| Course | NR 447 Collaborative Leadership in Healthcare |
|---|---|
| Week | 8 |
| Paper type | Course reflection paper |
| Length | About 1,090 words, 7 pages |
| Format | APA 7 student paper |
| School | Chamberlain University |
| Program | RN-to-BSN |
| Updated | October 2026 |
Free sample paper for NR 447 Week 8
Waiting for the Sixth Patient: A Reflection on an Hour I Handled Badly as Relief Charge
Student Name
College of Nursing, Chamberlain University
NR 447: Collaborative Leadership in Healthcare
Instructor Name
Month Day, Year
Waiting for the Sixth Patient: A Reflection on an Hour I Handled Badly as Relief Charge
The Hour
At 1640 on a Sunday in the third week of this course, I was relief charge on our 30-bed medical unit when the emergency department called to say they had a patient for us: a 71-year-old man with a gastrointestinal bleed, hemoglobin 7.4, two units of blood ordered. Every nurse on the unit had five patients. The nurse with the most room had a patient being discharged at 1700, which would bring her to four and then back to five with the admission. I decided to wait for the discharge. I told the emergency department we would take report at 1715.
At 1705 the discharge was delayed because the family ride had not arrived. At 1715 I called the emergency department back and asked for another thirty minutes. At 1730, the emergency department charge nurse called the house supervisor, and the house supervisor called me. I remember the moment I understood what was happening. The supervisor asked whether the unit was unsafe to take the patient, and I realized I could not say that it was. It was not unsafe; it was inconvenient. I had been waiting for a sixth patient's bed to be comfortable when the emergency department had a bleeding man who needed a transfusion started in a bed with more space and more staff than a hallway stretcher. He came up at 1745, over an hour after the first call, and went to a nurse who had five patients, which was exactly what I had been trying to avoid. I had spent that hour at the desk refreshing the discharge order and texting the family's ride, which is to say I spent it doing a unit clerk's task so that I would not have to make a charge nurse's decision.
What I Had Wrong
I had been treating the assignment board as the thing to protect. Every decision I made that hour was about keeping every nurse at five patients, and I told myself that was about patient safety. It was partly about that. But it was also about avoiding a conversation with a nurse who would not want a sixth patient, and about my own discomfort as a relief charge nurse asking someone to take more than their share. The cost of that avoidance was paid by a patient with a falling hemoglobin who waited on a stretcher. Aiken et al. (2002) found that higher patient loads are associated with worse outcomes, and I believe that. But the same logic applies to a patient left in the wrong place for an hour. My job that afternoon was to weigh the whole hospital's risk, not only my unit's.
What the Patient Experienced
I went to see the patient at about 1900, after his first unit of blood was running. He told me he had lain on the stretcher in a hallway of the emergency department for most of the afternoon, next to a man who was shouting, and that he had been embarrassed because he had needed a bedpan twice with only a curtain between him and the hallway. He did not know that his wait had anything to do with me, and he thanked me for the room. That conversation was harder than the call from the house supervisor. From the desk, my decision had looked like a choice between two nurses' workloads. From the stretcher, it looked like an extra hour of lying in a hallway with a bleed, being seen by strangers. The Code I say I practice by puts the patient first, and for an hour I had put the assignment board first without noticing that I had done it.
Earlier Work as Evidence
Two assignments from this course showed up in how I acted afterward. In my Week 5 case analysis, I priced four staffing options and chose one that asked a nurse to carry a heavier load, with specific protections attached. Writing that paper made me see that choosing who carries the cost is part of the charge role, not a failure of it. The following Sunday, when a similar call came at 1600, I gave the admission to a nurse with five patients immediately, took her next two medication passes myself and asked the house supervisor to round at 1800. In my Week 3 conflict analysis, I examined how I had corrected a colleague in front of a family. That paper made me more careful about where I have difficult conversations, and I used it the following week when I asked a nurse, privately, to take a sixth patient rather than announcing it at the desk.
What Has Not Changed
I still dislike asking a nurse to take more than her share, and I still feel it in my stomach when I do. On a shift two weeks ago I caught myself calling the emergency department to ask for fifteen more minutes before I had checked whether anything would change in those fifteen minutes. I did not wait, but the impulse is still there. Marquis and Huston (2021) describe the tendency of new leaders to protect their team from discomfort at the expense of the wider organization, and I recognize that tendency in myself. I do not think eight weeks has removed it.
The Habit I Am Taking Back
The habit is small and visible. When the emergency department calls with an admission and I am charge, I will ask one question before I answer: what would change for this patient if I made him wait? If the answer is nothing but my unit's comfort, I will assign the admission within ten minutes of the call and deal with the load on my unit, rather than delay. A colleague could watch me do this on any ordinary Thursday. I will also tell the house supervisor, before accepting an admission onto a unit already at five patients per nurse, what help I need, so that the heavier load comes with support instead of in silence. Kouzes and Posner (2017) describe leaders who model the way by acting on stated values in visible ways, and the value I claimed all term was patient safety. The admission call is where I will show whether I meant it.
References
Aiken, L. H., Clarke, S. P., Sloane, D. M., Sochalski, J., & Silber, J. H. (2002). Hospital nurse staffing and patient mortality, nurse burnout, and job dissatisfaction. JAMA, 288(16), 1987-1993. https://doi.org/10.1001/jama.288.16.1987
Kouzes, J. M., & Posner, B. Z. (2017). The leadership challenge: How to make extraordinary things happen in organizations (6th ed.). Wiley.
Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer.
The Chamberlain NR 447 Week 8 instructions
The final NR 447 reflection has you reflect on your growth as a leader across the course. The instructions typically list a specific situation, what you got wrong and why, its effect on others, how course work changed your conduct, what has not changed, a habit going forward and APA. Open inside one hour, with times. Place the moment of realization exactly. Name what you had wrong, including any uncomfortable motive. Describe what the patient or colleague experienced. Use earlier assignments only where they proved something about your later conduct. Admit one habit that has not changed. End with a behavior a colleague could watch you do.
How the NR 447 Week 8 example is put together
The first section sets the Sunday: the emergency department's call at 1640 about a 71-year-old patient, the delayed discharge at 1705, the request for thirty more minutes at 1715 and the house supervisor's question at 1730. The second section explains that the writer was protecting the board at five patients per nurse and avoiding asking someone to take a sixth, linking it to Aiken and colleagues. The third describes visiting the patient at 1900 after his first unit of blood, when he described hours on a hallway stretcher. The fourth connects the Week 5 staffing analysis and the Week 6 huddle proposal to later shifts. The fifth admits still feeling it when asking more of a nurse. The last section gives the habit.
Reading the NR 447 Week 8 grading rubric
Reflection rubrics in NR 447 generally score a specific event, honest analysis of the writer's role, the effect on others, evidence of change from course work, acknowledgment of what remains, a forward habit and APA. Honest analysis carries the grade, and the paper earns it by naming the motive of avoiding a hard conversation. The event is credited for times and the exact moment of realization. The effect row scores through the patient's own account. Evidence of change earns points because earlier assignments appear only where they changed conduct. The remaining habit is credited for being admitted with a recent example. The forward habit scores because a colleague could watch it. Kouzes and Posner's modeling the way frames the close.
NR 447 Week 8 help from the desk
A warm letter about the term with no events in it scores lowest of all. Second is a week-by-week recap that lists assignments without showing any change in conduct. Students also describe only success, hide their motives or end with values instead of a behavior. Citations are needed only where a source explains what happened. Describing a shift you handled badly will not hurt your grade if you analyze it honestly. Earlier weeks should connect only where they proved something. An hour in charge that still bothers you is the best starting point; our writers can shape an NR 447 closing reflection around it.
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NR 447 Week 8 questions, answered
Does a reflection need citations?
Often yes, since many sections require at least one source even in a personal paper, and current formatting rules still apply throughout. Use sources sparingly and attach them to the mechanism behind the change, such as why a particular approach to correction works. A reflection carrying eight references usually has too little of the writer in it to be graded on the criteria that matter.
Will describing a shift I handled badly hurt my grade?
The opposite is more common in this course. Rubrics for closing reflections reward self-assessment, and an account of poor judgment examined honestly demonstrates it directly. Keep the failure inside judgment rather than in patient harm, keep everybody unidentifiable, and follow the account with what changed afterward, so the paper shows analysis rather than confession alone.
How much has to connect back to earlier weeks?
Enough that the term reads as one line of development rather than eight separate submissions. Two or three connections are usually plenty, each showing an earlier assignment producing different conduct later on. Check your prompt, because some sections explicitly require reference to particular weeks or to a set of course outcomes, and that requirement then decides the coverage.
Where can I find a free NR 447 Week 8 sample paper?
The Week 8 reflection on waiting for the sixth patient appears here in full, with the timed hour, what the writer had wrong, the patient's experience, earlier work as evidence, what remains and three references.
What habit does the writer take on in the NR 447 Week 8 reflection?
Asking what would change for the patient if the admission waited, assigning it within ten minutes if the answer is only the unit's comfort, and telling the house supervisor what help is needed before accepting.