NU144CL Unit 5 Clinical Journal Reflection Example

Twenty Minutes Too Long to Say I Was Behind: A Clinical Journal Using Johns' Model of Structured Reflection on a Composite Morning When Two Medication Passes Ran Late and a New Admission Arrived

[Student Name]

Purdue University Global

NU144CL: Medical-Surgical Nursing II Clinical

Unit 5 Clinical Journal

[Instructor Name]

[Date]

The shift, patients and staff are composite; times are bracketed where illustrative, and no patient was harmed in the events described.

Description

At [0845], I had given morning medications to two of my four patients. The other two, [Mr. K.] in room 14 and [Mrs. L.] in room 16, had scheduled medications at [0900], including Mr. K.'s metoprolol and Mrs. L.'s antibiotic. At [0850] a new patient was admitted to room 15, also on my assignment, and my nurse asked me to help with the admission while she finished a dressing elsewhere. I took the new patient's vital signs, started the admission questions and kept going. I knew the two medication passes were getting close to the end of their window, but I did not say so. At [0925] I finally told my nurse. She came at once, and both medications were given at [0935] and [0945], at the edge of the window the facility allows for scheduled doses that are not time-critical (Institute for Safe Medication Practices, 2011).

Reflection: My Aim in That Moment

I wanted to look capable. My nurse had trusted me with the admission, and saying I was behind felt like admitting I could not handle four patients. I also wanted to finish the admission questions in one sitting, since the patient was tired and I did not want to make him repeat himself.

I protected how I looked to my nurse at the cost of two doses arriving at the edge of their window, and the patients carried that cost, not me.

Why Did I Act as I Did?

I thought I could finish the admission and then catch up. I was underestimating how long admission questions take with a patient who is short of breath and needs pauses.

What Were the Consequences?

For Mr. K., the metoprolol was given late, and his heart rate at [0930] was [98], higher than his usual [80]s. For Mrs. L., the antibiotic was given later than scheduled, which for some antibiotics can matter for keeping blood levels steady. Neither patient was harmed, but both doses were later than they should have been. My nurse also lost the chance to plan around the problem twenty minutes earlier.

How Did I Feel, and How Did Others Feel?

I felt embarrassed when I told her, and then relieved. She was not angry; she said she would rather know at [0855] than at [0925]. The new patient, I later realized, would have been fine pausing his admission for ten minutes.

Influencing Factors

Internal: wanting to appear capable, not wanting to interrupt a nurse who was busy, and a belief that asking for help is a sign of weakness in a student. External: an admission nobody had planned for, arriving right before a medication time, and no set point in the shift when I was expected to report my status.

Could I Have Dealt With It Better?

I can see two earlier moments to speak. At [0850], when the admission arrived, I could have said: "I can start the admission, but I have [0900] meds due for rooms 14 and 16. Should I give those first?" That would have taken ten seconds. At [0905], when I noticed the time, I could have stepped out and told her. Either would have kept both doses on time. The first would have been better, because it let my nurse decide with all the information.

Learning

Being capable is not the same as doing everything alone; it includes knowing when a plan has stopped working and saying so early. Reflection on a single decision helps me find the habit behind it, which a summary of the whole shift would hide (Johns, 2017). Communicating status clearly and early is part of safe care, as much as any skill I perform (Potter et al., 2023).

What I Will Do

At [0845] every shift, whether I am behind or not, I will give my assigned nurse a short status report: which medications are given, which are due and anything that could get in the way. When something new is added to my assignment, I will say what it will push back before I start it. My instructor can watch for both, and I will note in my next journal whether I did them.

The Question I Am Left With

I cannot yet judge the line between a delay I should report and one I can handle. I plan to ask my nurse what she wants to hear and when, so that I do not swing from saying too little to interrupting her with everything.

References

Institute for Safe Medication Practices. (2011). Acute care guidelines for timely administration of scheduled medications. Institute for Safe Medication Practices.

Johns, C. (2017). Becoming a reflective practitioner (5th ed.). Wiley Blackwell.

Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). Fundamentals of nursing (11th ed.). Elsevier.