Autonomy in nursing

[Christopher McDowell, EMT-P]

Hey guys, not sure where this post should actually go so I'm going to just drop it here.

So I'm a critical care paramedic and I've been looking at possibly going to nursing school. Here is my only catch though, as a paramedic I get a tremendous (and sometimes terrifying) amount of autonomy in how I treat patients. If I believe a pt's vent settings need to be altered I alter then, if I think they need a cricothyroidotomy I perform it, if I think they need a pleural decompression I decompress.

Now my question is what kind of autonomy do nurses have, I understand that it probably various depending on the department you work in and the area, but just in general. Like do you have standing orders that you can follow that allow you to treat a pt. when a doctor isent on hand? is there like an approved skill set where you can perform them without a doctor's order?

Please excuse any ignorance (and I am fairly ignorant of nursing) that these questions show, I really am just looking for some information.

Thanks everyone!!

[NICU Guy, BSN, RN]

37 minutes ago, Christopher McDowell said:

Like do you have standing orders that you can follow that allow you to treat a pt. when a doctor isent on hand? is there like an approved skill set where you can perform them without a doctor's order?

There may be standing orders on select, limited basis. You will not have the ability to adjust ventilator settings (excluding FiO2) because you feel that they need to be changed. You would need to contact the doctor for a verbal order. You are definitely not going to have a standing order to intubate or insert a chest tube or any other invasive procedure, if you feel a patient needs one.

[Golden_RN, MSN]

You would have to pull back a lot as a nurse because working in a facility is a lot different than working in the field. For instance as an RN in the hospital, I was not allowed to adjust vent settings even WITH an order. Only an RT was allowed to do that (I know this varies at different facilities, but this was my experience).

The short answer to your question is that in the hospital you have to have an order to do anything. If you need something that is not already ordered, then you call the MD or the on-call to ask for the order. There may be very limited things an RN can initiate w/out an order, but it has to be a facility-approved policy/procedure (think: basic pressure ulcer care).