Care Plans an Exercise in FUTILITY??????

alacek · Jul 6, 2004

My post was geared towards LTC and the way they are used in that setting. IN LTC a nurse can easily have 60 patients. The care plans in LTC are written and utilized differently than they are in a hospital. We have elderly people with ADL defecits and several medical problems, CHF, Diabetes, Stroke, Shizophrenic, etc. The care plans for these folks look like a novel. On the other hand in your setting you are responsbible for like 2 or 4 patients that have similar problems with a few extra things here and there. And I am sure with this few you have the time to review, update and read the care plans every shift. On 60 residents with as many as 25 different problems we dont have time to review the care plans.

Absolutely the difference! Although, I usually have more than 2-4 patients. Well, in L&D, that is about right, but we chart on our patients on average of every 15 minutes, so it is pretty busy. In PP, we sometimes have up to 10 couplets, so this can be very busy, and I find that reviewing the clinical pathways really helps me better care for the patients. As for LTC, I will give it to you guys, because I could never do that type of nursing. Actually, I think I could, but I would not enjoy it. I did home health for a few years, and the paperwork was awful, so I can imagine in LTC. Good Luck!

Destinystar · Jul 6, 2004

i did ltc nursing for 27 years and didnt enjoy it. couldnt do it anymore. would not recommend it. when it comes to ltc nursing takes on a whole new meaning. :)

absolutely the difference! although, i usually have more than 2-4 patients. well, in l&d, that is about right, but we chart on our patients on average of every 15 minutes, so it is pretty busy. in pp, we sometimes have up to 10 couplets, so this can be very busy, and i find that reviewing the clinical pathways really helps me better care for the patients. as for ltc, i will give it to you guys, because i could never do that type of nursing. actually, i think i could, but i would not enjoy it. i did home health for a few years, and the paperwork was awful, so i can imagine in ltc. good luck!

missmercy · Jul 6, 2004

We use careplans, kardex and are looking into clinical pathways as well. Our house policy states that we must have 3+ pertinent care plans on each patientand they must be updated at least daily! Your idea of using the Kardex isn't bad -- ours would need some tweaking -- am not sure if it covers all the legalizms etc.......... Of course, the Kardex would have to remain multidisciplanary, but a section of it could be purely nursing care plans!!

HMMM!

AMICRW · Jul 6, 2004

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care plans are used in our facility as well as "care cards" so that all have a brief of what the care plan requires and shows any changes. all caretakers, then, know what is the actual current expectation. in fact, each caregiveer is accountable for any thing done that goes against what is on the care plan / cards. when litigation has happened, and care was being given according to the care plan, it is easier to show that it was a suddden change in the patient's condition, which does influence the outcome.

kateRN · Jul 6, 2004

Care plans are meaningless wastes of time. They don't mean anything, and their only purpose is to generate more points when JCAHO comes. :)

I fill mine out everyday because we're supposed to, but they don't influence my nursing care at all. Especially because most of them have information about prescribing meds in them. I'm not going to say to the docs, "excuse me? as you can see here on the care plan, it is day #3 on the 'acute coronary syndrome pathway' and this patient is not on an ace inhibitor. don't you think they need to be on one?" They would look at me like I had three heads. Patients would get much better care if nurses didn't have to spend hours doing worthless paperwork.

Destinystar · Jul 6, 2004

as far as my perspective on care plans is concerned it is from the stand point of ltc. in ltc we have federal regulations, the rn nursing practice act and the state regulations to deal with. in order for a care plan to be considered to be complete we have to do this 2 hour assessment called an mds, then we have to write care plans on priority problems, then within 3 weeks after admission have a complete one, in addition to care plan meetings initially that involve the resident and their responsible party and every three months. now imagine this you come to work on the noc shift and have 60 patients to take care of and this is your first day you are on this unit because you have to float to different units. you have 4 cna's. you have to do narcotic count for a ton of medication. take the daily report, then tend to residents who are crying out in pain, iv is empty, ngt empty, make assignments, chart etc. for 60 residents!!! where are you going to find the time to read all of the care plans on all of the residents and communicate this to all of your cna's. even if you read the care plans it is not like you have any idea who some of these residents are or are going to recall every thing you read. this is in addition to reviewing the md orders. i am not saying they are useless. i am saying we dont use them. therefore and exercise in futility. :uhoh3:

i did ltc nursing for 27 years and didnt enjoy it. couldnt do it anymore. would not recommend it. when it comes to ltc nursing takes on a whole new meaning. :)

Destinystar · Jul 6, 2004

that is exactly the point of my post. wouldnt our time be better spent on a task that actually benefitted the patients???i am not saying that care plans have a theory but when the outcome is no one is finding them useful doesnt this exercise in futility need to be addressed??? dont we need to think outside of the box?? doesnt something need to change??? most of our ability to care for patients come from on the job experience. once we learn the skill and practice it over and over again we dont need to look at a care plan to spell out what needs to be done. like if someone is in a coma any body on staff ought to know to turn and repostition, the patient q 2h and to perform adl's why in the heck in long term care are we required to state the obviouse in a care plan??? if someone is a diabetic the md orders and mar plainly spell out what needs to be done for the patient and when to call the md, so why duplicate the effort and write it in a care plan??? when i write nursing care plans reminds me of giving instructions to a student to someone who has no experience. :uhoh3:

care plans are meaningless wastes of time. they don't mean anything, and their only purpose is to generate more points when jcaho comes. :)
i fill mine out everyday because we're supposed to, but they don't influence my nursing care at all. especially because most of them have information about prescribing meds in them. i'm not going to say to the docs, "excuse me? as you can see here on the care plan, it is day #3 on the 'acute coronary syndrome pathway' and this patient is not on an ace inhibitor. don't you think they need to be on one?" they would look at me like i had three heads. patients would get much better care if nurses didn't have to spend hours doing worthless paperwork.

Jailhouse RN · Jul 6, 2004

A Major League Waste Of A Good Nurses Time. Do You Not Assess Daily? Do You Not Make Regular Rounds? Do You Not Talk To Your Pts?

mscsrjhm · Jul 7, 2004

that is exactly the point of my post. wouldnt our time be better spent on a task that actually benefitted the patients???i am not saying that care plans have a theory but when the outcome is no one is finding them useful doesnt this exercise in futility need to be addressed??? dont we need to think outside of the box?? doesnt something need to change??? most of our ability to care for patients come from on the job experience. once we learn the skill and practice it over and over again we dont need to look at a care plan to spell out what needs to be done. like if someone is in a coma any body on staff ought to know to turn and repostition, the patient q 2h and to perform adl's why in the heck in long term care are we required to state the obviouse in a care plan??? if someone is a diabetic the md orders and mar plainly spell out what needs to be done for the patient and when to call the md, so why duplicate the effort and write it in a care plan??? when i write nursing care plans reminds me of giving instructions to a student to someone who has no experience.

totally agree. sure is alot of wasted time busy work in nursing. maybe we could cure the nursing shortage if we got rid of some of the unnecessary administrative paperwork schmuck.

perhaps we should simply point out these allnurses.com discussions so that someone in charge could see the waste.

who is in charge?

AMICRW · Jul 7, 2004

as far as my perspective on care plans is concerned it is from the stand point of ltc. in ltc we have federal regulations, the rn nursing practice act and the state regulations to deal with. in order for a care plan to be considered to be complete we have to do this 2 hour assessment called an mds, then we have to write care plans on priority problems, then within 3 weeks after admission have a complete one, in addition to care plan meetings initially that involve the resident and their responsible party and every three months. now imagine this you come to work on the noc shift and have 60 patients to take care of and this is your first day you are on this unit because you have to float to different units. you have 4 cna's. you have to do narcotic count for a ton of medication. take the daily report, then tend to residents who are crying out in pain, iv is empty, ngt empty, make assignments, chart etc. for 60 residents!!! where are you going to find the time to read all of the care plans on all of the residents and communicate this to all of your cna's. even if you read the care plans it is not like you have any idea who some of these residents are or are going to recall every thing you read. this is in addition to reviewing the md orders. i am not saying they are useless. i am saying we dont use them. therefore and exercise in futility.

i loved long term care, i'd still be there if i could physically do the care. after 40 years of nursing my "old self" just can't hack it anymore. i wish that they would have types like myself to enforce the care that people should be getting, you know tackling the dr relations so that protocol wouldn't be a who is right so much as what is right and that is mandated to be done. sometimes it is an ego fued. one would think that 'we' would be past that by now! ltc is unique and not for everyone. hope you found your nitch! amicrw

Destinystar · Jul 7, 2004

i stay home and take care of those who are the closest to my heart and mean more to me than anything else in the world. my children. being a mom was my calling. i also work part time for a pediatric neurologist. a thousand wild horses could not drag be back into ltc.:)

i loved long term care, i'd still be there if i could physically do the care. after 40 years of nursing my "old self" just can't hack it anymore. i wish that they would have types like myself to enforce the care that people should be getting, you know tackling the dr relations so that protocol wouldn't be a who is right so much as what is right and that is mandated to be done. sometimes it is an ego fued. one would think that 'we' would be past that by now! ltc is unique and not for everyone. hope you found your nitch! amicrw

steve0123 · Jul 7, 2004

Care plans can be useful, so long as they are designed to serve a purpose (rather than just creating more paperwork). Where I work however, they are the biggest waste of paper since the National Enquirer went to print. We have a "checklist" system, and every shift come hell or high water we go through each patients plan and *tick* things like "frequency of obs" and so on (despite the fact the patient may just be a social admission - oh no Sister Smith, QID obs regardless...). The best system I have ever seen was where the care plans were incorporated into the clinical notes in much the same way the attending MO writes their notes (ie: patient history and assessment followed by plan of care). This way they are actually useful, relevant, and are a form of documentation for the care provided. I've also seen some of those Kardex systems in use, but found they can be fiddly and also they do not form part of the patients record.

I think as nurses, we have a love affair with forms and paperwork with little check boxes and arrows and multiple choice questions and graphs and charts and so on... When it can all be achieved with minimal fuss by scribbling in the notes. Also - these clinical pathways are almost as bad (a mild improvement as they are slightly more relevant to the patients condition). They are a tool developed to reduce LOS which aint always a good thing - they fail to take into account comorbidities, the fact that each patient responds to illness differently, and that not all nursing care can be quantified and measured for the bean counters statistic purposes. Most of us are intelligent and knowledgeable in our areas of expertise - how about practising some of this "autonomy" we are told we have by using independent thought to formulate our own plans of care for patients... And thats all I have to say about that.