At the beginning of this semester, I really didn’t think of myself as a strong writer. Honestly, I still don’t! Writing has never come naturally to me, and I’ve always felt more comfortable explaining things out loud than putting them on paper. In my Writer’s Autobiography at the start of the course, I talked about how writing usually made me feel stressed and unsure of myself, especially when it came to organization and knowing if I was doing things the right way. As the semester went on, though, I started to realize that writing doesn’t have to be perfect to be effective. This class helped me see that my experiences and voice actually matter, and that writing can be a way to reflect and explain things instead of something to be afraid of.
The first essay in my portfolio, “Being a Detox Nurse: Hard but Worth It,” really shows my personal voice and my ability to tell a story. This essay is very close to me because it comes directly from my work as a detox nurse. One part that really shows my growth as a writer is how I focused on one patient and followed her story from beginning to end. I used detailed descriptions of the facility, her condition, and her progress to help the reader understand what detox nursing is really like. This essay shows that I can stay focused on one main idea and develop it with detail, emotion, and reflection instead of just listing events.
Being a Detox Nurse: Hard but Worth It!
The hardest job I’ve ever done, besides being a mom, is being a detox nurse. Every day I walk into work knowing I’m responsible for people’s lives while they’re going through withdrawal, and that’s a heavy weight to carry. I am responsible for these people’s lives. Every shift I work, I walk in and have to buzz myself in with my badge. You have to go through 2 locked security doors to get into the main area. It’s all for safety and security, so our court -mandated section 35 patients don’t elope. It really sets a serious tone the moment you arrive. The walls are a dull gray, the lighting is harsh and fluorescent, and everything feels a little cold and sterile, more like a hospital than a place of healing. There’s not much color or comfort, just that faint smell of disinfectant that never really goes away.
Most patients we get are still intoxicated upon arrival. Some are not very alert and can barely make it through the admission process, and some are really starting to get sick. You can already see the signs of withdrawal. These people have usually been trying to detox themselves at home but end up becoming scared of what they are experiencing and come in to be safe. Detoxing, especially from Alcohol and Benzodiazepines is extremely dangerous. Some are tremulous, shaking so bad they can barely hold a cup of water. Some are drenched in sweat, pale, and weak. A lot of them have chills, get nauseous, and even vomit . Their bodies are just going through hell trying get rid of the poison inside of their bodies. Some even have withdrawal seizures. It’s not pretty. Detoxing never is. People are scared, angry, sad, and just sick. My job is to keep them safe, check their vitals, give them meds, and help them through one of the hardest things they’ll ever do. It takes a lot of patience, heart, and sometimes just plain toughness.
One Patient I’ll Never Forget
I’ve had many patients over the past two years, but there is one patient that has stayed with me. I don’t know exactly why, but she has. She was one of my first patients at the treatment center. For confidentiality reasons, I’ll call her J. She’s about fifty years old, with long, dirty-blonde hair that always looks a little tangled and un-kept. Her clothes soiled and torn. Her face shows the years of struggle, tired eyes, sunken cheeks, and just plain hurt and sadness. She just looks like life has been too hard on her.
J has been back to detox about six times in the past three months. One particular time she was sent out to the ED for a wound on her foot. She had an infection that was so bad that she needed IV antibiotics. She was admitted to the hospital for about a week. The day she returned to my facility, I was on shift. I went out to the reception area past the two security doors and signed for the EMS to release her. I was happy to see that she was okay. Infections are no joke, especially one that you need IV antibiotics for. We went into the intake room to readmit her into our system. When patients are admitted to hospital, we have to discharge them out of our system. Before I could get signed into the computer to re-admit her, she started saying she was going to go. She became anxious and restless and couldn’t sit still. She told me she had to leave and couldn’t stay. She was so desperate to leave all of a sudden. She was saying she had to go move her truck from where it was parked, or it would be towed. J is homeless and lives out of her truck most of the time. “I have all of my stuff in there. I have to go move it.” It was obvious to me that she wanted to leave to go use drugs. I tried to convince her to stay, but I had no success. Staff retrieved her belongings from the locked warehouse where we keep every patient’s things. She was so eager to leave that as she was going through her things in the hallway, y she started handing me things, telling me to “just throw it out.” She didn’t even want to wait for her shoes. Her foot was wrapped up with a bandage to protect the wound, she was also wearing a non-slip sock on that foot, and there was a shoe on the other. We were trying to find her a shoe or slipper to fit over the bulky wrapped foot, something to protect the foot. It was raining out, and she was still getting over the infection. J was not waiting. “Oh man, I really need to go.” “I’ll be fine with this,” pointing to her foot with the nonslip sock on it. I again pleaded with her to stay. “I’m gonna come back,” she said. “I’m moving my truck, and I’ll be back,” to which I replied, “You promise you’ll come back?” And she said in her raspy voice, “I promise.” I helped her put her stuff in her backpack and walked her back through the security doors. As she rushed out into the parking lot, she turned and called out, “I’ll be back!” I yelled after her, “I really hope so; we’ll be here!” I remember standing there watching her go, feeling sad for her and wondering if she would ever make it back here.
When someone has not used drugs in a while and then goes back to using, they think they can handle the same amount /strength / strength of drugs as they did before. Well, they can’t, and a lot of people overdose and die. I didn’t know if she would make it back. She never came back that day, or the day after, or even the week after. She did eventually make it back; she was broken again, dope sick! Withdrawing from fentanyl. She came in with her head down, nose dripping, unbathed, sweating, itchy, and tremulous. I was happy to see her. She made it back to us. I remember thinking, “Maybe this time will be it for her; maybe she will stay longer this time; maybe she will make it!”
She stayed with us for about three weeks this time. Every time I went up to her unit, I’d look for her to see if she was still there. She is always so kind, respectful, and sweet. When I’d see her, she’d smile and tell me, “I’m still here; I’m going to do this this time.” And she looked it. Her hair was washed and braided neatly, her eyes bright blue again, and her skin glowing. She was dressed in jeans and a cozy sweater instead of the torn clothes she first came in with or the facility-issued, maroon-colored scrubs the detox patients need to wear. She looked beautiful, inside and out. There was hope in her again; her soul was finally starting to heal. She left us a few days ago. She was going to a halfway house. On to continuing her treatment. When I asked her how she was feeling about the transition, she told me she was excited, hopeful, and nervous. When she left, she thanked all of us nurses and left us a card she made that expressed her appreciation for us. This is what motivates me to keep doing this job. Knowing I have helped someone and made them feel cared about.
I once asked her if she still wanted to keep trying to get sober and what makes her keep trying. She said yes, and she keeps trying because she loves herself and she doesn’t want to die. That answer hit me hard. It’s heartbreaking to watch her, or any patient for that matter, return again and again, but at the same time, I’m thankful they keep making it back to us instead of dying out there on the street. I hope that the next time I hear about her, it’s because she’s doing well. My wish for her and every other patient is that someday they’ll come back just to visit and tell us they are living clean, sober, and beautiful.
There are days this job breaks my heart, and days when it fills it right back up. Some shifts feel really heavy, the sights, the smells, the exhaustion, and the constant worrying if someone will make it through the day without having a seizure, overdose or die. But then there are moments that remind me why I do this. When a patient finally sleeps after days of being sick or says “thank you” through tears, or even just smiles for the first time in a while. Those are the moments that matter. They might seem small, but working in this field with so much sadness and pain, the small wins are everything. They’re proof that the human spirit, heart, and soul are still alive underneath all the pain. Those moments remind me that being a detox nurse isn’t just about medicine; it’s about caring about what you do, showing kindness and patience, lending an ear to listen, lending a shoulder to cry on, and giving people hope when they’ve lost it.
Being a detox nurse, you see people change right in front of you; sometimes they look completely different, better, even after just a week. You also see how strong addiction is when they relapse. There’s a mix of heartbreak and hope every single day. Being a detox nurse isn’t easy. The hours are long, the work is stressful, and the stories weigh heavy on my heart. But the reward is real. I get to see people at their lowest and sometimes watch them rise again, even if it doesn’t last forever. Helping someone through just one part of their journey matters. Every detox is another chance, and as long as people keep coming back, I’ll keep showing up for them.
The second essay, “Brave New World Dept.: Prompt Diagnosis,” shows a different side of my writing. This piece helped me practice summarizing and responding to an article while still keeping my own voice. I had to clearly explain what the author was saying before sharing my own opinion, which was something I struggled with in the past. A specific part that shows my growth is when I connected the article to my own experience with looking up my thyroid levels online. That example helped support my response while still staying on topic. This essay shows that I can organize information clearly and balance research with personal experience.
Brave New World Dept.: Prompt Diagnosis
A lot of people use A.I. now to check their symptoms before calling a doctor. It’s becoming normal in healthcare, but it also makes people wonder how safe it really is. In the article “Brave New World Dept.: Prompt Diagnosis,” Dhruv Khullar explains how A.I. can help doctors and patients, but he also points out the problems it can cause. I also read a short piece from the Mayo Clinic that says online symptom checkers and A.I. should be used carefully because they can be wrong (“Symptom Checkers”). Both sources show that A.I. can be helpful, but people still need real medical advice from real medical professionals.
In “Brave New World Dept.: Prompt Diagnosis,” Dhruv Khullar talks about how A.I. is becoming a bigger part of medical care. He starts with the story of Matthew Williams, a man who had stomach problems for years. He went to different doctors but still didn’t get answers. When he typed his symptoms into ChatGPT, the A.I. suggested that oxalates might be causing his issues. This ended up being correct, and changing his diet helped him. Khullar uses this example to show how A.I. can sometimes help when doctors haven’t found the answer yet.
Khullar then explains how A.I. systems are being used to train medical students. He talks about an A.I. tool called CaBot that was tested at Harvard. CaBot solved a very hard medical case in just a few minutes, while the doctor it was compared to took weeks to figure it out. Khullar says A.I. can go through a huge amount of information very fast, which is something humans cannot do on their own. He also explains that doctors might use A.I. to get quick first ideas for diagnoses or to double-check their thoughts, almost like getting a second opinion.
Even though A.I. can be helpful, Khullar makes it clear that it also has problems. He shares examples of times when A.I. gave dangerous or totally wrong advice. One man got sick because A.I. told him to use a bad salt substitute. Khullar says A.I. can “hallucinate,” meaning it gives answers that sound confident but are not true. He also talks about privacy concerns and warns that doctors could lose some of their thinking skills if they depend too much on A.I.
Khullar also says that A.I. is being used in other countries, like Kenya, where doctors use a system called AI Consult to check their own diagnoses. He calls this a “centaur” approach, which means humans and A.I. working together. He explains that A.I. is most helpful with unusual or complicated cases. For regular, common problems, A.I. doesn’t really add much. Khullar ends by saying A.I. should support doctors, not replace them, and that real medical decisions still need human judgment.
I connected with this article right away because I had a similar experience to one of the examples. Not long ago, I looked up why my TSH and T4 levels were high. Google told me I had hyperthyroidism. I already knew I had hypothyroidism, so I was confused and honestly a little scared. I ended up calling my doctor, and they explained that a high TSH means the thyroid is underactive. What Google told me was the complete opposite. This experience showed me exactly what Khullar meant when he said A.I. can sound confident but still be wrong.
I also understand what Khullar says about how people use A.I. as a quick check before they talk to a doctor. That’s exactly what I did. The Mayo Clinic says symptom checkers should only be used for basic information and not for real diagnosing (“Symptom Checkers”). That makes sense because A.I. doesn’t know your full medical history. It doesn’t know anything personal about you. It just gives an answer based on typing. In my case, the answer didn’t match what was actually going on with my body.
Overall, I agree with Khullar that A.I. can be helpful as long as people don’t depend on it too much. It can give ideas or help someone know what to ask their doctor, but it shouldn’t take the place of real medical care. My experience showed me why you always have to double-check with a doctor. A.I. might have a lot of information, but it doesn’t know me the way my doctor does. After going through that, I know I won’t rely on A.I. for anything serious again.
Works Cited
Khullar, Dhruv. “Brave New World Dept.: Prompt Diagnosis.” The New Yorker, 29 Sept. 2025. Gale OneFile: High School Edition, https://go.gale.com/ps/i.do?p=STOM&u=mlin_s_bristcc&id=GALE%7CA856566465&v=2.1&it=r&sid=bookmark-STOM&asid=5ec12c8d.
“Symptom Checkers: Can You Trust Them?” Mayo Clinic, 2024, www.mayoclinic.org/symptom-checkers.
The third essay, “Should Nurses Be Allowed to Refuse Unsafe Assignments?”, is my final draft of Essay 4 and the piece that best shows how much my writing has improved. When I started brainstorming, I thought about a few different healthcare topics, but I chose unsafe nurse assignments because it’s something I deal with in real life and feel strongly about. For prewriting, I spent time reading research studies, nursing organization guidelines, and government information, while also thinking about my own experiences at work. Writing the first draft took several sittings and was challenging because I had to combine research with personal knowledge. After receiving feedback, I made changes by moving my thesis, improving organization, strengthening my argument, and fixing citations. Revising this essay helped me see how feedback can actually make my writing clearer and stronger.
This essay also shows growth in how I organize and support an argument. One part that stands out is where I address the hospital administrators’ arguments about cost and staffing shortages and explain why those arguments don’t hold up in real healthcare settings. That section shows that I can focus on one idea, respond to opposing viewpoints, and support my points with evidence.
Should Nurses Be Allowed to Refuse Unsafe Assignments?
Every day at work, I walk into an unsafe situation. We have no security in the building and care for unpredictable, sometimes violent patients. Staffing is always short, and it often feels like a riot could break out at any moment. All we have is a call button that alerts the police, and if something does happen, we are left waiting for them to arrive. This is the reality of my job every single shift. When I am responsible for multiple detoxing patients with only one other nurse and a few staff members caring for nearly forty patients, it is hard not to wonder how any of this is considered safe. Unsafe assignments are not just busy days. They are dangerous situations that put patients and nurses at risk, and nurses should have legal protection to refuse unsafe assignments without fear of being written up or fired.
Unsafe assignments do more than exhaust nurses physically and emotionally; they increase the risk of serious harm. Research shows that when nurses are responsible for too many patients, the likelihood of errors, missed assessments, and complications increases (Needleman et al.). When nurses are stretched too thin, important signs of patient decline can be missed, medications can be delayed, and care becomes rushed instead of safe and thoughtful. The American Nurses Association also links unsafe staffing levels to burnout and emotional exhaustion, which further affects patient care (“Nurse Staffing”). Nurses want to provide quality care and build trust with patients, but when assignments are unsafe, it becomes impossible to meet patient needs. This impacts patient safety, nurse well-being, and the healthcare system as a whole.
Despite these risks, the legal protections for nurses who refuse unsafe assignments are limited and unclear. There is no federal law that clearly protects nurses from retaliation when they refuse an unsafe assignment. Instead, protections vary by state and by hospital policy. Some states allow nurses to file objection or “safe harbor” forms, but these do not always prevent discipline, write-ups, or job loss. In many cases, hospitals still hold the power to punish nurses even when assignments are unsafe. This lack of clear legal protection leaves nurses feeling forced to choose between protecting their license and protecting their patients.
Some organizations argue that refusing unsafe assignments is actually a way to protect patient safety. The Massachusetts Nurses Association explains that refusing an unsafe assignment can be appropriate when done correctly and with proper documentation (“Accepting, Rejecting & Delegating”). The Joint Commission also emphasizes that safe staffing is essential to meeting national patient safety goals (“National Patient Safety Goals”). Research supports this position. A large study found that hospitals with lower registered nurse staffing levels had higher patient mortality rates (Griffiths et al.). These findings show that unsafe assignments are not minor inconveniences, but serious safety risks that can lead to life-threatening outcomes.
Hospital administrators often argue against allowing nurses to refuse assignments, mainly for financial reasons. Labor costs make up more than half of hospital expenses, and administrators claim that hiring additional staff is too expensive (“AHA Hospital Statistics”). They argue that allowing nurses to refuse assignments would create staffing chaos and disrupt operations. From their perspective, refusal threatens efficiency and profitability.
Another common argument is the nursing shortage. The Bureau of Labor Statistics projects that nearly 193,000 new registered nurse positions will be needed each year through 2031 due to retirements and nurses leaving the profession (Bureau of Labor Statistics). Hospital leaders use this data to argue that there are not enough nurses available, and that refusal would worsen staffing problems. However, this argument ignores the fact that unsafe working conditions are a major reason nurses leave in the first place. Allowing nurses to refuse unsafe assignments could actually help retain experienced nurses by improving working conditions.
There are also legal concerns related to patient abandonment. The Washington State Department of Health warns that refusing an assignment without following proper procedures could be interpreted as abandonment, which may lead to disciplinary action (“Questions of Assignment”). Nurses are often pressured with statements such as “just follow orders” or “my license will cover you,” making it even harder to speak up. This creates a system where nurses feel legally vulnerable for prioritizing safety.
Some administrators argue that technology and temporary staffing solve the problem. However, research does not support this claim. A study in the International Journal of Nursing Studies found that when nurse staffing levels decrease during a shift, the risk of inpatient death increases (Musy et al.). Technology cannot replace hands-on nursing care, and temporary staff may not be familiar enough with a unit’s routines, patients, or safety risks to manage complex situations effectively.
These arguments fall apart when real-world healthcare is considered. Nurses do not refuse assignments to avoid work; they refuse because they fear serious harm will occur. Unsafe assignments are a major contributor to burnout and turnover. The National Academy of Medicine reports that burnout affects up to half of all nurses, largely due to excessive workloads (National Academy of Medicine). Punishing nurses for speaking up only pushes more of them out of the profession.
Unsafe staffing is also costly for hospitals. The Agency for Healthcare Research and Quality estimates that preventable errors, infections, falls, and complications add more than $30 billion in extra healthcare costs each year (Agency for Healthcare Research and Quality). While hospitals may view safe staffing as expensive, unsafe staffing ultimately costs more.
Allowing nurses to refuse unsafe assignments does not mean abandoning patients. Instead, it encourages hospitals to create safer systems and staffing practices. Legal protections could include laws that prevent retaliation, clear procedures for refusing unsafe assignments, and independent review processes. These protections would allow nurses to advocate for patient safety without fear of losing their jobs or licenses.
Nurses should not have to choose between protecting their patients and protecting their careers. Unsafe assignments place everyone at risk. Giving nurses the legal right to refuse clearly unsafe assignments is not about avoiding responsibility; it is about prioritizing safety. Legal protections for refusing unsafe assignments would benefit nurses, patients, and the healthcare system as a whole.
Works Cited
Accepting, Rejecting & Delegating a Work Assignment: A Guide for Nurses. Massachusetts Nurses Association, 2023, https://www.massnurses.org.
Agency for Healthcare Research and Quality. Patient Safety and Adverse Events. AHRQ, 2023, https://www.ahrq.gov/patient-safety/index.html.
AHA Hospital Statistics. American Hospital Association, 2023, https://www.aha.org/statistics.
Bureau of Labor Statistics. Registered Nurses: Occupational Outlook Handbook. U.S. Department of Labor, 2023, https://www.bls.gov/ooh/healthcare/registered-nurses.htm.
Griffiths, Peter, et al. “Nursing Team Composition and Mortality Following Acute Admission.” BMJ Quality & Safety, vol. 28, no. 8, 2019, pp. 609–617.
Musy, Sarah N., et al. “The Association Between Nurse Staffing and Inpatient Mortality.” International Journal of Nursing Studies, vol. 120, 2021, article 103950, https://pubmed.ncbi.nlm.nih.gov/34087527/.
National Academy of Medicine. Taking Action Against Clinician Burnout. National Academies Press, 2019.
National Patient Safety Goals. The Joint Commission, 2024, https://www.jointcommission.org/standards/national-patient-safety-goals/.
Needleman, Jack, et al. “Nurse-Staffing Levels and the Quality of Care in Hospitals.” The New England Journal of Medicine, vol. 364, no. 11, 2011, pp. 1037–1045.
Questions of Assignment. Washington State Department of Health, June 2022, https://nursing.wa.gov/sites/default/files/2022-06/QsOfAssign.pdf.
Overall, this semester helped me feel more confident about writing. With the help and feedback from my professor, I learned how to organize essays better, use sources correctly, and revise instead of just fixing grammar. I still want to work on writing more efficiently and trusting myself earlier in the process, but I can clearly see my progress. These essays represent how my writing has grown over the semester and how I’ve learned that writing is a process that gets better with time, effort, and hard work. Hopefully I am prepared for ENG 102.
