Nursing Reflective Essay: Critical Incident Analysis and Reflection

This nursing reflective essay details a critical incident that occurred during a night shift, where a miscommunication regarding patient allocation led to a stressful situation for the student nurse. The essay employs Gibb's reflective cycle to analyze the experience, describing the incident, the nurse's feelings of confusion, anxiety, and hopelessness due to being wrongly accused of a care discrepancy. The evaluation highlights both the negative aspects, such as workplace stress and miscommunication, and the positive outcomes, like the implementation of improved duty allocation procedures. The analysis focuses on the nurse's actions, management's shortcomings, and the role of supervisors, offering insights into how the situation could have been better managed. The essay concludes by emphasizing the importance of this experience for the student nurse's professional development and future practice in nursing.

Running head: NURSING REFLECTIVE ESSAY
NURSING REFLECTIVE ESSAY
Name of the student
Name of the university
Author note

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Reflection is the process of retrospection upon the past experiences and actions that
helps us to understand the strengths and limitations of our personal and professional abilities
(Schmidt and Brown 2016). In nursing professional, reflection helps professionals to
understand the aspects that could help them to improve their skills and provide the patients
involved with effective quality of care (Lestander, Lehto and Engström 2016). Besides this,
identification of strengths helps to boost their confidence that eventually makes their practice
efficient (Eng and Pai 2015).
In this paper, I would reflect upon one critical situation I faced while working in night
shift and affected me, my thoughts and confidence. I would be using Gibb’s reflective cycle
to critically analyse the situation and would mention about the discrepancies and
disorientation occurred in the care condition. Further, I would also mentions about alternative
choices that I could have made to avoid the consequences of this situation and highlight the
positives as well negatives of the situation to develop the understanding of future nursing
management.
Description
This incident occurred at my healthcare facility while working in night shift.
Handovers and shift changes are things which generally takes place in the Matron office
where nurses exchange their handover while changing or completion of their shifts. However,
that day the bedside handover exchange took place at the nursing station in which every
nursing professional gathered and handed over their patients report to us, night shift nurses. It
was informed to us by the Nurse In Charge (NIC) of night shift, Lisa that in the bay 6, two
beds are empty and no changes has been done related to any patient. I was in doubt as nobody
discussed about the patient in Side Room 8 (SR 8), and hence I asked her about that patient
and confirmed whether I am assigned with that patient or not. I was clearly informed that SR

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8 is not my patient and that patient has been transferred to bay 6, to complete the empty beds
in that area and hence the bay 6 nurse would take care of the patient.
I was assigned with 6 patients in bay 4 and 3 patients in bay 5 as I received handover
from both of the day shifts nurses allocated for these patients. Jessica, the day shift staff
nurse, responsible for the care of patients in bay 6, side room 7 and 8 was supposed to
handover her duties to a night bank staff. However, when I observed the allocation board, I
was SR 8 was reflecting alongside my name. Throughout the night shift, I cared for my
patients and upon handing over the reports to the day shift nurse in the Matron’s office,
which is the usual place for exchanging handover reports I did not mentioned about any of
the complications that I faced in the night shift. After one day, everyone was called upon and
was asked for this anomaly in the care process and due to the absence of Jessica in these
meetings, on the complaint of a Health Care Assistant (HCA), I was made responsible for the
disparity in this situation. Upon recalling I came to know that the HCA who has made this
complaint was involved in a dispute three days ago and hence, she has escalated this issue to
the NIC of day shift. However, when Jessica showed up after 5 days and mentioned about
this complication it was clear that I was not involved in this discrepancy related to care of
patient in SR 8. This is the incidence that helped me to understand my strengths and
weaknesses as a person and nursing professional and influenced me to become more active
and efficient about my care process.
Feelings
That day, from the commencement of my shift, I was feeling unusual and improper
activities happening around me. The first anomaly that I observed in the care process is the
bedside handover exchange meeting that was taking place at the nursing station, instead of
the Matron’s office. After this, when I observed that no one is discussing about the handover

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of side room 8, I asked the NIC that whether that patient is my duty or not, however, I was
made clear that SR 8 is not responsibility and I should focus my care for the 9 patients in bay
4 and 5. However, upon watching the allocation board which indicated SR 8 patient under my
care, I was unable t understand the reason of this discrepancy. I neglected this condition as
the NIC usually changes or updates the allocation board after allocation of duties or uses their
verbal communication for the allocation of the tasks, but in this case the board was not
updated even after the commencement of the shift. I felt that this might be a technical issue
and the patient might be allocated to the nurse responsible for the bay 6.
However, upon knowing about the complaint escalated by the HCA of day shift to the
NIC, I felt anxious and devastates because I was blamed for the entire discrepancy of care
that happened with the patient of SR 8. Few days back I had a dispute related to care for one
patient and this was the same HCA who escalated the issue, after the left hospital after my
shift to the NIC and she held me responsible intentionally. I felt confused and hopeless as that
HCA was not present during the night shift and instead of identifying her mistakes, the NIC
and nursing supervision held me responsible for the complication. Despite this, I knew that if
Jessica comes and states her point of view, people would be able to know about the
complication that occurred due to the negligence and technical error of the allocation board.
However, when after repeated efforts, she did not received my calls or did not show up to the
healthcare facility, I felt that I am in the middle of nowhere.
Within this, one condition that made me happier was the patient’s stable condition. I
came to know that the patient had his last medicine at 18:00 hours and after that he did not
had any medicine to be administrated. Hence, his condition was stable. However, it was the
duty of the HCA to maintain safety and provide care to the patient in night shift. This was the
primary reason I was feeling anxious and hopeless because nobody was blaming her for her
mistakes and were raising fingers at me.

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After five days, when Jessica came to the healthcare facility and cleared authorities on
her mistake while handover, I felt relieved as people came to know the truth of that situation.
I also reflected upon my actions that I did or should have done to avoid such complications. I
felt that there were three parties involved in this discrepancy and due to their faults, one
patient and his security was compromised. This analysis helped me to feel hopeful as I was
able to identify my limitations as a nursing professionals and hence I would be able to
overcome this complication with proper action plan.
Evaluation
This complete experience of facing trouble while caring for patients efficiently was
both positive and negative, however while facing such condition, I felt disheartened and
hopeless. The negatives of this situations were affecting my thought process, my abilities as
an efficient nursing professionals. While analyzing the negatives it should be mentioned that
this experience affected my inner strength which reflected in my thought process. As per
Karimi et al. (2017), workplace complications are the most crucial and critical conditions due
to which majority of the patients suffer from depression or stress, and similar condition was
faced by me. I was unable to think about any aspect that could have helped me to overcome
this critical workplace stress. Further, I also did not get any help from the fellow nursing
professionals, despite the fact that they also observed the duties allocation board. This
reflected the negative aspects of the healthcare facility and work environment. I also observed
miscommunication between the healthcare authorities, specifically, the NIC, the nursing
management and the HCAs. While commencing my shift I was clearly informed that I am not
assigned with the care duty of patient in SR 8, however, when confronting my mistakes. They
did not taken note of this message that was conveyed to me. Lisa, the NIC of night shift also
did not mentioned her statement due to which I was assured that SR 8 patient is not under my
observation. Hence, there was a huge gap of communication between the nursing staffs, the

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NICs and the management that did not even think of investigating the situation. I tried
convincing the officials that I was not responsible for the SR8 patient and the allocation
board was not updated since few days but I did not sense that the HCA would be convinced
and look into the matter. The management confronted other staffs and nobody spoke
anything, putting me under the culprit position. I was astonished to see the turn of events and
was left speechless. My only hope was Jessica, but that hope also went in vain because
Jessica could not respond over phone. If only something severe would have happened to the
patient, I would have been disbarred from practicing nursing ever again in my life. I thought
that I had positive relationship with the other nurses, but turns out, I do not. This showed me
the mundane quality of teamwork because if the team members do not stand up for them or
do not support your decisions then the teamwork is pretty much just work, everybody is
concerned with themselves. This showed that the organization’s teams where not effective
because the members started to make their own small team within the team unintentionally.
However, the only best or positive aspect that occurred in this aspect was that after
knowing the truth about the condition, the management of the healthcare facility decided to
make improvements in the updating of the duty allocation board. They mentioned that they
will look into the need of improving the management and quality care by updating the
allocation boards on a regular basis. This is an important step as Walker and Mann (2017)
mentioned about this in their research and it was proven that application of proper allocation
boards would help the nurses to be aware of their duties in the care facility (Wong,
Cummings and Ducharme 2013). Further by taking, the account of all the nurses and their
respective patient for both the day shift and the night shift is also positivity. Even the Nurses
in Charge who assigns the nurses to the respective wards will not just do it verbally and will
also update it with the management team to have a control and recordings of the
organization’s surroundings. The management will also ask the nurses to update the board

6NURSING REFLECTIVE ESSAY
when they change their shift from day to night. Hence, upon analyzing the conditions, I was
able to identify the aspects which was responsible for this occupational mishap that occurred
in the care process. Further, I also analyzed the positives that were included in the care
process after thus care process. Therefore, in this condition, I was able to understand the
significance of this critical condition, for my future nursing practice and my abilities as an
efficient nursing professional.
Analysis
While analyzing the condition or the situation, there are multiple ways and aspects
that I could have developed or implemented so that I could manage the conditions effectively.
I conducted a holistic analysis and focuses on my mistakes, the management’s mistakes in
investigation and the mistake of immediate supervisors due to which this entire mishap
occurred. While analyzing my mistakes, I was able to identify only one mistake that I commit
and that has the capability of hampering the entire working environment is not opposing or
escalating anomaly happening around us. As per World Health Organization (2018), it is the
responsibility of the nursing professional to implement effective steps while observing or
going through any discrepancy in the care process, and escalate the issue to the higher
manager so that the complications could be eliminated from the process. I was aware of this
process, and I also observed that the allocation board did not changed even after the
commencement of the shift and showed my name assigned for the care of SR 8 patient.
Hence, this is the condition I should have escalated to the NIC Lisa and should have
mentioned my complication. However, I did not mention this condition to anyone due to
which nobody noticed this discrepancy and blamed me for this condition after they came to
know of this critical situation. Hence, there are several negative as well as positive aspects
that could have affected this healthcare condition. The negative aspect of this mistake could
have become severe for the patient as the patient did not receive any care or medication due

7NURSING REFLECTIVE ESSAY
to this anomaly and if the morning shift nurse did not have administer medicine of 18:00
Hrs., his health condition would be compromised. Therefore, this is the negative aspect of the
mistakes occurred in the care process.
The analysis of the second mistake by the NIC Lisa and Jessica would have affected
my abilities as a nursing professional and would have hampered the reputation of the hospital
in providing efficient and effective care. As per Lloyd, Elkins and Innes (2018), it is
important for the nursing professionals and management to think of every patient admitted as
these patients and their recovery would be an effective measure for the growth and
development of the hospital’s reputation. Further, the nurses involved in the care process
would be able to develop effective nursing skills and abilities as they would be managing
each of their patient’s complications effectively. As per Kangasniemi, Pakkanen and
Korhonen (2015), if the staff nurse Jessica would have informed the NIC Lisa about the SR 8
patient and his status and would have handed over the bank nurse about the care process, then
this complete incidence would have been eliminated. Further, while confronting me for the
improper care or avoidance of the patient, the NIC Lisa should have taken a stand and
mentioned of the statement she made while clarifying my duties that particular night. Hence,
in such condition, both the staff nurse Jessica and the NIC Lisa did not showed their ethical
code of conducts and their professional codes depending upon which, they should have
stayed true and honest to their job roles so that effective and quality care could be provided to
the patients. Therefore, these are the positives and negatives of this critical condition, which
would have been eliminated if these professionals would have performed their job
responsibly.
The major reason behind this entire incident was the lack of confidence and
management teamwork. I think that if the management would have been more active
regarding the assignment of nurses to the respective wards and by keeping and maintaining a

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record of the nurses assigned. The importance of management plays a significant role in the
hospital organization (Najjar, Lyman and Miehl 2015). Apart from effective treatment,
quality improvement management helps the nurses to take care of the entire situation and
they manage their times in such a manner that they make sure each and every patient they
have been assigned to is given proper treatment and medication. As per Cannaerts, Gastmans
and Casterlé, (2014), the author emphasizes on the importance of time management in
effective communications and actions, which further helps in efficient dealing with the goals
(Kangasniemi et al. 2013). With the help of proper management, the stress can be reduced
and will assist the nurses to boost the treatment procedure of the patients. Improvement in
management could have avoided the entire scenario and the patient would not have any due
medications (Vaismoradi et al. 2014). Apart from poor management, the importance of
ethical principles was also neglected. The HCA (Health Care Assistant) did not prioritize the
patient’s requirement instead; she used it to frame me in front of the organization. Clearly the
HCA (Health Care Assistant) did not abide the ethical principles of nursing which clearly
states that the nurses have to prioritize the patient’s needs and requirements, regardless of the
nurse’s personal life issues (Cannaerts, Gastmans and Casterlé 2014). Nurse’s main objective
is to cure the patient, but in this incident, HCA (Health Care Assistant) was least concerned
about the SR8 patient instead she was more determined to frame me responsible for the due
medications of the SR8 patient, by taking the advantage of non-updated allocation board.
In addition, the other nurses also did not help me to take off my charges by remaining
silent when asked about the incident and the allocation board. This shows lack of unity
amongst the team of nurses. I was disheartened of the entire incident, but I thought to myself
that if I were not able to face the challenges then how would I learn and move forward in my
life. I sensed that the whole incident was based on the intentions of revenge and fault
accusations and these kinds of practices are not supported in the field of nursing. The ethical

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principles, which are the fundamentals of the nursing prohibits the nurses to perform any
kinds of actions, which will put the patient in a harmful situation or the actions, which will
harm the patient’s treatment (Perry, Potter and Ostendorf 2013).
Finally, the management should have conducted an independent and effective
investigation to find out the mistakes and improper activities performed by the healthcare
professionals. This would have increased the chances to identify the loopholes in the care
process and would have increased the effective communication abilities so that patient could
be provided with effective and quality care. Hence, upon analyzing these positives and
negatives of this critical condition, it could be said that there are three aspects of it and
everyone should analyse their complications and make improvement so that in future such
condition could be treated. The role of management is effective in the occurrence of the
patient, because if only the Nurses in Charge were asked to update the table on a regular basis
and make a record of each nurse and their respective patient, all this fuss could have been
averted (Wong, Cummings and Ducharme 2013). If the management had provided quality
and effective work procedures, then even Jessica might have not forgotten to handover the
SR8 patient to the night shift nurses. In the hospitals there are many wards and sometimes
few beds are empty, in that case the nurses shift the patients to the empty beds without
informing the management or updating the records of the patient, this creates confusion,
which results in severe consequences like mine.
Conclusion
Upon concluding this above-mentioned analysis, I would mention that application of
ethical principles, professional code pf conducts would have been an effective strategy to
eliminate the risk of such conditions. Now I feel that if I would have my concerns to the NIC
or the management that night and made the allocation board updated, then this complication

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would have been eliminated and I would have able to eliminate the risk of quality or activity
related complications. As per Cannaerts, Gastmans and Casterlé (2014), effective
communication is the most important attribute of a healthy and efficient working place so that
people could understand the effectiveness of it and implement care that would be beneficial
for the growth of the efficient care professionals. I think communication plays a key role
because an effective communication can help prevent many severe conditions of a scenario.
Because even after clarifying with Lisa regarding the SR8 patient, I ended up being
responsible for the due medications of the SR8 patient. I guess I would have communicated
efficiently and specifically and confirmed with the Nurse in Charge of the night shift and
asked the officials to update the board. Further, after Lisa informed me about the transfer of
patient from SR 8 to the bay 6, I should have informed the management about the condition
so that this improper condition could be eliminated. Being a registered nurse, I should be able
to understand the need of proper and effective management and should not repeat same
repeats in future, if a situation like this rose again. Although the SR8 patient was medically
stable but the consequences could have been worse. Therefore, in such condition, I would
have been indirectly responsible for the merging health crisis and hence this was my duty to
make everything solved after knowing these series of anomalies occurring in the care process.
As Perry, Potter and Ostendorf (2013) mentioned the duties and responsibilities of nurses, I
also agree to the fact that while delivering care to the nine patients, allocated to me I would
have also checked for the patient as his bay was right beside the patients that I was assigned
with. However, I lacked in assuring the maintenance of the treatment and medication quality
regardless of their personal issues. Effective management skills would have helped the Nurse
in Charge in effective assignment of the Nurses to the respective wards and patients (Perry,
Potter and Ostendorf 2013). Proper teamwork efforts and supports would have helped in
avoiding the situation and helped me in clearing of my false acquisitions. I believe I should

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not have been so anxious and agitated while I was held responsible for due medications of
SR8 and would have been calm and patience in order to react to the situation efficiently.
From this situation, I learned that life can be uncertain but we should not lose our faith and
hope and look to the brighter side of the situation. I should have focused on the positivity of
the situation rather than the negativity, which would not have helped me to achieve anything.
I want to be prepared for similar kinds of upcoming future scenarios and I can achieve that by
developing skills like problem solving, effective communication, teamwork, commercial
awareness, motivation and others, which will assist me in facing such challenges (Sade and
Peres 2015). The situation could have been positive for everyone involved if everybody
would have performed their work efficiently and the management would have taken actions
to improve and modified the organization’s system for effective outcomes (Kleinpell 2013).
Action plan
To avoid these complications in future, I have developed certain strategies so that I
could eliminate such complications from occurring in front of me. I will try to have a cordial
relationship with my team members (Moon 2013) and will try to organize the list of the
patients with their assigned nurse, in order to avoid any future disturbances that might affect
the patient (Iacobucci et al. 2013). I think that we should challenge our initial decisions, in
order to provide efficient outcomes in the near future. I will effectively communicate with my
team members to avoid confusions, because any confusion might lead to harming the patient
(DiCenso, Guyatt and Ciliska 2014). If situation like this arose again in near future, I would
effectively correspond with the Nurse in Charge and not just other assigned nurses. I would
have informed the Nurse in Charge to update the allocation table to escape from any
distraction and disorientation (Paterson and Chapman 2013). I will try to build effective
therapeutic relationship with my patients to promote self-healing. Apart from these, with the
help of effective management, medical skills and administrative officials, I will also look into