data to evaluate 16 communication input and align with evidence linking nurse–provider communication to patient safety culture and teamwork (Kochis et al., 2025; Lee & Jun, 2024). A small sample of pages/messages will be reviewed using a simple checklist to determine if the SR elements are present including: (1) a clear Situation statement describing the clinical change and urgency, and (2) a clear Recommendation stating what is needed and by when. The audit will focus on the presence or absence of SR elements rather than individual performance. Sampling may be drawn from pages that are typical 3–5-day patient stays during the pilot period to maintain consistency with the usual hospitalization workflow. Anticipated feasibility barriers include limited access to message content depending on the messaging platform and time constraints for completing the review. The audit will use a small convenience sample (e.g., 20–30 messages) reviewed by the project lead and/or clinical nurse educator during two time points (early and end of pilot). If message access is unavailable, the audit will be replaced with a brief self-check method using the same SR checklist elements. Survey results will be summarized with descriptive statistics (e.g., percent agreement and mean scores) and compared pre-to-post to identify improvement trends. Audit results will be reported as the percentage of sampled messages that include both SR elements. Findings will be shared with unit leadership and stakeholders to guide sustainment decisions and determine whether the process should be continued, modified, or expanded. Ethical Considerations This project will be conducted with ethical standards to ensure staff protection, autonomy, and privacy. The primary objective is to optimize the clinician communication process, not to evaluate individual employee performance. Education on SR paging will be 17 available to all staff to ensure expectations are clear and consistent, but participation in evaluation components (such as surveys) will be voluntary. Staff will be informed that completing the pre- and post-surveys is optional. Choosing not to participate will not affect scheduling, evaluations, or employment. Survey responses will be collected without names whenever possible and reported only in aggregate, so individual participants cannot be identified. If a paging audit or sample review is completed, it will focus only on whether SR elements are present (Situation + Recommendation + timeframe). The review will not be used to “grade” individual clinicians. Any examples shared for education will be de-identified, and no patient identifiers or protected health information will be included in project reporting. Evaluation data will be stored securely with access limited to the project lead and designated unit stakeholders. A potential ethical concern is that staff may perceive the project as a tool to monitor or discipline them. This will be addressed by being up front by clearly communicating that the project is unit-based quality improvement and that results will be shared only at the unit level. Further, to reduce bias, the same survey questions will be used pre- and post, an audit will be conducted to be objective at the criteria (presence/absence of SR elements), and the findings will be looked at with unit leadership and key stakeholders to support fair interpretation. Discussion This section provides a comprehensive overview of the dissemination of project results and how the results contribute to advancing nursing practice by informing evidence based practice strategies. Additionally the section outlines implications and recommendations for sustain the intervention over time and expanding the project to other units or settings. 18 Evidence-Based Solutions for Dissemination Dissemination will begin at the unit and organizational level, to support translation of findings into actionable practice changes. At the unit-level results will be shared during staff huddles and staff meetings, with emphasis on changes implemented lessons learned, and strategies for sustaining the intervention. Results will be presented using simple visuals such as a one-page summary with pre- and post-survey trends, audit adherence rates, and key implementation lessons (e.g., common barriers and compelling SR examples). The use of brief summaries and interactive forums, such as huddles and support staff engagement with QI findings that are clear, practical, and tied to workflow decisions (AHRQ, 2023). This approach will increase the likelihood that practice changes will be sustained. At the leadership level dissemination will occur through a concise written report shared with the nurse manager, clinical nurse educator, and appropriate quality or safety stakeholders. This report will include the rationale for adopting SR paging, the implementation strategy, outcome measures, and recommendations for longevity. If results demonstrate positive outcomes, next steps may include, incorporating SR cues into new nurse orientation and identifying unit “champions” to support ongoing use of this paging format. Communication improvement projects are more likely to be sustained when leaders reinforce expectations and integrate tools into workflow and onboarding processes (AHRQ, 2023; Kochis et al., 2025). Additional dissemination opportunities may include presenting the project to a hospitalbased shared governance council, a nursing professional practice meeting, and a patient safety committee. These venues support interdisciplinary discussion and allow the project findings to reach stakeholders who can influence policy, education, and clinical workflow. If the project demonstrates meaningful improvement, a podium presentation or brief abstract submission may 19 also be considered for a regional nursing conference or quality improvement forum. Sharing structured communication outcomes aligns with national priorities focused on teamwork, safety culture, and reduction of preventable harm (AHRQ, 2023). If the organization supports dissemination beyond internal sharing, the project may be prepared for submission as a brief quality improvement report or practice paper. Potential outlets include nursing quality and safety journals or professional newsletters. Significance of the Advancement of Nursing Practice This project supports the advancement of nursing practice by strengthening a core nursing role: communicating clinical changes clearly and advocating for timely interventions. In acute care settings, nurses are often the first to identify early signs of deterioration however, variability in paging practices may limit the efficiency and clarity with which urgency and clinical needs are conveyed. Standardizing paging messages can help reduce variability, improve shared understanding between nurses and providers, and support faster decision-making (Kochis et al., 2025; Lee & Jun, 2024). Improving nurse–provider communication also supports professional practice by minimizing frustration, reducing the need for repeated clarification messages, and promoting mutual trust. Over time, consistent structured communication can support a stronger safety culture. It will improve collaboration and reduce communication-related errors. For pediatric settings, when subtle changes matter quickly, emphasizing Situation and Recommendation can help ensure providers receive the most important information up front and understand what the nurse is requesting and the expected timeframe (Lee & Jun, 2024). 20 Furthermore, standardizing SR paging supports the development of nursing clinical leadership by reinforcing consistent escalation language and strengthening interprofessional reliability during patient deterioration. Implications This project has several strengths. The SR paging intervention is simple; aligns with exising workflow and can be easily reinforced. The addition of brief education and point-of-care tools (a tip sheet and examples) helps support the change and increases the likelihood of early adoption and long-term sustainability. If implemented consistently, SR paging has the potential to improve clarity of urgent pages, reduce back-and-forth communication, and strengthen teamwork. However, limitations and barriers must be considered. A short implementation timeframe may limit how quickly staff build consistency. Variability in provider preferences and differences in messaging platforms may influence how SR is received and utilized across shifts. To reduce these obstacles, stakeholder engagement is essential, along with continued reinforcement of expectations during staff huddles and onboarding. Additionally, SR examples should be updated based on staff feedback can also help address areas of confusion or improve real-world applicability. For nursing practice, these implications highlight the importance of pairing communication tools with realistic education and shift-level reinforcement. Nurses can escalate concerns consistently and efficiently during high-acuity moments. Recommendations Feedback from stakeholders during development and early implementation phases highlight the importance of maintaining format that is simple and realistic for staff. Staff also 21 identified the value of reinforcement strategies, such as reminders during huddles and visible tip sheets These recommendations were incorporated into the SR tip sheet wording cues and the brief PowerPoint examples used for training. If evaluation findings demonstrate improved clarity and nurse confidence with SR paging, the primary recommendation is to sustain the intervention on the unit-level. Sustainability strategies include maintaining readily accessible tip sheets at the nurse’s workstation and ensuring SR paging expectations are reviewed during orientation and reinforced during huddles. If evaluations identify gaps, such as missing timeframes or unclear recommendations targeted updates to the tip sheet and PowerPoint examples will be completed accompanied by refreshers during staff meetings. If the outcome is positive, the recommendation is to expand SR paging to additional units. The spread should be intentional, with unit-specific changes and stakeholder review to ensure the change can remain realistic and consistent. Brief education, visible workflow examples, and reinforcement should remain part of the implementation process. This adoption improves when staff have clear examples and leadership support (AHRQ, 2023; Kochis et al., 2025). Finally, future work should focus on evaluating any remaining gaps and long-term outcomes. Next steps may evaluate whether SR paging influences response-time trends, helps reduce avoidable clarification messages, or improves perceived teamwork over more extended periods. Disseminating these findings supports continuous learning and strengthens nursing-led quality improvement efforts focused on communication reliability and patient safety (Agency for Healthcare Research and Quality, 2023). Conclusions 22 Communication breakdown between nurses and providers remains an ongoing problem in the hospital setting, especially when pages are brief or unclear. These identified communication gaps can delay care when patients are in crisis. Literature consistently demonstrates that the use of a structured communication tool enhances message clarity, improves the transfer of critical patient information, and reduces the need for repeated clarification. This project addresses the critical gap by the implementation of a standardized Situation–Recommendation (SR) paging format. Findings from the literature strongly indicate that the implementation of a structured communication tool facilitates more rapid comprehension of patient concerns and results in more timely clinical responses which has the potential to strengthen interprofessional communication, decrease patient safety events, and improve quality of patient care. 23 References Agency for Healthcare Research and Quality. (2023). 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Response Scale: 1 = Strongly disagree | 2 = Disagree | 3 = Neutral | 4 = Agree | 5 = Strongly agree Clarity: 1. The urgent pages I receive are clear and concise. 2. Urgent pages include a specific request or action. 3. Urgent pages include a timeframe for the requested action. 4. I can quickly tell how urgent an urgent page is. Efficiency & Confidence 5. Paging communication on this unit is efficient. 6. I feel confident prioritizing my response after receiving an SR-formatted urgent page. Post-survey only (optional): 7. What part of SR paging helped most? 8. What’s one thing we should improve next? 33 Appendix D Visual Timeline Week Week Week Week Week Week Phase / Activity 1 2 3 4 5 6 Confirm needs assessment findings and currentstate gap (brief staff input; common paging X patterns) Stakeholder approval (manager, educator, provider X X rep; QI/safety; IT if applicable) Develop/Revise deliverables (PPT, tip sheet, SR, X X survey) Final stakeholder review of deliverables X Staff education (huddles/staff meeting rollout; X X distribute tools) SR paging pilot implementation X X X X Coaching + reinforcement (charge nurses/educator) Post-survey distribution and collection X Data summary + stakeholder debrief and X sustainment plan