Elective in the US

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To answer a few of your questions:

1. No, you don't have to have an order to perform duties that are in the RN's basic care areas, such as hygiene, teaching, etc. Now the MD does order special diets, meds, procedures,test, etc, that the RN carries out. Depending on the area/unit you are working in, some MD's allow more autonomy to the nurses. A lot of units, especially ER's and Cardiac units have "care pathways" in which the MD's orders are "prewritten" eg...a pt comes into the ED with abdominal pain, so the nurse grabs the "CP", which tells him to start an IV, hang this fluid, order these tests etc etc...all before the MD sees the pt. Paperwork is going to suck up a lot of your time as a nurse no matter where you work. Most hospitals are using computer charting that interfaces with monitors, so it saves time. The nurse's role is spelled out in each state's nurse practice act. Check out Texas' state board of nursing for their NPA. Most nurses (RN) role includes assessing, teaching, collecting samples for lab studies, administering drugs, performing (allowed) procedures, eg catheterization, dressing changes, analyzing rhythm strips, assisting in code situations, managing ventilators, suctioning, administering o2/resp tx, etc. This by no means covers it all. I hope this helps!

Stevern21