Embracing Reflection: How to Answer "What Could You Have Done Better?" in Nursing

Kimesha Blackwood BScN, MEd

February 2, 2026

As a nurse, I have participated in several Quality of Care (QC) reviews. Each time, I feel the same dread and anxiety that anyone else would experience. A QC typically involves a deep dive into the care provided, assessing whether it was safe, timely, patient-centered, equitable, and aligned with the organization's policies. In healthcare, few questions feel as loaded as: “What could you have done better?” This question arises during incident reviews, performance evaluations, clinical debriefings, interviews, and reflective assignments. For many healthcare professionals, it triggers defensiveness, guilt, or self-doubt, especially in environments where mistakes can carry serious consequences.

However, I have learned that when approached correctly, this question is not an accusation. It is an invitation to grow. I know this may not be true for everyone, but I believe it’s all about perspective.

Why This Question Feels So Uncomfortable

Healthcare professionals are trained to be competent, precise, and accountable. We work in systems where errors can significantly affect patient outcomes, professional licenses, and team trust. As a result, we often equate “doing better” with “failing.”

The reality is this: perfection is not the standard; continuous improvement is. When the question is framed constructively, it encourages:

• Clinical insight

• Professional maturity

• Patient safety awareness

• Lifelong learning

  
  

The Purpose Behind the Question

When leaders, educators, or interviewers ask “What could you have done better?”, they are often assessing your ability to:

• Reflect honestly on practice

• Recognize system-level factors

• Learn from experience without self-blame

• Apply insight to future care

  
  

This reflective practice is a cornerstone of safe, high-quality healthcare.

Shifting From Self-Criticism to Reflection

Effective reflection is not about listing personal failures. It’s about identifying opportunities for improvement while acknowledging context. Instead of thinking:

“How could I have missed that? I should have known better.”

Reframe it to:

“Based on the information I had at the time, I acted appropriately. However, in hindsight, here’s what I would do differently.”

This subtle shift protects professional confidence while promoting accountability.

Examples of Thoughtful Reflection

Here are professional, growth-oriented ways healthcare professionals can answer this question:

• Communication: “I could have clarified expectations earlier with the interdisciplinary team to prevent delays in care.”

• Clinical Judgment: “I would reassess sooner and escalate concerns earlier if I encountered similar symptoms again.”

• Time Management: “I could have prioritized patient education more effectively by delegating non-urgent tasks.”

• Advocacy: “I could have voiced my concerns more assertively when I recognized a potential risk.”

  
  

Each response shows insight without assigning blame.

Recognizing System Factors

Healthcare does not exist in a vacuum. Staffing levels, workload, policies, and communication structures all influence outcomes. A strong reflective response acknowledges this:

“While system constraints played a role, I recognize where my actions could be optimized within those limits.”

This demonstrates professionalism and situational awareness—key traits in leadership and advanced practice roles.

Why This Question Actually Makes You a Better Clinician

Healthcare professionals who can answer “What could you have done better?” thoughtfully tend to:

• Adapt faster to complex situations

• Communicate more effectively

• Improve patient outcomes

• Experience less burnout through self-compassion

• Earn trust from colleagues and leadership

  
  

Reflection is not a weakness; it is a clinical strength.

Practical Strategies for Effective Reflection

To enhance your reflective practice, consider these strategies:

1. Create a Reflection Journal

Journaling can be a powerful tool. Write down your experiences, thoughts, and feelings after significant events. This practice helps clarify your thoughts and identify patterns over time.

2. Engage in Peer Discussions

Talking with colleagues can provide new perspectives. Share your experiences and listen to theirs. This exchange fosters a supportive environment for growth.

3. Seek Feedback

Don’t hesitate to ask for feedback from mentors or supervisors. Constructive criticism can illuminate areas for improvement that you might not see on your own.

4. Attend Workshops

Participate in workshops focused on reflective practice and self-assessment. These sessions often provide valuable tools and frameworks for effective reflection.

The Role of Continuous Learning

In the ever-evolving field of healthcare, continuous learning is essential. Embrace opportunities for professional development. Whether through formal education or informal learning, staying updated enhances your ability to reflect and improve.

Conclusion

The next time you are asked “What could you have done better?”, pause before reacting emotionally. This question is not about proving your inadequacy; it’s about demonstrating your commitment to excellence. In healthcare, growth does not come from being flawless. It comes from being reflective, accountable, and willing to improve for yourself, your team, and your patients' outcomes.

Dedicate time to review research material that supports best practices. Familiarize yourself with your workplace policies. Talk to colleagues about your concerns and seek clarifications if unsure about a task. Be the expert in your field of practice. Understand that you are only human; mistakes will happen, and something will go wrong despite your best efforts.

And finally, but most importantly, be gentle with yourself. Please give yourself grace and remember that the world is better because you’re in it. Even on your hardest days, you are enough. Thank you for all you do!