The Value of Reflective Journaling in Nursing Education and Practice

Do you ever wonder if there is any practical application to the reflective journal assignments that are assigned in undergraduate nursing programs? The assignments that we may have been quick to dismiss as the "fluffy stuff", in favour of the the "real nursing", like taking a blood pressure or changing a complex dressing. 

I think that the answer to this question depends on what one's understanding of Registered Nursing is, and also, what the role of the Registered Nurse is in practice.  

If you believe that Registered Nursing is comprised of a series of tasks that are completed throughout the day to help sick people, then it may be that the value of engaging in reflective journaling to improve one's practice may be a hard activity to sell. However, if you believe that Registered Nursing is a complex process involving assessment, diagnosis, planning, implementation and evaluation, then you might believe otherwise. 

I am going to try to explain the utility of what may initially be viewed as a useless task and/or waste of time by telling you about my own experience with reflective journaling.

Finding My Place in Mental Health Nursing

When I began my mental health clinical rotation way back (seemingly ages ago, even thought it was only in 2008) when I was completing my Bachelor of Nursing program at the University of Calgary, I felt like I finally found what I was going to do with the rest of my life.  Prior to starting this rotation I was not sure that I would actually practice as an RN (a first clinical rotation filled with Norwalk and C. Diff was partly responsible). I had a hunch that I would enjoy mental health (primarily because I had a completed psychology and sociology degree prior to starting my nursing program and was already working as a behaviour therapist and youth care worker). After completing my first two clinical practicums on a stroke unit and EENT, I still did not have the feeling that I was in this for the long haul; nursing seemed like a temporary gig that I might try for a bit until I figured out what I really wanted to do with my life. 

To my relief, when I got to the acute inpatient mental health unit and began talking to the people who were admitted on the unit I did experience that feeling of comfort, this clinical area was my new home. Looking back, my a-ha moment had nothing to do with my experience observing the nurses working on the inpatient unit because they were mostly engaged in custodial care (observing and reporting), but everything to do with being with the patients and families I was engaging with and providing care for.

The Reality of Practice as a New Graduate 

When I started my first job as a Graduate Nurse at UBC I did not realize that there was very limited educational support for RNs who chose to specialize in mental health nursing.  The patients who were admitted to the unit that I was working on were acutely ill.  The unit that I worked on was open, meaning the doors were not locked from the inside at any time; patients were able to exit the unit at any time, provided they were not confined to one of the two seclusion rooms.  The only unit that I ever worked on in the lower mainland that was locked from the inside 24/7 was tertiary neuro rehab, where the risk of harm due to impaired cognitive ability of patients (such as wandering into the street) that the doors needed to be locked. This was the context of my mental health nursing experience.

Learning Through Reflection

Flash forward to working in Alberta.  I started a three week orientation as a Mental Health Clinician in Alberta that I realized that there was so much opportunity to improve the orientation that RNs entering mental health receive.  

I also realized that inpatient mental health services happen very differently here than anything that I had experienced in the Lower Mainland.  I worked in a lot of places in the Lower Mainland, many that admitted formed patients, many outpatient programs that provided services to people who were on Extended Leave.  

Being out of the hospital setting was an eye opening experience.

Coming Full Circle

Looking back now, I can see that those early reflective journals were never about filling space on a page, they were about making sense of who I was becoming as a nurse. Reflection gave me a way to connect the dots between what I was seeing, what I was feeling, and what I was learning. It helped me understand that nursing isn’t just about doing; it’s about thinking, noticing, questioning, and growing.

If I had known then what I know now, I wouldn’t have rolled my eyes at those assignments. I would have recognized them for what they were, an invitation to slow down and pay attention to my own development. Reflective journaling taught me that every experience, even the messy ones, has something to teach. And that lesson has stayed with me far longer than any care plan or procedure ever could.

Love,

Michelle