Care Plans an Exercise in FUTILITY?????? - page 4

: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   Dixiedi
    Quote from 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
    in home care we only see 1 or 2 pts at a time, that is not all we are responsible for! my agency has hundreds of pts and each has to have the care plans up to date.
    i agree with the same thing over and over again. we all know what's there for the female pt with an indwelling cath. what's there for mrs. smith? know what i mean?
  2. by   kids
    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 the same feelings about care plans (except I've been a nurse for 14 years). In my experience all disiplines were responsable for initiating and updating "their" problems (nursing, dietary, PT/OT/ST, Psych).

    The acute (hospital) care plans I have seen cared for a problem not the person. LTC has far more focus on the individual. In LTC you can have all the common sense and experience with caring for a CVA patient, it is the care plan who tells you how to take care of that specific CVA patient or how to tell the CNAs how to care for that patient.

    And no, I didn't read all my patients care plans every day but I can be pretty confident I reviewed each one at least oncea week. And they don't sit "ignored" for 6 months at a time, my State mandates far more frequent care plan reviews and MDSs.
  3. by   mscsrjhm
    In over 20 years of nursing, over 12 years agency, I have never seen anyone do anything with a care plan other than gather the papers on admission, and only because it is part of the admission procedure. NEVER. The Kardex and report is our lifeline. If the care plan is so important- why have I never seen anyone use it? NEVER.
  4. by   mscsrjhm
    Having worked in 3 states, two major cities, and over 20 hospitals, including nursing homes, doctor's office, prisons. I have never worked L&D, dialysis, or OR. NEVER seen them used. (I keep repeating this, because it baffles me also.)
  5. by   Destinystar
    THANK YOU. I AGREE.AN EXERCISE IN FUTILITY (HOWEVER NECESSARY AND MANDATED BY LAW IT IS)
    Quote from Mschrisco
    In over 20 years of nursing, over 12 years agency, I have never seen anyone do anything with a care plan other than gather the papers on admission, and only because it is part of the admission procedure. NEVER. The Kardex and report is our lifeline. If the care plan is so important- why have I never seen anyone use it? NEVER.
  6. by   Dixiedi
    Quote from Destinystar
    THANK YOU. I AGREE.AN EXERCISE IN FUTILITY (HOWEVER NECESSARY AND MANDATED BY LAW IT IS)
    The really irritating thing about care plans in home care is they only get review/updated for each certification period. So much can change in that time that they very often become nearly useless. We don't have a kardex to look at, we have a communication book. That's a huge laugh! You look at that and see things like "great day". Rarely, do you see anything about new orders that will alter the plan of care!
  7. by   Destinystar
    it is impossible in ltc when there is 1 rn for up to 120 patients or so to formulate a nsg dx, formulate a care plan teaches the pt. & family how to care for the pts needs, delegates tasks to subordinates, evaluates the effectiveness of the care plan, modifies the care plan and perform assessments.

    the above mentioned items are only under the rn authority under scope (in the state of california). not to mention all of the care plan conferences she-he must attend, the mds that have to be completed, the raps that have to be written etc. since the rap's stand for "resident assessment protocals" it would fall under the rn scope.

    in light of staffing patterns in ltc this seems like an unreasonable burden for any rn to carry
  8. by   Dixiedi
    Quote from destinystar
    it is impossible in ltc when there is 1 rn for up to 120 patients or so to formulate a nsg dx, formulate a care plan teaches the pt. & family how to care for the pts needs, delegates tasks to subordinates, evaluates the effectiveness of the care plan, modifies the care plan and perform assessments.

    the above mentioned items are only under the rn authority under scope (in the state of california). not to mention all of the care plan conferences she-he must attend, the mds that have to be completed, the raps that have to be written etc. since the rap's stand for "resident assessment protocals" it would fall under the rn scope.

    in light of staffing patterns in ltc this seems like an unreasonable burden for any rn to carry
    ya know, you sound as if you think the lpns out there on the floor aren't able to inpput anything useful. in my experience, the lpn inputs the info and the rn goes ahead and makes it so on the care plan. after all, you really can't do it all by yourself. that means you should get help! your lpns know how to formulate a nursing diagnoses, and they surely know the pts better than you do! why are you wasting your resourses?
  9. by   kids
    Quote from destinystar
    it is impossible in ltc when there is 1 rn for up to 120 patients or so to formulate a nsg dx, formulate a care plan teaches the pt. & family how to care for the pts needs, delegates tasks to subordinates, evaluates the effectiveness of the care plan, modifies the care plan and perform assessments.

    the above mentioned items are only under the rn authority under scope (in the state of california). not to mention all of the care plan conferences she-he must attend, the mds that have to be completed, the raps that have to be written etc. since the rap's stand for "resident assessment protocals" it would fall under the rn scope.

    in light of staffing patterns in ltc this seems like an unreasonable burden for any rn to carry
    sounds like a problem specific to california (and maybe some other states as well) or specific to some facilities.

    while the rap falls under the rn scope, the gathering of information does not and unless the patient has had a significant change of condition there is absolutely no reason to re-invent the wheel when doing the careplan.

    i worked as the mds coordinator for the 116 ltc beds at a 160 bed facility. that works out to about 6 hours per patient per quarter.
    if the charting was an accurtate reflection of what was going on with the patient (and the other disciplines did their portions on time) it was more than adequate.
  10. by   Destinystar
    unfortunatly in california title 22 california code of regulations states in section 70215.(b) that "the lvn does not have the statutory authority to formulate a nursing diagnosis, etc". you can get this info from the cna (california nurses association) website. when i see licensed nurses both lvn & rn with anywhere from 30-60 pts. to give meds, tx, weekly charting, daily charting, etc. & with our severe staffing shortage and call offs they might have the knowledge but not the time. i would be interested in hearing from nurses from other states and how there nursing practice act treats this process.
    Quote from dixiedi
    ya know, you sound as if you think the lpns out there on the floor aren't able to inpput anything useful. in my experience, the lpn inputs the info and the rn goes ahead and makes it so on the care plan. after all, you really can't do it all by yourself. that means you should get help! your lpns know how to formulate a nursing diagnoses, and they surely know the pts better than you do! why are you wasting your resourses?
  11. by   Destinystar
    the care plan process is confusing to me. maybe you can clarify some issues since you have a lot of experience with them. in obra it is refered to as an interdisciplinary care plan. just states the rn must coordinate it that of course is a federal regulation. i dont know about your state but in california the state regulations (title 22) states that lvns are limited to writing whatever interventions they are responsible for on the care plan and only rn's can formulate nursing diagnoses. in spite of that it is common practice in the ltc in california for dietary supervisors, activity directors, & social service designees to be writing care plans. i mean nursing diagnoses, goals and interventions. lvn's write them to.
    Quote from kids-r-fun
    sounds like a problem specific to california (and maybe some other states as well) or specific to some facilities.

    while the rap falls under the rn scope, the gathering of information does not and unless the patient has had a significant change of condition there is absolutely no reason to re-invent the wheel when doing the careplan.

    i worked as the mds coordinator for the 116 ltc beds at a 160 bed facility. that works out to about 6 hours per patient per quarter.
    if the charting was an accurtate reflection of what was going on with the patient (and the other disciplines did their portions on time) it was more than adequate.
  12. by   ErinR
    Quote from Dixiedi
    Ya know, you sound as if you think the LPNs out there on the floor aren't able to inpput anything useful. In my experience, the LPN inputs the info and the RN goes ahead and makes it so on the care plan. After all, you really can't do it all by yourself. That means you should GET HELP! Your LPNs know how to formulate a nursing diagnoses, and they surely know the pts better than you do! Why are you wasting your resourses?
    My LPN's and RN's on the floor are scared to death of the careplans because the surveyors pick them to death and then someone gets the finger pointed at them. I don't really blame them. They are quite capable of the task, but so overloaded they don't have time. I am a part-time MDS Coordinator, CRNAC, in a small rural facility of 54 beds. I depend on the copy of the telephone order to keep up with the daily changes. My hours in the facility are based on the current number of residents in house, so I may be out of the facility for 4-5 days at a time. My floor nurses make extra notes to me on my copies of the TO that help me a lot to keep up with resident changes. I am very grateful for what they do and try to extend to them my appreciation regularly. Input from SS is another story. Like pulling teeth.
  13. by   missmercy
    Care plans are SUPPOSED to assist nurses in providing CONSISTANT care for patients across shifts, days etc...... Great idea in theory -- in practice, while they are nurse driven, independent from physicians orders and can provide specific , individualized road maps for patient care --they have become cumbersome, and often ignored. Nurses are so busy doing the tasks that we have piled on top of us that the care plan issue feel like extras. In truth, care plans outline thing we can do without haveing to wait for a doctor to get back to us, things we do not have to wait for someone else to approve prior to initiating it! They have the potential to be a great source of evidence in favor of the professional role of the nurse. I think we need to find a way to streamline care plans as a whole -- they are time-consuming. Many facilities have computer careplans that will spit out a form for the nurse based on what nsg, dx is entered -- that weems to trim some of the excess time --

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