30+ page care plans

mspontiac · Oct 7, 2010

I sooooooo envy those who are given time after clinical to complete the care plans! We have to gather pt info the day before clinical and complete the 20-ish page care plan that night. I usually spend about 10-12 hrs working on it (we also do a second shorter version of the paperwork for the second patient we work with.) I typically start around 2 or 3 in the afternoon and finish at around 2 am because our instructor expects them to be *perfect* and she will rip them apart if they're not. It's so tedious...we even have to explain why lab values are within normal limits. We need four that are over 90% to pass. It's not so bad this semester because I have afternoon clinicals, but the last two semesters I had to be back up at 4:30 am for morning clinical. Working on so little sleep is really difficult and honestly, I think it was dangerous for patient care when you have 8 students running around on 2 1/2 to 3 hours of sleep.

I understand needing to have all medication information completed so as not to make med errors, as well as analyzing lab values so we can be aware of what is going on with that person and orders so we know what to do with them, but I really think everything else could wait until after clinical to be completed. I don't buy the garbage about doing it to be prepared because if our pt is discharged before we come in, we're tossed on to another pt we know nothing about, and we are still expected to perform all of the same duties with that person. Meds included.

Speaking of which...what's really maddening is when you do that 12 hours of work and then they're discharged right before we get there, which means we don't get any points for the paperwork. All of that work for nothing. Now THAT makes me want to stab my eye out with a pencil. :uhoh3:

ETA: Is there a way to attach documents in replies? If so I will attach an example of one of our care plans.

crossingfingers10 · Oct 7, 2010

I sooooooo envy those who are given time after clinical to complete the care plans! We have to gather pt info the day before clinical and complete the 20-ish page care plan that night. I usually spend about 10-12 hrs working on it (we also do a second shorter version of the paperwork for the second patient we work with.) I typically start around 2 or 3 in the afternoon and finish at around 2 am because our instructor expects them to be *perfect* and she will rip them apart if they're not. It's so tedious...we even have to explain why lab values are within normal limits. We need four that are over 90% to pass. It's not so bad this semester because I have afternoon clinicals, but the last two semesters I had to be back up at 4:30 am for morning clinical. Working on so little sleep is really difficult and honestly, I think it was dangerous for patient care when you have 8 students running around on 2 1/2 to 3 hours of sleep.
I understand needing to have all medication information completed so as not to make med errors, as well as analyzing lab values so we can be aware of what is going on with that person and orders so we know what to do with them, but I really think everything else could wait until after clinical to be completed. I don't buy the garbage about doing it to be prepared because if our pt is discharged before we come in, we're tossed on to another pt we know nothing about, and we are still expected to perform all of the same duties with that person. Meds included.
Speaking of which...what's really maddening is when you do that 12 hours of work and then they're discharged right before we get there, which means we don't get any points for the paperwork. All of that work for nothing. Now THAT makes me want to stab my eye out with a pencil.
ETA: Is there a way to attach documents in replies? If so I will attach an example of one of our care plans.

We had to have meds, labs, diagnosis, history, etc done before the next day for some of our clinicals as well. However, we could add more detail and perfect everything before we turned it in for the grade. Also, this is the time we were supposed to formulate our nursing dx and everything that went with them. Our instructor said she didn't want us basing all of our nursing dx off of info out of the chart, she wanted us to work with the patient first and then construct our nursing dx. It is frustrating when your patient gets discharged, however we still received credit for the care plan we worked on. We also had to do a mini care plan on the 2nd patient whether it was a planned 2nd patient or an alternative patient you took if yours went home. During clinicals like critical care and OB, we could not go in the night before to choose a patient since there was no way to know who would be there the next morning. You'll be done soon and these ridiculous care plans will be a thing of the past :)

p.s. I have to say I am envious of your afternoon clinicals :) ours were ALWAYS morning! I think our latest was 7 am.

mspontiac · Oct 7, 2010

p.s. I have to say I am envious of your afternoon clinicals :) ours were ALWAYS morning! I think our latest was 7 am.

Oh yes, I loooooooooooooooooooooove my afternoon clinicals!!!! I'm very much a night person, so it works out really well for me. :yeah: We don't have many spots for afternoons, so I'm happy that I got one of them.

citylights89, BSN, RN · Oct 7, 2010

That's ridiculous. 30 pages? And here I was ******** about my care plan I just had to turn in today. It was only 2 pages, but it also included our client report sheet (which is like our form of a Kardex), lab values and implications, patho, epi, PIE note, 8 page assessment form, an index card with dx, short term goal, and 4 nursing interventions on other patient, list of prioritized nursing dx, med worksheet, medication reconciliation sheet, whatever worksheet that may be due that week, APA references, and CPAT. In the end, with information for both patients, it did probably end up around 20+ pages.

We only have to do 2 care plans this semester, one regular and one teaching care plan, so I guess its not that bad. The thing is you have to pass it...obviously, or else you keep repeating until you get it right. I hope mine is passing! :/ And we don't have to do the assessment form and prioritized nursing diagnoses when we don't have a care plan, although we are still expected to do the little index card and assessments each week until the end of the semester.

Snehala · Oct 7, 2010

The care plan itself is not 30 pages long.

Personally, I have not done a care plan longer than 5 pages. We have to do a weekly care plan (2 nursing Dx, 4 goals per Dx, 3 interventions per goal), a weekly medication tracking sheet, full research on 4 medications, and research on all Dx. We also have weekly narrative notes to hand in. When you add all of that up, it becomes 30 pages. :nurse:

HalfmoonMaggieRN · Oct 8, 2010

Boog's Girl has succinctly described the steps of the care planning process. The exhaustive listings of some of the posts: "every single lab value", "every single medication and their interactions", your assessment and your patient's medical diagnosis(es), all are the stuff of these 20 and 30-pagers monsters!!! :eek: As students, we pigeonholed our plan information. We followed the pattern of the care plans we had seen in our textbooks. In reality though, all of that detail and focus prevented us from seeing the whole picture, minimizing our efforts. As our clinical skills become more sophisticated, we followed the same nursing process we used in our student years, but there was a more natural progression through the care planning steps. (Remember having to "show your work" for math problems, though you were skilled enough to arrive at the correct answer in your head?) I also recall, as a student, having trouble wrapping my head around the continuity of the steps of the care planning process. Data collection and assessment were jumbled together, and weren't we planning as we listed our interventions? As a practicing professional, I eventually realized that the reason for my confusion was that the process truly IS a fluid one, and that our academic exercise was complicating a simple process. :rolleyes:

decembergrad2011, BSN, RN · Oct 8, 2010

In the clinical environment nobody could be bothered to read a 30 page care plan let a lone actually write one. It seems that there are still some nursing schools where academics are completely out of touch with the real world where real nurses practice.

I agree with the fact that nobody has the time or energy to create a 30 page care plan in the real world. However, the purpose of care plans (and research class for those in the BSN program) is to give the foundations for being able to think EBP in everything. Knowing how your medications play into care, why the lab values look like this, what a patient with a disease process of this with a comorbidity of this, etc, are all important for bedside nursing, too. I know that while I absolutely loathe care plans, they have contributed to increasing my clinical knowledge and ultimately have made me a better nurse.

reigh · Oct 8, 2010

i think what you’re referring to is called a chart. ralmao ;-) drug info at 20 pages sounds like a drug guide or whole monograms wt? i say keep it simple stupid and summarize were appropriate. six to eight pages including labs, assessments, nursing dx, and relevant history and that is harder than copying/retyping an entire chart mentally but is more beneficial then busy work wasting time typing.

in my practice as a nurse i try and keep all the relevant info needed to take care of all my patients combined kept down to a single page helps me think and plan. then i use that info to reference or point me to places in the chart or care plan.

for instance as simple as just a list of times for drugs because i have to double check the mar anyhoo but if i don't have to flip through the whole chart at each med pass then great. if my mar was electronic i wrote a great little sheet that automatically shows the current list of times at the top of the mar set for each patient separated by shift. that way every time a med time is added i can a. see the current list of times at a glance b. consider combining med times were appropriate for correct implementation c. pass that new info onto the next shift worker with minimal work. alas not yet electronic distribution machines like the ones in hospitals get close with search by time but i preffer to have a feild i can copy to my notes with all the times no duplicates per patient and constantly updating.

or a lab sheet with different color highlights for norms high and low so i can think through how all the labs interact quickly. like anemias in fact a little logic function in there and presto =if hematocrit and hemoglobin and rbc are ... then specific result you know what i mean. then you could look at it and say if it just barely out of range anemic or real serious stat kind of anemia.

mspontiac · Oct 8, 2010

Here's an example of one of mine...yuck. I have edited it to remove any identifying pt. info. I highlighted in yellow all areas that are completed during clinical.

Week 2 - suprasellar cyst in brain.doc

ruaalien2 · Oct 9, 2010

Here's an example of one of mine...yuck. I have edited it to remove any identifying pt. info. I highlighted in yellow all areas that are completed during clinical.

That doesn't look as bad as ours. I'm finishing our first one now, it's a mock care plan and it's 25 pages. I'm dreading having to do a real one.

HalfmoonMaggieRN · Oct 9, 2010

The documents attached to some of the comments here are more than nursing care plans. They're academic exercises with the goal of teaching the students to put the nursing process into practice. Most of the verbage is documentation of the assessment data, followed by the (much shorter) actual care plan. Practicing nurses do not document their assessment and plan, but simply the resulting interventions, goals, and evaluation criteria. I'm not certain that the fact that the former is an academic exercise is clear to the students, and the discrepancy between the theoretical basis and practice intensifies the challenges faced by the newly-graduated RN. :crying2:

CrunchyMama, ASN, RN · Oct 9, 2010

A careplan is 1 page. We do have to look up their drugs which is on a separate paper. How/why would a careplan be 30 pages, I have no idea and would really despise being in such a program that required that.