Are care plans valuable?

JustBeachyNurse, LPN · Jul 22, 2015

I work home care/private duty. Care plans are are base of operations. But our clinical nurse managers are diligent about updating the plan of care as needed and not just resubmitting the same stuff every 60 days. Goals are frequently adjusted as our pediatric clientele grow and change. Infant/toddler safety precautions are no longer appropriate for the elementary school child that no longer is in the oral stage and walks with supervision so goals are changed to fall/ambulation/environment safety b

Here.I.Stand, BSN, RN · Jul 22, 2015

For myself, days when I don't update the written care plan (EMR section specifically labeled "cate plan") are days when I didn't have time to chart anything during my shift except drip titration which I do in real time, barely had time to scarf down a meal, and am looking at staying over to finish charting. Those days I do the minimum necessary charting because my time is valuable. I want to go home--not pour over Epic w/ a fine tooth comb.

Now of course I critically think and plan care appropriate to the situation. Take the issue of risk for impaired skin integrity. The LAL mattress, cervical collar care, and repositioning of ETT is already documented in the PCS. The q 2 hr repositioning, pillow under heels, changed electrode/sat probe site, etc. is already documented in the VS/infusions flow sheet. So now I'm working past 2330; do I want to spend time double charting--it's not a matter of "if it wasn't documented, it wasn't done," because I did chart what I did for the skin; or do I want to go home? Not a difficult choice.

Bobjohnny · Jul 22, 2015

Quite honestly when I worked an inpatient unit, I not only thought that care plans didn't contribute to patient care I think they took away from it. The time that I spent working on care plans I could have spent actually with my patients, or ensuring that orders were completed. There are literally at least a dozen things that were more pertinent to patient care than a care plan.

kidsmom002 · Jul 22, 2015

On my postpartum unit our care plans are really just busy work. Most of the nurses have standard comments they can just click into the care plan, no thought there really and they do not guide care. We had never had care plans until we went to computerized Epic training and we managed just fine and provided the exact same care. To me the care plans are just another thing keeping me at the computer charting when I could be taking care of patients.

OCNRN63, RN · Jul 22, 2015

Care plans are fine when you're in nursing school because they help you learn how to think critically. Once you've actually been working for a while, they become busy work.

If we could ditch the frou-frou verbiage, courtesy of NANDA, and make them more concise, then maybe there could be a place for them.

cardiacfreak, ADN · Jul 22, 2015

In theory care plans are important, they are suppose to be driving the care....blah blah blah. In reality, most days I don't have time to update and I just click "care plan reviewed".

dream'n, BSN, RN · Jul 22, 2015

On my acute unit, care plans are useless and a huge waste of time.

Dranger · Jul 22, 2015

I do them every shift, not because I find them valuable (although I do put thought and detail into "not progressing" tabs") but because I am OCD and like seeing all green on my EPIC patient view list . Haha

nurseprnRN, BSN, RN · Jul 22, 2015

I review medical records for legal purposes. I want to tell you that someday, someone will be reviewing the charting and the care plans you have on record. I have reviewed records for LTC, AL, OB/L&D, critical care, home health, and garden-variety med/surg. Do not ever think that your charting, including your documentation of an RN-determined plan of care to be delivered or delegated, is a waste of time. It can save your butt ... or have it in a helluva sling. Your call.

But don't just do it out of fear. Do it because it documents your worth. Yes, it does. When the atty comes a-calling on your risk manager and s/he is at ease when he does because s/he knows your care is awesome, be sure s/he can back that up with good documentation. And if your documentation sucks because the system they make you work with sucks, agitate. If you were a fine finish woodworker, you wouldn't be able to make beautiful furniture with lousy tools.

nurseprnRN, BSN, RN · Jul 22, 2015

Care plans are fine when you're in nursing school because they help you learn how to think critically. Once you've actually been working for a while, they become busy work.
If we could ditch the frou-frou verbiage, courtesy of NANDA, and made them more concise, then maybe there could be a place for them.

For what it's worth, if you are remembering the old NANDA from when we old bats were in school, you don't know what it's like now. This, the current NANDA-I, is not your mama's NANDA. It's very concise, clear, and much more user-friendly. It is a great tool for teaching students for the reasons you mention; it's also a great tool for justifying what you do when the atty comes calling, too.

OCNRN63, RN · Jul 22, 2015

For what it's worth, if you are remembering the old NANDA from when we old bats were in school, you don't know what it's like now. This, the current NANDA-I, is not your mama's NANDA. It's very concise, clear, and much more user-friendly. It is a great tool for teaching students for the reasons you mention; it's also a great tool for justifying what you do when the atty comes calling, too.

If it's anything like the nursing dx. I see students posting here, no, it's not concise.

You can write care plans that are so wonderful they could win a Pulitzer Prize. But if you don't follow through and actually provide the care, those care plans aren't worth a wooden nickel.