Specialties NP


Hi all

I wanted to see what level of autonomy you have with your practices. I work in NYC part of a teaching hospital in a malignant hematology clinic. I work very closely with my attending. My primary role is to manage patients that are undergoing treatment. When I used to work Bone Marrow transplant I was allowed to do the full consult and write the note. I perform all necessary procedures unassisted as well. 

In your practice how comfortable are you making the diagnosis yourself and fully managing a patient without physician oversight? I understand in some states, including NY, you can practice independently. 

I personally believe there should always be physician oversight due to the complexity of some patients. Our differential knowledge pool is also much more limited from our studies. 

Thanks for your time.

Trauma Columnist

traumaRUs, MSN, APRN

97 Articles; 21,237 Posts

Specializes in Nephrology, Cardiology, ER, ICU.

I work in nephrology and rarely see a physician. I see/write all my own notes, none are co-signed. If I have a question, I ask but otherwise I'm on my own. I've been an APRN for 15+ years now and as the years have gone by, I'm more comfortable with pt care. However, I still do ask questions when needed. No one needs a cowboy taking care of them....


590 Posts

Inpatient medicine, pretty much full autonomy depending on the attending (but even with the micromanagers I give a one-liner on patients and that's it). Honestly, I don't care how much they get involved at this point because they are getting paid and I am not. I am at one of those hospitals where travel RNs are making double my salary, autonomy matters little to me right now.


1 Article; 2,675 Posts

Specializes in ICU, LTACH, Internal Medicine.

Small (25 beds) critical access hospital. 100% autonomy, on my days on I am the only one provider on floor. Support, if I need it, from ER doc and from "main" hospital over the phone. Enjoying it immensely. 

Specializes in Corrections, Public Health, Occupational Medicine.

I work in Occupational medicine with in a restricted state and handle all the day to day patients myself. Treat, refer, diagnose, medications etc. My supervising physician comes in once a week and may see one or two patients but he does not look over my shoulder or micromanage me. He is actually awesome in the sense that he has taught me so many more things and is always available if I have any questions.


122 Posts

I know this post is one year old but the topic of autonomy and collaberation has always been on my mind. I believe physician collaboration is paramount to APPs because we do not have the same amount of education and training as docs (I guess this impression may change as I gain more experience as a NP?).

Being in neurology for 3.5 years, I see patients mostly independently including small amount of new epilepsy patients. Ideally I would like all my new patients being staffed but my attendings refused (probably since they don't get RVUs and they can be busy with their own clinics). I also would like the possibility to send refractory patients to the doctors to evaluate once a while but the answer for that was a "no" as well. I envy the clinics in which docs see new patients and send returns to APPs. I think that will be a good model as well. My admin really does not care, so I'm looking for a new job hopefully finding my niche and the balance between autonomy and collaberation....


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