Therapeutic Journaling with Minimal Committment

I have been a registered nurse on a pretty intense inpatient unit for seven months. It's fast-paced, emotionally intense and physically demanding. The start of my nursing career was rocky, as my anxiety and emotions were getting the best of me, not to mention, day shift was not being kind to this nocturnal brain of mine. I feel I'm coming out of that stage a bit as work straight nights, and gain competency and confidence with more acute patients. This entire time, I've been seeking out easy things to add to my day to help me avoid being weighed down by the life-or-death scenarios I encounter on every shift.

There are a few things on this list of coping devices, but today, I just want to focus on one. My aptly-named Sentence Journal was started in August of 2016, one month after I started my job, around the same time I realized my endlessly supportive partner, Doug, was unable to be the lone and constant audience for all the pretty intense stuff I had to get off my chest after each shift.

As you can guess from the title, A Sentence Journal is a no muss, no fuss system...I essentially unload all the things on my mind in one or two sentences per topic, resisting the urge to elaborate on these stories. (I'll try to funnel the raconteuring to this blog.) Not only does this serve as a way for me to get stressful stuff off my chest, but now, I'm amused to go back reminisce at the funny things, smile and remember patients we've lost, and also have a record of my growth and maturation in my role as a nurse. There are gaps in my journaling, usually during periods of high stress or illness or whatever, but I've resumed my commitment to myself to write a little for every shift.

For the sake of not violating my patients' privacy, and not going to prison or losing my license, I don't include names or identifying information in my journal. I learned in elementary school that, if you don't wanna get in trouble, you should never put sensitive things in ink. #bustednotepasser

The journal itself is small, maybe 4" X 6", and a quarter inch thick, covered in a repeating skull and crossbones pattern. (It came in a set with another that was adorned with pirate ships, which I mailed to a friend.) It's not entirely inappropriate for me since I love the macabre, am a supporter of death positivity (which you can read about here), and regularly provide end-of-life (EOL) care as part of my job. I carry it in my work bag, concealed in a pocket so as not to be easily lost if dumped out. While it's HIPAA-clean, it's still my journal and personal to me. I like having it at work so that I can jot things down if I get a break and feel compelled by something - usually something I find funny.

I wanted to share a few that I find most entertaining, and hopefully, I won't let anything scandalous slip. Although, as I read back through, it's pretty tame in terms of sarcasm or hilarity. I'll have to work on that. And yes, nursing can be funny without being mean.

Ok, here's one:

My patient vomited minutes after swallowing a narc; I wondered if any of it remained in their belly. A short while later, I discovered the half-dissolved pill dried and stuck to the hem of my pant leg.                                  *I wasted it with another nurse who laughed at me

Two days later I overheard a transplant surgeon doing patient education with a woman who was about to discharge after her bilateral lung transplant.

Because of the incision (under the breasts) female transplant patients can only have sex standing up or on top until the incision is healed. Keep those edges approximated!!

Honestly, I had forgotten about this moment:

I started an IV in a broken arm at the patient's request. "That arm already hurts, and I won't be using it, so just put it there."  I felt this was a reasonable conclusion and obliged.

or this night:

The combined total weight of my three patients tonight is 1056lbs. Already tired and I just got here.

I had also forgotten about this sad day, which serves as a reminder that the work-life-balance can be tough when both suck. This is why self-care is a required skill in this line of work.

"My first patient death occurred last night. Unfortunately, so did the death of Doug's dad. I am tired. so. so. so. tired. and so sad."

This little book is quickly becoming a roller coaster ride of emotions, but I don't feel distressed when looking back on these things. I almost feel like I don't need to carry this baggage with me because I know it's contained on these pages. It's a symbolic setting down of the weight of my job. 

I didn't journal from September 2016  to January 2017, and I'm kinda sad that I 'lost' those insights and milestones. The months I have journaled I was smart enough to mark my progress with little uninteresting tasks like, I took two admissions today, or IV push meds make me really nervous or I feel like I'm getting the hang of giving thorough report, and other inane details about learning the ins-and-outs of fast-paced nursing.

I almost feel challenged, going forward, to fill this little book with the best and worst of my experiences. I'm a romantic in the sense that I want to have something to look back on as an old woman that can make me giggle and cry and remember those first months of my career. I also think this book works to fulfill the intrinsic human desire to document one's own existence and experiences. I can at least daydream about someday using it as an outline for my outrageously interesting memoirs which I'll write in my golden years.

I'd love to hear how others use journaling as a stress-reducer. Does the minimal-commitment nature of a Sentence Journal sound appealing to the busy, tired or lazy wannabe journaler? Comment below, folks.


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