Another thread brought to the forefront one of my biggest pet peeves about nursing. The dreaded "Care Plans". I hate them. I think they are task oriented and are simply paperwork created to satisfy the state. I attach no importance to them what so ever in my nursing theory.
I'd like to know what others think of them. I'm opening up a debate here. Please, dont be afraid to say so if you think they are significant to pt. care.
I'd also like to see if there is a difference between what younger nurses vs. vet. nurses say about care plans.
So please, give me your opinion of care plans, but classify your comments with which group you fall in. Please state your field of nursing and if you are new or vet. nurse. For the purpose of this debate, we will define new vs. vet. nurse as having more or less than five years experience. New if you are 5 years or less, vet. if you have more than five years.
Well I am wayyyyyyyy new. (plus I have no clue what is going on. LOL) I know someone here said they provide critical thinking skills as a student and yeah maybe I think that is somewhat true but when I am actually on the floor those stupid things are always getting in the way! As a student I used to bs the whole thing so I personally didn't learn anything from them, and my instructors never read them so its not like they were important.
I would rather spend time in the patients room then doing all this boatload of paperwork. I hate the paperwork especially care plans. I would maybe hate it less if my preceptor wasn't so anal about it but I suppose it's for my own good.
Specializes in Community Health, Med-Surg, Home Health.
I also believe they are a waste of time. Writing redundant notes...the same mess in different areas are second on the list. All of this, in my opinion, takes time away from the patient. We spend more time trying to cover our butts with these regulatory agencies than we actually do in patient care. I'd go more for flow sheets, where you check off what is needed and maybe write a more specific note afterwards, or charting by exception.
Where you have a diabetic patient - you do not need a diabetic care plan.
A pre-op pt does not need a pre-op care plan - tho it depends on what pre-op they need - so perhaps a flow chart works well here eg pre-printed colonoscopy prep that can be checked off and signed.
But what about a post-op mobilisation programme? (I have no idea if there's set format/routine or not for this - I'm psych - we immobilise more often than we mobilise :wink2: )
And what about the old woman with the sacral wound that's having a particular dressing with topical application and changed at intervals like every other day - or only when the outer layer is shown to be soiled?
And when it's next due for a medical review?
It's not ike the (new) nurse working the ward has time to go back 4 weeks through the file to look up the wound care instructions on such n such a date.
Or the pre-discharge client? Do you complete discharge plans? Aren't they the same thing as a care plan? Planning an intervention.
Experienced nurses often know more 'care plans' in their head as they become more experienced. But someone experienced at working ICU - who has to float to surgical - might also appreciate those crib note care plans?
They could be a great tool for communication if they are actually utilized instead of just being written up and put in a bood that no one except the RNAC and the state will look at.
A care plan should be able to tell you exactly what should be done for each patient..what their specific needs are for each issue they have. As somenone else mentioned, a good nurse knows most of this already. The think with care plans (in a ltc environment) is that they need to be specific for this to work. General care plans are easy to do..you can print them off the computer or get them from any book, but that is where it changes in LTC. More spedifics.
We all know the phrase...if it wasn't written..it wasn't done. In this case....it wasn't planned or assessed. Each person in a LTC needs a comprehensive asssessment (MDS..minimum data set)to be done at least quarterly or more often depending on insurance..this drives reimbursement and also helps formulate a care plan.
That is all good and we can careplan and say we are going to do things until we are blue in the face, but getting stuff communicating it to the rest of the staff, getting it done and documenting what was done is a whole other issue.
So...yes good and bad with care plans. Many moons ago I was a RNAC or assessment co ordinator so I still have a love hate with these things.
As a student nurse....these are very very important to help formulate the thinking process.
I agree with Valerie, They are great for learning to put the whole picture together, but once you get past a certain point in your pratice, they're just more busywork. I guess I can see the point of them in the sense of communication, but I still find them more work than they're worth.
I am a veteran nurse who has worked as a staff nurse, staff nurse, and clinical instructor.
I think:
Care plans can be a great help in teaching the thought processes used to provide good nursing care. However, in most of their current forms, they are not a useful tool for the day-to-day practice of nursing.
They could be a good tool to document the day-to-day practice of nursing and to help in the communication between care providers IF (and that's a big "if") a format could be developed that would be quick and easy to use.
I think care plan are a great example of a good educational strategy that was poorly adapted to the practice setting by people who meant well, but who lacked a necessary sense of the practicalities of practice.
In summary ... Care Plans have their place. But even good tools need to be properly adapted before use in situations other than that for which they were intended.
I am a veteran nurse who has worked as a staff nurse, staff nurse, and clinical instructor.
I think:
Care plans can be a great help in teaching the thought processes used to provide good nursing care. However, in most of their current forms, they are not a useful tool for the day-to-day practice of nursing.
They could be a good tool to document the day-to-day practice of nursing and to help in the communication between care providers IF (and that's a big "if") a format could be developed that would be quick and easy to use.
I think care plan are a great example of a good educational strategy that was poorly adapted to the practice setting by people who meant well, but who lacked a necessary sense of the practicalities of practice.
In summary ... Care Plans have their place. But even good tools need to be properly adapted before use in situations other than that for which they were intended.
Yeah, I think that about sums up how I feel. I wasnt so annoyed with them in school. Now, on the floor, I am.
Specializes in med/surg, telemetry, IV therapy, mgmt.
i've been writing care plans for years--30+. some of you may recognize that i am the only allnurses member that has come forward to help the students try to make any sense out of writing care plans. students have to learn how to do them (1) in order to pass their nursing courses, and (2) on the job. if they end up working in acute hospitals or ltc the federal government has passed laws that mandates that care plans will be a part of every patient's medical record. care planning is a difficult subject to teach. for some it is even more difficult to understand and learn. critical thinking is not something we are born with. it is a learned skill and not everyone is good at it and even less are any good at teaching it.
in school, care plans not only help students learn how to think critically but also learn what is happening to their individual patients--in depth. on the job, care plans serve as a documentation of our problem solving process showing the rational thinking process that went into our identification and solving of patient's specific nursing problems. i think that this is a misunderstood reason for why care plans are required by state agencies on the job.
you might be interested to know that there is a sticky on the general nursing student discussion forum entitled care plans - what's their purpose? - what do you think of them? (https://allnurses.com/general-nursing-student/care-plans-whats-321788.html) where the value of students doing care plans has been discussed for some time.
I hated careplans; but they really have their place when you are building on your medical knowledge. The purpose is to help you make the connections between disease, maintenace, and getting well or just coping. Many of the skills and critical thinking skills may be very connected to careplans. Mine used to take hours!!!Hated them!!!! Yet when I think back, just like computer flow charts it is a way of thinking-horizontal and vertical.
Opens the mind. OBTW, Thank God I don't need them anymore!
Veteran nurse here, telemetry unit. I actually used Concept Maps in NS, and they are sooo much better than care plans for learning in the school settings. In school, as much as I hated them, they did help my critical thinking skills and to be able to understand the APIE process. Meeting state and fed requirements are the only real purpose I see in my real world practice. Ours are computer generated R/T admission diagnosis and history. One of the few things I actually remember about NS was when an instructor was trying to help us with prioritizing our patient needs, "What's going to kill them first?". I still use that philosophy, and to date, it has served me well.:redbeathe
Specializes in Certified Wound, Ostomy & Continence Nurse.
At the beginning of nursing school, everyone I talked to thought care plans were senseless exercises. For some reason I believed that. My nursing instructors tried to tell me how important care plans were in the real nursing world but I found it hard to believe.
As an experienced home care case manager, I now know the value of care plans. Care plans justify the nursing visits that are taking place, provide direction for nursing visits, allow me to recognize when are goals are met and the patient needs to be discharged. When per diem nurses see one of the patients I case manage, she can follow the plan and determine what needs to be done. Medicare can look at the plan and documentation to justify payment for my services.
My instructors were correct about care plans. They are essential to communicate our goals and our actions to achieve the goals. How else can other members of the care team, payers for services or even patients themselves know what it is we are doing. How could a different nurse go to do a home visit for a patient without a plan? Something as simple as wound care needs a plan. The frequency of the wound care, frequency of wound measurements, duration of wound care before other options are explored. Even to order supplies for the wound care requires some sort of plan.
The longer I am a nurse, the more value I see in care plans.
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chicookie, BSN, RN
985 Posts
Well I am wayyyyyyyy new. (plus I have no clue what is going on. LOL) I know someone here said they provide critical thinking skills as a student and yeah maybe I think that is somewhat true but when I am actually on the floor those stupid things are always getting in the way! As a student I used to bs the whole thing so I personally didn't learn anything from them, and my instructors never read them so its not like they were important.
I would rather spend time in the patients room then doing all this boatload of paperwork. I hate the paperwork especially care plans. I would maybe hate it less if my preceptor wasn't so anal about it but I suppose it's for my own good.