autonomy

Nurses General Nursing

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Hello!

I'm from Canada, where I've been nursing for 13 years. Included in my experience is teaching nursing students, in med/surg. I also have been working the past 7 years in NICU. I decided to go on an "adventure", so I relocated myself and my family to California, for a new job. So, far, it's been a lot of red tape (especially with the IRS), and broken promises. I've found it very frustrating, to say the least. One thing that has truly surprised me is the lack of autonomy that the nurses on my unit have. The doctors are "gods", and you can't even sneeze without getting an order first. Is this situation common in the US, or do you think it's specific to my experience, at this particular hospital? I don't want to make assumptions about nursing in the US, based on my one experience. I sure would like to know, as I'm already considering relocating elsewhere. However, if I will still feel claustrophic, due to lack of autonomy, I wonder if I should just move home.

There's much more to my story, but we'll just leave it at this for the moment.

Just to clarify- when I say "autonomy", I mean do activities that are totally within the nursing scope of practice. Does the term "nursing judgement" ring a bell with anyone else? For example, if my patient doesn't look well, why do I have to get an order to stick an O2 sat on? Heaven forbid, one of my patients actually need some oxygen- I might be shot if I do it without an order!

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Oh wow, you mean you can't do something simple like put on a sat monitor??? Is it possible that you are being told not to by a nurse who has no independent thought on her part? Or a territorial thing with RT....This is really interesting.

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Okay, I'm glad I'm not insane for thinking that it is stupid. But it is. I had a kid (I work NICU), who was starting that lovely "stridor", so I went a put a sat monitor on him. Then I was told (by more than one person), that I'm not supposed to do that without an order. I actually had to track down the doc to get a "cover" order. Also, even though I've worked with neonates for 8 years, I'm not allowed to use judgement when to dress them, try to bottle them, or put O2 on them without orders!

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Unbelievable,what are you up there ROBOTS..I've been working as anurse for 7 years now and in the last 3years Iam in Rehab ward.Somethimes I think I got too much autonomy,I work mostly PM Shift ,where doctors go home @5:30 and all we have are on-calls DR's.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.

Technically speaking we need an order for just about everything we do. We can administer up to 2L NC without an order, we can do accuchecks whenver we want to.

However when a patient is in need, for instance if they need an EKG or an ABG, or CBC, I'll do all of that, get my ducks in a row and call the doc. Why call the doc and say "he's having chest pain" only to have her/him surely say "get an EKG". I'll say "I did an EKG for chest pain and it shows......" Then after talking with her, I'll write the orders.

Or if someone has an accucheck of 20, while someone is calling the MD, I'm giving an amp of D50W.

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by kimmy2

. Does the term "nursing judgement" ring a bell with anyone else?

Actually it **does** ring a bell for me; but autonomy in nursing is BROAD by definition, even from one hospital to another in the SAME STATE! (I know from personal experience just working at two different places as a labor/delivery nurse). No need to get this snippy! sorry I asked. Maybe, this hospital is NOT the place for you to work?:confused:

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by 3rdShiftGuy

Technically speaking we need an order for just about everything we do. We can administer up to 2L NC without an order, we can do accuchecks whenver we want to.

However when a patient is in need, for instance if they need an EKG or an ABG, or CBC, I'll do all of that, get my ducks in a row and call the doc. Why call the doc and say "he's having chest pain" only to have her/him surely say "get an EKG". I'll say "I did an EKG for chest pain and it shows......" Then after talking with her, I'll write the orders.

Or if someone has an accucheck of 20, while someone is calling the MD, I'm giving an amp of D50W.

Yep this post makes sense to me.:)

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Specializes in Nephrology, Cardiology, ER, ICU.

I think we can all agree that autonomy is in the eyes of the beholder. While I feel that standard protocols give ER nurses quite a bit of leeway - it still stands to reason that legally, we have orders to do so. I think a lot of posters have a valid point.

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SmilingBluEyes- I did not mean to sound "snippy", nor insulting. I just meant that a lot of issues I have surround nursing judgement, which I feel that, on my unit we are not allowed to have. I think you misinterpreted my post, or my tone. Sorry!:)

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.
Originally posted by kimmy2

SmilingBluEyes- I did not mean to sound "snippy", nor insulting. I just meant that a lot of issues I have surround nursing judgement, which I feel that, on my unit we are not allowed to have. I think you misinterpreted my post, or my tone. Sorry!:)

Well my name sure does not fit me today...I am sooo bytchy. I am sorry, I guess I just read that all wrong. Chalk it up to PMS and oversensitivity. I am sorry!!!:confused:

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"It's all good". :cool:

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