Care plans are stupid.

hiddencatRN, BSN, RN · Feb 16, 2011

They are not necessarily stupid but rather informational. You will NEVER do another one the rest of your life in the real world. They just try to get you to think about what is going on with the patient and put things together. Good luck the rest of the way

We do care plans on every one of our patients on the floor. They're not as complex as what we did in nursing school, but we use NANDA diagnoses and list out some general interventions. We have a few premade ones (post surgical and asthma for example) but patients often require one made from scratch.

CCL RN, RN · Feb 16, 2011

They are not necessarily stupid but rather informational. You will NEVER do another one the rest of your life in the real world. They just try to get you to think about what is going on with the patient and put things together. Good luck the rest of the way

I hate care plans and think they are stupid. However; they are required on every pt in our hospital, and EVERY hospital I've worked at in the last 15 years.

We even do them in the cath lab. Every patient. Every day. Real world.

G in Scrubs · Feb 16, 2011

I hate NANDA; it's not as relevant to the patient. It would be easier if nurses and doctors just went by the same format. It's quite annoying that can't put an actual diagnosis, when it is the very diagnosis dictating the care required. Since I started work, I noticed nurses don't use NANDA. We have some pre-made "Alteration in Respiratory Status" care plans, but the rest we make up on our own as relevant to the patient. I like reading MAPs at work though as they help me predict the course of care of the patient. I also find shift comments more relevant than DARPS at times.

Despareux · Feb 16, 2011

I am in my 2nd semester of nursing school and I am convinced that writing care plans has taught me more about how to care for my patients than reading through a 2000 page book. But I still hate them.

metal_m0nk, BSN, RN · Feb 16, 2011

They only got stupid after they got all stirred in with the Nursing Diagnosis thing. That's when it was decided that only RNs trained in the NANDAS were allowed to create it, and I find that nowadays people think NANDA was the reason for the care plan all along.
In the olden days the care plan was easily accessible to everyone, it was written in pencil and (gasp!) even the CNAs could add things to it. It was a flexible practical shorthand derived directly from the dx and orders, because you didn't have to stop at NANDA to pick up your nursing diagnosis first.

I love posts like this.

Appreciating the historical insight!

handyrn · Feb 16, 2011

I have to say, you hit a nerve with me. I used to do care plans in LTC and would JUMP at the chance to do it again. I love doing them. Hated them in nursing school and could never understand them until someone put it in perspective for me when I actually had the job. Basically, you should be able to walk into a facility, know absolutely nothing about the patient, and be able to take care of them based on the care plan. I will say the pre-assigned interventions are sometimes irrelevent, but if you have a good care plan nurse, it makes all the difference. For example, say John Doe gets anxious at bedtime and the new CNA doesn't know how to deal with it. All the things she has tried (bathroom, drink, food, dim lights, etc) have failed. She should be able to go to the care plan and see that the care plan nurse has care planned to patient warm milk and a favorite blanket at bedtime (because that was their normal routine at home). The care plan really is helpful when you put it to good use. The information is good when you cannot bother the other staff for the answers or if something got missed in report. Really, I think that one sentence is the key: care plans should be such that you could walk in the facility as a temp or new staff member and know how to take care of a patient. It also has saved a lot of hassle because I remember when state surveyors used to get mad if they saw a resident in a nursing home folding towels. They used to say it was making the resident work. But, if they went to the care plan and it was care planned for patient to fold towels for ROM and because it decreased anxiety/boredom/whatever, then it was acceptable to state surveyors that resident was folding towels.

nurse2033, MSN, RN · Feb 16, 2011

I think the thought concepts behind care plans are benefitial, but have never used them on the job.

maestrotee · Feb 16, 2011

I think the thought concepts behind care plans are benefitial, but have never used them on the job.

That is precisely my point. Thank you.

danh3190 · Feb 16, 2011

Care plans were somewhat useful in the first semester of clinicals, but after that I don't think I got much out of them but I could put one together really quickly by the end of nursing school.

I hated NANDA. Took me the longest time to get that the patient wasn't in shock from all the blood loss, but that he was Fluid Volume Deficient. Still think it's a useful thing for doctors and nurses to speak in the same language. Happily for the most part they do in the real world.

morte, LPN, LVN · Feb 16, 2011

I have to say, you hit a nerve with me. I used to do care plans in LTC and would JUMP at the chance to do it again. I love doing them. Hated them in nursing school and could never understand them until someone put it in perspective for me when I actually had the job. Basically, you should be able to walk into a facility, know absolutely nothing about the patient, and be able to take care of them based on the care plan. I will say the pre-assigned interventions are sometimes irrelevent, but if you have a good care plan nurse, it makes all the difference. For example, say John Doe gets anxious at bedtime and the new CNA doesn't know how to deal with it. All the things she has tried (bathroom, drink, food, dim lights, etc) have failed. She should be able to go to the care plan and see that the care plan nurse has care planned to patient warm milk and a favorite blanket at bedtime (because that was their normal routine at home). The care plan really is helpful when you put it to good use. The information is good when you cannot bother the other staff for the answers or if something got missed in report. Really, I think that one sentence is the key: care plans should be such that you could walk in the facility as a temp or new staff member and know how to take care of a patient. It also has saved a lot of hassle because I remember when state surveyors used to get mad if they saw a resident in a nursing home folding towels. They used to say it was making the resident work. But, if they went to the care plan and it was care planned for patient to fold towels for ROM and because it decreased anxiety/boredom/whatever, then it was acceptable to state surveyors that resident was folding towels.

I "temp" for a living, and I wouldn't know where to find the careplans in most places I go....pretty much useless and time consuming.

SharonH, RN · Feb 16, 2011

I am def not saying I don't plan my care. Oh, my gosh. I am planning my care every moment of the day. It's called prioritizing. A piece of paper doesn't ensure that everybody's on the same page regarding certain dx or problems. I would surely hope that our education and licenses do that already.

Well, it's supposed to....after all that's the whole point. Here is the problem, and here are the interventions. Otherwise how am I supposed to know what your priority is? That's why most other disciplines except for nursing create a plan of care and write it down. Plan care=problem, intervention, outcome. That's a scientific, organized approach to taking care of patients. Why does everyone get that but nurses?

madwife2002, BSN, RN · Feb 16, 2011

What do you mean I won't have to do another one in the 'real world'? I wish. I'm an ADON in the real world at a LTC facility and I bet we spend almost half of our day staring and obsessing over these stupid pieces of paper that don't meet any specific patient need at the very least, and at the very worst takes away from patient care, worried that the state will come in and hang us because we didn't update the care plan with the latest coumadin dose adjustment! It's absolutely asinine to even conceive that writing something on a piece of paper somehow contributes to patient care! I was a floor nurse for a few years before the admin thing, and I don't ever remember opening a care plan for ideas on how to better serve the needs of my patients. I grabbed their H&P and meds and let my assessments dictate how I took care of that patient. If they tell me they are in pain, and they have an order for PRN tylenol, I'm not going to take a break to go find out that they like a calm quiet environment as an intervention to pain. Duh! I don't know anyone who prefers a loud, busy, bright environment to help them cope with pain! The only reason that nurses are still burdened with this arbitrary regulatory mandate is so the board of health can find tags and generate revenue. I absolutely hate the concept of them. The end.

I am a manager of a dialysis unit and we have 96 to do each month and update and everybody has to sign! If we dont we are worried about the state who will close us down if we dont do them-it is ridiculous and a total waste of time-just a paper exercise