Care Plans an Exercise in FUTILITY??????

DG5 · Jun 18, 2004

FrazzledRN has a point. The thing is, it sounds as if the facility where she works has made it a priority to staff properly. If we all had the time to pour through each and every care plan, update them, and direct staff accordingly, it would be a perfect world. We fought for an extra team member to do just that and we finally got them whose job was only to do the care planning, sit in reviews, update and follow up and make sure the care plans got implemented. But when one went on maternity leave, and the other resigned to take up another position, they never got replaced and the positions just evaporated into thin air.

FrazzledRN · Jun 19, 2004

FrazzledRN has a point. The thing is, it sounds as if the facility where she works has made it a priority to staff properly. If we all had the time to pour through each and every care plan, update them, and direct staff accordingly, it would be a perfect world. We fought for an extra team member to do just that and we finally got them whose job was only to do the care planning, sit in reviews, update and follow up and make sure the care plans got implemented. But when one went on maternity leave, and the other resigned to take up another position, they never got replaced and the positions just evaporated into thin air.

Yes, we do have full time MDS staff, as do most of the facilities in our area. It is a prime target for State and unless you want to invite surveyors to cite you...it should be made a priority in buildings...is unfortunate...and I agree an exercise in futility for staff that has to try and do it along with their other job duties. I know it is a full time job for myself and another RN for a 120 bed skilled facility. Very time consuming....I am salaried and do not get paid for all of the overtime that I do. Also the surveyors in our buildings dissect those care plans...so it behooves facilities to make an effort to make care plans and MDS's important...like I said ideally isn't reality all of the time.... :uhoh21:

julia@ · Jun 19, 2004

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 :uhoh3:

Cubby · Jun 19, 2004

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

Destinystar · Jun 19, 2004

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 :balloons: :angryfire

Nemhain · Jun 20, 2004

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.

Home Health Columnist / Guide · Jun 20, 2004

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.

FrazzledRN · Jun 20, 2004

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 :balloons: :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.

Destinystar · Jun 20, 2004

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". :uhoh3:

CapeCodMermaid, RN · Jun 20, 2004

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.

FrazzledRN · Jun 22, 2004

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!

FrazzledRN · Jun 22, 2004

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! :)