over the years and in different hospitals, i have never seen anyone really use care plans. they are just a required (non-functional) form placed on the chart to satisfy accrediting agencies.
like nursing diagnoses, they are fine as a learning tool (i suppose), but do they make us any better at what we do? (personally, i think the days of nursing dx and careplans have come and gone). when i went to school, i learned how to care for 'hepatic encephalopathy' or 'pneumonia' not 'fluid volume excess' or 'ineffective airway clearance'.
nursing diagnoses leave gaps -- or at best one has to peruse thru a long list of interventions and select only the ones that apply to this particular patient -- for example, the patient who is SOB -- where is "elevate the HOB"? or, what about the patient with hyperkalemia -- or any electroylyte imbalance for that matter?
so, does anyone really use the care plan? or is there a better way?
can i ask this question are you nurses aloud to ignore doctors orders? what can happen if you don't follow doctors orders?
Let me put it this way: I'm not 'subservient' to a doctor and/or his/her 'orders'. Anything I do is subject to my approval. If I disapprove, I'm not only within my right, but my obligation to 'challenge' said order. I have, more than once told a doctor that I refuse to carry out his questionable order and he would have to do it himself. I have, more than once, taken a dispute up as far as the chief of staff. And the 2 times in my career that a dispute went that far, the CoS agreed with me.
I love this answer: "You woke me up to settle an argument between you and the Critical Care nurse? Let's be clear here - when a critical care nurse questions your orders and is willing to put his reputation on the line by bringing it this far . . . next time, listen to what you were told."
And, I've used 'creative interpretation' on more than one order. As most nurses have.
What can happen if you make an issue and habit out of challenging docs directly? You can lose your job and/or possibly be reported to the board.
But, what would happen if nurses weren't independent practioners, playing fast and lose at times with the rules in order that the right thing be done? Suzanne Gordon in 'Nursing Against the Odds' said it right: The 'medical' profession would ground to a halt if nurses weren't routinely 'practicing' by another name. . .
can i ask this question are you nurses aloud to ignore doctors orders? what can happen if you don't follow doctors orders?
Ok, I'll take a stab at this.
First, I must ask, why is your CNA being "pulled'?
Second, I don't think a careplan can exactly be considered a dr's order--it's a guide to a plan of care.
I think the point everyone is making is, in nursing school, students use careplans to learn what should be done for patients with certain disease processes. However, by the time you graduate, they've been burned in your head and you pretty much know what to do.
can i ask this question are you nurses aloud to ignore doctors orders? what can happen if you don't follow doctors orders?
Yes, we can and DO NOT carry out certain physician orders. This is expected of us. We are the pt advocates. If a treatment/order will Knowingly do harm instead of good for the pt, we are to NOT perform that treatment/order, and follow the chain of command. We call the Doc and let them gently know WHY its not a good idea to do whatever, and gently suggest an alternative. If this gets us no where, we can contact out supervisor, DON, and administrator. But no, we don't ignore orders b/c we don't feel like doing an order, or b/c its not what we would choose for ourselves/our families if we in that situation. We can and will loose our license if we do something that will knowingly hurt a pt. Nursing isn't blindly following orders. There is a reason why school is very difficult, and we must pass boards. We have to be able to know safe from unsafe.
As for the careplans, they are NURSING careplans, with NURSING interventions on them. The NURSE determines what goes on them. As others have said, by the time you graduate nursing school, you will automatically know what to do for a COPD or other common diagnosed pt. You will not need it written out. It will be engraved into your brain what needs to be done. If anything needs to be done out of the ordinary, the dr. will have written an order for it.
if the care plan say client is a diabetic do you dare to give the client a tostie roll pop?
No, I would not hand them one. If they asked me if they could have one, I would do some teaching regarding a diabetic diet. Yes they can have one, but they would have to give up a certain amount of carbohydrate from that meal they would like the pop included in. Would I take a tootsie roll pop away from someone? No. If they are of sound mind, they can make their own decisions, even if they aren't the best decisions. But I will document that teaching was done, and what the pt said, and that they continued to eat their tootsie pop. Anyone planning on giving a diabetic pt any food outside of what is on their meal tray, should be discussed with the pts nurse.
They're just another form we click through in the computer. There are about fifteen categories, broken down by body system. You choose the problem, and it gives you a list of five or so interventions, you choose as many as you need, and then choose outcomes. I agree that they're burned in your head - I did maybe twenty in nursing school, NONE in the field in which I'm doing my preceptorship, and I've never had a problem.
Specializes in MDS coordinator, hospice, ortho/ neuro.
I'm an MDS coordinator and I write care plans every day. No one reads them except me and the state surveyors.
The aides don't even know what they are, however they do get an assignment sheet everyday that lists each residents needs according to the care plan.
The nurses go by whats on the MARs and TARs. I liked the old Kardex system better, but you can't carry that around in your pocket.
The idea is sound, and it's great for making your look at the overall picture, which we'd like to hope that we all learned in training. It's supposed to be a tool to communicate to each other what we plan to do to care for this patient.
But know there are staff who do not think. And we all know that we're all drowning in excessive paperwork and documentation now.................
who's really doing the over all assessment and evaluation of care in your facility?
ZASHAGALKA, RN
3,322 Posts
NO. Care plans are a student's tool. A useful tool in school maybe; but no place in the 'real' world.
In the 'real' world, they are just smoke screens.
~faith,
Timothy.