[traumamomtx30]

I don't know where we lost the power to do our jobs. Seems like the patients, family, and even the neighbor know more then we do in managements eyes. The medical profession says we've done it to ourselves. I don't know if that's true. I think it is a combination of things but I sure would like to get it back. I know House, E.R., Grey's Anatomy all have interesting situations but; HELLO -they are t.v. shows. We actually had a pt the other night tell a nurse that "doctor's give pca's so nurses don't have to do their jobs". Any response to that? I know there will be some good ones because this is a very bright bunch.

[TheCommuter]

Did we ever have a great deal of workplace autonomy in the first place?

Hmmm. . .let me think. We can only do a limited amount of tasks and procedures without a doctor's order (read: lack of autonomy). We, as shift workers, cannot come and go as we please without anyone watching the clock (read: lack of autonomy). We cannot even organize into a massive united front, so that society knows what we're made of (read: lack of autonomy). We normally act upon the decisions of doctors, managers, administrators, and others who are not nurses (read: lack of autonomy).

Feel free to disagree with me, but this is what it is (a career that lacks autonomy). Did we ever have autonomy? I have serious doubts that nurses from the 1950s were so very much more autonomous in their practice.

[ocankhe]

I agree that nursing has very little autonmy. It probably started to erode when the majority of nursing employmnet changed from private or individual case nursing by independent practicioners to being employees of hospitals. At one time over 80 % of nursing employment was in hospitals, this is being greatly reduced as opportunities for nursing expand out of the hospital. Hopefully as this trend continues it will help nursing regain its autonomy. Also having nursing regain control of basic education requirements for entering nursing will also help.
What other profesion doesn.t control its on educational requirements?

[TheCommuter]

Originally Posted by ocankhe

At one time over 80 % of nursing employment was in hospitals, this is being greatly reduced as opportunities for nursing expand out of the hospital. Hopefully as this trend continues it will help nursing regain its autonomy.

Yes. I've noticed that nurses in certain specialties possess a great deal of autonomy. Typically, these nurses work in a setting where they have no direct supervision, such as home health, outpatient hospice, private duty, legal consulting, psychiatric intake, case management, prison nursing, and so forth. Hopefully these interest-piquing types of career opportunities will expand as we move into the near future.

[pagandeva2000]

I never thought that nurses were autonomous to begin with, actually. And, now, with everyone adding their loads to nursing, from the pharmacy, dietary to housekeeping, it seems that we have to grow arms and wear rollerskates.

[laurelmae]

Nurse does not equal autonomous. I don't feel the profession ever has. we as RN's are trained to analyze data then take action, but not necessarily decide which action...that's what MD's are trained to do.

we can make a nursing diagnosis, and then follow pre-set care plans based on our decision.

we collect then analyze data, ,then decide which protocol to follow based on it.

we can hold meds and give extra if values dictate so. ETC...

We are nurses. We choose where we work, in what conditions, which types of pt's and problems we want to fix, what pay we want, we are our clients voices! We are there at 3 am when mr.smith just needs to tell someone he's scared of his surgery and at 330pm when ms.jones just called you back into her room for no other reason than someone to talk to (despite her saying she musta hit that call bell by accident). we may not have the autonomy that is described in the above threads, but darn it all, we do have the ability to independently make everyone's healing process more comfortable, whatever that entails. that's pretty darn awesome and to me, that's more important than having the privilege of picking when i come and go.

[fancee free]

Originally Posted by laurelmae

Nurse does not equal autonomous. I don't feel the profession ever has. we as RN's are trained to analyze data then take action, but not necessarily decide which action...that's what MD's are trained to do.

we can make a nursing diagnosis, and then follow pre-set care plans based on our decision.

we collect then analyze data, ,then decide which protocol to follow based on it.

we can hold meds and give extra if values dictate so. ETC...

We are nurses. We choose where we work, in what conditions, which types of pt's and problems we want to fix, what pay we want, we are our clients voices! We are there at 3 am when mr.smith just needs to tell someone he's scared of his surgery and at 330pm when ms.jones just called you back into her room for no other reason than someone to talk to (despite her saying she musta hit that call bell by accident). we may not have the autonomy that is described in the above threads, but darn it all, we do have the ability to independently make everyone's healing process more comfortable, whatever that entails. that's pretty darn awesome and to me, that's more important than having the privilege of picking when i come and go.

With all due respect, where is the autonomy is writing nursing diagnosis no one else recognizes or even cares about? Where is the autonomy in following protocals? I don't know about you, but I sure don't feel fufilled if I hold a med. due to a patients values. Anyways, at the end of the day you need an MD order to discontinue a med., no autonomy in that. And sure, reasuring someone when they are scared of surgery is great, but who has the time to do this regularily, plus this isn't autonomy either.

Your enthusiasm is something I truly admire and I think you are a wonderful nurse. However, it seems to me that nurses are sick and tired of having to follow orders and protocals and our intelligence and experience seem to mean nothing.

[pagandeva2000]

Originally Posted by fancee free

With all due respect, where is the autonomy is writing nursing diagnosis no one else recognizes or even cares about? Where is the autonomy in following protocals? I don't know about you, but I sure don't feel fufilled if I hold a med. due to a patients values. Anyways, at the end of the day you need an MD order to discontinue a med., no autonomy in that. And sure, reasuring someone when they are scared of surgery is great, but who has the time to do this regularily, plus this isn't autonomy either.

Your enthusiasm is something I truly admire and I think you are a wonderful nurse. However, it seems to me that nurses are sick and tired of having to follow orders and protocals and our intelligence and experience seem to mean nothing.

I never saw the purpose of a nursing care plan or nursing diagnosis, personally. In fact, I think it is INSANE. As you mentioned, nobody looks at it but other nurses, and Joint Commission. I remember our idiot DON stood before us during one of the famous magnet marathons "The Nursing Process is OURS, OURS, OURS!!! We are autonomous, and should be proud". Of course, first of all, as an LPN, I am even more "not autonomous", so that was the joke of the day. Also, she bragged of the fact that the nurses are independently able to assess and administer flu and pneumococcal vaccinations (but, there needs to be a STANDING order from the Chief Medical Director, and somehow, it has not materialized for this flu season). Now, nurses are so afraid of screening and administering these flu shots based on this fictitious standing order that they are making sure that the doctors write out these orders (hence, no autonomy here...).

One of the first things these care plan books seem to say is "Medicate the patient"...but, of course, this cannot happen without a doctor's order, unless he is nice enough to cover for us when he gets there... I'm already getting annoyed.

[Mulan]

Originally Posted by pagandeva2000

I never saw the purpose of a nursing care plan or nursing diagnosis, personally. In fact, I think it is INSANE. As you mentioned, nobody looks at it but other nurses, and Joint Commission. I remember our idiot DON stood before us during one of the famous magnet marathons "The Nursing Process is OURS, OURS, OURS!!! We are autonomous, and should be proud". Of course, first of all, as an LPN, I am even more "not autonomous", so that was the joke of the day. Also, she bragged of the fact that the nurses are independently able to assess and administer flu and pneumococcal vaccinations (but, there needs to be a STANDING order from the Chief Medical Director, and somehow, it has not materialized for this flu season). Now, nurses are so afraid of screening and administering these flu shots based on this fictitious standing order that they are making sure that the doctors write out these orders (hence, no autonomy here...).

One of the first things these care plan books seem to say is "Medicate the patient"...but, of course, this cannot happen without a doctor's order, unless he is nice enough to cover for us when he gets there... I'm already getting annoyed.

Even the other nurses don't look at it.

[CITCAT]

Autonomy in nursing well by goodness why is it nurses and i mean rns,rnas,lpns.lvns,cnas,cenas are not autonomous ? Because they are not unionized we have being brainwashed by corporate sector its not in our best interest and it wouldnt work. Believe AMA and all there members wouldnot tolerate such injustices that nursing has indured because we choose not to be proactive We have at this point and time in the history of nursing the upper hand due to nursig shortage but we still sit on our hands and complain and do nothing proactively and when you try oh no thats not good we cant fight becuase we afraid of losing our jobs,but we continue to use lipservice HOORAH to the nurses who strike incalifornia and kentucky HOORAH support them encourage them that their efforts are worthy. When are we alll going to wake up?