How much of NS is just BS??? Let's be honest here...

[Curious1alwys]

Got to thinking about this today after I took a nursing exam and walked out boiling with high blood pressure!

Ok, so we have these tests in Process. Pharm and Assessment..not bad at all, but Process?? Ok, ok,......I know...they are "teaching us to think like nurses" and "there may be more than one right answer, but pick the BEST answer". I understand that nursing is not "black or white" but let's be real people??? The teachers don't know everything, but very few of them admit they don't! How many of you have questions on those tests that DO have TWO BEST ANSWERS??? Dare I say it?? Yes, Two RIGHT answers!! What I mean is, two answers that COULD BE right. The teacher did not weight one more heavily than other in lecture, but since you are learning to be a super nurse (right?), you know that, say, patient safety is more important than administering pain meds. So....... you pick that one on the test, the one pertaining to safety. OOOOPPSSS!!! Well, you were right on question #2 with that rationale but SORRY, on question #12 and #14 this is no longer the rationale. You can defend your answer to the grave. You see the teachers point, but darn it, you have a good point too. The teacher acknowleges that "yes, you could be right, you have a good point, your answer is not wrong, but what I say is right".:doh: It is TOTALLY INSANE. There are questions that I swear are just up to whatever the instructor wants that day. Everyone in my class swears she said one thing and then the next day she'll tell us that "oh no, X gets priority over Y" and then the next day, "well, you are right but Y gets priority over X" I mean, C'mon!! Anybody feelin' me on this??? :rotfl:

I mean, I AM critically thinking. I am doing what I am supposed to be doing!! I can fight why I answered what I did and they can fight why they say the right answer is the right answer. They will say neither answer is wrong, you could do both. Ok, then WHY WHY WHY is picking the answer about patient safety wrong? It's like on one test it is the right answer and then next test you get it wrong. I mean, isn't patient safety always your #1 concern??? DUH.:uhoh21: I swear, if I had a copy of the q's I got wrong, I would post them, just to see how many experienced RN's would get them right!!

Even getting past the stupid tests...the instructor is always right:rolleyes: . I have had an instructor agree with me that a question made no sense and was indeed misleading and then just say "Oh Well" and laugh and NOT give me any more points!!

Careplans??? We have two consecutive days clinical. One teacher (thank goodness for her) says that we could write up a preliminary care plan 1st day and she would correct. Then second day we would resumbit, corrected, the total care plan. This way, we would SLEEP the night before clinical and it would be safe for the patient. OH NO!!! Says the nursing department. "This is how it has always been" they say, and DEMAND that the whole entire careplan (25 pages) be done the night before clinical for 1st day. Doing this, students are taking 12-14 hours to finish the careplan and not sleeping. They acknowlege that this may not be safe for the patient, that it may be better to do careplan day 2 once you have done assessment, but won't change it. I mean, to give students only from 1pm on Wed to complete a careplan by Thurs 6 am, KNOWING it is going to take students almost 12 HOURS to complete and having the power to change that and NOT doing so.........well, that just seems like patient endangerment. It seems almost illegal!!

Anyway, the point I am making is that they often make things more difficult for no real good reason in nursing school. In fact, much of it is unfair while they pretend it is fair. I think it is all just a bunch of BS, a big huge "test" for the real thing. They treat you like crap, see how much BS you can take, so that you will be prepared for the real world. I get it, and there is no way getting away from it unless you GET OUT OF IT.:rotfl:

Funny.......police officers hold very important life or death positions too but they only have to be treated like crap and negated for 16 weeks. We have to do it minimum of two years!! I just hope I can do it. I hope I can suck down another not so good grade when I know I AM learning what I am supposed to be learning and my thinking is NOT incorrect. Ya just gotta bow down and take it.:bowingpur

The End:thankya: Thanks for listening to my rant.

[r_janice]

Whoever gave you the idea that care plans are never used in practice gave you BOGUS info.

Each and every patient whether hospitalized, at home or in other inpatient facility needs a care plan. Most hospitals and LTC facilities have standardized ones that you just pick and choose from, individualizing for patient/client.

However, when you are working out in the community, you are often create care plans for patients that the family, lay public (i.e. neighbors), aides and unlicensed care attendants follow. What you write and teach these folks greatly affects the care clients receive. When working out in the field, I created and updated care plans on daily basis.

Mastering them while in school ESSENTIAL!

All I ever hear about them are how useless they are and how I wont need to use them after I graduate.

Thank you for clarifying the importance of care plans........ :)

[hrtprncss]

IMHO hi...When you get a job in Nursing, do you do careplans the day before? Most likely no you don't, but practicing care plans while you're in school prepares you when you have to be in real life situations. Hopefully at that time, concepts about that particular diagnosis is already imbedded in your knowledge base and you could just access it like second nature. And care plans help alot with these. In regards to the forefather's of nursing...I always thought it was discussed during Issues/Trends class and not fundamental's...But like someone said, knowing the history of nursing "the best way to know where you're going is to know where you came from"

And to the OP, don't be so upset it's not always gonna be perfect, just move on and keep studying. When it comes to thinking critically. Thinking critically involves having an open mind about things and knowing that not everything is set in stone. New ideas come in and replace old one's. One book might say this and the a journal might negate it. One teacher may say it, and someone else says different. All in all, it won't be the the last time you'd have to deal with it. When you're working as a nurse, some doctors prefers other treatments over others, some conventional and some more bold. So just keep on studying and take a break a little:)

[sirI, MSN, APRN, NP]

Will we need to use careplans when we get out into the "real world" or is it just busy work for us while we are in school to make sure we do our researching on our patients?? I agree the roots are important. But nobody is going to ask me that question!! :)

Yes, you will utilize the care plan in the "real" world. You are learning the foundations of the plan of care for the patient and the myriad dx.

You will form a plan of care for every patient even if it is a standardized one. You will fit these pre-written plans to the patient. You will change the plan of care as needed, weekly, daily, hourly.........

The care plan is not something we educators lie awake at night pondering our next trap or dream about in regards to our students. Believe me, this is most important for the well-being of the patient.:)

[ZASHAGALKA, RN]

Sorry, but in my experience, care plans are the computerized garbage that is spit out during the admissions process to fool JCAHO into believing that our ivory tower elitist theorists make sense. (They don't). They are put into the chart on admission and completely ignored after that.

By me.

By my nursing peers.

Certainly by EVERY one of our multidisciplinary peers.

I've worked at several institutions and have never found that anybody finds any value in them. Or for that matter pays any attn to them.

As if I needed another nurse's opinion on what MY priorities should be. And as if I have time to play with useless paperwork to make them reflect MY priorities.

But my real gripe is that trying to fake our own 'language' makes us irrelevent to our multi-disciplinary peer. They can't understand this mess that is supposed to be our 'body of knowledge' and so they dismiss our charting, altogether. In an attempt to be 'professional' we've made ourselves inaccessible. In my opinion, care plans are like children that think talking in pig-latin makes them sophistocated.

From my perspective, care plans have no basis whatsoever in actual nursing care. And that's not a new perspective - I've been doing this for 13 yrs.

(Edit: Ok, thinking it over, maybe this is a tad 'over the top' in expressing my opinion. I suppose that care plans have a place in learning to prioritize things. But it is a common gripe that nurses don't band together, etc. I think part of that problem is HOW we choose to communicate and I believe that we in fact, communicate ineffectively. And because we don't communicate effectively, we are unable to show our worth. This goes beyond care plans, etc. This also goes to hinting about what a pt needs because we dare not step out of our place and actually say what we know. - if I tell a doc a pt needs lasix and the dr makes any kind of comment about knowing my place, I immediately demand that he/she come and personally evaluate that patient if they don't trust my judgement. Normally, after a small amount of bluster, I get an order for lasix. - Nursing school is where we begin to ingrain what it is to be a nurse to future nurses. I submit we can do a better job of that than focusing on care plans.)

~faith,

Timothy.

[Daytonite, BSN, RN]

There is something very interesting about this thread. The younger nurses and nursing students think a lot of what is required in their nursing programs is not important. The older, experienced nurses have just the opposite view. They are defending the making of care plans! Why do you suppose that is? Perhaps the older, experienced nurses know a few more things than the students, hmmm?

From my old 1966 version of Webster's New World Dictionary, College Edition: "wisdom is the power of judging rightly and following the soundest course of action, based on knowledge, experience, understanding. . ."

[Tweety, BSN, RN]

I realize you're just venting. Nursing school is tough and demanding. Spending 12 hours prior to clinical is obsence and you're not learning anything.

But the care plans and interventions listed on them are things you need to know. Granted in the real world we are not going to be spending 12 hours doing them. If we have a computer that spits them out it still has infomration on it worth knowing.

Thanks goodness where I work the care plans are not those wordy nursing diagnosises. But rather things like "care of the patient with a chest tube", "care of the patient with diabeties"...........and if I initial them, I'd best know what they say.

I agree Timothy, the language of nursing school can be maddening.

[speedykicks]

for those of you who are frustrated by nursing theory and history, a ADN program would probably be a better fit.

It doesn't matter what degree or professional school you go to - nursing, computer science, English, etc. - if you are in a four-year program, you are going to have to do some stuff that doesn't have a straight-on, clealry concrete application in your "real" job after school. Hell that is what school is - K-12 and higher ed.

I am really shocked at the amount of whining and entitlement the students have in my school - ask them to do a small write-up on a nursing theorist with APA style and you would think you just asked them for their left kidney and their first born! If we do get to the place of 25 page care plans, God help us.

[RedSox33RN]

I find it hard to believe that ANY facility does not have a plan-of-care for each patient. I know the ones in nursing school are much different than ones in the real world, but for a facility not to have some sort of careplan for a pt seems unethical.

Yes, I think a 25-page one is way over the top, but I have found them a good way to learn about diseases, drugs and procedures, and about my pt.

[r_janice]

Being that the only thing I know about careplans is from word of mouth, mostly from other students further in the nursing program than I, I have found this thread to be very useful. I have heard students tell me Nursing I is a waste of time and you barely use any info from it further in the program. Im glad I put my two cents in (that apparently wasnt worth that much! ), now I have realinfo to go on. NOt from ohter students but from nurses who know what the importance of the stuff we are learning now. No Im not a complaining student who thinks shes overworked.....just a working student/mom trying to balance things

[Chicklet2]

Care Plans are not gargage, if they are done appropriately. But a 25 page one is completely obscene. No one is going to read one that size on each and every student each week, they will weigh them, if anything..........something that I do not agree with at all. But there is nothing wrong with a two or three page paper before each clinical so that you know what you should be focusing on for that patient, labs, etc.

One extra long Care Plan per semester where you have several weeks to work on it is okay, but to expect that amount of work each and every week is just crazy.

Hey, in LTC during our practicum we had a 24page assignment on each of our clients. Well we had 3 clients and got new clients every 3 days. The assignments were to be handed in on the 3rd day. It was insane, the time I spent on that should have been time spent on the client. I mean staying up till 2am to try and get it done is ridiculous.

[Altra, BSN, RN]

I know...they are "teaching us to think like nurses" and "there may be more than one right answer, but pick the BEST answer". I understand that nursing is not "black or white" but let's be real people??? The teachers don't know everything, but very few of them admit they don't! How many of you have questions on those tests that DO have TWO BEST ANSWERS??? Dare I say it?? Yes, Two RIGHT answers!! What I mean is, two answers that COULD BE right. The teacher did not weight one more heavily than other in lecture, but since you are learning to be a super nurse (right?), you know that, say, patient safety is more important than administering pain meds. So....... you pick that one on the test, the one pertaining to safety. OOOOPPSSS!!! Well, you were right on question #2 with that rationale but SORRY, on question #12 and #14 this is no longer the rationale. You can defend your answer to the grave. You see the teachers point, but darn it, you have a good point too. The teacher acknowleges that "yes, you could be right, you have a good point, your answer is not wrong, but what I say is right".

Just a thought from a new RN ...

The reality of taking care of human beings is that you can do the "correct" thing ... and still have a crappy outcome. Perhaps a lot of nursing school BS is to begin to prepare you for this reality?

Oh, and the 25pp care plans ... I agree having to do them on every patient, or even every week, is not time well spent. But it does prepare you to be thinking about the WHOLE patient. Time with patients is limited, and there is never enough to address everything that you might have liked to address with any patient, but prioritizing means you've assessed the patient holistically and then used your judgement to choose which interventions are most meaningful or necessary RIGHT NOW.

Just my

[Catys_With_Me]

Funny.......police officers hold very important life or death positions too but they only have to be treated like crap and negated for 16 weeks. We have to do it minimum of two years!!

LOL, my husband's a police officer and I can assure you they are negated and treated like crap for a lifetime. They think it only lasts for 16 weeks and that's how they make it through the academy, then they return home and find out the sergeants, captains, lieutenants and chief are all their worst instructor personified and they're not going anywhere. One time his chief tried to get him to sign a contract unreviewed by union attorneys.. No sense dragging those pesky lawyers into it my boy... chuckle, chuckle HA!... recognizing a good screw-you-over in progress he called the attorney who laughed out loud upon hearing word for word what they wanted him to sign. His next visit to the chief's office (after the attorney had made an appearance) was not so fun. And this crap just goes on and on. You pull over the chief's friend on 3rd street? You are no longer allowed to patrol on 3rd street. You cite the lieutenant's golfing buddy for driving without headlights? You are no long allowed to cite ANYONE for driving without headlights... You mention to the chief in casual conversation that your car's acting up and all of the sudden you're being yelled at by a sergeant for violating the 'chain of command'. They tell you black in a squad meeting, then tell you 3 months later it's always been white and what the hell is wrong with you. They get in your face and yell obscenities and it's okay. You reply in kind and it's insubordination complete with internal review, probation and fines. My husband says 2 years of putting up with irrational power hungry idiots is nothing, count your blessings.