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

[Destinystar]

: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 about getting report, or reading the assignment board.

Yes the RN nursing practice act mandates that we formulate one, and the state and federal regulations mandate that we develop one as well. Most of the care plans just duplicate what is already built into the standards of care, & the MD orders.

Do you think that the care plans in the residents medical records have a significant impact on the way you deliver nursing care?:uhoh21:

[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:uhoh3:

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! :)

[Dixiedi]

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.

[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

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.

[Dixiedi]

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?

[kids]

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.

[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.

[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.)

[Destinystar]

THANK YOU. I AGREE.AN EXERCISE IN FUTILITY (HOWEVER NECESSARY AND MANDATED BY LAW IT IS):)

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.

[Dixiedi]

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!

[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:rolleyes: :rolleyes:

[Dixiedi]

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:rolleyes: :rolleyes:

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?

[kids]

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:rolleyes: :rolleyes:

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.