area of nursing in your experience that allows most autonomy?

Nurses General Nursing

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Hi everyone

I begin nursing school on the 24th and can't wait. I've been reading alot of posts on here where

some nurses have more independence than others. I know it depends on where you work so I

was just wondering what area of nursing you all have been in that allowed for the most autonomy?

Thank you in advance for all your replies.

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Specializes in Medical and general practice now LTC.

Moved to a more appropriate forum to obtain responses

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Specializes in Home Health Care.

Home Health.....

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Definitely home care. Nurses run the show.

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Home care, overall. You're the only care provider around. In the hospital? ICU. Nurses do a lot of things based on protocols and nomograms, at least in the ICUs I've been in.

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I read a v. interesting study a number of years ago (although I have no idea by now where I saw it or who wrote it) that looked at all the various inpatient nursing specialties and broke them down into how much time they spent performing dependent and independent functions, and arranged them all on a continuum from most independent practice to least independent practice. "Dependent" functions were things like carrying out physician orders, following established protocols/routines, and following hospital P&Ps. "Independent" functions were actions and processes that nurses could choose and implement on their own intiative, without anyone else's permission or direction. The final results were that psychiatric nursing was the most independent nursing specialty and ICU nursing was the least independent (since nearly everything they do is based on orders and protocols). I don't recall where other specialties feel between those two extremes, just the two "ends" of the continuum.

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Is this question to take into consideration advanced practicing nurses like NP's, FNP's, CRNA's, etc.? Keeping in mind that they are nurses too. Or, is this question pertaining to RN level only?

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Specializes in Transgender Medicine.

I would definitely say home care, whether it be hospice or home health. True, you may need drs orders for the things you do, but you basically go in and make judgement calls about what's needed and just do it/order it. Then later you get the order "approved." In the hospital setting, my vote goes for ICU and emergency dept. In these you typically do what's needed and worry about the order later. Or you have protocals/standing orders to use. In this, it could be considered not independent b/c you're following set orders, but 85% of the time, you are the one who decides whether or not to implement those orders, so I say it's autonomous. Most settings where things can happen quickly have this type of setup. Like in the dialysis units. They usually have set protocals for what to do when things start going down the drain, too. However, most places that allow you this much autonomy usually desire to hire folks with some acute care experience so that you already know the basics of things and won't have to play "catch-up" so much.

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Specializes in Critical Care Nursing AKA ICU.

CVICU in a teaching facility, we had so much autonomy that it was scary for alot nurses, many nurses left after working just a couple of shifts(2-5 shifts) we called it "cowboy nursing"

Don't recommend it b/c i put my license on the line everyday that i clocked in for 7+yrs. glad to be out of that environment

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RB2000, my question pertains to RN level only. Thank you all for your replies.

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Specializes in Flight, ER, Transport, ICU/Critical Care.

IMHO -

Flight.

:tinkbll: We work as a team (medic, other RN or RCP) and good FN's must have top-notch diagnostic and technical skills and an almost endless ability to adapt, overcome, improvise and get it right - every time, every patient. We also have to have a very broad knowledge base and be able to do a very thorough assessment - and then immediately intervene. At times, we care for the sickest of the sick - and rarely have any prior knowledge of the patient (their history or anything!).

Just my (biased?!) opinion - others may vary. There are some amazing nurses in all specialties! Actually, all nurses are amazing!

Good Luck.

Practice SAFE!

;)

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NREMT, Flight Nursing sounds exciting...never a boring moment, I'm sure. How many hours/days do you typically work a week as a FN?

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