Sunday, April 14, 2013

the end of an era

Care plans are all the rage in nursing. At least they were. In nursing school you are forced to slave over them, re-formatting them to fit your instructor's version precisely. Like almost every other student, I thought they were ridiculous then, and like every other nurse I've ever met since, I think they're ridiculous now.
The premise was a good one. We needed interventions with measurable outcomes (NIC and NOC), and we needed them so that we could "prove" ourselves as a profession, the way that physicians do. From there things got a little crazy. To the point where we, as nurses, had to spend hours listing "interventions", every possible common sense thing you can think of, and daily rating on a scale of 1 to 5 if it was working. If you are a nurse, or even a college graduate of any kind, you should have the ability to recognize a problem, intervene in some way (even if it's just to keep observing), and evaluate internally whether this plan is working or not. You shouldn't have to write 10 paragraphs about it. You shouldn't have to check over 75 boxes per problem! 

To make matters worse, no one was reading these care plans, no one but the poor nurse doing them. They were irrelevant, in the end, to the patient's treatment and plan. It made me feel like a ninny. Like a L-O-S-E-R trying to be important when really that time filling in check boxes and numbers was a total waste. Just busy work. Which made me feel that my real job, that of patient care, that of actual critical thinking, was trivial and menial.

But then... everything changed. They took our care plans away!!!

Yes, care plans, at my current institutional, are a think of the past! I went home and danced naked with bells on my ankles, burning piles and piles of worthless paper, in pure joy! (Ok not really, but I thought about it.) Instead, we have a simple patient/family goal-oriented note, in which we state the patient and/or family members' goals for the shift, and for the hospitalization, and any progress that has been made toward them.

All I have to say is: Good riddance to good rubbish.

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