Student Nurse Diary: Ethical Dilemmas and Discrimination
This reflective diary explores two significant incidents from a student nurse's early clinical training. The first entry examines an ethical dilemma in which a registered nurse refused to administer a breakthrough pain dose to a patient suffering from severe arthritis, leaving the student feeling guilty and inadequate. The second entry recounts discriminatory treatment experienced by student nurses on a surgical ward, including a racially charged confrontation. Together, the entries analyze the consequences for patients, fellow students, and nursing staff, and reflect on lessons learned about patient advocacy, professional conduct, and the resilience required to persist in the nursing profession.
- Introduction to Reflective Practice: Overview of challenges faced in early nursing career
- Diary Entry One: The Pain Medication Dilemma: Nurse refuses breakthrough pain dose for Mr. A
- Consequences and Feelings from the Medication Incident: Guilt, patient suffering, and missed accountability
- Diary Entry Two: Discrimination on the Surgical Ward: Student nurses face hostility and racial discrimination
- Consequences and Feelings from the Surgical Ward: Anger, exclusion, and burnout from sustained bullying
- Lessons Learned and Major Themes: Resilience, advocacy, and professional growth from adversity
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What makes this paper effective
- The structured diary format consistently applies a reflective framework — examining the problem, role, actions, consequences, and feelings for each incident — which gives each entry analytical depth beyond simple narration.
- The paper balances personal emotional honesty with professional accountability, showing the student's awareness of their own limitations as well as broader systemic issues in clinical environments.
- Both entries end with constructive takeaways, demonstrating growth and a forward-looking professional mindset rather than dwelling solely on grievances.
Key academic technique demonstrated
This paper demonstrates structured reflective writing in the nursing tradition, closely aligned with frameworks such as Gibbs' Reflective Cycle. By methodically addressing each sub-question (problem, role, actions, consequences, feelings, and themes), the author transforms personal experience into professional learning. This technique is widely used in nursing education to develop critical self-awareness and ethical reasoning.
Structure breakdown
The paper is organized into two self-contained diary entries, each built around the same set of reflective sub-headings. Entry One focuses on a clinical ethics scenario involving pain management, while Entry Two addresses interpersonal and discriminatory dynamics on a surgical ward. Each entry concludes with a summary of what was good or bad about the experience and identifies a major theme, reinforcing the reflective and analytical purpose of the writing.
Introduction to Reflective Practice
When we first start out in the nursing profession, there are often incidents that arise to test our ability to confront challenges head on. While these challenges often take the form of medical emergencies, they can also come from colleagues who may not always act in the patient's best interest. I experienced one such challenge early on in my student nursing career, and the way I responded to it has weighed on my mind ever since.
Reflective practice is a cornerstone of professional nursing development. By examining our own responses to difficult situations — what we did, how we felt, and what we would do differently — we grow both ethically and clinically. The two diary entries below apply this approach to two formative incidents from my student training.
Diary Entry One: The Pain Medication Dilemma
What Is the Problem?
As a young student nurse, I encountered a man, Mr. A, who was experiencing severe arthritis-related pain in his left hip. The discovery of this patient's condition and the ensuing conversation regarding his pain with the registered nurse on duty led to an ethical dilemma when she refused to administer his pain medication. Ultimately, this left me feeling as though I had let down the patient because I did not stand up for his individual rights.
What Was My Role in the Situation?
I was the nurse who discovered Mr. A in bed in the morning and the one to whom he expressed that he was in pain. It was then my responsibility to assess his condition and check when his medications had last been administered. I was able to discern that while the regular dose of oxycodone had been given at 0600, he had not received a breakthrough dose since the night before, when he had twice required it.
What Was I Trying to Achieve?
It was my intention that Mr. A should be immediately relieved of his pain by receiving the breakthrough dose as soon as possible.
What Actions Did I Take?
Since, as a student nurse, I was unable to administer the medication on my own, I informed the registered nurse responsible for Mr. A's care of his situation and the need to administer a breakthrough dose as soon as possible.
What Was the Response of Others?
The registered nurse replied rather curtly that she was very busy and, since Mr. A had already received a regular dose at 0600, she did not consider him in need of another. She then sent me to help out elsewhere, and I left — shocked — without knowing whether Mr. A would receive the extra dose of medication he needed.
The ethical tension in this situation is well recognized in nursing literature. Patient advocacy and ethical practice are core professional obligations, and withholding necessary pain relief raises serious concerns under standard nursing codes of conduct.
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