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

Suzuki Ryabusa · Oct 7, 2009

They are evil, tedious and totally impractical in many workplaces. Luckily I only have a year left of school, then it's off to the real world. Where nurses give you funny looks when you rattle off all the patients nursing dx and your interventions/rationales in report, few might even laugh. :chuckle
I had a dx of Effective Breastfeeding with good interventions and rationales, some might say sounds good but no. According to her all dx had to be negative, you heard me.. So I showed her the NANDA book and my care plan book written for the NANDA book, she still insisted that I must be doing something strange and that it was wrong. I'm glad I fought her though it bumped my grade up a fair bit. Needless to say she was a little off (read crazy) and I'm glad that rotation is done and gone. Maybe someday we can find a way to relieve future nursing students from the horrors of care planning. :zzzzz

I know your post is a year old and it's a very good thing you brought that up. Nowadays, for the 1st year of Nursing school, instructors always reiterate the importance of identifying the patient's problem and dx accordingly. Since the patient is presented to clinical/hospital situations with special and unique problems that are patient specfic, all of my clinical instructors always wanted the problem based on subjective/objective data/assessments: focused or head to toe and name the etiology. Yes, I too, believe it is cumbersome but I think it is meant to help students think specifics and then "outside the box."

I've had clinical days where the patient seemed completely WNL according to labs, assessment findings, PT interviewing, etc....I wouldn't be able to pull out a decent NDx for the life of me b/c the patient had "nothing" wrong with them that day. Especially chest pain patients on the Med-Surg/Tele unit who had their issues resolved. But....according to some of my instructors, there still is a very REAL problem that manifested itself to its current situation. I had to think about why the patient came to the ER, then to Med-Surg, what the diagnostic tests revealed, lab values over the past few days, Home medications and MD prescribed meds and figure out WHY they are on what they are, pharmacokinetics, SE's/adverse reactions, nursing interventions, etc.....AHHHHHHH!!!! But, you start to visualize these things and Concept Map the ideas in your head. In the end, it somehow makes sense.

Now, Don't even get me started on DAR charting :chuckle:stone

diane227, LPN, RN · Oct 13, 2009

At our facility we have the easiest care plans in the world. I would be glad to send an example to anyone who would like a copy. Just send me a private email with your fax number and I will send it to you. Our care plans are a snap to complete.

diane227, LPN, RN · Oct 23, 2009

I am no longer a student (thank God) but I HATED care plans when I was in school. But I work on a unit now that has care plans down to a science. It is SOOOOO easy. They have basically put the entire care plan together for us and all we have to do is fill in a few blanks .

Jljkhorton · Nov 7, 2009

I'm about to graduate, and doing careplans tirelessly. I go to a school where we have 1 class every 5 weeks. It's intense, and we have different instructors every 5 weeks. It's hard to know what everyone wants. Some say, "copy out of the book", others say, "you can formulate a plan of care for these patients", etc. I understand the purpose of care plans, but fail to understand the everlasting purpose of care plans. Who doesn't have a pt that could fit the nursing dx of "pain" or "anxiety"...? Seriously? If you're in nursing school, you're somewhat of an adult. If you're telling me that someone in the hospital doesn't have anxiety you're out of your mind. Some of this stuff is just so common sense that it's ridiculous. I mean, we can't use medical terminology in our diagnoses, but we can in our r/t and secondary to's? To me that says we're not medical professionals. And even though we see the diagnosis in a chart, we STILL can't write that? It would take a professor 2 minutes to listen to a student verbalize a plan of care for any patient, as opposed to sending them home to spend a few hours on a written, mostly copied "care plan."

Like I said, I understand their purpose, but fail to see their ever present need. I don't mind doing them, because one: most of the info is common sense, and two: i plagiarize my butt off. And yes, I've told my instructors that very thing many times. But they continue to make me write them. So I ask, "Why do I need to rewrite what my NCP book already has typed up, edited, and bound for a teacher?" Any NCP book will give you everything you need for a successful NCP, why the need to rewrite everything? I think that if a teacher pulls you aside, for a minute or two, and asks you what you plan to do with your patient, should get a NCP. But why waste the time typing, researching, looking up, and plagiarizing? If you can't formulate a plan of care for a pt based on their needs, maybe you ought to be seeking a different degree?

Sorry if I offended anyone, not my intention at all. But I base my practice and care on the best advice given to me by a man who was once my wifes nurse, and the one who made me decide to follow his path. And that is - "What would you want done if you were the one lying in that hospital bed?" NCP's are easy, common sense approaches to nursing.

jjjoy, LPN · Nov 9, 2009

Some say, "copy out of the book", others say, "you can formulate a plan of care for these patients", etc. Who doesn't have a pt that could fit the nursing dx of "pain" or "anxiety"...? And even though we see the diagnosis in a chart, we STILL can't write that? It would take a professor 2 minutes to listen to a student verbalize a plan of care for any patient, as opposed to sending them home to spend a few hours on a written... "care plan."

You make some very good points. I think you'll get some slack for describing writing care plans as "plaguarizing." Most schools have a strict no plaguarizing policy that many interpret as applying to student care plans as well. However, writing a nursing care plan is not the same as writing an academic paper, such as the application of nursing theory in practice. For the purpose of a care plan, whether or not a point is reworded or copied verbatim wouldn't seem all that important to me. What would seem most important in care plans is that the information is applied appropriately based on the patient's case (demonstrating critical thinking).

You might also get some slack for describing some nursing as "common sense." Many of the fundamentals of nursing are known and understood by many who have never had a formal nursing education, such as providing for physical comfort or helping with personal hygiene. Nursing programs have a responsibility to ensure that every student has a good grasp of the fundamentals including things that many might consider common sense that anyone should already know. HOW the basics are covered is a different question and one that I think is more constructive. For example, washing one's hands before patient contact and introducing oneself prior to initiating patient contact are important but fairly common sense things to do. Should senior students be required to spell out such basics in agonizing detail with variations on wording for each and every written care plan? It doesn't seem like a very effective way to use very limited time on.

Whether copied or meticulously re-worded, whether common sense or not, if student NCPs are demanding lots of redundancy of basic concepts that students should already have down, it can feel like time would be better spent on more advanced concepts than on spelling out the basics again and again.

txhorseshowgirl · Nov 16, 2009

To all: The purpose is great, but I agree with the OP I can tell you I was a driving hazard Sat am going to clinical. As well as going over my paperwork when I got home. I discovered the next day (after some sleep) some big things I missed- Now I work full-time Mon-Fri and attend school Mon-Thurs night, Friday after work I go to the hospital and select my patient for Sat clinical. 6 pages of clinical paperwork, certain area's have to be done before Sat am (we start at 645am) So this past weekend I had clinical prep, reading,an exam that monday (10 chapters), Summary to a nursing article related to my patient-Summary-meaning header-footer-all the goodstuff. And two other conditions to look up and report. So after I did as much as I could I went to bed at 2am, or passed out head on laptop, awoke to my 4am alarm, because I had still more prep to do. Anyway I finished everything - My exam grade was barely passing though. I am not even all the way through the first semester yet....I was very concerned after this weekend, what if I had made a critical mistake.....because I was caring for someone on 3.5hrs of sleep.....so I do understand what you can learn from a care plan and everything that gets piled on you, but at what point are you creating a dangerous situation. For student and patient...I also wanted to state in NO WAY did I think NS would be easy in anyway at all. I just think if you want to graduate compentent nurses, there has to be balance somewhere...Nursing is hands on...it's great to pass NCLEX but can you carry out those tasks on the floor. ;-)

txhorseshowgirl · Nov 16, 2009

I think we attend the same school!!!! We have two evening theory instructors and 3 different clinical instructors. It's caos , there is no standardaztion at all...you never know what to expect... Some groups do certain things on their plans and others do something way opposite...We had the day and 90% of the night class completely fail the first Commons exam...and they brought a remidial speaker in for US! which floored me....7 people of over 100 failed....and you dont see anything wrong..They are now moving times around for when paperwork is due...so we have more study time for exams!!! NS is hard enough and you add the lack of organization into the mess....and you want to know why students are beyond stressed!!! My last clinical inst wanted like a book written and my instruct this time marked up my paper stating why is all this in here...lol one would think the school would have guidelines on this and what instructors need to follow. My question also...most people in NS are beyond HS age, is there some sort of reason instructors think they need to speak in a condesending tone...really ??? There is no reason for that...for the most part students want to impress their instructors, and when you come across someone like that, you dont want to be around that person. Now I really like an instructor that expects you to know your stuff, such as med's why are you giving them , what does it do, side effects. Someone that holds you accountable for what you need to know, rather than looks and talks down to you, is unnecessary. Why would someone like that get into an educational position? Any person highly skilled and knowledgeable in their profession can stand in front of a group and rattle off information, but it really takes a talented person to have students understand and apply the given knowledge. I am in no way a confrontational person, I also do not let people walk over me and talk to me like I must be an idiot. Then you have the one's that like to make innapropriate comments...which I wonder how in the world did this person get this job...whew ok thanks for listening to my rant!

thelittlemissus · Dec 5, 2009

I despise care plans, although I don't mind the psych care plans as the psych teachers made their own separate from the rest of the nursing care plans at our school. The psych care plans are 7-10 pages where as medsurg and ob/peds care plans are 20-28 pages long. I understand their purpose is to get us thinking like nurses but seriously if we can come up with diagnoses, goals, interventions that are applicable and address the primary problem why does it matter how we get there. I see on the internet that other schools have these small care plans and seriously wonder if our teachers really think all these extra pages that they make us do is helping us or if they just want to torture us. Not to mention we do not have separate classes at my school on pathophys or meds. That no one actually shows us how to do care plans, they expect us to learn these things on our own. We aren't allowed to work on our care plans during clinical hours because we need to focus more patient care. So we have to stay after everyday do hours of research and then spend all of our waking hours (if we sleep at all) on them just so instructors can send them back with red all over them telling us to redo them and turn them back in. Well you can't get any extra information because your patient is home so hopefully you already have that and then you have to redo the old one on top of the new one. The instructors are inconsistent about what they want and how they grade. My medsurg clinical instructor this semester will mark something wrong one week saying you need to list all medical dx (we have do circle pages as well) in the main circle and then the next week she will so only list one. So it isn't just even inconsistencies with different instructors it is the same instructor that can't make up her mind how she wants it (first year clinical instructor--who recently graduated from our school and then did fast track to get her np and is still in school while working 2 or 3 jobs (I get it that she doesn't have time to really help us but why did she take the job then?). I don't have issues at all with interventions or outcomes it's just all of the things in between especially labs which I have a terrible time with listing all of the possible causes, nursing significance, s/sx, and assessments of the abnormal lab result, looking at them together etc... I hate the labs, also the diagnostic tests it takes me forever to figure out what the impression means, nursing significance, s/sx, assessments etc... of those as well.

Daytonite, BSN, RN · Dec 6, 2009

I despise care plans, although I don't mind the psych care plans as the psych teachers made their own separate from the rest of the nursing care plans at our school. The psych care plans are 7-10 pages where as medsurg and ob/peds care plans are 20-28 pages long. I understand their purpose is to get us thinking like nurses but seriously if we can come up with diagnoses, goals, interventions that are applicable and address the primary problem why does it matter how we get there. I see on the internet that other schools have these small care plans and seriously wonder if our teachers really think all these extra pages that they make us do is helping us or if they just want to torture us. Not to mention we do not have separate classes at my school on pathophys or meds. That no one actually shows us how to do care plans, they expect us to learn these things on our own. We aren't allowed to work on our care plans during clinical hours because we need to focus more patient care. So we have to stay after everyday do hours of research and then spend all of our waking hours (if we sleep at all) on them just so instructors can send them back with red all over them telling us to redo them and turn them back in. Well you can't get any extra information because your patient is home so hopefully you already have that and then you have to redo the old one on top of the new one. The instructors are inconsistent about what they want and how they grade. My medsurg clinical instructor this semester will mark something wrong one week saying you need to list all medical dx (we have do circle pages as well) in the main circle and then the next week she will so only list one. So it isn't just even inconsistencies with different instructors it is the same instructor that can't make up her mind how she wants it (first year clinical instructor--who recently graduated from our school and then did fast track to get her np and is still in school while working 2 or 3 jobs (I get it that she doesn't have time to really help us but why did she take the job then?). I don't have issues at all with interventions or outcomes it's just all of the things in between especially labs which I have a terrible time with listing all of the possible causes, nursing significance, s/sx, and assessments of the abnormal lab result, looking at them together etc... I hate the labs, also the diagnostic tests it takes me forever to figure out what the impression means, nursing significance, s/sx, assessments etc... of those as well.

Why are you even in Nursing school? God help me if I get you as my nurse.

Daytonite, BSN, RN · Dec 6, 2009

I'm about to graduate, and doing careplans tirelessly. I go to a school where we have 1 class every 5 weeks. It's intense, and we have different instructors every 5 weeks. It's hard to know what everyone wants. Some say, "copy out of the book", others say, "you can formulate a plan of care for these patients", etc. I understand the purpose of care plans, but fail to understand the everlasting purpose of care plans. Who doesn't have a pt that could fit the nursing dx of "pain" or "anxiety"...? Seriously? If you're in nursing school, you're somewhat of an adult. If you're telling me that someone in the hospital doesn't have anxiety you're out of your mind. Some of this stuff is just so common sense that it's ridiculous. I mean, we can't use medical terminology in our diagnoses, but we can in our r/t and secondary to's? To me that says we're not medical professionals. And even though we see the diagnosis in a chart, we STILL can't write that? It would take a professor 2 minutes to listen to a student verbalize a plan of care for any patient, as opposed to sending them home to spend a few hours on a written, mostly copied "care plan."
Like I said, I understand their purpose, but fail to see their ever present need.

I've addressed the reason for care plans before and I think if we ever get a national health care the need will increase 100-fold.

That said. . .nursing is all about daily changes in the rules and the way doctors and administrators want things done. Like the military. . ."Jump!" And, you just respond by saying, "How high?" If you can't handle that, how do you think you will survive as a nurse? I would take a short 5 days off of work as an RN and come back only to find we had a new charting form! Or, we were doing shift report differently! Or, Dr. So-and-So doesn't want his patients made NPO for some procedure even though protocol says we are to do so. And, Dr. X won't order a PTT for his patient on Heparin which we all think is too high a dose. Change and aggravation are a constant in this profession.

pagandeva2000, LPN · Dec 7, 2009

I don't think that disliking care plans or useless changes in documentation reflects one's dedication and skill to be a consciensous, caring nurse. I have been reading "Nursing Against the Odds" and one thing that was stated that stood out to me, and that was that many of the other disciplines thought that the nursing diagnoses and care plans were gibberish. While I do believe that nursing care plans can assist in having a plan of care for a patient (especially for a student), I can easily see how this is yet another distraction from caring for the patients themselves.

thelittlemissus · Dec 7, 2009

I think you misunderstood what I wrote, I was venting, sorry. I could do care plans all day long if they consisted of my assessment data and figure out nursing dx, outcomes, and interventions and that was it. It is all of the other stuff that takes hours to type and waste my print allotment when the actual care plan part is relatively short. I actually like that part of it (the part of it that other schools have to do). I know other schools don't have as lengthy care plans as my school. I've seen what care plans look like at other schools because of posts that I have read here and on other online forums. I'd take that any day over my 28 page, small book that I do on every single patient I have. It bothers me because if I can use the assessment data and critical thinking to get where I need to be then I don't think I should have to write 25-26 pages of everything else. The care plan is 1 to 2 pages typed so why do I need 28? That is my problem with care plans. I never miss a beat on my outcome statements, interventions or figuring out the diagnoses. Right now the care plan I am working on now has 8033 words and not finished, no one could do that in a couple of hours. My schools care plans are lengthy and you get little time to do them in. So you research and then go to clinicals and then stay after, stay up because you have to finish the care plan to implement your interventions, then you are suffering from no sleep, and that is not a good state to be in when you are giving patient care.

Why am I in nursing school?

I am in nursing school for the emotional aspect. I did not get excited when I had to memorize the bones, the muscles, the cranial nerves although I was excited after I accomplished it. During it I wasn't like cool this is my favorite nerve, this is my favorite bone or anything like that--I had class mates like that--I had class mates that hated the endocrine system while I found it interesting--- I want to educate patients on things they might not know, I want to help them in their time of need, I want to make a difference, explain to them about their disease or illness, help them achieve their goals. I really just want to be a nurse. I have been in situations where I have dealt with good and bad nurses and I feel that there is a lot of room for good nurses who are there for the right reasons.

Many times you do not get thorough explanations--I want to cover it all and make sure my patients know they can ask me anything. I am not going to get burnt out because I will have a responsibility to my patients and anytime I start to I will recall myself at my sons first surgery and remember how I felt and try to help my patients and their families as best as I can.