Student Nurse Diary: Ethical Dilemmas and Discrimination

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.

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.

Diary Entry One: The Pain Medication Dilemma

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.

It was my intention that Mr. A should be immediately relieved of his pain by receiving the breakthrough dose as soon as possible.

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.

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.

As a consequence of this exchange, Mr. A was, at the very least, forced to wait longer for his breakthrough dose than was necessary, and may not have received it for several hours. This left him dealing with considerable pain that would normally have been relieved by the breakthrough dose. A patient who could easily have been helped was instead left alone to suffer.

For my part, I was left feeling guilty that I had not done more to relieve Mr. A of his pain. I was also left feeling intimidated by a registered nurse who showed both me and the patient little concern or respect. All I could do for the patient was tell him that his medications were on the way — but even that did little to alleviate my guilt, since I was not certain that was true.

Consequences and Feelings from the Medication Incident

The registered nurse faced no consequences at all, as far as I am aware, for her role in failing to promptly administer the breakthrough dose. I am also certain that the episode reinforced her belief that she was in charge and that no student nurse could tell her what to do.

I am sure that, for Mr. A, the experience evoked strong feelings of anxiety as he waited to receive the medication that he knew could quickly relieve his pain. It may also have led him to distrust much of what he was told by nursing staff in the future.

This entire episode evoked strong feelings of resentment in me towards the way the nurse had treated both me and Mr. A. I also felt considerable guilt for not getting Mr. A his medicine sooner and for not being completely honest with him about when it would arrive.

The registered nurse was already feeling annoyed and overburdened by her duties; having a student nurse raise concerns about her decisions only exacerbated those feelings.

The negative aspects of this experience are readily apparent. Mr. A was denied quick access to his pain medication and left in his room to suffer. The registered nurse was allowed to believe that she did not need to take any student nurse's concerns seriously, and that patients could wait until she was ready to address them. I was left feeling very inadequate about my own experience and the way I had handled the entire matter.

On the positive side, I resolved never to let anything like this happen again. As a direct result of this incident, I decided to become a stronger advocate for patients' rights and not to be intimidated into accepting inadequate care. I also hope that I have become more sensitive to the concerns of student nurses who may one day work under my supervision. Effective pain management is a fundamental patient right, and advocating for it — even in the face of resistance — is a professional and ethical duty.

The major theme of this entry was the timely delivery of necessary medications and the inherent responsibilities of nursing staff to ensure patients receive them.

Diary Entry Two: Discrimination on the Surgical Ward

When I was placed alongside a fellow student on a busy surgical ward, the staff seemed less than pleased to have us there. The antagonistic and even hostile environment did not subside for the entire duration of our placement, and there were several specific incidents of outright discrimination directed at my classmate. One such incident left her in tears and culminated in an apology from one of the nurses on the ward, but the tension on that ward never fully relented.

From the moment we set foot on the surgical ward for our training, we were treated as pariahs by the staff. We were ignored for some time and then pushed from one nurse to another. When we reported to the registered nurse to perform a medical round, my classmate, "L," who is of Asian descent, informed the nurse why we were there. The registered nurse replied with profanities and said she could not understand a word L. had said. I later found L. by herself, crying.

Both L. and I felt clearly unwanted on the surgical ward from the moment we arrived. I was present when L. spoke to the registered nurse and felt just as shocked as she did by the nurse's response. Eventually, it was I who went to our university facilitator and reported the incident, which prompted an apology from the nurse to L.

Initially, L. and I were only looking to be included in the regular ward routine. We were not trying to cause any problems for anyone. By contacting the university facilitator, I was hoping to foster a friendlier atmosphere towards us on the surgical ward. At the very least, I hoped that the nurse would recognize how poorly she had treated L. and would offer an apology — which she did.

I contacted the university facilitator and continued to try to be as involved as possible in the regular ward routines.

The nurse did offer an apology to L. after the university facilitator became involved. However, the overall environment on the ward did not change, and we were never truly welcomed.

Discrimination in clinical training environments is a documented concern. Workplace bullying in nursing has been shown to negatively affect student performance, mental health, and retention in the profession, highlighting the importance of institutional intervention when such behavior occurs.

While there were no direct consequences for any patients arising from this situation, a case can be made that the nurses on that ward showed as little patience with their patients as they did with us during our placement.