Nurses working in learning disability care settings are encouraged to engage in reflective practice. This process is envisaged as likely to improve care insights, to enhance circumstances for service users and to increase nurses’ confidence as they draw on experience. However, some authors have argued that reflective practice can be difficult in clinical settings, noting challenges such as bias blind spots, overestimation of the healthcare practitioner’s ability to evaluate their own care contributions, and ambiguous clinical contexts. To revisit the process of reflective practice and to review its associated challenges, this article uses a case study involving the hospital admission of a man with a moderate learning disability for a bowel resection following diagnosis of bowel cancer. The author explores what reflection entails practically based on the experience of the nurses involved in this case study.