1. 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.
  2. Visit kmaryniak profile page

    About kmaryniak, MSN, RN

    Joined: Dec '02; Posts: 43; Likes: 3
    Nurse leader
    Specialty: 26 year(s) of experience


    Sorry to hear that your having such trouble were you have relocated I certainly know how you feel. I get it each time I go to work overseas.And I still have to deal with the IRS, get used to it, there are few things in this world that are going to happen to you in a lifetime. Death and Taxes.
    However on your other issue of autonomy:
    Not all of the facilitys treat thier Drs as Gods. But the Majority do simply because that is the way it has been done for many many prehistoruc years, and the GODS DEMAND IT. Its a true shame isnt it. I do however find that when Im working somewhere other than the USA it isnt necessarily the case. I have worked in a few countries where when I wanted to do something and called, or spoke with the Dr to confirm my thoughts and process and the whys and hows I want to do something I get a lovely blank stare followed by Why did you call me if you knew what you wanted to do. The reason why I and the only reason I say (I) is because I cant speak for other nurses other than myself. Is because if I did something that wasnt approved by the Dr, in standing orders, or went out on a limb on a hunch, I WOULD BE HUNG OUT TO DRY BY THE DR, ADMINISTRATION, AND OTHER NURSING STAFF. Just because to them I went beyond my scope of practice, this includes even the most mundane of functions .
    With the Healthcare industry so gunshy of a Lawsuit , it binds our hands in care that is the easiest to take care of ourselves without the consultation of a DR. But in the wake of those that went beyond and tried to save precious time by tending to the matter and then notify the Dr, they have been hung out to dry and most likely lost thier jobs and placed their licence in the hands of the Boards to decide thier fate.
    Its not that we dont have autonomy, its that we cant use it because our judgement isnt covered by the attending Drs., Administration and others that run the healthcare facility.
    Just my thoughts
  4. by   traumaRUs
    I'm an ER nurse working large midwest level one trauma center and I feel we have a lot of autonomy. We have nursing guidelines set in place where the nurses assess the pt, start IV's, order labs, xrays, EKGs, give meds, etc.. Its a large teaching facility and the docs really appreciate us a lot.

    We are also in the process of becoming a magnet hospital which is going to help with nurse recruiting efforts.

    I think a lot depends on the institution and also the management outlook.
  5. by   montroyal
    Originally posted by traumaRUs

    We are also in the process of becoming a magnet hospital which is going to help with nurse recruiting efforts.

    I think a lot depends on the institution and also the management outlook. [/B]
    Magnet Hospital designation does not help with recruiting efforts!
    Hospital staff is your best hope. The hospital I work at as a Per Diem RN has over 200 open nursing positions it can't fill. Morale is low and turnover is high. The ratio of experienced nurses to newer nurses has caused the experienced nurses to spend more time teaching the new nurses than doing patient care and teaching. All this going on and we are about to receive Magnet designation.

    If you want a good idea of how the working conditions are at a particular hospital, call the unit you are interested in and ask the staff. Make sure you call during all the different shifts and speak to several different people. If you constantly get, were to busy to talk, its a good sign that unit isn't staffed and has alot of the stress that goes along with this sernerio. Most nurses will give you an honest opinion. Good luck
  6. by   montroyal
    I almost forgot, during your interviews at any hospital, ask for the nursing turnover ratio for the last five years, a copy of all open nursing positions in each unit, how many nurses have been at the instition for 5/10/15/20 years, and the last JCAHO scores. This information is available to the public and will give you a good idea of the morale of the nursing staff before you even talk to anyone.
  7. by   sjoe
    "One thing that has truly surprised me is the lack of autonomy that the nurses on my unit have."

    This is the rule rather than the exception, in part because of frequent and expensive lawsuits. ER, trauma, and critical care units seem to give RNs more room for autonomy than other kinds of hospital units.

    Corrections often offers substantial autonomy (if you don't mind being locked up).

    Some folks seem to feel that home health gives they a lot of autonomy, but these people don't seem to be counting the mounds of paperwork that occupy up to 90% or more of their time.
    Last edit by sjoe on Dec 30, '02
  8. by   Audreyfay
    I worked in the LosAngeles area for 6 months. Absolutely hated it. Then I moved the the SF Bay area. Health care and nursing were good there. I think the best area though, is in the midwest. It's not all the same everywhere. Good luck. CA is not an easy place to make it. I couldn't wait to leave. A nice place to visit, but........ I'd put Oahu in the same boat. I lived and worked there for 6 months also...a nice place to visit, but......
  9. by   mattsmom81
    From posts by numerous Canadian nurses on this BB I haven't gotten the impression that Canadian nursing is more autonomous than other countries.

    Nursing is not autonomous by nature in the US...unless one is a NP. As others have stated, some facilities and units run off protocol more than others which may help us FEEL more autonomous.
  10. by   jemb
    I think a lot depends on the facility. Where I work, there is more of a partnership between the doctors and nurses. The doctors and nurses in our department, simply put, have mutual respect. I work oncology, and we even get calls from docs in other departments asking for help dealing with particulars about some of our mutual patients. (They call the nurses , not the docs.)

    I have in the past, though, worked places that are more like you describe. I hated it, too.

    Don't give up yet, though. Look around - there are many good places to work in Southern California.
  11. by   JohnnyGage
    I don't know if your lack of autonomy is a regional thing, but I'm sure it's a facility thing. Working in out unit is wonderful -- not only do we have a lot of autonomy but the docs and nurses really work together as a team. (Not all docs, of course, but most.) Is your position permanent or are you a traveler? If you're a traveler, I would just advise you to grin and bear it ... other hospitals might be better. If you're not a traveler, you might want to consider it. That way, you can audition hospitals before you sign on as staff.
  12. by   altomga
    Sorry to hear about all the trouble your are having At the hospital I work at it is a large teaching university hospital (that actually is private, but is open to everyone); now there are those DR's that think they are god, we could never get rid of those..(mostly surgeons) I work medicine...I see the fresh out of med school doc's through their last year of residency and normally we build a respectful working relationship...I help pull them out of the s**t when they do stupid stuff when they are young and starting out, they ask my opinion and for suggestions on treatments for the patients, technically yes all the nurses need an order from a MD to do something that is beyond nursing judgement..but we typically do "things" until the doc gets to the floor. The MD's that myself and the only other senior person on the floor have a tremendous respect for one another are the private doc's that don't typically enjoy getting woke up at 2am for a tylenol order, etc...they trust our judgement and decision and frequently say "don't go on vacation; who's going to save us? LOL" (my co-worker and I take vac at the same time every year)
    To me it's a mutual thing, respect me for my knowledge and position and in return you will be respected. And don't always assume I will call you DR. whatever....they don't call us Nurse___, it's alway hey you or your name.....
    Good luck! Just whip those smart a** into shape..(LOL, just kidding)
  13. by   SmilingBluEyes
    Maybe, their definition of "autonomy" and yours did not match? I find nursing very limited in autonomy most of the time everywhere I go. I guess it depends on what you consider to be autonomous. Even the most autonomous of nurses (NP'sm CNM's CRNA's) answer to M.D.'s and others in the hierarchy in some way or shape----R.N.s have much less autonomy as a rule than these advanced-practice nurses do.
  14. by   kmaryniak
    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!