Do ICU nurses really have more autonomy?

[IHeartPeds87]

Everyone states that ICU nurses tend to have more autonomy than nurses on other floors. Can someone elaborate? In what ways are ICU nurses more autonomous?

Just curious...I have been interested in working with babies and am considering the NICU...i have a ways to go lol im only a prenursing student right now!

[elkpark]

Please don't put words in my mouth. I NEVER said "psych nurses don't practice real nursing, they just sit around", and that's not what I think. I do think psych nursing involves a lot of one on one talking, and that's half the point of it. God bless psych nurses, I absolutely couldn't do it. As I clearly said THAT'S JUST ME and what I prefer to do. My point was that the definition of "nursing autonomy" is irrelevant - what you and I feel is "more" or "less" independence in practice isn't the same. If you think critical care nurses "stand around and fiddle with stopcocks and follow orders all day" I hope you never need one.

Ah, yes, the ol' "psych nurses don't practice real nursing, they just sit around and chat with people all day" hoohah ... You don't think psychiatric nursing ever involves "keeping someone alive"?? What about all the acutely suicidal people we deal with on a day-in-day-out basis? I'd rather use my critical thinking skills and extensive knowledge of psychology, psychiatric nursing, and human development and behavior to make significant changes in people's lives than stand around and fiddle with stopcocks and follow orders all day, but that's just me ...

I do not understand this one-up-man-ship that people display.

Extremely UNNECESSARY.

I was responding (sarcastically, but obviously it was wasted) to the previously displayed oneupsmanship that I agree is completely unnecessary.

[netglow, ASN, RN]

Oh commmmmmm 'on! I agree with Elkpark. I seriously don't think anybody was trying to be hurtful. I read all this bantering as just healthy muscle flexing/teasing that comes with feeling you got what it takes. Specialty to specialty horsing around, that's all.

[Dinith88]

To OP-yes, they have more autonomy than a med-surg nurse but less than an ER nurse

Nah thats wrong.

The reason for this is because (forgive me if this has been stated already),

In the vast majority of ICU's there are no doctors there 24/7. Yes, certainly there are many hospitals that have intensivists, and hospitalists, and etc... But in even these cases many times the MD isnt 24/7. MOST ICU's in the USA dont have this luxury.

Now...keeping that in mind...the ICU is where the sickest of the sick patients are...period. Couple this with a nurse who hasnt an MD on her hip, the 'autonomy' we're talking about is born of necessity(sp?). Of course, ALL NURSES are bound and dependant on physicians orders....otherwise we'd be practicing medicine...but...the ICU nurses often-times dont have time to wait around trying track down a doctor while working with critically ill patients. If they were to wait for physician direction (which can waste considerable time) these same patients may die.

As far as 'evidence' of autonomy is concerned, i'm sure ICU protocols, ACLS algorythms, etc. have been mentioned. But a better (i think) example of how an ICU nurse can be considered more 'independant' is that in many ICU's (the one i currently work in for example), the 'routine' ICU orders include various labs and tests (cbc, cxray, abg, etc.) that an icu nurse can order "In an urgent situation". This is important precisely because there is no protocol or algorythm attached to it....but rather based on clinical judgment(sp?). And yes the MD will eventually be informed and may even disagree... but it's the nature of the ICU beast.

And as far as being more autonomous than ER nurses...it's simple. ER doc is always there...within earshot. And...any critically sick patient that comes through and is NOT being closely followed by the ER MD is one where patients dont want to be...!! Also, ICU nurses (ideally) only handle critically sick patients...the vast majority of ER patients are not critically sick. So...the ICU nurse becomes a specialist in this regard...because it's the only kind of patient she handles.

Lastly, i think it's important to add that although there is the 'appearance' of having more autonomy, it's simply because of the work ICU does. If the ICU nurse is thought of as a 'specialist', then this pseudo-autonomy can be thought of as one aspect of this specialty. 'critical care nurse' can be applied to many nurses...including ER nurses and ACLS-trained tele nurses, etc... but the critical-care nurses who work in the ICU setting are the 'specialists' i'm speaking of.

[Otessa, BSN, RN]

I agree with the perceived autonomy. That was what I had as an ICU nurse-I had protocols or standing orders.

When I worked Med-Surg I had to call for everything.

otessa