Are we Autonomous Nurses or Employees?

[UM Review RN, ASN, RN]

Do you feel that nurses have real autonomy? If so, vote yes, we have autonomy.

Or are we really just employees with a highly developed conscience? If you believe this, vote no, we do not have autonomy.

If you feel that we have autonomy apart from the facilities we labor in, please specify how it's different from non-nursing jobs.

Comments/discussion welcome, of course.

[unikuelady, RN]

Do you feel that nurses have real autonomy? If so, vote yes, we have autonomy.

Or are we really just employees with a highly developed conscience? If you believe this, vote no, we do not have autonomy.

If you feel that we have autonomy apart from the facilities we labor in, please specify how it's different from non-nursing jobs.

Comments/discussion welcome, of course.

I am confused by the wording of this question. I voted no because working in a hospital I have to follow policy and procedure. I feel free to make my own decisions on patient care within this framework. for example:

on newborns: multiple studies state that you do not need to care for the umbilical cord with alcohol. but our P&P has not been updated to follow the new recomendations. So I still have to do cord care with alcohol and instruct parents to do the same because it is P&P.

If you mean that I am free to make my own decisions on pt care, prioritizing care, interactions with staff and doctors then yes. as long as it is within my scope of practice.

If you mean outside of the job setting. I would say yes, because I can choose whether or not to give advise/assistance to family and friends or not. This would be the same as if I was any other type of LISCENSED professional where we have to be careful of personal liability.

[UM Review RN, ASN, RN]

I am confused by the wording of this question.

Sorry, I put the answers in and thought I could go back and rephrase them, but I couldn't.

Maybe I can clarify.

We nurses always talk about how important it is to have autonomy. But most of the nursing issues that we complain about today represent the reality that we do not, in fact, have autonomy over our practice--we must take that extra admission, we can't staff for acuity, we have to continually work in unsafe conditions where we feel our patients' lives are in jeopardy.

This is the kind of autonomy I mean.

We can actually do the work of nursing within our scope of practice, but as employees, our scope has become more and more limited over the years. We have to accept whatever decisions TPTB make, and we have no voice in this workplace of today.

Compared to the nurses of yesterday, who took a private patient and had much more control over their care, we have very little autonomy.

Maybe I'm wrong, but a great number of our profession's ills is clearly stemming from this powerlessness over our own practice, which I see as a loss of autonomy.

Do you agree or disagree and why?

[snowfreeze, BSN, RN]

Autonomy, yes. I make decisions within my scope of practice. Do I use "standing orders", yes. Do I sometimes make decisions to treat then call the doctor, yes. Am I backed up by the physicians, yes. Do I go home and have bad dreams about these decisions, not anymore. I used to when I was a new nurse (first 3 or 4 years). Do I feel like I am pressured to make decisions that seem to be outside of my scope of practice, No. Maybe a longer questionaire would be appropriate with this question.

Have I ever caused a patient harm with my decisions to treat before talking to a doctor, No. Have I had patients die even though I treated them to the best of my ability, Yes. Have I had doctors, patients and families yell at me and throw things at me, yes. What did I do under these circumstances, talk to them in a calm monotonous voice, calm them down, take them by the hand and walk away from the situation, grab their arms and pull them behind their back by the elbows and press them against a wall until security arrives, take them to a private area to discuss things fully, call a social worker, call the police, write an abuse report. Making critical decisions is part of the job.

[unikuelady, RN]

I think the powerlessness over our nursing practice has to do with not enough time to DO EVERYTHING! I've been an RN for 6 years, when I started the average patient load was (in couplet care) 3 moms and 3 babies. we had nurses aids to do vitals, bed changes, bed baths for those on bedrest. assist with changing diapers and bottle feeding babies. We always had a ward clerk to answer the telephones, paperwork, put orders in the computer and keep the nurses station fairly organized. When food trays came-the dietary people passed out the trays and picked them up. The RN's were able to do all medically necessary care for the patients. We had time to teach new moms how to care for their infants. That was then.....this is now:

3-4 couplets depending on if they are c/s, nvd or antepartum (6-8 patients) each. NO nurses aids, OCCASIONALLY a ward clerk, no assistance with passing trays or picking them up. This means the RN is responsible for the entire stay of the patient. I am now responsible for being a ward clerk, cna, dietary, housekeeping, taking care of visitors at the nurses station-directing them where to go, switchboard operator (phones never stop ringing), security, contacting other departments for supplies needed-and having to go get them myself (hiking...good for your health. lol) I guess you get the picture. So I would say that the RESPONSIBILITY has increased, with LESS ACTUAL time spent physically with the patients. Which I equate with less autonomy in the workplace. If I was truly autonomous-I would tell the powers to be that the working conditions are unacceptable and the powers to be would LISTEN and ACT! Enabling me to give optimal nursing care to each one of my patients.

[live4today, RN]

Employees? Most definitely! Closer to slaves instead of nurses.

Autonomous nurses today? I wish we were, but....we are NOT (IMPO)! :stone

I felt as if I had more autonomy as a nurse in the late eighties to early nineties, but not in the 2000's. No time to do direct patient care.

"Multi-tasking" is just another way for the employer to define us as "Gal Fridays" who are expected to do it all PERFECTLY! :rotfl:

[nursemaa]

One of the biggest problems seems to be lack of support staff. Every time a department decides they're not going to do something anymore, guess who picks it up? That's right- nursing! So you're all correct, less time spent on teaching, supporting and doing the extras that patients expect and need. And the nurse runs around trying to do it all, even though the load is sometimes unbearable. Leads to incredible frustration for the nurse and dissatisfaction for the patient. So organizations implement service programs- where the nurse gets blamed everytime a patient didn't get the extras, or the nurse didn't smile enough, or something.....nurses begin to feel less and less like professionals and more like task masters....this leads to even more frustration, and nurses start turning on each other. So now we have an ugly culture, burned out nurses, unhappy patients....ugh!

I guess what I'm trying to say is that while we have a degree of autonomy when it comes to direct patient care decisions, we are employees because we have so little control over our work environment and the tasks we must perform.

[zambezi, BSN, RN]

I think that we are both autonomous and employees (is that possible?). I can make autonomous decisions/plans of care within my scope of practice and per hospital policy...We certainly have guidelines to follow... I work in a critical care unit and frequently take care of post op CV surg patients (as well as all types of other cardiac patients). We have about four pages of standing orders that cover about anything, allowing us to make autonomous decisions based on patient presentation, "numbers", and our knowledge of best practice and patient history. We have to use our judgement on when to call the dr vs. what/when to try different options before we call. For the most part, our docs are pretty lenient and trust our decisions...I think that in some areas, RNs have more autonomy than in others (and that goes for areas within the hospital and in various parts of the country as well). Of course, it often depends on who the dr. is too...

We have to use our autonomy in making decisions for all nursing rationale too (most people probably do this unconsciously...) Thankfully, I think that most of the doctors that I work with expect this from us...

I think that it is a shame that autonomy is not more standardized. It does make it difficult when each doc wants it done their way...

[Tweety, BSN, RN]

One of my papers this semester I analyzed my time and came up with a figure of 68% autonomous. I think being a night nurse and orienting a new grad made my time more automonous. I think the nuring process for lack of a better term, or however we do our work is autonomous.

Much is driven by our employers of course, paperwork, assignments, etc. Some driven by MDs, i.e. passing meds.

My answer would be we are partly autonomous. But I'm certainly not a robot or slave of my employer.

[DelightRN]

I think a lot of it is unit specific, as well. I work on a small neurobehavioral unit and we are a VERY important part of the health care team. I have more autonomy here than I have in other acute care settings.

But here too we are bound to policies and procedures as staff members and must abide by our scope of practice. Its a wash, in my opinion.

[HarryPotter]

Sorry, I put the answers in and thought I could go back and rephrase them, but I couldn't.

Maybe I can clarify.

We nurses always talk about how important it is to have autonomy. But most of the nursing issues that we complain about today represent the reality that we do not, in fact, have autonomy over our practice--we must take that extra admission, we can't staff for acuity, we have to continually work in unsafe conditions where we feel our patients' lives are in jeopardy.

This is the kind of autonomy I mean.

We can actually do the work of nursing within our scope of practice, but as employees, our scope has become more and more limited over the years. We have to accept whatever decisions TPTB make, and we have no voice in this workplace of today.

Compared to the nurses of yesterday, who took a private patient and had much more control over their care, we have very little autonomy.

Maybe I'm wrong, but a great number of our profession's ills is clearly stemming from this powerlessness over our own practice, which I see as a loss of autonomy.

Do you agree or disagree and why?

So sorry that I have to agree...I certainly have autonomy on a one to one basis with a patient, but very little in the scheme (no pun intended) of the organization. I think that this is one of the major cause's of burnout.

[Tweety, BSN, RN]

So sorry that I have to agree...I certainly have autonomy on a one to one basis with a patient, but very little in the scheme (no pun intended) of the organization. I think that this is one of the major cause's of burnout.

Much or policies are in committees formed by nurses. We're a magnet facility. Supposedly a lot of policy is nurse-driven. In some respects that's true as we have A LOT of committees. So it's nice to have some say so, but I'm not on a committee as I work nights.

I also see a lot of policy that is budget driven, or driven by the desire not to get sued.

So I agree, as far as the organization goes, we are not autonomous.