are care plans a joke for you?

[MoopleRN]

so much emphasis was placed on them when i was a student. i enjoyed the challenges of writing individualized/relative/practical care plans back then even though i realized what was required of us to write was unrealistic in the real world. it was a just another student-hoop we had to jump through and i jumped like all the other students.

bam! real world! i work in a hospital and care plans are a pre-chewed and spit-out part of the software we use to document. there are some basic diagnoses to choose from and their complementing, basic interventions. 2nd shift is responsible for keeping them current (goal met/goal not met/continuing). other shifts may chart on them.... and of course other shifts don't.

what's your opinon on care plans/how you're required to write/document them at your facility? do they make an impact on patient care?

[clhRN2b2010]

I am interested in the replies he too. I just held a conversation with a fellow student who clued me in on the "fact" that the care plans we write in school are archaic and should be done away with and replaced with something that resembles what actually happens in the real world.

What would a better system look like? What sorts of things should we be learning from the current system?

[elkpark]

Please keep in mind that the nursing care plans written in school are an educational tool -- to help you learn to think about client's needs, priorities, appropriate interventions, evaluation of progress, etc., and to give your instructors a way to see how you're thinking about client's needs and appropriate nursing care and give you feedback on how you're doing with that process.

There are many, many things you do in nursing school that are different from actual nursing practice in the "real world" -- that's because learning to be a nurse is different from being a nurse.

[NurseCherlove]

They are a complete flippin' joke and total waste of my time. In fact, I don't even do them half the time. We have computer charting at my facility where you can chart your interventions and areas of focus, etc. Why should I have to basically double-chart on these stupid little pieces of paper that tell me how to think as a nurse? I AM a nurse, so I don't think I need to prove my thought processes as to how I arrived at doing X intervention for a patient.

[MoopleRN]

Please keep in mind that the nursing care plans written in school are an educational tool -- to help you learn to think about client's needs, priorities, appropriate interventions, evaluation of progress, etc., and to give your instructors a way to see how you're thinking about client's needs and appropriate nursing care and give you feedback on how you're doing with that process.

There are many, many things you do in nursing school that are different from actual nursing practice in the "real world" -- that's because learning to be a nurse is different from being a nurse.

I agree (and thank you for that reminder). I also think that since RNs (who are responsible for writing care plans/updating them) should not be restricted by the software their facility uses. It seems to me that at my facility, we're doing our care plans so the Joint Commission doesn't slight us, not because they are a worthwhile component to our patients' care. It also bothers me that something that was so important in school is so scoffed at (in my experience) out of school (but again, I do agree with you, it was an invaluable tool for us as students).

[MoopleRN]

They are a complete flippin' joke and total waste of my time. In fact, I don't even do them half the time. We have computer charting at my facility where you can chart your interventions and areas of focus, etc. Why should I have to basically double-chart on these stupid little pieces of paper that tell me how to think as a nurse? I AM a nurse, so I don't think I need to prove my thought processes as to how I arrived at doing X intervention for a patient.

Exactly. The great majority of the interventions we do are so basic/inherent that it seems redundant to chart them. Charting outcomes of those interventions needs to be done but that's going to get done anyway (or should).

[S.T.A.C.E.Y, LPN]

I agree, careplans were just another hoop to jump through in nursing school. A way to learn how to be a nurse. Now that I work in the ER I haven't seen or done a single careplan in over a year! YAYYYYYY! Maybe they're done up on the floors, but for sure not done in the emerg.

[Wsmith16, ADN, BSN]

As a student with no medical experience. Even though I find the endless careplans to bed a pain in the.....

It nonetheless is a wonderful tool for student because it reinforces the basic interventions that you need to know. From an educational standpoint they are a necessity.

Once you hit the floor and your a nurse you don't need 'em as they've already served their purpose.

[bluefabian]

Do we even have time for care plans now?

Four years plus nursing experience, not a single care plans done!!!

But if you ask me about nursing notes, ultrasound orders, radiology, labs, consent, doctor's notes, separate questionnaire on top of checklist for each different types of health screening, bed order, AOR discharge, triage, consumable.... I think I am overwhelmed.

Not another one of those paper that I don't use. Then again, that was ER.

[ktwlpn, LPN]

They are certainly a great tool in LTC-provided that all staff are encouraged to access the info,especially the cna's.The unit I work on now seems to have a high percentage of alert,oriented manipulative women.It's vital that we all are aware of their behaviors and are consistent with the plan of care both for the resident's well being and our job security.The DOH takes allegations of abuse very seriously-a few of these residents have come close to shoving a few staff members out the door with their game playing.

[jjjoy, LPN]

Some kind of explicit, point by point, care plan written as a learning tool makes sense. The kind of care plan I had to write for school often didn't feel like a very effective learning tool, though. We had to reiterate again and again and again the most basic of tasks and assessments. So 80% of the care plan would be the basics... ambulate, assist to toilet, assess for skin breakdown, turn-cough-deep-breath... and 20% might actually be something beyond those basics. It's absolutely important to remember those basics, but once it's taught and understood, I think it should only constitute maybe 10% of the work of formulating a care plan. After all, for the working nurse, such basic tasks will only make up a small portion of the day's work, and if there are nursing assistants, they do most of the hands on basic nursing care. And then care plans wouldn't have to be so long either and could focus on what's unique about the nursing care of different diagnoses. Yes, the nursing care of different medical diagnoses. Nurses cannot diagnose but are often working with patients with a known diagnosis that influences nursing care. Even if a patient is currently asymptomatic or not in acute crisis, when the nurse knows the patient has COPD or cancer or hypertension, etc, the nurse will base their care on the given medical diagnosis... and not solely upon their own independent nursing assessment of the patient.

[supafly]

they seem like a painfully inefficient way to learn rationales for interventions and the rest. i dont put much effort into them, unless i happen to come across something i find interesting or worthwhile.