Describing Your Nursing Practice

[begalli]

What is it that you do in your area of nursing practice that distinguishes you as a nurse with experiential knowledge and clinical grasp? How much autonomy do you/are you permitted to use?

Having only the experience of the ICU, I would like to know what others do and would like you to talk about the "good saves" or "near misses" that standout in your mind and to what extent was your involvement using your nursing autonomy and voice.

Stand up and be proud of what you do each and every day.

Let's hear about it!

[begalli]

I have told a couple of my "stories" in another thread. As an ICU nurse in cardiothoracic surgery, I feel very fortunate to be in an environment that totally supports the RN's voice and autonomy.

We frequently deal with drastically sick, sick patients and we are a high volume cardiac surgery unit. Clinical grasp of the usual course of a case type or disease is paramount to the job we do. All of our surgical doctors orders are written in protocol. That means we have the same 4-5 pages of typewritten orders, tweaked for individual needs, for every case that is similar (eg: cabg, valves, heart/lung transplants, patients on VADS, IABP's, CVVH, thoracic or abdominal aneurysms, etc).

As nurses we have the choice of how to manage a patient. The orders give us options that we choose from in delivering patient care based on our clinical judgment of a particular situation at a particular time and the knowledge of how a particular doctor prefers their patient to be managed.

The orders usually include everything, from fluids to drugs, to at what hct we give prbc's to when we feel is a good time to pull an ett. They (the docs) know we manage their patients. They listen to our voice and we have everything we might need with all parameters within which we work independently.

Frequently we will initiate treatments or order tests in anticipation of what we know needs to be done and what we know the doc will do once we notify them. We initiate codes, we are the ones at the bedside shocking the patient and pushing the drugs before a doc ever sets a foot in the room. We take care of patient needs first.

It's the ultimate in automony, I think, and I would not want to be at any other place at this time in my nursing experience. I think that being able to use this autonomy promotes great relationships between doctors and nurses, I think, because we are not forever bugging the docs for things and it enables us to truly collaborate for the good of the patient.

I LOVE what I do!

[Tweety, BSN, RN]

I feel pretty autonomous even in med-surg. Especially at night. I decide how to assess a patient, what to focus on and what findings are significant. I put the whole picture together and decide, using my expert clinical thinking skills (:)) and decide on the plan of care. What is significant, what isn't, what needs attention and what doesn't. What can lead to trouble down the line and needs to be monitored and what is a normal finding given the patients condition, history and current diagnosis.

It's all about autonomy for me.

[llg, PhD, RN]

As an experienced staff development educator, I am pretty good at assessing the abilities of a nurse. There have been times when I have quickly assessed that an orientee was "not going to make it" through orientation and was able to save that person a lot of pain by helping them see that the job was not a good fit -- and help them find a better fit in our hospital. It always makes me feel good to see that same nurse succeeding and happy on another floor (rather than failing and miserable on mine.)

I have also assessed that certain orientees who were struggling COULD succeed if only we gave them a little extra help. "Saving" these orientees has also been quite satisfying.

Making those judgments and knowing how to counsel someone to help them find their best niche in nursing requires in-depth knowledge of the clinical field as well as in-depth knowledge of the education field. It takes a while for a new educator to develop that judgment. It doesn't happen over night.

llg

[begalli]

Thanks Tweety and llg! :)

Maybe my question isn't clear to some.

Do you actually practice the nursing that you are trained to do or do you just go through the motions to get through your busy day? Are you beyond the "tasks" that comprise your day and are you able to reorganize your delivery of care based on your assessment of a changing clinical situation? Do you think it has anything to do with the area of nursing that you work? For example M/S vs Critical Care; Occupational Health Nursing vs Community Nursing? Are you encouraged to "think" about your patient's condition clinically and relay your findings to other members of the healthcare team and do they act upon your findings? Or are your findings brushed aside, the "s/he's just a nurse?"

A negative question will get dozens of posts, no problem, but attempting to put a positive spin on what nurses do gets two? Even if the experience is negative, I'm interested in knowing.

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

I'm probably autonomous in the ER although I work hand in hand with the EMT's/medics. The doc usually isn't there until I call him from next door where he is seeing patients in the clinic or asleep . .depending on the time of day.

It is still more of a team effort though . . . when I work the floor I have a good relationship with my CNA, who usually spots trouble first since she is with the patient more than me. In OB, I'm essentially alone with the patient, no CNA and the doc is not there until called in.

So it is a mixed bag . . . I don't want to feel alone with a laboring mom though . . .things can turn bad so quickly.

In the ER I have lots of backup help.

Can't think of specific examples where it was "all me" . .. . except maybe when I notice a scary fetal heart tracing.

Teamwork - that is the key to my success. :)

steph