Reflection on Nursing Professional Issue: Surgical Ward Experience

This report presents a reflective essay by a student nurse detailing a challenging experience in a surgical ward, focusing on the professional issue of assertiveness. The essay describes a scenario where the student, while providing post-operative care to a patient who underwent hip replacement, faced a lack of support and assertiveness, leading to feelings of inadequacy and a diminished ability to advocate for herself. The student analyzes the situation using the "What? So What? Now What?" reflective framework, highlighting the importance of assertiveness and patient-centered care. The report includes an examination of relevant literature, identifying the impact of lack of assertiveness on patient outcomes and team dynamics. The student identifies the challenge as a professional issue of not being assertive and discusses possible solutions, such as seeking mentorship and improving communication skills. The report concludes with a discussion of changes the student will implement in future practice, emphasizing teamwork, ethical practice, and improved communication to enhance patient safety and outcomes. The student also reflects on the importance of building confidence to better interact with patients, their families, and other healthcare professionals. The report highlights the significance of clinical leadership and assertiveness for positive patient outcomes.

Running head: REFLECTION ON NURSING PROFESSIONAL ISSUE
REFLECTION ON NURSING PROFESSIONAL ISSUE
Name of Student:
Name of University:
Author’s Note:

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Introduction
This reflective essay aims to highlight how lack of confidence and assertiveness affected
the student nurse whilst faced with a challenge in a surgical ward, during her placement. In this
reflection, I will show the incidence of surgical ward in care of patient who has undergone hip
replacement that helped me to become compassionate, assertive and confident in my nursing
skills. Patient will be referred to as Debbie maintain confidentiality and privacy of information of
patient, which has followed the standards, and code of nursing and midwifery guideline of giving
respect to right to confidentiality (Nursing and Midwifery Council 2018).
What
Nursing experience
In my nursing profession, I was working in general surgery unit of Kingston hospital. I
was assigned to give post-operative care to a patient named Debbie of 60 years-old female, who
had undergone hip replacement surgery. The patient had diabetes and post-operation she was
showing major health complication. Debbie’s granddaughter Suzan (pseudonyms) is the primary
caregiver for her and takes all the crucial medical decisions for her. My aim was to relieve the
pain of the patient and provide competent care. I was working with a senior nursing practitioner
to provide post-operative assistance to Debbie. I was instructed by her to take vital signs
immediately and change the dressing of the patient. While I was taking vital sign, I was
questioned in every step of my action. Suzan was commenting and yelling that I am not doing it
in the right way and asking to assign a proper nurse. Even my senior nurse was supporting
Suzan. I was feeling bullied, distraught and tearful with the behaviour of my nursing team and
patient family. The nurse practitioner replied in an aggressive manner, as I was not able to dress

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the wound efficiently. I being a student nurse, lacked in many nursing skill for it so I was not
able to confidently advocate for myself. Instead of being supported, I was upset that I was taken
over by my mentor. I was not able to perform my duty with full competency. I was powerless to
keep my viewpoint and opinion with self-confidence. The professional issue of assertiveness was
prevailing in the care of the patient. My work was to give patient-centred care in the surgical
unit, but I was not being supported by my colleague which was needed to develop professional
competence and confidence.
So what
Identification of the challenge
It is evident that nurses play a major role in giving effective care to the patient and
maintain patient dignity as outline by NMC (Nursing and Midwifery Council, 2018). The
primary nursing goal in this scenario was to control the pain and provide post-operative care to
Debbie. From the scenario, the feeling of inadequacy and lack of assertiveness arose because I
was not feeling encouraged in my work. I was clueless how to react in such situation where my
mentor was trying to pull me to down in front of the patient and their family. The strong
assertion by Suzan of being patient’s granddaughter and sole caregiver was negatively
influencing my practice and confidence. However, the intervention by the mentor and Suzan on
every aspect of nursing care were pulling me down. Thus, the challenge identified in the case
scenario is a professional issue of not being assertive, as it is evident that lack of assertiveness
can increase the chance of health deterioration of the patient (Goss et al., 2017).

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Evidence and analysis
For giving effective nursing care, nursing surveillance and observation activities are
essential for consideration of patient (Osborn et al. 2015). It is also evident from the research that
assertiveness is critical in creating a capable team in the field of nursing (Meyer-Kalos et al.,
2017). However, it is the most common nursing professional issue that persists in the care of the
patient. In the surgical unit, it was understood that registered nurse was not able to take the work
pressure. For the nursing staffs, it is of prime importance to maintain ethics in their behaviour
(Nursing and Midwifery Council, 2018). I as a student, was trying to give my best to provide
care to the patient. At that time, I needed support from the senior staffs so that I could be
compassionate towards my work. I also tried to manage the issue, as the most priority thing at
that time was to control the situation of the patient. It is evident from the research of Shivers,
Hasson and Slater (2017) where the author has done a survey analysis and concluded that the
student nurse and staffs nurse are not assertive in their practice because they doubt their own
capability. Andersson, Salickiene and Rosengren (2016) stated that student nurse and staffs nurse
are not efficiently trained with skills that is needed to give effective care to the patient for
example in assessing the patients, communicating with family members and handling the adverse
and emergency condition of the patient. Therefore, I could say that, I also lack in such skills and
doubt in my own capability. This is the major reason, that I am not assertive in my action and
behavior.
For nurse, it is crucial for us to require the ability of clinical thoughts and clinical grasp;
for example, what is happening to the patient and essential intervention that need to be engaged
It is the responsibility of the nurse to display clinical leadership and assertiveness to direct the

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health care team for positive patient outcome (Benner, 2019). I felt that I lacked in the
confidence with the nursing interventions of post-operative care.
From the study of Maheshwari and Gill (2015), it was seen that student nurses are not
assure about the plan they have undertaken for the patients and they needed supportive guidance
to become competent. In the case study, the caregiver of Debbie also bullied me as she was
continuously commenting on changing the nurse. When they saw that patient vital signs were not
being recorded in the right manner, they judged my expertise. From the study of Andersson,
Salickiene and Rosengren (2016), it can be said that nursing student is at the stage of learning
and needs proper mentoring and guidance. As per my surgical experience, I was not supported
and instead was humiliated by the caregiver and registered nurse. It reflects the professional
issue of lack of confidence and assertiveness. As I was working in association with her, it is
evident to speak and confidently put my thoughts regarding my feeling to meet the nursing goal
(Schroeder 2018).
The study of Slemon, Jenkins and Bungay (2017) has highlighted the nursing behaviour
in the care of the patient. The author has done the observational survey, concluded by saying that
due to work pressure and health condition of the patients, nurse tends to behave aggressively,
and busted on other nursing staffs. Talbot, Dorrian and Chapman (2015) also support the finding
where the author said that due to aggressive behaviour of nurse; the teamwork is adversely
affected whose impact is seen in the health of the patient. When they are not assertive in their
profession, they end up in making mistake. Hence, he concluded by saying that being confident
in attitude is being lacked in most of the nurse. Such evident resemble the case scenario I have
faced. As per the NMC guideline, it is important to uphold position of registered nurse by giving

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respect to team member working with (Nursing and Midwifery Council 2018). Therefore, it can
be said that lack of assertive attitude by nurse can make the team work a problematic situation.
Possible solution
The possible solution for such action, which I have experienced in taking care of hip
replacement patient, Debbie is seeking assistance for my mentor who educated me and helped
me to act more confidently. According to the study of Beauvais et al. (2017), assertiveness is
emphasised as the way to work against bullying and improve the stressful situation. As a
solution, I was helped by my mentor to give adequate care. Instead of instigating the nurse, team
collaboration must be maintained by assisting the other team member (Roberts, Marshall &
Chaboyer, 2017). I asserted my query and opinion that help me to build confidence in my action.
By receiving effective education and knowledge related to the importance of being assertive, I
was able to understand about professional issues prevailing in the field of nursing.
Now what
Changes made for future practice
From my experience of taking care of the patient in surgical unit, I have learned many
things related to the nursing attitude and behaviour which is of prime meaning in delivering
effective care. I have learned about the importance of teamwork, the role of nurse in patient-
centred care, significant of assertiveness and ethical practice. In my future practice, I will
implement the principle of surgical nursing to be more towards the care of the patient. As I have
understood the theory of assertiveness, in my profession, I will respect the opinion of the other
nursing staff. If some nurse is not comfortable in performing interventions, I will assist them and
take in a positive manner in my future practice as being evident from the study of Beauvais et al.

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(2017). Before involving in care of patient, I will give a brief review about the interventions,
which need to be taken for the care of patient so that they will discuss their problem area before
which can avoid any health risk. I will try to improvise communication skill in me so that I can
construct effective team relationships for my future practice. I will also get training in clinical
leadership and assertiveness through which I can become competent enough to provide support
to the patient. I will try to build confidence in communicating with my mentor, so that I could
share about my feelings regarding the care of the patient. All the above-mentioned goal with help
me to be successful nurse and will be able to implement safety practice in health care sector.
The rationale for the changes
It is evident from the study of Rafferty (2018) that, to give effective care to the patient, it
is important to evaluate the whole case scenario and make proper care plan, which must be
communicated to the other staffs. Through such actions, it minimises the health risk to the
patient. Hence, I will implement this evidence-based practice in my future exercise. I will always
try to be assertive rather than being conceited. As I have sensed through my experience that this
behaviour of nurse violates the ethical practice, so I will apply these changes in my nursing
practice. From the study of Nibbelink and Brewer (2018). In order to accomplish it nurse have to
be efficient and assertive in their work. Hence, they need to work in a team as a member in a
collaborative manner. Reviewing such evidence, I will implement and adopt these changes.
Additionally, other reasons for such adaptation is to reduce the chance of health risk for
surgical patients and improvise their health outcome. I want to make myself competent enough
in giving care to the patient and work in a team member. I also want to be assertive in my
attitude, so I will sincerely apply all these changes in my nursing practice. This experience has

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made me more confident, compassionate and confidence in interacting with the patients, their
family member and other staffs.

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