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Share Policies That Have Not Saved One Life

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Specializes in ER. Has 28 years experience.

2 hours ago, Hannahbanana said:

So yes, a mechanism for this sort of care planning communication is both useful and productive, and yes, I have seen it work beautifully. You may have things like this posted at the bedside, but that white board doesn’t document them and we need to do that to continue to push for recognition of nursing’s value. 

Agree with everything you said about the potential utility of good care plans.

A huge problem is that it is our employers who want the right to value our profession as they see fit and they have endless shenanigans that keep us from doing our work as we were trained to do.

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

59 minutes ago, JKL33 said:

A huge problem is that it is our employers who want the right to value our profession as they see fit and they have endless shenanigans that keep us from doing our work as we were trained to do

As I said, you can’t wait for your employer to give you power. You have to seize power. 

2 hours ago, JKL33 said:

A huge problem is that it is our employers who want the right to value our profession as they see fit and they have endless shenanigans that keep us from doing our work as we were trained to do.

The other thing with this is the regulatory requirements that force us to use computer based care plan templates. They have to be able to run reports to show to whatever regulatory body they are bowing and kneeling to that we are fulfilling their requirements no matter how far removed they are from actual patient care. More useless busy work to feed the academics. 

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

On 7/23/2021 at 1:46 PM, Wuzzie said:

In my role I look at the physicians' "impression and plan" documentation dozens of times a day to determine what needs done in a big picture sort of way. If the nursing care plan was anything like what I use then it would be extrememly helpful. 

Why not start a pilot program? Nobody but you has to know you’d just be reverse-engineering nursing plans of care, LOL. If people like it, as they are apt to do by relating to your perfect example, then who knows what kind of professional effectiveness could break out? Maybe they even put it just like you want it in the EHR, same as the medical impressions and plan. My goodness, then what?

Daisy4RN

Specializes in Travel, Home Health, Med-Surg. Has 20 years experience.

IMO Care Plans have outlived their purpose. When I first started they were hand written (on paper) with nurses providing nursing diagnoses and updates PRN. At some point we changed to some check off boxes (which helped) but one could still write in whatever was necessary for a custom plan. Other departments/ancillary staff wrote their own also in the same care plan. We updated our nursing plan when we had time as needed (sometimes 2 times a shift, sometimes 1time a week) and nobody made a big deal about it if it didn't happen exactly when it should. Fast forward to now (last hospital I worked). The Care plan (on computer) was barely recognizable and had very little way to add anything, just check off whatever seemed close. RN was responsible for updating every shift and you better find something or it would be a write up. RN also was responsible for opening, closing, and updating other departments/ancillary staff (OT, RT, SP etc) if they didn't do it (and guess how many didn't do it once they realized this!), and again, a write up for the RN if they didn't do the other's work. 

At one point in time the care plans were useful and relevant, now they are just for regulatory purposes etc. They have just become an exercise in futility that does not help nursing or the pt at all and if anything hurts the pt because of the ever growing time suck of paperwork/computer time. Care plans are worthless!

Hannahbanana, BSN, MSN

Specializes in Physiology, CM, consulting, nsg edu, LNC, COB. Has 51 years experience.

On 7/25/2021 at 1:15 PM, JKL33 said:

A huge problem is that it is our employers who want the right to value our profession as they see fit and they have endless shenanigans that keep us from doing our work as we were trained to do

As I said, you can’t wait for your employer to give you power. You have to seize power. 

Care plans IN THEIR PRESENT FORM may be worthless. However, reinstating good ones (as only working nurses can do) will be a big step towards regaining the power we should wield in our care and advocacy for our patients. Do it. Do it. 

BetterTomorrowThanToday

Specializes in Flight/ICU-CCU/ER/Paramedic. Has 18 years experience.

On 7/19/2021 at 3:40 PM, amoLucia said:

Hey! Where did his come from? Seriously ...

I worked a travel contract for a large system on the east coast (prolly shouldn’t out them as I may tell other things that occurred at this portal to hell that could actually lead to identification of someone) where licensed nurse staff were required to wear full white — including shoes!! 
And athletic shoes did NOT qualify as “white”. 👻

While it was EASY to identify nurses, I can assure anyone, everyone and myself this “policy” did not SAVE one life. 
 

👻👻👻

Jedrnurse, BSN, RN

Specializes in school nurse. Has 29 years experience.

14 hours ago, BetterTomorrowThanToday said:

I worked a travel contract for a large system on the east coast (prolly shouldn’t out them as I may tell other things that occurred at this portal to hell that could actually lead to identification of someone) where licensed nurse staff were required to wear full white — including shoes!! 
And athletic shoes did NOT qualify as “white”. 👻

While it was EASY to identify nurses, I can assure anyone, everyone and myself this “policy” did not SAVE one life. 
 

👻👻👻

Bet things didn't stay white for long...

Julius Seizure

Specializes in Pediatric Critical Care.

On 7/25/2021 at 10:00 AM, Hannahbanana said:

Note what isn’t in there: routine vs, monitoring that you should expect any nurse to do, basic universal precautions for falls and infections, and (my personal hot button) “give meds/IVs as ordered.” (Grrrrrrrrr)  … It might be important to add specifics for an individual but just what you’d like to make sure gets done, like a particular way to do a dressing or engender cooperation for a diagnostic exam, or an unusual way to secure a tube.

 

But wherever will I write "will continue to monitor?"

On 7/27/2021 at 9:28 AM, Hannahbanana said:

As I said, you can’t wait for your employer to give you power. You have to seize power. 

I love your attitude.

I'm sure some here are familiar with the "sticky note" section if you use Epic as your EMR.  That is about as close to a useful nursing care plan as I have ever seen - and probably updated more often.