*Original post released on 9/22/2022
You may read the title of this article and think to yourself, “I already have more than enough to do now that I’m in nursing school. Why should I do another thing that doesn’t even affect my grades?” I can’t say I blame you for thinking or feeling that way. However, I do intend to enlighten you about a few of the MAJOR benefits to keeping a nursing clinical journal so that you can make the informed choice of whether or not to keep one. First, we’ll talk about what a clinical journal is and break down those benefits of keeping such a journal. Then, we’ll discuss methods for maintaining the journal. Finally, we’ll wrap it up with some dos and don’ts of keeping a clinical journal. Without further ado, let’s jump in!
Nursing school isn’t solely about making passing grades so you can graduate and pass the NCLEX. You’re also taking the time to go through a multitude of experiences, each semester, that will ultimately shape the type of nurse you are going to become. You will have those experiences, good or bad, one way or another…you might as well use them to your advantage. So what is a clinical journal? A nursing clinical journal is basically a reflection or recollection of what happened during any given clinical day. You’ll be able to discuss things that happened on the unit, any ethical dilemmas encountered, your thoughts and feelings throughout the day, new skills learned/performed, surgeries or procedures witnessed, etc. The possibilities are truly endless on what you can include in your journal. But, if you’re in need of some ideas, that can help get you started!
What are the potential benefits of keeping a clinical journal? There are quite a few and some of them may or may not be so obvious. For instance, the most obvious reason is to be able to review clinical memories later on down the road in either your nursing school path or your nursing career. It can be fun to re-read how excited you were to place your first foley or assist in the delivery of a newborn for example.
Another reason that may not be as prevalent in your mind as a new nursing student is for the purpose of potential interviews towards the end of nursing school, whether it be for an internship during your final semester or for your new grad nurse position after graduation. If you take the time to reflect seriously on each clinical day’s experience and vary your journal entries, it can serve as a great way to prepare for potential interview questions that may be emotional intelligence or case scenario based. Your clinical journal can also be a goldmine for content based on ethical dilemmas and conflict resolution scenarios, which *hint hint,* potential employers love love LOVE to ask about.
Additional benefits of maintaining a nursing clinical journal include having added scenarios and experience to draw on when applying for graduate school. Many schools will have a portion of the application that includes a section where you respond, in writing, to emotional intelligence or case scenario based questions. If you have a similar experience to recall information from during clinical, you can curate a better response and improve your chances for admission into the grad school program of your choosing. Furthermore, some once-in-a-lifetime experiences may be able to be included on your resume when applying for new grad nurse positions.
One last MAJOR benefit I’ve saved for those of you pursuing CRNA school and a career in nurse anesthesia. By maintaining a nursing clinical journal as early on in nursing school as possible, you can save information about surgical cases or bedside procedural cases you may encounter that utilize anesthesia. Recall and record as much information as you possibly can about each case and be bold in requesting the nurse anesthetist or anesthesiologist’s contact information in case you want to pursue a shadowing opportunity in the future. Many CRNAs know the value of that experience and that it is often required by programs in order to gain acceptance. Fortune favors the bold here, so remember their names, titles, the procedure you observed, and any details that stuck out during the time you spent together. Try to make yourself memorable and schedule a shadow experience with them at least once a semester.
Now, let’s move on to discussing what you should include in your journal entries, especially since they may vary by type of entry. If you’re simply recalling experiences of the day, breakdown each hour of the clinical day and include any procedures witnessed, major medications administered, resuscitations that occurred, codes that were attended, skills performed, any interactions with providers that were significant, any patient interactions that were significantly meaningful. Potential future employers love to hear examples of how you interact with other professionals and patients, and they love to see ambition and advocacy.
If you’re recalling an ethical dilemma or conflict that you encountered, your entry may look a little different. First you’ll want to note the series of events that led up to the ethical dilemma or conflict. Then, you’ll want to discuss how you addressed the situation. Did you bring it up to your preceptor? Instructor? The charge nurse? Provider? All of the above? How was the situation handled by them and by yourself? What were your actions in that moment? What happened as a result of addressing the situation? (Or did you not address the situation and wish in hindsight that you had?) What did you learn after taking the time to reflect and discuss the situation with your instructor/clinical group? These are prime situations that serve as the basis of interview questions. Have a few of these in mind as you head into an interview and you can help prevent yourself from being caught off guard when asked.
Lastly, if your entry is geared towards logging experience in anticipation of CRNA School one or a few years down the road, your entry will look more detailed and methodical than the others. Here, you’ll want to make sure you include the CRNA/Anesthesiologist’s name and title (after getting their permission to do so!!!), the surgery or bedside/outpatient procedure you witnessed, time spent with them from pre-op to post-op recovery, major tasks witnessed throughout that timeframe, a description of events that took place…especially any issues encountered and how they were addressed “in the moment,” any potential ethical dilemmas that occurred (this won’t always be the case), type of anesthetic utilized, and contact information should the professional provide it to you. If the information in this type of entry is thorough enough, some schools may allow it to count towards your overall required shadow experiences if it falls within a certain timeframe (Ex: within the past two years prior to application).
Now, let’s take a brief moment to discuss some dos and donts when writing in your clinical journal. Some, of course, may seem blatantly obvious, but for some students…common sense isn’t all that common and I want to cover all the bases. DO NOT include any identifying information of patients, as this is a HIPAA violation and you could be in serious legal trouble for doing so. DO NOT include any identifying information of nurses or providers unless they provide explicit consent in doing so after being made fully aware of how their name/title will be used…In fact, I would avoid doing this at all, with the exception of the shadow log entry for those trying to pursue CRNA school (because contact information will likely be required for verification later on with the submission of your grad school application). DO NOT include any photos, especially of other persons or patients or the facility. Best to be safe, rather than sorry on this one, because again, it can be considered a HIPAA violation with serious ramifications. DO NOT post any journal-like information on social media, whether or not it includes any identifying information for persons or facilities involved, especially if it has a negative context. Other students, faculty, and even the facilities may be able to deduce who, what, or where you are referring to based on your clinical schedule…so just don’t even go there. AVOID social media at all costs in regards to clinicals.
Let’s move on to more positive tips! DO make time to sit down in a quiet environment to reflect about your clinical experience shortly after it is completed. Write your journal entry shortly thereafter because events of the clinical day will be the most detailed at this point in time. The longer you wait to write things down, the less detailed it becomes and the less beneficial it will be for you at a later time. DO set a goal for yourself prior to the beginning of each clinical day. For example, don’t always defer to writing about what you did and how you felt during the day. Make it a priority to approach some days with the intention of spotting an ethical dilemma, conflict that was experienced, or a way that you impacted a patient’s health or care in a meaningful way. DO record the dates of clinical entries so that you can reference the timing correctly later on. DO describe experiences with as much detail as you possibly can. Yes, this may be a little time consuming, but future you WILL thank you for doing this. DO find ways to be memorable to healthcare providers. This is especially important for those of you pursuing CRNA school. DO take time and do the prep-work to truly prepare for your clinicals, because this will inadvertently help you stand out in the best way possible to those healthcare providers.
If you’ve stuck it out with me this far, I sincerely hope you’ve found something useful in this article. Yes, you do need nursing school in order to become a nurse, but that doesn’t mean that nursing school can’t also benefit you in ways that extend past graduation. If you’re willing to put a little side work into it, nursing school can give you an enormous return on your investment. Now, go out there and kick some clinical a$$!
Until next time, happy studying!
XOXO,
Andra Alyse
The Study Nurse 