Why You Should Keep a Clinical Journal
If you’ve watched Grey’s Anatomy, you probably remember that Meredith reads her mother’s clinical journal entries for inspiration and reflection. As a new nurse, I saw an episode where she did this and thought, “What a great idea! I should keep a clinical journal!” As I would see situations in the ICU, I would file them away with the idea that if I have a patient in a similar situation in the future, I’ll have some sort of background knowledge to draw on. It really helped boost my confidence and provided a way for me to track my progression from deer-in-the-headlights newbie to still-terrified-but-my-poker-face-is-better ICU nurse.
In a job with a steep learning curve and many opportunities to learn from experience, a clinical journal can help you in so many ways
It can help you learn from past experience
Not only can a journal help you learn from your experiences, it also helps you apply what you’ve learned in future situations. For example, let’s say your patient suddenly drops their oxygen saturation level after the nurse gives him IV dilaudid. You can see his chest moving up and down, but the oxygen level still decreases. You watch as the nurse puts one hand in front of the patient’s nose, then tilts his head back and lifts his chin (need a visual? Here’s a clip). Suddenly you can hear the patient ventilating again and the oxygen saturation level increases. What the heck just happened?
Some patients will collapse their airways when given narcotics, especially after surgery when they may still be recovering from anesthetic agents. The patient was still trying to take in breath, hence the chest moving up and down, but the airway was occluded. The nurse placed her hand in front of the patient’s nose to feel for air movement. When she noted no air was flowing, she performed a chin-lift maneuver to open the airway. The patient started ventilating again and the oxygen level increased.
As you write this scenario in your journal, you reflect on what triggered the event, what the assessments were, what the intervention was and how the patient responded (sounds a lot like the Nursing Process doesn’t it?). Now, the next time you see a patient occluding their airway, what will you do? Hopefully you’ll try a chin-lift or jaw thrust maneuver (one of the easiest and most effective things the nurse can do for a patient having airway associated respiratory compromise!) and also call for help. Imagine how confident you’ll feel next time you take report on a patient you suspect might be at risk for an airway obstruction, such as a patient with obstructive sleep apnea who is on a PCA.
Whether you’re a student or working RN, debriefing after clinical is the MOST useful tool you can utilize to help you grow from a novice nurse to the expert nurse you aspire to be. Download the debrief form I created for you and use it religiously after each and every clinical rotation or work day.
DOWNLOAD THE CLINICAL DEBRIEF FORM HERE
A clinical journal can help you identify your current goals and track your progress
Identifying your goals is the first step in attaining them. Maybe you want to get proficient at starting IVs in neonates, want to learn how to manage a patient on ECMO, or aim to get your chemotherapy certification. Think about your current position, and write out some goals that will motivate you to continually improve your practice. As a student, some typical goals might be to practice specific skills on real patients, or get comfortable performing a head-to-toe assessment. Whatever they are, write them down, identify steps you’ll take toward achieving them, and then circle back occasionally to track your progress. Seeing how far you’ve progressed is really motivating and helps you see that all your hard work is paying off.
A journal can help monitor how much satisfaction you are getting from your current position
If you look back at six month of entries and they’re all about how exhausted, drained, and frustrated you are…maybe it’s time to move on. And yes, this applies to students, too! Just know that nursing school is temporary, so any stress associated with exams, homework and your schedule should resolve once you graduate. But are your entries about how much you dislike working with a certain patient population or how exhausted you are after a shift? Then maybe you should gear your job search toward areas of nursing that don’t exacerbate these growing frustrations.
A journal can help you develop communication strategies
Effective communication is vitally important for nurses as we often have to speak up on behalf of our patients, assert ourselves in a professional manner, and work cohesively with a broad range of personalities (and egos). A journal can help you develop strategies for handling difficult situations such as a coworker that talks down to you, a family member who is inconsolable, or a patient that engages in manipulative behavior. Even if you don’t say the right thing the first time, reflecting on how you should have responded can help you react in a professional, confident manner the next time this happens.
A journal can help you manage work-related stress
A journal can provide a healthy outlet for your fears, frustrations, worry, uncertainty and any other challenging emotions you may be feeling. While you’re at it, it’s also important to be able to talk about those feelings, too. Do you have a trusted friend or family member you can speak openly to? Being open and honest with your feelings and mental health can help you remain a well-adjusted nurse, even when stress levels are high.
A journal can help you stay focused on your “why”
If you’ve gone through my Crucial Concepts Bootcamp, you probably remember that I talk about how important it is to understand your “why.” Nursing is a very demanding and emotionally difficult job. It is so easy to get frustrated, burned out, exhausted and drained. By focusing on the factors that motivate you, you can stay engaged and recharge your batteries when you’re running on empty. What drives you to be a great nurse? What is your role? What difference do you want to make for your patients? How does being a great nurse help you, your family, your patients? When you answer questions like these, you’ll probably realize it’s so much more than, “I want to help people.” Your WHY is huge and it deserves a lot of respect!
A journal can help you define your career pathway
Do you want to become a unit director one day? Do you picture yourself teaching? Are you interested in exploring options beyond the bedside? Would you like to become a specialty nurse such as a WOCN or diabetic educator? Whatever your career pathway may be, you’ll only get from A to B if you actually create a roadmap to get there. If you’re going to get an advanced degree, how and when will this fit into your life? If you’re going to attain more skills, what are they? Where will you get this training? How will you pay for it (some employers offer education assistance programs and scholarships!). By mapping out your plan, you can start taking active steps toward making them a reality.
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I hope this helps you see the value in keeping a professional journal. Are there other ways that journal-writing has helped you? Share your experiences in the comments below!
Get this on audio on the Straight A Nursing podcast, episode 80!
BEFORE YOU GO, DOWNLOAD THE CLINICAL DEBRIEF FORM HERE