I Hate Careplanning

Alrighty, before I start I just want to say that I am primarily focusing more towards CSULB nursing students, specifically trimester students with this blog post. I am not saying that CSULB trimester students are better than any other nursing students. CSULB trimester students just have a different experience and I just want to acknowledge that but also respect other nursing students and programs.  

okies, back to your regularly scheduled program

Careplans were the bane of my existence. It is what makes nursing school so difficult; those days before clinical will be the longest days you will ever experience. I only have experience as a trimester student, so my careplan days were a little different. If you’re a trimester student, I hope this doesn’t scare you. I just want to help set your expectations. As I mentioned before in my previous blogs, Long Beach Memorial instructors expect much more from their students, the very best. But if you don’t remember, I have a blog all about nursing school expectations and you can read it here!

Careplans are there to prepare us to care for the patient. It’s a way for instructors to see if we are competent enough to care for the patient. It’s possible for instructors to send you home on the day of clinical if your careplan is not up to par. This is another thing that made clinicals so nerve-wracking. You can spend hours and hours on your careplan and it still might not be good enough. And when I say hours and hours, I don’t mean 3-5 hours. I mean literally all day. 3 AM to midnight isn’t uncommon. If you go into detail with cellular level pathophysiology, then you will be okay.

Semester student careplans are slightly different. But again, I’m not saying they are bad nurses or below me or any other trimester student. As trimester students, we had to do a lot more writing to do because of our instructors' expectations for the same degree. If you want to read more about the trimester vs. semester, click here!

When you first enter the program, you won’t start careplanning right away. The calm before the storm. You have orientation and death by powerpoint. Then you start off with simple tasks that you can perform like changing linens, checking blood sugars, practice taking vitals, etc. You might be itching to just go into the hospital and help patients but trust me when I say to enjoy this time. You’ll miss the early days of clinicals when you start careplanning. After like 4-6 weeks, you’ll begin. I dreaded careplanning days, everybody does. You might think I’m exaggerating and ask “Are careplans at CSULB as a trimester student really that bad?” Yes. They are. So let me give you a rundown of careplan days as your progress through the program.

Careplan days are on the days before your clinicals. School will not schedule a careplan day when you register for class; it’s an unofficial school day just to careplan. It can land on a weekend or on a day you have a lecture. It was very common for us to careplan during class. We had no choice but to careplan in class because if we didn’t we wouldn’t finish in time. Even with doing that, most of us still went to bed around 2 or 3 AM, just a few hours before clinicals.. It just requires an immeasurable amount of information to be written in literally less than one day. Nothing but typing on your computer for about 24 or more hours. It’s exhausting and time consuming but doable. All trimester students have been doing it, so you can too. I have no doubt that you can do it. 

You begin with one patient. I know it’s easier said than done but try to enjoy the one patient because you will get two during the second semester. I know it’s really hard to enjoy it because you’re starting off new with no clue on how to really careplan. Then you’ll think to yourself “how can I do two later?” You will. You will have no choice really, but you’ll get faster and better at it.

During my first semester, my clinicals were on Monday so my careplan days were on Sunday. It sucked having one of my weekends taken away but what can I do? First semester careplans are not as intense as the following semesters, but still long. You don’t  have to dedicate too much time just yet, but it will still be a whole day affair. Careplan day attire was business casual clothes and your CSULB lab coat. You go to the hospital in the morning, go to your assigned floor, and talk to the nurses or check the charting to pick a patient that will still be inpatient the next day. You then walk to the Van Camp computer lab and begin careplanning. You gather all the info needed, read the notes, and start typing away.

LBM instructors are usually present the first few times you careplan to provide some guidance, but eventually you’re on your own. When you think you have everything, you go back home and continue careplanning. The biggest bulk of careplans are the pathophysiology sections; they make your careplans 60-80 pages long(make sure your printer is working). This is what the instructors pretty much grade you on because it’s the disease process and the reason why the patient is at the hospital. They want you to go into cellular detail and from inside to out to show how it affects the patient. Once I got home, I started with the patho section because everything else was smooth sailing as soon as you got that section done. 

At the end of your first semester they give you an option to careplan on two patients. I decided to do it because I wanted to see what it was like and to prepare myself for second semester. I didn’t think it was too bad at first, but as time went on I felt like I was not ready for second semester. 

New instructors. This time, they were ICU veterans so they expected so much more. My first semester instructor wasn’t very strict, but my second semester instructor was notorious for grading at a higher difficulty. There’s a rumor that she graded a careplan and gave it a 17%. I have no idea how it got scored like that but it scared me to know that my best may not be good enough. She questioned everything and tested you on every medication and the next steps to take. My anxiety was through the roof and the amount of sleep I got lessened. But she’s a great instructor who is really there to help you. She might make you cry, but it’s tough love. Lol. 

They were very kind during the first week and allowed us to careplan on one patient just to get our feet wet again because the careplans would be a little different that time around, and with new instructors meant new expectations and standards. In my opinion, second semester was the most difficult one for me because of my instructors and the workload doubled, but this is where I learned the most. 

Remember how I mentioned that you might have to careplan on days you had lecture? I did that during my second semester. My clinical day was a Friday, which meant Thursdays were my careplan days. But I also had a lecture on Thursday. So I had to schedule my time around lecture time, which was at 8-10:45AM. I would get up around 4AM to get to the hospital, pick my two patients, and start my careplans around 5AM. My entire cohort was in the computer labs by 6AM careplanning. At 7:15, most of us would carpool from Van Camp to school and then go to class. We would record the lecture because none of the trimester students were paying attention. We were just careplanning the entire time. After the lecture, we would go back to the hospital to double check that our patient is still there and get updated information. Then we’d go back home to finish off. It really sucked when some of us found out that our patients went home or planned to get discharged and would have to pick a new patient and start all over. Med-surg has a high turnover rate so sometimes we were unlucky with our choices. 

We didn’t take many breaks when we were carpelanning. I would take about a 5-10 minute break just to stretch or take micro naps. Other than that I would careplan the entire day from 5AM and the latest I finished was 2AM, then try to sleep for clinicals the same day lol.

We had the same instructors from second semester to ICU since they were ICU veterans. It was beneficial for us because we knew what to expect and what to do. The only difference were the careplans. ICU careplans are more intense because they include the hemodynamics of the patient. They look at what causes the patient to go into the disease process and what to look out for to prevent complications. Also, patients can and will be on drips that are keeping them alive. The one that I remember is levophed. “Levophed or leave them dead,” something my instructor said often. It’s cool to see, but it’s terrifying that one little mess up can be the end of it. I was very hesitant when it came to touching the patient because I didn’t want to mess up any of their lines or drips. I felt that there was just a lot of watching and learning when it comes to ICU because as students we weren’t allowed to do very much. We were very helpful for the nurses because we helped with the small tedious tasks like hourly I/Os, cleaning patients, turning, etc. 

During ICU, you careplan on one patient. Even though it’s one patient, the careplans are just as long or even longer because of how much more info and detail you go into. One of my peers had a 120 page careplan. I had ICU during the summer so I actually had two clinical days each week. I would careplan on Monday for one patient, pray and hope that they were still either alive or hadn’t transferred out before Tuesday or Wednesday. During my time, there weren’t very many ICU patients (in hindsight, that was a good thing), so we were all fighting for a patient. I would go to bed at 4PM (melatonin was a godsend), and wake up at 1AM to go to the hospital and start careplanning. Even though I woke up early, I still finished careplanning about 1-2AM the following day. Just for one patient. These were a little more interactive because you would place EKG strips into the careplan and look at their current numbers and pressures and lines that they have. You would actually have to use them during clinical and then turn it in. 

After Tuesday clinical, we would all go back to the computer lab to update our careplans to prepare us for our next clinical day. Sometimes, a few of my friends would make an abridged version of a careplan to care for a different patient if they passed away or were transferred out of the ICU. At least, the instructors didn’t make us write a whole new plan, that was nice.

If you’re wondering about careplans after ICU, don’t worry about it. Careplans after ICU are a breeeeeeze. Pediatrics are usually less than 20 pages. You get so much more free time and less stress. You will survive ICU careplans and you’ll see pediatric careplans and think to yourself “That’s it? Oh okay, I got it.” I finished my peds careplans at Van Camp and still be able to have the entire day to myself with enough sleep.

One last thing.

Always do your best. Your best varies every day and that’s okay. Careplans are not easy, far from it. I did it and you can too. I know you can. Don’t give up; you made it this far and you can keep going. Take small breaks, but keep going. I know how strenuous it is but it’s worth it in the end. All the careplans, stress, anxiety, and lack of sleep for two letters at the end of your name, but you’ll look back and think “I did that.” Every careplan and clinical completed is an accomplishment. Celebrate every little victory and enjoy being a student. I wish you the best of luck in your careplanning days! Learn, watch, and do as much as you can!

If you want to know some tips and hacks on how to make your careplan days easier, look out for my next post called “Just the Tip(s)” lol.

Until then,
<3 Mags

as always, thank you emily!