What are your care plans like?

jnj818 · Mar 16, 2007

I forgot this part. We have clinicals Wednesday and Thursday. If at any time before noon on Thursday one of our patients is discharged, we are assigned another patient and have to turn in another care plan, along with the others at post conference at 2:00 Thursday. Even if all three of our patients are discharged, we have to do three new care plans.

squee-gee · Mar 16, 2007

Whoa. That is a crazy amount of work. We do care plans but only once per semester. They are a bit more involved, but once every few months I can handle. We do have to hand in the usual paperwork each week - med sheets (I always get the guy with a million meds!), lab values sheet, clinical journal (3 pages of info on patient ranging from med dx to psychosocial(Erikson) plus 3 nursing dx with interventions), student journal and physical assessment data for both days. I thought that was a lot until I read what you have to do. I don't really get the rationale for requiring that much work from students. Well, good luck - and (if your semester started in January) there's only 8 or so weeks left so hang in there - you can always sleep during the summer break!

jones21498 · Mar 17, 2007

I go to a local community college and we have 4 care plans due every week. We have about 17 pages in all. There is an in depth health assessment, one page divided on patho and written health assessment, then you have your wonderful concept mapping, and from that we take out four nursing diagnosis for our care plans. It takes a good while, but I am getting faster as I go. I really don't feel like it is too much to ask, I know it is a pretty intense program. If you have a NANDA book and the internet it helps speed things up quite a bit. Our rotation right now is in a nursing home, so we have several pages of medications that have to be looked up with rationales, but I figure it is good practice for my ATI pharm test and NCLEX.

SmetRN2008 · Mar 17, 2007

Wow, that is insane!! We only have to do 3 successful careplans for the whole semester, and the ones we do don't even compare to that. We only have to come up with 2 nursing Dx, 2 short term goals and one long term goal, then at least 4 interventions (and they don't have to be a certain amount of sentences). For our paperwork we look up our patient's Dx and write a description of it and common S/Sx's. We only have to do 2 abnormal labs (can do more if we want, but I usually don't). Then we have to look up all the meds. That's basically it. And sometimes I find that time-consuming. I couldn't even imagine doing what you do 3X a week! The reason are instructor doesn't pile it on us like some other instructors do is because she believes we really aren't going to learn anything if we have to stress about all the paperwork we have to do each week. Which I agree with that. I won't learn anything if my anxiety levels are through the roof trying to get everything done. But, look on the bright side. This won't last forever and someday you will be done and never have to write another careplan again!! Hang in there, it will all be worth it in the end. Good luck!! :)

IrishIzCPNP, MSN, RN, APRN, NP · Mar 17, 2007

We have to do a care plan for every patient. We have clinicals on the weekend and generally have the same patient both days...so it's 1 plan. Sometimes a pt goes home and you get a new one...sometimes they will say to skip the care plan.

Our plans are easy. We have a few columns...

Diagnosis, Goal, Interventions, Evaluation and Comments (rarely used)

Diagnosis has the nursing diagnosis related to manifested by. There is no requirement on the amount of words. How could you put a requirement on it? Sometimes a major diagnosis really only has a few things it's related to or manifested by and anything else is just making up words to make somebody happy.

Our goal is to be patient oriented and must have a time frame attached to it. Pt will verbalize an acceptable pain level.

We must list at least 5 or 6 interventions. I forget because I always list a ton. I try to get 10. My clinical instructor LOVES interventions so I list as many as I can.

Evaluation is something we will fill in on Sunday (the rest of the plan is written on Saturday night). The evaluation may say that patient reported the his pain level has decreased today. Patient does not feel the pain is acceptable at this point. or Patient reports that pain is not at an acceptable level.

We have to do 5 diagnoses and they are to be in order of importance or numbered.

We then have to do a concept map with the 5 diagnoses. In the center goes the major diagnosis, age and sex of the pt. We then would have 5 boxes around it each with the diagnosis information from above. So the concept map is easy if you do it after the care plan (I can't imagine the poor soul who hasn't figured that out yet). You literally just copy the diagnosis column into the concept map giving each diagnosis it's own box. Again they have to be numbered by importance (which was already done in the careplan). I just put mine in a clockwise fashion by importance. We then have to draw lines. First set goes from center box to each diagnosis. We then have to connect the diagnoses. Not all connect to each other. So we have to see if # one is somehow related to #2, #3 and so on. Whatever ones it's connected with in some way we draw a line. So it's a lot of lines but not everything is connected and they will get you if you just draw lines for the sake of drawing lines.

So an example an actual diagnosis of activity intolerance would have a line to risk for falls. The activity intolerance may not have a line to allergy response. So the concept map is basically to make us thing how these issues play off each other and realize that one can cause another which can cause another...and that some just aren't related.

I do mine on the computer. My instructor LOVES them. I have a care plan here with "Excellent Care Plan! WOW!" on it. At my eval she commented how my care plans, besides being on the computer and wonderful because of that, are excellent. I like doing our care plans. I think what we have to do is very reasonable and really makes us think about what our job could and does entail.

We still need to know labs, meds, diagnostic tests and that kind of stuff but we were taught that that does not belong on a care plan. That is just prep.

I'm not sure how there's a page for each intervention. We were taught that interventions are what you are going to do to work towards the goal you have created for the diagnosis. It's a list of things.

I have to say that it seems some instructors work students just to work them. Our instructors work us on things we need to know...not just to make us do stuff. We need to know our patient, we need to know about them and their medical history.

Daytonite, BSN, RN · Mar 18, 2007

jnj818. . .school should be your primary focus as well as nursing. You are there to get a degree and all these assignments and writing are a requirement of the degree. Clinicals are nothing more than labs. They are just labs that are being done at a site that are off campus. Yes, patient care and patient safety are important (so is your safety in a science lab in any science class), but your focus should always be to get your school assignments accomplished. This is Job 1 and you should be managing your time to do that. You should think of your classes as important as any job. But, you are in college to get a college degree. RNs are thinkers and managers of patient care and that is why you are being asked to do all this time consuming work. They are traditional exercises in nursing known to help you learn about disease processes, how nursing principals fit in and how to think critically. If you are not happy with what your school requires of you as a student, then look for another school that approaches this in a different way. Bottom line is that you are, #1, a college student, and #2, studying nursing. That is why you are doing all the writing.

When I was in my nursing program we typically had 50+ page nursing care plans that had to footnoted and referenced to turn in. It was a BSN program and this, I have learned, is typical of many bachelor's programs be they in nursing, engineering, English, psychology or any other scholastic program. A bachelor's candidate at just about any U.S. college or university is expected to know how to research and write. Otherwise, the alternative would be to find a different type of school. However, RN training typically is being done in colleges and universities where this level of academic performance is expected. This is what separates an educated person from those who do not have formal college educations.

Care plans are nothing more than the written expression of the nursing process that you will think through every day of your nursing career in the years ahead. The difference between the writing and thinking is that the actual writing takes longer. It is taking longer now because you are just learning these things. We all have to start at the beginning. There are no short cuts. However, when the writing and the specific subject areas are learned, the writing and thinking goes much faster. You can't hurry time.

Bonny619 · Mar 18, 2007

One word, easy.

I come here and read about these insane care plans and I only wonder if we are being shortchanged!

Our care plans are usually 5 different pages of info.

IrishIzCPNP, MSN, RN, APRN, NP · Mar 18, 2007

One word, easy.
I come here and read about these insane care plans and I only wonder if we are being shortchanged!
Our care plans are usually 5 different pages of info.

Honestly I don't think you are being short changed. There is much more or less to nursing then just being about to write 50 page care plans. No offense but I don't think much is really learned about nursing by being able to write a paper. The instructors in my program are master level nurses and one is working on her Phd. They are extremely educated and I don't think for one second they would short change us.

IrishIzCPNP, MSN, RN, APRN, NP · Mar 18, 2007

This is what separates an educated person from those who do not have formal college educations.

I'm sorry but I think that's a very offensive and false comment with a gross assumption. An educated person does not need a formal college eduction. An educated person doesn't mean they are a good nurse or that they are smart.

So just because somebody has a more formal education doesn't mean they are any better at what they do or that they are smart. It means they spent a lot more money.

Educated and smart are different things. Educated does not equal the best.

My mom has her master's degree. She is very educated. She happens to be smart and very good at what she does. My mother works with some stupid educated people who are frightening on the floor.

I don't know if you dislike diploma programs but it kind of comes across that way.

marilynmom, LPN, NP · Mar 19, 2007

Honestly I don't think you are being short changed. There is much more or less to nursing then just being about to write 50 page care plans. No offense but I don't think much is really learned about nursing by being able to write a paper. The instructors in my program are master level nurses and one is working on her Phd. They are extremely educated and I don't think for one second they would short change us.

I agree. I'm in a BSN program and every single one of our instructors have PhDs (or are working on their phd) with years of nursing experience and none of them make us do long care plans. Ours are very simple, yet to the point--a couple pages of pertinent information (meds, labs, patho, history, etc).

Yes we do have to write papers for other classes like any other bachelors program, but not absurdly long care plans.

jnj818 · Mar 19, 2007

Yes we do have to write papers for other classes like any other bachelors program, but not absurdly long care plans.

And I imagine you have more than 12 hours to write these papers.