Time to get rid of care plans?

[kubelkabondy, ADN, RN]

Does anyone else agree that care plans are an extremely ineffective and outdated way to learn? I found myself getting so frustrated during clinicals this quarter because due to COVID, we didn't have in-person clinicals last quarter and it looks like they might be canceled for next quarter too. The clinical time we have is therefore extremely valuable, but our instructor expects us to spend hours poring over the care plans and the paperwork which cuts into the time we should really be spending at the bedside honing the psychomotor skills we will actually use when we become nurses.

I certainly understand the value in learning about the nursing process and being able to select and justify appropriate nursing diagnoses, interventions, and outcomes for your patient. 

But do care plans really need to be 10 pages long and take 8 hours to do? It seems so ridiculous, especially considering that we are expected to get it all done in between two 8-hour shifts on two consecutive days. 

Sleep is also really important and frankly it upsets me that there seem to be so many nursing educators out there who act as if needing sleep is a weakness. It's not just important for us, it's important for the safety of our patients.

But what really gets me is that writing care plans is not an actual thing that nurses do. My preceptors would come in, spend a few minutes getting report on each patient, glance at the charts, then start caring for their patients. And obviously as students we are not at that level yet, but still the disparity is absurd.

Even IF writing care plans was a necessary and vital part of nursing education, it is something we can do from home. It is not a skill we need to practice in the clinical setting - we can just look at fake patient charts online and write care plans based on "virtual" patients like we did in v-sims.

As a former educator myself, I'm really bothered by nursing educators who are so stuck in their ways just because "it's the way it's always been done." Where is the innovation? If you see your students stressing to get their 10 pages written and coming in the following day on two hours of sleep, you're really not going to question whether this is an effective way to learn? 

Okay. Rant over.

[londonflo]

11 hours ago, kubelkabondy said:

Does anyone else agree that care plans are an extremely ineffective and outdated way to learn?

Care plans were designed to see a student's thought processes at collecting data, planning care and evaluating the results of that care. Since a student on clinical will only be there at a fraction of the time the care is delivered, care plans do help to see the student's followthrough. Unfortunately care plans became unwieldy and difficult to construct for patients who have a multitude of interacting acute and chronic health problems.

 

11 hours ago, kubelkabondy said:

we can just look at fake patient charts online and write care plans based on "virtual" patients like we did in v-sims.

Nursing is a practice discipline and as such needs to be practiced in the actual setting. Nursing care can be isolated in a simulation, but there are so many other health care providers involved in the actual implementation of care - interrupting your care, changing the medications, procedures, requiring a patient to go to another department, interruptions by visitors at  a time that disrupts everything...whew. All those things need to be managed every day in a nurse's world. 

11 hours ago, kubelkabondy said:

The clinical time we have is therefore extremely valuable, but our instructor expects us to spend hours poring over the care plans and the paperwork which cuts into the time we should really be spending at the bedside honing the psychomotor skills we will actually use when we become nurses.

I so agree. Your time at clinical should be spent employing a nurse's role, providing teaching and therapeutic communication with the psychomotor skills. 

 

11 hours ago, kubelkabondy said:

As a former educator myself, I'm really bothered by nursing educators who are so stuck in their ways just because "it's the way it's always been done."

I can appreciate your feelings about this. Care plans are an extraordinary time-waster that could be used for a more fruitful activity that shows the acquisition of nursing knowledge. At my last school, we adopted concept mapping as it really does show the dimensions of health nurses interact with. I am sure it is very frustrating as an educator to spend so much time on a paper assignment but it does not serve a purpose

I respect your feelings and wish you a better educational program as hospitals/schools achieve a more 'normal' way of functioning and you are an involved member of the health team.

[kkbb, BSN, RN]

Care plans were the bane of nursing school for me.  But now that I am practicing, I can understand what was really being taught through our care plans.  For my school we had to document what additional labs/testing we would anticipate and explain why.  While I don't have to document this now, I am actually thinking about this throughout my shift.  We had to document a full head to toe assessment, obviously I do this for everyone.  We had to list all meds and labs and write out the significance of everything.  Again, while I am not actually writing this down, I am thinking about all of this.  Hindsight lets me understand that there really was a reason behind what we were doing.  And, as the previous poster pointed out, part of this is to actually see what your thought process is regarding the situation.  Remember, the clinical instructor isn't with you at all times and they need something as "proof" of your education.  

That said, we were also give a couple of days after clinical to put everything together.    

Although you do bring up an interesting point about virtual learning.  Then the instructors control what information everyone is getting and it regulates things a bit.  I will be honest, I have had a student with me that so clearly had no idea what was really going on with my patient.  I kept trying to explain the situation and lasting implications to the patient (spinal cord compression from tumor with possible permanent paralysis....student just thought patient fell and hurt their spine).  I think this student didn't have to do a care plan for this shift.  Listening to her talk with the instructor, there was no way the instructor would know how off base this student was (they were in their last semester and this their last clinical so she should have had a little more insight).   

[RiverRat788]

On 12/6/2020 at 3:21 AM, kubelkabondy said:

But what really gets me is that writing care plans is not an actual thing that nurses do. My preceptors would come in, spend a few minutes getting report on each patient, glance at the charts, then start caring for their patients. And obviously as students we are not at that level yet, but still the disparity is absurd.

Even IF writing care plans was a necessary and vital part of nursing education, it is something we can do from home. It is not a skill we need to practice in the clinical setting - we can just look at fake patient charts online and write care plans based on "virtual" patients like we did in v-sims.

I had the same thoughts almost 50 years ago when I was in college for my BSN.  I often went without enough sleep to write those ridiculous plans.

We also had to take the entire history of the patient and write a life plan for them.  

It will take major regulatory changes to rid our systems of this beast.

I could on and on but will spare you the rant.

[DeeAngel]

Nursing school really has no bearing in preparing you to actually work the floors as a nurse.

[MotoMonkey, BSN, RN]

I guess my program was in the minority, I wrote a single lengthy care plan during the first year of my BSN. Then never again. Even that one seemed like a silly abstraction of the actual care being provided.

[Guest856929]

I used to think that care plans were rubbish, but I have come to know better. If a care plan is well designed, it can be very useful. I am not talking about the the ones that you make silly diagrams. I am talking about concise and systematic care plans: Age, wt, ht, BMI, labs, Hx, Meds, current plan. That can help you decipher and decide interventions with appropriate rationales within a meaningful timeframe. I don't think they should take hours to make either. Hit the main and pertinent issues. Who cares if a 75 yr old pt s/p knee replacement is taking fish oil and has two divorced sisters? However, it is important to know the aforementioned variables in order to make wise decisions and predict possible complications. 

[FiremedicMike, RN, EMT-P]

On 12/7/2020 at 8:47 PM, MotoMonkey said:

I guess my program was in the minority, I wrote a single lengthy care plan during the first year of my BSN. Then never again. Even that one seemed like a silly abstraction of the actual care being provided.

Same, we’ve spent very little time on care plans and nursing diagnosis.. 

[PugMafia, PhD, RN]

On 12/7/2020 at 4:25 PM, DeeAngel said:

Nursing school really has no bearing in preparing you to actually work the floors as a nurse.

I'm sorry to hear you did not have a good clinical experience while in your program.  I have students who consistently reach out and thank me for teaching them skills needed to survive their first nursing position.  If that's the case, why have nurses go to nursing school? Or better yet, why don't we just license doctors and lawyers without any formal education?

[soon2beRN2021, ADN]

Yup. Care plans are the devil. 

Luckily for me, my RN program restarted clinicals since last semester and we are doing alllll our makeups + more. I graduate next semester so, this is crunch time for us. My program is really sneaky, as they do care plans on written documentation sheets in a succinct manner. We have four columns: we need to provide two concepts we are discussing for that patient. For example, perfusion, metabolism, infection, clotting, etc. We then write two nursing diagnoses for each concept. 

Example: I had a patient entering thyroid storm. I did perfusion and metabolism. The patient had underlying A Fib and CHF so I discussed decreased cardiac output for one diagnosis (he was on diltiazem, thirty million beta blockers, diuretics (Lasix then spironolactone--he became hypokalemic yikes..you name it he had it for that irregular rhythm and tachycardia), and then impaired gas exchange. His H&H were very low, he was anemic (seen in Graves disease) and satting quite low, showing signs of dec peripheral perfusion, etc. We then explain what interventions we did for each diagnosis and if the goals were met that we made (SMART goals). I don't think any care plan should be 10 pages long. Maybe they should change their format..

I dislike wordy care plans but they REALLY get me thinking, especially with complex concepts like HF patients with multiple comorbidities. I get it, I felt like I didn't get a lot of hours of personal practice. I had to hound the nurse I had politely, but I was able to do some IV med admins, insulin injections, PO meds (IV admin'ED Lasix--wild right?) LOL. My nurses I shadowed (preceptors you called it) would do the same thing yours did. They have the experience, we do not--so of course they aren't doing care plans and charting it out mentally. They do that mental gymnastics in seconds. 

I totally get your frustration with limited clinical hours and tons of paperwork. COVID has really put a lot of things on pause. For us, we had to sign waivers and daily we put ourselves out there at clinical with the best PPE possible. That's our job, right? I hope things get better for you. 

[londonflo]

15 minutes ago, soon2beRN2021 said:

I dislike wordy care plans but they REALLY get me thinking,

thank you for sharing. When I was in graduate school in the early 80s, I had to develop a care plan for someone with Hodgkins' (care planning was in it's infancy and we had a very short list of approved nursing diagnoses. For some reason that was the moment it all clicked. I still remember my struggles with it and the the lightbulb above my head. Best wishes on your career!

[whalestales, ASN, RN]

On 12/11/2020 at 12:10 PM, soon2beRN2021 said:

I don't think any care plan should be 10 pages long. Maybe they should change their format..

Our care plans are 20+ pages before we put any info into them. I submitted one this semester (my first) that was 30+ pages.