Why do nurses create care plans instead of drs?

[jkmk]

Hi All,

I am a pre-nursing student and I'm confused, seeing everyone creating care plans. I would have assumed that doctors diagnose and create a plan of care and that nurses would carry out their instructions. If nurses create care plans, then what the heck are the doctors doing? I thought it would be out of the scope of practice for nurses to make these types of decisions.

There are a ton of threads on people needing help with their first care plans, but I guess I'm looking for a more basic explanation of what is included in these plans, why do nurses create them instead of doctors, and are there certain hospital departments where nurses do this more regularly than others, or is this an RN's job in all settings? Do drs. diagnose, then we do the research and care plan and then they sign off on it?

Thanks for your help!

[DirtyBlackSocks]

Nurses spend a lot more time with patients than Doctors do. By nature of the job, Doctors are a lot more stressed for time.

[Tait, MSN, RN]

MD's determine the disease process, the course of medications and monitor the patients progress while adjusting those elements.

Nursing care plans are intended to map out the basic needs and cares for a patient to compliment the regiments they are receiving for their diagnosis.

They are intended to provide a plan of basic care that is measurable, manageable, and can easily be handed from one shift to the next.

Many people feel the care plan is just something we go through the motions of these days. In school we learned that care plans were vital due to patient stays often being extremely long. Currently, with high patient turnover it is sometimes difficult to argue the validity of the plans because often there isn't enough time in a patient stay to actually see measurable outcomes in the action plan.

This being said care plans are called "Nursing" care plans because that is what they are. We, as nurses, use our schooling and expertise to design plans of care that are manageable, measureable and continue from shift to shift.

Aka: If you have a post surgical patient you want to address basic needs common to all human beings:

Pain: Administer pain medications as perscribed.

Non-pharmacological alternatives: distraction, repositioning, heat, cold, visualization.

Hydration: Monitor I&O

Administer IVF as perscribed.

Encourage PO fluids as diet increased.

Mobility: Ambulate per orders.

Encourage use of walker (if this applies)

PROM/ROM

Tissue Perfusion: O2 as needed to maintain saturations.

Coughing and deep breathing.

Incentive spirometry.

Now these aren't perfect care plan examples and are not formulated in the correct written form. My point is nursing is about nursing. Most physicians do not have the full scope of knowledge of what nursing does, however they know they can rely on us to use our expertise to manage the basic cares of a patient and help them progress on a path to recovery.

Bottom line is, it isn't the physicians responsibility to make NURSING care plans, it is ours. We are trained, delegated and responsible for this very important aspect of care.

You can teach anyone to run an IV or clean a bottom, but nurses have something very special. We are professionals trained to assess, evaluate, reevaluate and manage every minute of a persons time in a hospital/rehab/nursing home/home care bed.

I think I am a bit off track, so I apologize if this is ricocheting about a bit. I read the original post as somewhat disturbed that nurses are allowed to make decisions and I think it is spinning a bit on my post.

Tait

[jkmk]

Tait,

Thanks so much for the information. I apologize if my post implied that nurses shouldn't have any plan authority because of a lack of knowledge/expertise. I've probably just watched waaaay too many hospital tv dramas that only depict nurses as providing the care based on the dr's orders. I completely appreciate that nurses perform the bulk of patient care and that is why I want to be one. I was just under the impression that we had to become advanced practices nurses before we had any say in the course of patient care.

Your examples were very helpful. :)

[Flare, ASN, BSN]

most simplified - doctors treat, nurses give care.

[elkpark]

Nurses plan and implement nursing care of clients, which covers a much wider scope of issues/problems than simply the medical illness or surgery that brought them to the hospital. Also, because you have two or three shifts of nurses providing nursing care to clients each day of a hospitalization, and, often, not much consistency of staffing even from day to day on the same shift, the NCP helps ensure that there will be consistency and continuity to the nursing care during the stay, and not a matter of each individual nurse on each shift doing what seems like the priority or focus to that particular nurse on that particular shift, or whatever s/he feels like doing -- there's a "big picture" there, and it's being attended to. The NCP identifies all the nursing concerns related to a client's condition/situation, prioritized by importance, and outlines the necessary nursing interventions to address those concerns and meet the client's needs in a comprehensive, holistic way, above and beyond whatever her/his acute medical issue/diagnosis may be (which is the focus of the physician's care).

Nurses do lots of stuff that isn't a matter of following physician orders.