Clinical Reflection in Nursing

Students are asked to write reflections as part of their nursing curriculum. Recently, the students were asked to read an article and compose a response based on what they were experiencing in the program. Ruby Engreitz was kind enough to share hers with us:

I think it is best that this reflection writing is happening a few days after my first clinical day as a nursing student. Don’t get me wrong, there is huge value in physically writing down your feelings and emotions immediately after a new experience, but this time I think I needed a few days to let my thoughts about the day really sink in.

I just got back from a really fun self-care weekend of skiing at Mt. Bachelor. I am extremely happy and relaxed. And this has made me realize exactly how tense and anxious I was during and immediately after my first clinical day. Now, after completing the roller coaster cycle between super-anxious and super-relaxed, I can truly piece together how I was actually feeling this past Wednesday. 

Beck’s (1993) article, “Nursing Students’ Initial Clinical Experience: A Phenomenological Study,” was a great tool to help frame and process my first clinical day.  I think it succinctly addressed and validated many of the emotions I was feeling on Wednesday.  First and foremost, it is obvious that I was feeling quite anxious about getting into the hospital and seeing real patients in the flesh.  I am not a stranger to anxiety.  I was a competitive gymnast for fifteen years and performed weekend after weekend in front of hundreds or thousands of people, every time in a new environment.  It is close to impossible not to get a physiological reaction to this situation.  As such, I have become very familiar with the feeling of stress, and I get very tuned into my body when I am in a stressful environment.  My heart pounds out of my chest, my hands and feet sweat profusely, my eyes get big, my jaw gets tense.  In a competitive environment, I was able to take some slow, deep breaths, focus, and do what my body had trained to do.

But nursing is not gymnastics.  The physiologic response was the same, but the focus is completely different.  I have not practiced nursing for fifteen years.  Everything is new, and everything is difficult, even figuring out where to throw your garbage (trash can?  Biohazard?  Sharps?  Dirty laundry?  Recycling?  Is there a recycling?  Why isn’t there a recycling?)  There is no autopilot in nursing, and I don’t think that matters whether it is your first day or your ten-thousandth.  It is both a physical and a mental job and you have to be on, all the time.  This was the biggest anxiety provoker for me.  The heaviness of the job is daunting.

This brings me to the second concept from the Beck article that I immediately identified with – the feeling of unpreparedness.  It is hard for me to grasp the concept that I will be responsible for a real person’s health.  It is one thing to read about nursing, to practice things on mannequins or classmates, to imagine yourself being a perfect, competent, caring, skillful, smooth-sailing super-nurse who is going to make people feel good and happy and healthy.  It is another thing to walk into the room of a sick, vulnerable stranger with a nurse preceptor you just met with no idea what to say to either of them, or even where to stand.  I wanted to act naturally and pour all my attention into the patient like a “good nurse” is supposed to do, but I was so hyperaware of how unprepared I was and how much I needed to learn from my preceptor in one day that it was impossible to be fully patient-centered.  I felt like my preceptor, her patients, and her patients’ families could see right through me and feel my nervous naivety, and this worried me because I did not want my nervousness to become contagious.  Essentially, just as the Beck article described, my unpreparedness and my anxiousness were inextricably linked.

The third predominant emotion that I felt is hard to classify according to Beck’s categories, but I suppose it might fit under “reality shock.”  Basically, I felt invasive and nosy, wanting to know every medical detail about people I had just met.  I am aware that as a nurse I need to know these things in order to take the best care of my patients.  Nosy is not really the right word to describe it.  But since it was my first day, and I knew nothing about anything, and my preceptor’s patients were not technically my patients, that is how I felt.  The concept of entering that intimate space between a patient and their family in a professional manner will take some getting used to for me, but that is the reality of nursing.  You meet someone, you find out what they need help with, and you help as much as you can to make them feel better.  Knowing the details is my job now.  Coming from a family that highly values privacy, this will be a challenge for me, but as I am entering a new profession and developing a professional identity, this is going to push me to see things in a new way.

It is this mindset of self-determination that is going to make or break my experience in this accelerated nursing program and my growth as a nurse.  There is a lot to learn in a very short amount of time, and I have to take control of each new learning experience.  I am learning that even these reflections are so important and valuable in helping me to work out my wants, needs, challenges, and victories, and I already feel like I have a firmer grasp on what I have accomplished and where I need to go from here.  As far as accomplishments go: I made it through my first clinical day without seriously injuring anybody; I got some hands-on experience with vital signs, PPE, bed baths, changing bedding, conversing with patients and their families, and simply spending 8 hours on the floor; I held a patient’s hand when an uncomfortable procedure was being performed, and I felt like I helped make the experience better; I recognized some of the medications that patients were getting; and I left the hospital with a stronger appreciation for the profession I am entering and a will to do better the next week.

I know that nursing is not an easy profession.  I also know that I am young and unlike many of my classmates who have had previous professions, I am still developing my professional identity.  While continuing to monitor my own progress and tune into how I am feeling through these reflections, I think it is an important goal for me to continue to focus on the patients themselves while I am in the hospital.  How I present myself as a professional directly affects the patients who come to the hospital to get nursing care.  Even if I am a scared, naïve nursing student, I can still take some slow, deep breaths and walk into my patient’s room with a calm attitude and a will to learn.  I can make a larger effort to communicate to the patient that I am still learning – I think this will help put both of us at ease.  And most of all, I can keep asking questions, because this will only help me to be more prepared with every new day.

I hear over and over again that nursing is about getting comfortable being uncomfortable.  Embracing that will be the greatest challenge but also the key to my success.  I can dream of being a super-nurse, but I have to put in the work first, and that will inevitably involve a lot of discomfort and unpreparedness.

Beck, C.T. (1993). Nursing students’ initial clinical experience: a phenomenological study. International Journal of Nursing Studies, 30(6), 489-497.


Ruby Engreitz

Ruby Engreitz is a Northwest native, a former collegiate athlete, and a current nursing student in the Accelerated BSN program at OHSU. After graduating from the University of Washington with a degree in Psychology, spending some time working in delis and coaching gymnastics, and doing a whole lot of soul searching, she has ended up in Portland, diving into the methodical melee of the healthcare world. In her limited spare time she enjoys being active outdoors, baking cookies, and exploring her new, quirky city.


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