Time to get rid of care plans?

[kubelkabondy]

Does anyone else agree that care plans are an extremely ineffective and outdated way to learn?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

[FiremedicMike, RN, EMT-P]

That’s just absurd.. 

Is it a BSN thing?  Am I skating because I’m only in an ADN program?

[trixie333, ASN]

In the real world, when you hit the floor cold and are expected to start running immediately, a good care plan is a Godsend. A good care plan addresses all the systems AND individualizes what nurses do for a patient. They can orient you immediately out of confusion. (See 'soon 2 B RN's'  pt. she just described.) As an RN in my hospital, I was occassionally floated from ER to ICU to Ortho to Stepdown. Care plans were extremely helpful. As a travel nurse, this was a common occurance too.  Care Plans help a lot. And they are a good tool to help with report when you hand-off to the next shift. JAHCO thinks very highly of care plans. Helps with continuity of care. We used to argue that if nurses were reimbursed for all they do as described in a  care plan, the plans would be lengthy, complete, and we'd be rich. Your care plans in school help you think like a nurse, not a layman, and demonstrate your progress in your education and preparation for your first job. Learn to love a good care plan. I remember buying a certain critical care textbook only because it was soley care plans, and it was a great learning tool.

[londonflo]

On 12/17/2020 at 5:03 PM, whalestales said:

Our care plans are 20+ pages before we put any info into them.

What was on these 20 pages? Was it a format for you to complete for a full assessment? Something for you to fill in?

[whalestales, ASN, RN]

16 hours ago, FiremedicMike said:

Am I skating because I’m only in an ADN program

It is an ADN program 

4 minutes ago, londonflo said:

On 12/17/2020 at 6:03 PM, whalestales said:

Our care plans are 20+ pages before we put any info into them.

What was on these 20 pages? Was it a format for you to complete for a full assessment? Something for you to fill in?

It is a template. So the first page is demographics, after that is labs and stuff like that. The last few pages are the part that gets the longest because it is "important data" that you then separate into nursing diagnoses, then you take the diagnoses and give objectives and interventions 

[londonflo]

8 hours ago, whalestales said:

It is a template.

So it is to focus you on the data to collect and then distill it to the significant data to develop and plan care. 

[FiremedicMike, RN, EMT-P]

8 hours ago, whalestales said:

It is an ADN program

That didn’t really answer my question..

[whalestales, ASN, RN]

Sorry, I thought you were asking if they only do it in a BSN program

[londonflo]

On 12/6/2020 at 2:21 AM, kubelkabondy said:

My preceptors would come in, spend a few minutes getting report on each patient, glance at the charts, then start caring for their patients.

Your preceptors are RNs and have demonstrated competency on a structured examination and many clinical hours of practice. You on the other hand are a student

 

On 12/10/2020 at 10:20 PM, Guest856929 said:

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. 

AND medical education also requires thorough study of a patient's lab, Radiology, medication list etc, in addition to writing out a complete MEDICAL care plan. Haven't any of you seen a medical student sit in the station all day creating the care plan that is crucial to their passing the course? AND this activities are crucial to a medical students success.

Quote

Swango had obtained his medical degree from Southern Illinois University School of Medicine in 1983, but only after being threatened with expulsion because of suspicions that he had faked patient examinations and otherwise might be unfit to be a physician.

 

The charges were heard by an SIU committee, but expulsion required a unanimous vote, and one member held out against expelling Swango. Instead, Swango was required to repeat his obstetrics/gynecology rotation and did not graduate with the rest of his class. the oddest thing is he did not tell his mother he was NOT graduating and she showed up with friends.

In his book on the Swango case, Blind Eye (1999), James B. Stewart adds that some of his fellow medical students, realizing that the conditions of a surprising number of patients worsened after treatment by Swango, nicknamed him “Double-O Swango,” a takeoff on spy character James Bond’s “license to kill” rating. Not until later, however, did any of the students seriously suspect Swango might be deliberately trying to injure patients.

Stewart wrote that circumstantial evidence links Swango to at least 35 deaths, including five that occurred while Swango was studying at SIU. However, Stewart also writes that the FBI at one point suspected Swango in as many as 60 deaths.