Journaling As a Tool for the Professional Development of the New Graduate RN in Hematopoietic Stem Cell Transplant (HSCT)

Topic Significance & Study Purpose/Background/Rationale

The transition of new graduate RN to professional nurse can be a time of high anxiety and stress especially when providing care in the increasingly acute HSCT patient population.  Approximately 40% of patients receiving HSCT require critical care monitoring with advanced life support at some stage of the transplant process (Saria, Gosselin-Acomb; 2007).  This requires RNs to learn a specialized skills set to care for the HSCT patient. Literature states approximately 53% of new graduate RNs leave their position within the first year of hire due to high work expectations, feelings of incompetence, and high patient acuity (Hardin-Pierce, 2005). It is important to identify and utilize techniques that minimize stress and support the development of these nurses. Journaling has long been identified as a way to reflect upon and manage stressful situations. Journaling “fosters conceptual development and critical thinking and increases self-esteem, confidence, and the integration of nursing professionalism” (Diekelmann, 2003).

Methods, Intervention, & Analysis

We decided to implement a journaling program with our new graduate nurses as a way to develop critical thinking and provide methods of self-care during stressful situations. New graduate RNs were given a journal along with the following guidelines:

• What went well?
• What struggles/conflicts/concerns did you experience?
• Describe a specific patient scenario and how you applied critical thinking
• End your entry with at least ONE positive thought from the week

They were then asked to share two entries with their preceptor each week.

Findings & Interpretation

The RNs that participated in the journaling project were surveyed 1 year after implementation. Five of the seven found it extremely helpful stating it was a way to “de-stress, organize their thoughts, reflect, and begin to see patterns in their own behaviors”. The other two listed factors such as “not being good writers” and “being too busy to journal" as barriers.  None of the RNs surveyed verbalized any discomfort with being asked to journal. All seven recommended continuing this practice with the new graduate RNs.

Discussion & Implications

Due to the positive feedback from our new graduate staff, we now provide journals to ALL RNs orienting to our HCST program and encourage them to journal as well.