Are we Autonomous Nurses or Employees?

[UM Review 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.

[Spidey's mom, ADN, BSN, RN]

I voted for not autonomous but then read Angies definitions and yes I'm autonomous. Angie's quote says: "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"

I don't work over our 6:1 ratio (well, it is the law here in CA ya know), so I don't take that extra admission if it puts me over my ratio. We also staff for acuity. I don't work in an unsafe condition where I feel my patient's lives are in jeopardy - I'd quit a job like that in a heartbeat.

I was thinking initially about something that came up the other day at work .. as the Nursing Supervisor you are also the RN in the ER (we have 3 beds). But your duties also include being paged to the CT scanner to start IV's. I mentioned it would be nice to be reimbursed for that. But it is all part of the job of supervisor/er nurse. That was what I was thinking.

So I voted that we really are employees. But I think we do have some autonomy.

Confused? :)

steph

[renerian, BSN, RN]

I used to think we were but after learning more about life/work/laws and regulations I realize this:

You have to work within the following guidelines:

OSHA

HIPPA

JCAHO

STATE REGs

FEDERAL REGS

INSURANCE POLICIES

CHAP

HOUSE POLICIES AND PROCEDURES

EPA REGS

BOARD OF NURSING RULES

WAGE AND HOUR RULES

FEDERAL REGISTER

I know there are more regulators of such but off the top of my head this is what I could come up with.

renerian :rotfl:

[jnette, ASN, EMT-I]

Most definately NOT autonomous... at least not in the company I work for.

Nurses (where I work) have no say reagrding ANYthing.. nor are we even ASKED for our input. Everything is handed down from management, and we are to follow like sheep. Even when it comes to the most trivial things.. policies and procedures dreamt up by those in mgt. who have never worked the floor.. many who are not nurses and never have been.. those who have "business mgt." degrees only. It is this which ruins it for me.

So sad, because I so love what I do.. but the stress and frustrations of feeling so powerless makes my blood boil.

We are made to feel like we are no more than factory workers... "assembly line" workers.

[leslie :-D]

nsg autonomy, nsg judgement are catch-all phrases.

yes you can use your judgement and make a decision accordingly within the scope of your practice.

but you always have someone to answer to- the don can question why you did or did not do this.

you can do things to advocate for your patients, and it's the right thing to do; yet if it reflects negatively against the facility, you're in big trouble.

so no, i don't think nurses have as much autonomy as we'd like to....the

exception being what tweety said about working nocs and precepting a new nurse.

as a hospice nurse, i do have alot of control over any interventions with my patient- i decide when more meds are needed or when to stop a certain intervention; or calling the md stating i need this...so in that particular instance i feel i have alot of autonomy- until/unless it's questioned.

leslie

[Antikigirl, ASN, RN]

I absolutely agree that in some areas of Nursing, autonomy has taken a back seat to just being an employee working a daily grind so to speak. I find it especially true in my area of assisted living or LTC's!

And it does have much to do with having no time to do your job...in fact, I get 1/4 of the way through an assessment and start making a plan of action and I have another call on my walkie for the next probelm I have to solve (I have 160 residents, one floor nurse...it is too much!). I don't get time to really think about what I have to do...it just has to become automatic and more like moving cattle through a shute than nursing..and I absolutely hate it!

And I also very much agree that nursing departments get many jobs thrown at us by managment teams! Any new idea always gets thrown in a Nurses lap because we are supose 'nurses' (guess the idea of "nurses can do anything" deal our patients think!).

Just last week, I found that we are to have parking permits, and nurses are the ones responsible for contacting the employees if their car is to be towed because they forgot to put their permit on...WHAT?!?!?! SO I have to go through all the departments (housekeeping, nursing, management, maintanence...) and try to find whomever owns "a blue ford taurus licence plate...." (we don't have a PA system...We will have to get on the walkies and start chasing folks down...not all employees have walkies!).

PLEASE! What the heck does that have to do with nursing!!!!!!! But I was told when I asked about this situation so I knew my role in it that "as a nurse you should be compassionate about someone having their car towed, we thought you nurses were sympathetic for this type of situation!"...I was so dumbfounded by the answer I couldn't even speak....I was like..you have to be kidding but your not...*TILT*.

It would be interesting to know how many of the 'employee' voting folks like or dislike their jobs...because I really do think that this is the reason most nurses are unhappy with the career...the lack of autonomy for a professional!

[BeenThereDoneThat74, MSN, RN]

I don't work over our 6:1 ratio (well, it is the law here in CA ya know), so I don't take that extra admission if it puts me over my ratio. We also staff for acuity. I don't work in an unsafe condition where I feel my patient's lives are in jeopardy - I'd quit a job like that in a heartbeat.

You'd be breaking the law if you took more than 6 (and they'd be breaking the law if they tried). I'm so jealous!! The rest of us risk termination (or insubordination) if we don't accept that extra patient.

When you factor in all the governing and accrediting bodies as Renerian mentioned, well then no, we're not autonomous!!!