i'm a nursing student about to start second semester, first clinical semester. i'm getting increasingly concerned about the content of nursing school. i like science and pathophysiology. i don't like busy work or brainstorming about the "8 holistic parameters" and how they relate to every little thing. i don't like reading a care plan for ob (2 semesters from now) that says things like "interventions: 1) provide a supportive atmosphere, 2) provide reinforcement for infant care taking behaviors, 3) provide opportunities for adequate rest", and so on. is that realistically what i have to look forward to? i guess i'm looking to find out how much science there is actually involved, compared to the more touchy feely stuff, when you are actually a working rn. i may be able to stand the whole "assessing for fall risk" type of thing if it's not really so much like that in the real world. i'm really resenting that we're being told, basically, how to be good human beings, not professionals. i'm feeling like i'm on the verge of a meltdown and school hasn't even started back up yet. i just pray that it gets way more difficult and way less feely (although that care plan i read is from 4th semester), ugh....
Specializes in med/surg, telemetry, IV therapy, mgmt.
Believe me when I say that you will not spend hours formulating care plans when you hit the real world. There will be standard care plans on the front of the patient chart, but they are usually computer-generated. They are trying to teach you critical thinking and assessment skills, which is a big part of what you will be doing. You will look back at care plans as "common sense" for planning your clinical care. We all had to suffer with care plans - I even use them now in case management, but the computer does it for me.
Let me be clear. . .care plans are our documentation of the problem solving process that we use in treating patients. That's all it is on the job. I don't understand why people feel that doing them in nursing school is "suffering". This nursing process is what distinguishes us RNs from other personnel in the nursing industry and we should be proud to know that we have this skill because we spent most of our time in nursing school honing it. Anyway, all of us problem solve every day of our lives in and out of our work situations. Other professions use a similar problem solving approach. We just have to document it. Thankfully, some smart people have cut the writing time down for us by putting these things on the computer to help us out.
I think the problem is that learning to think about it systematically requires some real effort. It reminds me a little of a writing exercise I had in an English class: Write a set of instructions for tying shoelaces.
Not easy!
In real life, you do sometimes find yourself doing what needs to be done, now, then going back later to document the rationales. If a patient is cyanotic, you need to figure out whether the problem is ventilation or perfusion, but you don't have time to draw a concept map. But learning a systematic way of thinking in a non-emergent environment does help avoid more-or-less random reaction when the emergent situation arises.
More on the topic of "common sense" diagnoses and interventions, I recently had a bout of acute bronchitis and learned, first hand, about needing to take a rest break from eating a sandwich. Really brings it home in a way reading about it never could--but, I already knew that with a COPD patient, fatigue has to be taken into account, and if I see I'm getting an admission with a history of COPD, I'm not going to badger him if he doesn't finish his meals--I'm going to offer him a snack later in the evening. Just now, I'm thinking to myself, I really do need to work on being more diligent about documenting such things (thanks, Daytonite, for a lovely excuse to do more charting:uhoh3:) but I've seen enough family members pushing a loved one to "Eat just a bit more..." to realize that there's more to it than "common sense."
My patient populations varies from up ad lib to bed exits risk to completely immobile, and lately I've been wrestling with trying to tailor their activity to their ability. I have a tendency to do too much for a patient who needs to be doing what they can for themselves (I don't think this is uncommon--in fact, I'm told it's one of rehab nurses' biggest complaints about acute care nurses.) So as I'm answering a call for a bedpan, I need to be careplanning whether to get someone to assist or to encourage bed mobility. For a walkie-talkie or a GCS of 3, it may not need much thought, but most patients of mine fall in a great gray area between those extremes. Again, I may not need 4 pages of paperwork, but I do need to think it through--and preferably have some idea before I get the call for the bedpan.
well let me ask then, how much time is spent charting, documenting, etc compared to hands on work and problem solving? by problem solving, i mean complex problem solving dealing with the patients' physical response to illness, not psychological. that is the type of problem solving that i find complex and interesting, because it challenges me, while i realize others may have different opinions. is this a more "medical" interest?
Daytonite, BSN, RN
1 Article; 14,604 Posts
Let me be clear. . .care plans are our documentation of the problem solving process that we use in treating patients. That's all it is on the job. I don't understand why people feel that doing them in nursing school is "suffering". This nursing process is what distinguishes us RNs from other personnel in the nursing industry and we should be proud to know that we have this skill because we spent most of our time in nursing school honing it. Anyway, all of us problem solve every day of our lives in and out of our work situations. Other professions use a similar problem solving approach. We just have to document it. Thankfully, some smart people have cut the writing time down for us by putting these things on the computer to help us out.