Care Plans - What's their purpose? - What do you think of them?

Nursing Students General Students

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I saw a nursing student and her instructor reviewing a care plan today and she was reviewing something about wording of the care plan and it reminded how frustrating nursing education can be and how mixed up it can seem to be sometimes!!!

At my school, anyway, a care plan for something as post-anesthesia nausea would be grilled for the wording of the nursing diagnoses, the specific wording of the nursing interventions and goals.... to make sure that we were using impractical "nurse speak" as opposed to - oh no! - referring to a medical condition directly (eg pt constipated, possibly d/t medication side effect, keep hydrated, adm laxative as ordered, etc). Students should ideally be able to rattle off quickly the what's and why's. I think the nitpicky round-about descriptions required in nursing school make simple concepts more confusing... and end up wasting the valuable time of students.

Specializes in med/surg, telemetry, IV therapy, mgmt.
Psssssssst:

As of September 2006, AJN ceased being the official journal of ANA. It is an independent publication of Lipincott, Williams and Wilkins, part of Wolters Kluwer Health.

ANA's new publication is the American Nurse Today.

Sorry. I get rattled by the ANA from past history with them.

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My first semester of nursing school I felt care plans were nothing more than busy work, but soon realized I was developing a structured method of pulling needed information from a patient chart and developing a plan of care. I still do not enjoy doing one but realize they are a necessary evil. As far the use of proper terminology and spelling; I think students sometimes forget that when we graduate we are educated professionals and certainly should be able to write like one. Remember a chart is a legal document with the possiblility of being reviewed by your medical peers and possibly lawyers and judges. Why risk having your professionalism questioned by the fact you cannot document properly? I have read several nursing progress notes that quite frankly I was a little embarrassed for them.

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Being able to write a succinct, coherent progress note has little to do with being able to write out a nursing diagnosis in the various permutations that different instructors insist is the only (and obvious!) right way to do it. I don't know about your school, but my school had very little practice and instruction on writing progress notes; but we could whip out nursing diagnoses and wax philosophical about nursing as a profession.

I do think care plans are a useful tool. And I'm sure many instructors out there utilize them effectively. My gripe was that too many schools and instructors seem to make nursing care plans more difficult and time-consuming than they need be. If form and wording are so important, why not give the students a clear care plan book to model their care plans after? I see no need for students to create every last care plan from scratch for every patient they work with as a student. Learning how to pull relevant information from pre-fab care plans to create an appropriate individualized care plan sounds more useful than having to learn from scratch how to write care plans through trial and error with conflicting feedback from instructors over what's "the right way" to do them. Some schools might give a clear model to follow with clear expectations on how to word diagnoses, interventions, goals, etc. My school took the view that we'd learn more if they didn't give us much guidance on the details that they'd then pick apart and also required a lot of busy-work, such as having to give an full explanation and reference for the most common of care, meaning we had to write those out over and over and over again on each care plan. Given how little time we have to learn so much in nursing, I think that's an inefficient way to teach care planning.

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Specializes in 6 yrs high-risk OB.

I would love to say that I had time to read through all 14 pages of this thread, LOL, but as the rest of you nursing students probably know, i don't. LOL. I SHOULD be studying for my skills test tomorrrow, actually. ;-p

I HATE these care plans! The "client care form" we are supposed to fill out is 8 pages long. We have to go to the hospital the night before our clinical and get our patient assignment. We cannot go before 4 pm. Then we have to go read the chart, copy down all the lab values, etc and then go home and fill out this giant form. We have to look up all the abnormal labs and find out what that means, go through all their meds and fill out a 6-column chart on them, not to mention filling in all the labs, vitals, etc., Come up with definitions SPECIFIC TO THAT PATIENT of what their medical diagnoses are..... I have heard both from the teachers AND students who are ahead of me that I'll be up until 2 am doing this.

Here is my problem with that - WHEN DO WE SLEEP!? I have to be at my clinical site at 6:30 am, and parking is a 10-minute walk away, so lets make that 6:15 at the latest. I live an hour away, at least, so i have ot leave my house no later than 5:15, which means I need to be up by 4:30 am. If i'm up until 2 am, i'm gonna have 2.5 hours of sleep???? THIS DOES NOT SEEM SMART TO ME!

Why on earth do they want to send a bunch of nursing students who already don't really know what they are doing into the hospital to care for people and give meds (which we'll be doing in 2 weeks if we pass our skills tests) as ZOMBIES!? I don't get it.

I understand the purpose of the care plans, but do people REALLY do these on every patient? How do you do that when you have 8-12 patients to care for? There has to be a better way.

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Specializes in med/surg, telemetry, IV therapy, mgmt.
WHEN DO WE SLEEP!?

Weekends and holidays.

Why on earth do they want to send a bunch of nursing students who already don't really know what they are doing into the hospital to care for people and give meds (which we'll be doing in 2 weeks if we pass our skills tests) as ZOMBIES!? I don't get it.

In actuality, other nurses are really responsible for those patients you are taking care of and supervising what you are doing. If you don't think you know what you are doing, please, review procedures in your textbooks before going to the hospital in 2 weeks.

I understand the purpose of the care plans, but do people REALLY do these on every patient? How do you do that when you have 8-12 patients to care for? There has to be a better way.

Not the same kind of care plans that students do. Student care plans are lengthy and very involved because they are designed to help you learn about the patient's disease process and to teach you critical thinking skills. Once you get your license and are working the care plans you will write for an employer are much shorter and concise.

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Specializes in 6 yrs high-risk OB.
Weekends and holidays.

In actuality, other nurses are really responsible for those patients you are taking care of and supervising what you are doing. If you don't think you know what you are doing, please, review procedures in your textbooks before going to the hospital in 2 weeks.

Not the same kind of care plans that students do. Student care plans are lengthy and very involved because they are designed to help you learn about the patient's disease process and to teach you critical thinking skills. Once you get your license and are working the care plans you will write for an employer are much shorter and concise.

I know the procedures - I've done all the reading and studied and passed my tests, but that doesn't make me functional on very little sleep. I understand that other nurses and/or our clinical instructor will be watching us and supervising, but everyone makes mistakes, even them. If their mistake is missing our mistake, it could be really bad!

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I think some nursing instructors... need to get off their high horse because i've heard so many different things from instructors... they just want you to do it their way!!! So it leaves us students so confused about the whole thing!!!

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Specializes in Vascular Access Nurse.

I agree that care plans aren't on their way out, but they definitely aren't as important as they used to be in our nursing school. We definitely need to know how to do them, but they're less of a focus. In this day and age, it doesn't take a rocket scientist to push the buttons on the computer to "write" care plans. It's takes critical thinking skills to know WHICH buttons to push! We all get it.....and don't have to write them this year. Much more focus is on delegation and leadership, critical thinking skills and holistic patient care. GO PENN STATE!!

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Specializes in med/surg, telemetry, IV therapy, mgmt.
I think some nursing instructors... need to get off their high horse because i've heard so many different things from instructors... they just want you to do it their way!!! So it leaves us students so confused about the whole thing!!!

Hmmm. . .it'll be interesting when you meet your future employers. I guarantee that each of them will also be on a high horse and have their own way they will want you to do the care plans--or it will be the highway. There will be no confusion about what you will need to do.

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Specializes in 6 yrs high-risk OB.

I think we all get that each employer is going to have their own way of wanting people to do things, but I think what alwaysbroken was saying was each of our instructors will tell you how to do the same thing differently - at least that is how it is for us.

See, wee have our Clinical Instructors, and then we have a professor who oversees all the CI's. So, she tells us, for example "I want you to do your care plans this way, And i'm in charge so that's the way all the CI's will want to see it" (her words). then we meet our CI's, and they want it done a different way (one more detailed, one less detailed, one gives you a week to turn it in, others have you do it overnight (like my CI, which isnt' fair when oter's get a whole week! Why do i have to be up all ngiht working on it and they get to sleep?).

when we said to them, well Professor X said she wnated it this way, The CI's told us, "Well, we are the ones collecting it, and we dont' care what she wnats"

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Specializes in LTC, MDS, ER.

I'm in my second semester of LPN school, and I am finally understanding why care plans are necessary. I look back at the first couple I did, and am amazed at how much my thinking has evolved from "CNA" to "nurse". They're frustrating to figure out, but I enjoy going back and filling in the interventions I did for my patients after clinical. It helps me focus my care for my patients when I choose the "priority" care plan beforehand.

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The purpose of the careplan is not the careplan itself- The process of writing the careplan stimulates critical thinking and learning.

That is the pupose of student careplans.

It was a lightbulb moment for me when, as a student, I finally realized that.

If you have done a careplan on a s/p CVA pt- you will know what interventions to take when you get a CVA pt in real life.

No, I don't use or even look at care plans in my nursing practice- but because I did so many in school- I now know what problems my pts are likely to have and how to address them- off the top of my head.

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