Care Plans an Exercise in FUTILITY?????? - page 6

: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   Destinystar
    as far as my perspective on care plans is concerned it is from the stand point of ltc. in ltc we have federal regulations, the rn nursing practice act and the state regulations to deal with. in order for a care plan to be considered to be complete we have to do this 2 hour assessment called an mds, then we have to write care plans on priority problems, then within 3 weeks after admission have a complete one, in addition to care plan meetings initially that involve the resident and their responsible party and every three months. now imagine this you come to work on the noc shift and have 60 patients to take care of and this is your first day you are on this unit because you have to float to different units. you have 4 cna's. you have to do narcotic count for a ton of medication. take the daily report, then tend to residents who are crying out in pain, iv is empty, ngt empty, make assignments, chart etc. for 60 residents!!! where are you going to find the time to read all of the care plans on all of the residents and communicate this to all of your cna's. even if you read the care plans it is not like you have any idea who some of these residents are or are going to recall every thing you read. this is in addition to reviewing the md orders. i am not saying they are useless. i am saying we dont use them. therefore and exercise in futility.
    Quote from destinystar
    i did ltc nursing for 27 years and didnt enjoy it. couldnt do it anymore. would not recommend it. when it comes to ltc nursing takes on a whole new meaning.
  2. by   Destinystar
    that is exactly the point of my post. wouldnt our time be better spent on a task that actually benefitted the patients???i am not saying that care plans have a theory but when the outcome is no one is finding them useful doesnt this exercise in futility need to be addressed??? dont we need to think outside of the box?? doesnt something need to change??? most of our ability to care for patients come from on the job experience. once we learn the skill and practice it over and over again we dont need to look at a care plan to spell out what needs to be done. like if someone is in a coma any body on staff ought to know to turn and repostition, the patient q 2h and to perform adl's why in the heck in long term care are we required to state the obviouse in a care plan??? if someone is a diabetic the md orders and mar plainly spell out what needs to be done for the patient and when to call the md, so why duplicate the effort and write it in a care plan??? when i write nursing care plans reminds me of giving instructions to a student to someone who has no experience.
    Quote from katern
    care plans are meaningless wastes of time. they don't mean anything, and their only purpose is to generate more points when jcaho comes.
    i fill mine out everyday because we're supposed to, but they don't influence my nursing care at all. especially because most of them have information about prescribing meds in them. i'm not going to say to the docs, "excuse me? as you can see here on the care plan, it is day #3 on the 'acute coronary syndrome pathway' and this patient is not on an ace inhibitor. don't you think they need to be on one?" they would look at me like i had three heads. patients would get much better care if nurses didn't have to spend hours doing worthless paperwork.
  3. by   Jailhouse RN
    A Major League Waste Of A Good Nurses Time. Do You Not Assess Daily? Do You Not Make Regular Rounds? Do You Not Talk To Your Pts?
  4. by   mscsrjhm
    Quote from destinystar
    that is exactly the point of my post. wouldnt our time be better spent on a task that actually benefitted the patients???i am not saying that care plans have a theory but when the outcome is no one is finding them useful doesnt this exercise in futility need to be addressed??? dont we need to think outside of the box?? doesnt something need to change??? most of our ability to care for patients come from on the job experience. once we learn the skill and practice it over and over again we dont need to look at a care plan to spell out what needs to be done. like if someone is in a coma any body on staff ought to know to turn and repostition, the patient q 2h and to perform adl's why in the heck in long term care are we required to state the obviouse in a care plan??? if someone is a diabetic the md orders and mar plainly spell out what needs to be done for the patient and when to call the md, so why duplicate the effort and write it in a care plan??? when i write nursing care plans reminds me of giving instructions to a student to someone who has no experience.


    totally agree. sure is alot of wasted time busy work in nursing. maybe we could cure the nursing shortage if we got rid of some of the unnecessary administrative paperwork schmuck.
    perhaps we should simply point out these allnurses.com discussions so that someone in charge could see the waste.
    who is in charge?
  5. by   AMICRW
    Quote from destinystar
    as far as my perspective on care plans is concerned it is from the stand point of ltc. in ltc we have federal regulations, the rn nursing practice act and the state regulations to deal with. in order for a care plan to be considered to be complete we have to do this 2 hour assessment called an mds, then we have to write care plans on priority problems, then within 3 weeks after admission have a complete one, in addition to care plan meetings initially that involve the resident and their responsible party and every three months. now imagine this you come to work on the noc shift and have 60 patients to take care of and this is your first day you are on this unit because you have to float to different units. you have 4 cna's. you have to do narcotic count for a ton of medication. take the daily report, then tend to residents who are crying out in pain, iv is empty, ngt empty, make assignments, chart etc. for 60 residents!!! where are you going to find the time to read all of the care plans on all of the residents and communicate this to all of your cna's. even if you read the care plans it is not like you have any idea who some of these residents are or are going to recall every thing you read. this is in addition to reviewing the md orders. i am not saying they are useless. i am saying we dont use them. therefore and exercise in futility.
    i loved long term care, i'd still be there if i could physically do the care. after 40 years of nursing my "old self" just can't hack it anymore. i wish that they would have types like myself to enforce the care that people should be getting, you know tackling the dr relations so that protocol wouldn't be a who is right so much as what is right and that is mandated to be done. sometimes it is an ego fued. one would think that 'we' would be past that by now! ltc is unique and not for everyone. hope you found your nitch! amicrw
  6. by   Destinystar
    i stay home and take care of those who are the closest to my heart and mean more to me than anything else in the world. my children. being a mom was my calling. i also work part time for a pediatric neurologist. a thousand wild horses could not drag be back into ltc.
    Quote from amicrw
    i loved long term care, i'd still be there if i could physically do the care. after 40 years of nursing my "old self" just can't hack it anymore. i wish that they would have types like myself to enforce the care that people should be getting, you know tackling the dr relations so that protocol wouldn't be a who is right so much as what is right and that is mandated to be done. sometimes it is an ego fued. one would think that 'we' would be past that by now! ltc is unique and not for everyone. hope you found your nitch! amicrw
  7. by   steve0123
    Care plans can be useful, so long as they are designed to serve a purpose (rather than just creating more paperwork). Where I work however, they are the biggest waste of paper since the National Enquirer went to print. We have a "checklist" system, and every shift come hell or high water we go through each patients plan and *tick* things like "frequency of obs" and so on (despite the fact the patient may just be a social admission - oh no Sister Smith, QID obs regardless...). The best system I have ever seen was where the care plans were incorporated into the clinical notes in much the same way the attending MO writes their notes (ie: patient history and assessment followed by plan of care). This way they are actually useful, relevant, and are a form of documentation for the care provided. I've also seen some of those Kardex systems in use, but found they can be fiddly and also they do not form part of the patients record.

    I think as nurses, we have a love affair with forms and paperwork with little check boxes and arrows and multiple choice questions and graphs and charts and so on... When it can all be achieved with minimal fuss by scribbling in the notes. Also - these clinical pathways are almost as bad (a mild improvement as they are slightly more relevant to the patients condition). They are a tool developed to reduce LOS which aint always a good thing - they fail to take into account comorbidities, the fact that each patient responds to illness differently, and that not all nursing care can be quantified and measured for the bean counters statistic purposes. Most of us are intelligent and knowledgeable in our areas of expertise - how about practising some of this "autonomy" we are told we have by using independent thought to formulate our own plans of care for patients... And thats all I have to say about that.
    Last edit by steve0123 on Jul 8, '04 : Reason: Just adding my $0.02c regarding clinical pathways
  8. by   Destinystar
    i could not agree with you more. when we identify a problem if we could just formulate a nursing diagnoses, write a goal, and write the interventions write there in the nurses note it would be so relevent & in a logical time frame. all this duplication of effort is a joke. the problem with fill in the blanks is you have to read the whole form including things that are irrelevant to the patient. yes this stuff is required but it does not contribute to the care we provide. now we have to assess and fill out all of those pain scales. i swear if you dont know how to look at a resident and know if they are uncomfortable or know if the pain med you gave was effective should you really be a nurse?? if you are not sure of something you need to look in a nursing manual not some handwritten care plan written off the top of someones head or copied from some book or generated by a computer. i dont think i have heard one nurse who has been out of school for more than 5 minutes state that they just couldnt function if it wasnt for those care plans and depended on them to provide care.
    Quote from steve0123
    care plans can be useful, so long as they are designed to serve a purpose (rather than just creating more paperwork). where i work however, they are the biggest waste of paper since the national enquirer went to print. we have a "checklist" system, and every shift come hell or high water we go through each patients plan and *tick* things like "frequency of obs" and so on (despite the fact the patient may just be a social admission - oh no sister smith, qid obs regardless...). the best system i have ever seen was where the care plans were incorporated into the clinical notes in much the same way the attending mo writes their notes (ie: patient history and assessment followed by plan of care). this way they are actually useful, relevant, and are a form of documentation for the care provided. i've also seen some of those kardex systems in use, but found they can be fiddly and also they do not form part of the patients record.

    i think as nurses, we have a love affair with forms and paperwork with little check boxes and arrows and multiple choice questions and graphs and charts and so on... when it can all be achieved with minimal fuss by scribbling in the notes.
  9. by   missmercy
    [the problem with fill in the blanks is you have to read the whole form including things that are irrelevant to the patient.
    [font=book antiqua]and doesn't that just clog up the reporting system, the time management idea, the concise, usefull picture!!!?
    yes this stuff is required but it does not contribute to the care we provide. now we have to assess and fill out all of those pain scales. i swear if you dont know how to look at a resident and know if they are uncomfortable or know if the pain med you gave was effective should you really be a nurse??
    [font=book antiqua]very, very good point!!! nursing should be based on learned skill -- not a cookbook -- however, as in cooking, it isn't bad to be able to glance at a recepie -- just to make sure you have all the necessary ingredients. care olans should be guides -- not clinical pathways that are etched in stone or useless computer print-outs with no specifics to the individuals-- unfortunately, that's how they usually end up.:uhoh21:

    [font=book antiqua]and in response to the comment that we nurses like check boxes and fill in the blanks -- isn't that sad? we could be so creative and such if we had not been trained to check the box and fill in the blank!! i think some physycian, in some cave -- while examining neanderthal -- decided that forms and careplans would tie nurses hands and give them less time to practice true nursing -- and "poof!" dreamed them up.
  10. by   AMICRW
    Quote from BRANDY LPN
    Nope, I think they were thought up by someone with entirely too much time on their hands and NO bedside experience.
    The reason that the MDS and Care Plans became such a focus was because MANY facilities were not doing or documenting findings of the assessments and rounds. Residents were found to have advanced stage pressure ulcers not previously documented. There were patients who were undernourished and dehydrated with no documentation of any decline.

    All the current documentation requirement may be overkill, but it wouldnt be THIS bad if it hadn't been THAT bad.
  11. by   Destinystar
    the last time i looked the mds was a tool to determine if residents qualified for snf level of care so that a facility could be reimbursed by medical and medicare (too many 0's meant they could be discharged to a lower level of care). hcfa stands for the health care fianancing act. you can write all the assessments, care plans and recommendations until christmas the only correlation there has been to a positive outcome is the nurse to patient ratio. the obra guidelines is what the federal government has established as a tool to site facilities that have residents with sentinel events, etc. the responsiblity that we have for assesssing and developing a plan of care for the residents has always been built into the rn nurse practice act. the only thing the feds did was to make the facility accountable in the form of regulations, fines, and sanctions for ltc that did not comply. i agree with the majority of the nurses that responded that the care plans have no impact on their delivery of nursing care. the fact that the facilities have started facing economic sanctions has.
    Quote from amicrw
    the reason that the mds and care plans became such a focus was because many facilities were not doing or documenting findings of the assessments and rounds. residents were found to have advanced stage pressure ulcers not previously documented. there were patients who were undernourished and dehydrated with no documentation of any decline.
    all the current documentation requirement may be overkill, but it wouldnt be this bad if it hadn't been that bad.
  12. by   rEAL nUT
    Quote from menaaaaaaaaaaaaaaa
    what I think it is that care plan is very important for the patient as well as for us. by care plan we will be able to give the right care for the patients as you know each patients need different care according to thier case, age...ect.

    so, we have to write it daily.
    To me it seems that care plans take more time away from pt care. I think it is a waste of my time to write down what a nurse should do if a pt has a fever or a foley catheter ect. We do write them at the hospital I work at, but noone ever reads them, we just go through the motions.
  13. by   Destinystar
    Maybe there could be a more effecient and effective way for nurses to document the nursing process
    Quote from rEAL nUT
    To me it seems that care plans take more time away from pt care. I think it is a waste of my time to write down what a nurse should do if a pt has a fever or a foley catheter ect. We do write them at the hospital I work at, but noone ever reads them, we just go through the motions.

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