To much focus on care plans for students

SuesquatchRN, BSN, RN · Sep 13, 2008

Nalu, it sounds to me as if your instructor is using care plans as they were intended - to drive the nursing care of your patient. Unfortunately, too many seem to treat them as purely academic exercises.

I rarely disagree with Daytonite, but I do think that the skills we need should be learned BEFORE we hit the floor. Our co-workers and preceptors do not expect nor do they have time to teach us the basic that should have been learned IN CLINICALS.

You are lucky to have an instructor showing you how to integrate care planning into your practice.

lpnflorida · Sep 13, 2008

While the developing of care plans as already pointed out helps to pull things together ,helps develop critical thinking skills , will be used on some level of your caring for patients on a daily basis.

I also agree for those of us who do preceptor frequently, teaching 101 nursing skills is the most frustrating part. I do not have a problem teaching and assisting new grads or new employees who have not ever done some of rarer things.

But come on, never done a cath? Never set up a suction set, never did hands on sterile technique for a wound? Something is so wrong with this. It pushes the burden of education which in turn increases the cost to orient our new people.

What should have been orientation of 8 weeks becomes 9,10, 12 weeks due to having to teach, check off basic skills. I feel pretty strongly this burden of cost should not fall on the hospitals it should be on the institutions of learning.

Perhaps then the hiring of new grads would not be seen as a hindrance as they try to get their foot in the door of nursing.

Daytonite, BSN, RN · Sep 13, 2008

when i was a manager who was hiring new grads at a large city hospital with a new grad program we were well aware, as all other hospitals were aware, that new grads did not have the clinical experience. our new grad program supplied it. the days of the old hospital based programs that turned out clinically trained rns are long gone. people, however, wished they would return. there were problems with them that people don't recall. a lot of students saw themselves taken advantage of as free labor, many times forced to work night shifts, and a lot of mistakes got made at the expense of patients. some of the old timers older than me might remember those days, but the circumstances and requirements of training have changed and the amount of theory that has to be taught has increased substantially and takes up a great deal of the curriculum now. that theory is essential to the performance of the professional nurse's role. in part, the new insurance and accreditation standards have demanded it. like them or not, these standards have elevated the quality of care. if you sacrifice them, you cut to the heart of the nurse's ability to think critically and make rational decisions. in essence, you lose the managing and problem solving part of the role. that part is needed to keep all the rules and regulations organized and followed through. now, you may not be taught a management class per se in school but you are being prepared for it. and as healthcare comes more under scrutiny and, i believe, moves toward universal coverage of some type for everyone in this country, rules and procedures in the healthcare industry are only going to become more complex. what kind of nurses will it take to manage patient care under those circumstances? i'm not trying to be insulting here, but not high school dropouts or people who have never taken their education or learning seriously. believe me, as a patient, you don't want to enter a health care facility where the providers don't know or care about the rules of your insurance company because guess who ultimately gets stuck with paying the consequences? the patient--who at the time is ill and isn't much interested in anything else but getting help for their malady. been there; experienced that. and if a time should ever come for you to be in that same position you want some system checks and balances in place for you.

oldiebutgoodie, RN · Sep 13, 2008

I am a wound and ostomy nurse, and I have a student from the local ADN program 1 day a week. They are always THRILLED because I let them DO things. They get to touch patients, do dressing changes, change ostomy pouches. And while we are doing those things, we are discussing the pathophysiology, risk factors, treatments issues, etc.

It tends to make much more of an impact rather than spending time writing on a piece of paper.

I get the concept of care plans, but to turn them into 30 or 40 page ordeals is just silly, and I don't understand why educators have continued this practice.

And by the way, I barely remember anything I put in a care plan which I then apply to practice. It was more just an exercise than a learning experience. And amazingly, I use critical thinking, etc etc --how did that happen?

Oldiebutgoodie

PiPhi2004 · Sep 13, 2008

Care plans are extremely important in developing an intellectual basis for nursing care and determining the pathophysiology for the reasons you do certain actions. When I was in school I actually liked care plans, it made a little map for me of what needed to be done and why. I enjoy knowing WHY we do things instead of just doing them, and how to troubleshoot those things if they do not work. I had a lot of experience with both care plans and direct patient care. The first day I ever had clinical I practiced sterile technique for trach suctioning and performed that procedure. I will never forget how nervous I was and how it made me feel to be trusted to do that procedure under the guidance of my instructor. I know care plans are tedious and seem to take forever, but they really are building blocks for the foundation of your practice. However, clinial experience is also a huge part of building your practice as well. I hope that nsg schools in the future put more into making a balace between the two to prepare nurses for the real world of nursing.

Katie82, RN · Sep 13, 2008

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I do agree with others, though--procedures are picked up quickly when you get to practice them daily on the job. :yeah: When I have never done a procedure, I ask that another nurse come to the room and walk me through it--that way I don't have to keep saying "I'm sorry but I have never done that"--and they know that I WANT to/am willing to jump in and do it myself. It's also a nice confidence booster and sense of accomplishment--when I did my first catheter I was over the moon!!!

I totally agree, procedures are a learning process requiring hands-on practice. But there is not enough time in nursing programs to make anyone proficient in procedures. That's what hospital orientation/preceptor programs are for. Most reputable hospitals will require new grads to do a 6 month preceptor program. With hospitals hiring paraprofessionals like PCTs to do a lot of the procedures once done by RNs, they are relying on Registered Staff to be the thinkers and assessors, this is easiest done with lots and lots of care plans, as much as we all hate them. Gives the nurse a base of knowledge from which to assess and plan.

oldiebutgoodie, RN · Sep 13, 2008

I don't expect a nursing program to make someone PROFICIENT in a procedure. I do expect the program to EXPOSE the student to various procedures. I have had students nervous to do a moist saline gauze dressing (they didn't know how) who were in their last quarter of a prestigious BSN program.

No one is expecting students to just become procedure based drones. However, the ivory tower has gone so over to the other side that new nurses come out fearful and stressed out. Read some of the "1st year in nursing" posts. We can do a better job.

Oldiebutgoodie

lpnflorida · Sep 13, 2008

Daytonite,, I remember the diploma nurses well, the first hospital I ever worked in had a school on premise for them. I agree there were things wrong with the program, the many hours they put in.

The Diploma RN's were the best prepared new grad floor nurses I have ever worked with then and since.

Interns and Residents use to put in long hours also in our hospital at that time. It made our hospital a great place to learn and work. Yes, times change interns are now unionized can work no more than 40 hours.

To this day, I feel admiration for the Diploma RN's they turned out. Most of the ones I knew personally went on an obtained degrees .

Education will continue to evolve. Health care will continue to evolve. Some changes are absolutely for the better.

AnnaSL, BSN, RN · Sep 15, 2008

I dont know, but honestly, I guess those changes that they are actually introducing is somewhat for the better... They wont make these changes if it wont do any good...

Yes, I agree, exposure, hands-on is much better than in writting, but STUDENTS, wont have that excitement to do a certain procedure if they havent READ or ENCOUNTERED (either through making it on NCP)that yet... Let's say Tracheostomy care, if it was not introduce to the NCP, and the NEED of it in a PLAN, how will they be able to know the systematic way of doing it?? which comes first.. Do you immediately do this and that?? that's why they STRESS to ASSESS first then the rest FOLLOWS...

I dunno, all of these are for LEARNING and I dont know why most are disagreeing on doing it.

Main Problem I encountered with STUDENTS doing CARE PLANS are their SUBJECTIVES does NOT Jive with MANIFESTATIONS and much more, with the NURSING DIAGNOSIS...

These simple things or for others COMPLEX, is a way for you think and PRIORITIZE which problem are in need of attention...

See, you also learn to PRIORITIZE too...

I dont know if others are seeing my point here... Definitely, if you are already a nurse, it AUTOMATICALLY REGISTER in your mind that if a px has a certain problem, this should be done...

Of course if you are a student, these things dont automatically occurs to you...