Care Plans an Exercise in FUTILITY?????? - page 3

:uhoh21: I would like to know how many of you out there sit down and read each and every care plan on each and everyone of your residents each and every day before you start work? I am not talking... Read More

  1. by   julia@
    In my experience, all patients get the relevant care plans, they are not updated, and if you've had a busy shift, they make you late off
  2. by   Cubby
    Quote from TELEpathicRN
    In LTC we heavily rely on the care plan, they are extremely individualized and really give you a picture of each resident. No, we do not have time to sit down and read each and every care plan before we take care of a resident, but it is a good guidline. When I was in school I thought careplans were sooooo stupid, but after 7 yrs of nursing practice, I believe they help nurses develop thinking skills. Just my opinion....
    I have worked LTC for most of my career (close to 34 years) and the ONLY time I see a care plan is when I have to update them. They have no useful purpose as far as I can tell. I know my residents well enough to be able to treat what ever is going on with them without a care plan. Phooey on care plans. :angryfire
  3. by   Destinystar
    that is exactly my point after 27 years in ltc. i have written many (cause i had to) but have never neededto look at so much as 1 in my entire career. my post didnt ask if they are required i asked if they are needed. certainly not. i loved your post. instead of paying an rn to sit on her duff all day and write about the problems they could be paying 3 cna's to go out and fix the problems. writting more care plans wont improve pt. care, hiring more cna's. will!!!!!!!!!!:angryfire :angryfire [quote=cubby]
  4. by   Nemhain
    I'm a student who asked an RN recently how often she writes care plans or even looks at them (she's on step-down in a large hospital)....

    "Care plans?"...and then she just laughed.

    Oh, well.
  5. by   NRSKarenRN
    We have standard ones used that we check off. Home Care care plans are really individualized to fit our patients needs and are used by nurses who would follow me regarding exact type of dressing, when to change foley and type: silastic, or latex and GT change dates.

    I've walked into LTC facilities as perdiem staff in the 90's and those careplans really helped me know some patients individual "quirks"/needs.
  6. by   FrazzledRN
    [quote=destinystar]that is exactly my point after 27 years in ltc. i have written many (cause i had to) but have never neededto look at so much as 1 in my entire career. my post didnt ask if they are required i asked if they are needed. certainly not. i loved your post. instead of paying an rn to sit on her duff all day and write about the problems they could be paying 3 cna's to go out and fix the problems. writting more care plans wont improve pt. care, hiring more cna's. will!!!!!!!!!!:angryfire :angryfire

    i certainly am not being "paid to sit on my duff". i do not sit on my duff...i use the nursing process we were all taught....assess, plan, implement....etc..i am all over our building every day....the floor nurses call me when they have a question about a resident...or a med..etc..they also know i am there to start iv's and help with admits, etc.. it is wonderful in ltc to have staff that stick around and "know their residents"...fantastic....but alot of places have a high turnover rate and utilize agency staff...so for these people those "stupid" care plans are helpful...and i can be quite honest to say even though some of our staff have been there for years...they aren't the most motivated staff to even give a crap about individualized needs...and would not go the extra mile for the residents...so of course they aren't gonna be "bothered" reading the care plan. also if you didn't "pay someone to sit on their duff to do care plans"...then surveyors would have issue with the poor care plans and could lead to fines and facility issues that could affect everyone's job.

    more cna's are definitely needed everywhere in ltc...completely agree there. but your experience with care plan staff must not be very favorable....i know i work my butt off...i do work at home go in on thee weekends..i find med errors, and missed lab work and need for additional medical treatment..i call the doctors and set-up appointments, etc.....and have gotten my facility out of citations with the surveyors because i was able to find adequate documentation or a reasonable doubt for their issues...even those that had nothing to do with care plans...i worked every shift in that building as a charge nurse...(was charge for 7 years...care plans the last 3) so i know the staff and residents well....i have been in both jobs...and understand both sides....don't knock one if you have never worked it...it is time consuming, puzzling as they are forever changing the standards, and frustrating because of others that do not understand what you do and assume you are doing nothing.... :angryfire ....ultimately we are all there to help the residents. kudos to you for being a great staff member that knows their residents well...you are a valuable asset to your facility, but for every one of you there are 10 that are new or temporary...and do not know those residents and may find a care plan useful in their job.
  7. by   Destinystar
    i agree that nurses like you work very hard to produce a quality care plan that could improve the care of the residents if they were followed. i agree that there are nurses out there like you mentioned such as new employees and registry nurses who could benefit from them. i agree that it is in the rn scope of practice to utilize this process lest we be deemed incompetent.
    i have a question for you. would you say that when the nurses report to work do the rn's, lvn's, & cna's go to all of the residents care plans that they have been assigned to so that they are aware of their problems, new problems, and the interventions they are responsible for implementing? in california according to the code of regulation they are supposed to.
    our responsibilities as rn's dont end with writing the care plan we are also responsible for & i quote section 70215 of title 22 (ca) "a rn shall directly provide the planning, supervision, imlementation, and evaluation of the nursing care provided to each pt.. the implementation of nursing care may be delegated by the rn responsible for the pt. to other licensed nursing staff, or may be assigned to unlicensed staff subject to any limitatin of their licensure, certificatin, level of validated competency, &/or regulation."

    sorry, but in my experience i did not find the care plans being utilized the way they were intended and found the whole process fustrating. when i developed them and no one consitently read or followed them i told my self "this is an exercise in futility".
  8. by   CapeCodMermaid
    The SNF I work in now has 2 kinds of care plans...the ones in the chart that the state and federal government say we MUST have. The other ones are in a kardex...very specific information about each patient on the floor that is updated at least once a day. The nurses use it to give report to the CNA's. I am a new employee there...the nurse manager of the sub-acute unit, and I use it every day. I have only looked at the "required" care plans one time.
  9. by   FrazzledRN
    Quote from CapeCodMermaid
    The SNF I work in now has 2 kinds of care plans...the ones in the chart that the state and federal government say we MUST have. The other ones are in a kardex...very specific information about each patient on the floor that is updated at least once a day. The nurses use it to give report to the CNA's. I am a new employee there...the nurse manager of the sub-acute unit, and I use it every day. I have only looked at the "required" care plans one time.
    I agree Kardexes are great!! I wish we could use these.....we tried them for awhile but they weren't updated very well...too many things left off...only certain nurses took the time to update them....unfortunate....They are a great tool!
  10. by   FrazzledRN
    Quote from destinystar
    i agree that nurses like you work very hard to produce a quality care plan that could improve the care of the residents if they were followed. i agree that there are nurses out there like you mentioned such as new employees and registry nurses who could benefit from them. i agree that it is in the rn scope of practice to utilize this process lest we be deemed incompetent.
    i have a question for you. would you say that when the nurses report to work do the rn's, lvn's, & cna's go to all of the residents care plans that they have been assigned to so that they are aware of their problems, new problems, and the interventions they are responsible for implementing? in california according to the code of regulation they are supposed to.
    our responsibilities as rn's dont end with writing the care plan we are also responsible for & i quote section 70215 of title 22 (ca) "a rn shall directly provide the planning, supervision, imlementation, and evaluation of the nursing care provided to each pt.. the implementation of nursing care may be delegated by the rn responsible for the pt. to other licensed nursing staff, or may be assigned to unlicensed staff subject to any limitatin of their licensure, certificatin, level of validated competency, &/or regulation."

    sorry, but in my experience i did not find the care plans being utilized the way they were intended and found the whole process fustrating. when i developed them and no one consitently read or followed them i told my self "this is an exercise in futility".
    in response to your question....no...i am quite sure that noone reads the care plans that they are responsible for....but for the most part....the basis of the plan of care is being implemented...as nurses and staff deliver their care. if there is anything specific that i want staff to be aware of or to stand out i will leave messages on the stna flowsheets, mar/tar's etc..where they would be seen and (hopefully) read. yes, i agree...with your exercise in futility theory.....but....i continue to try to make them more important and useful in my building...so my job won't seem so futile....that is all anyone can do.....these things (care plans) are mandated to be done...we should all make the best of it and try and use them for what they were originally intended for...and maybe make them a useful tool for the facility. unfortunately it makes a lot more work for the already overworked nurses, especially those in the facilities that have to do their own and try and keep them updated while attempting to give quality care to the residents....quite a feat and hats off to all who are able to do that! i will continue to try and make these care plans worthwhile since that is my job to do, and hopefully help the staff and ultimately the resident's care. thanks!
  11. by   Destinystar
    if you read the nurse practice act (at least the one in california) for rn's it is unbelivable how much responsiblity falls on an rn's shoulders. since we also work with don's who are rn's it is anybodys guess who is ultimatly responsible for all the lvn's and cna's that we are supposed to be supervising. lord only knows outside of the mds care plan coordinator, most know little if anything about the care planning process. i dont think that the nursing practice act, obra, state regs. are very realistic in terms of the way a ltc is set up sometimes with one don, one rn (the mds coordinator) for as many as 300 pts. with the rest of the staff being lvn's & cna's. according to all of these regulations it is only in the rn nursing practice act to formulate nursing diagnoses, develop the care plan, etc. and of course to delegate the interventions to the rest of the staff and to make sure all of the interventions get done and to evalute them. seems very unreasonable if not impossible. no wonder why you are so frazzled. and the dept. of health is more concerned that the care plans are written and in place than if all those interventions are actually getting done. then all of the cna's checking off the box that they changed a pt. q2h. lord knows how often they work short and it is bs that all of the cna's change a resident within 2h all of the time. but if you read their documentation thats what it states. end of rant
    Quote from frazzledrn
    in response to your question....no...i am quite sure that noone reads the care plans that they are responsible for....but for the most part....the basis of the plan of care is being implemented...as nurses and staff deliver their care. if there is anything specific that i want staff to be aware of or to stand out i will leave messages on the stna flowsheets, mar/tar's etc..where they would be seen and (hopefully) read. yes, i agree...with your exercise in futility theory.....but....i continue to try to make them more important and useful in my building...so my job won't seem so futile....that is all anyone can do.....these things (care plans) are mandated to be done...we should all make the best of it and try and use them for what they were originally intended for...and maybe make them a useful tool for the facility. unfortunately it makes a lot more work for the already overworked nurses, especially those in the facilities that have to do their own and try and keep them updated while attempting to give quality care to the residents....quite a feat and hats off to all who are able to do that! i will continue to try and make these care plans worthwhile since that is my job to do, and hopefully help the staff and ultimately the resident's care. thanks!
  12. by   Dixiedi
    Quote from dhudzinski
    IN home care they are invaluable. It directs our care each and every visit and is how we get reimbursed for our services. If it is not in the care plan we don;t get paid. The nursing care plan also assists when another nurse needs to go out and see your patient.

    And the nursing care plan is only as good as the nurse who writes it. Most nurses never learned how to really write an effective nursing care plan. I teach nursing students and my students know how to write a realistic nursing care plan by the end of the semester.
    As I read the many entries I also thought of home care, my current field.
    Ours look like they were stamped from some big book. There is so much on them that it is difficult to find the particulars for an individual pt.
    Yes, we do have to have them to get paid! So, it's a catch 22.
    When you walk into a home you already know the genreal care required just because of the diagnosis (or multiples) so what's really important is what is specific to this pt. Alas, it also gets lost in the multi-page care plans.
    Bummer. We've got to come up with a better way than the traditional care plan.
  13. by   Destinystar
    if you home care folks have little bit of trouble using them for one pt. can you imagine us long term care folk rn's who write them for as many as 120 pts. and us long term nurses who have as many as 30-60 pts. or more assigned to us. it is just a lot of dupication of effort to have to write them. i do understand why we need to utilize the nursing process to take care of a pt. but why do we in long term care have to write the same things over and over again for resident who are incontient, immobile, etc?? cant there just be a standardized care plan that staff can refer to if needs be and then just use a kardex to write down info that only pertains to that pt?? would save a lot of time and make more sense. 1/2 the stuff written in care plans isnt even by a nurse and doesnt even meet the standards of care.:stone
    Quote from dixiedi
    as i read the many entries i also thought of home care, my current field.
    ours look like they were stamped from some big book. there is so much on them that it is difficult to find the particulars for an individual pt.
    yes, we do have to have them to get paid! so, it's a catch 22.
    when you walk into a home you already know the genreal care required just because of the diagnosis (or multiples) so what's really important is what is specific to this pt. alas, it also gets lost in the multi-page care plans.
    bummer. we've got to come up with a better way than the traditional care plan.

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