How much autonomy do nurses have??

HealingHands27 · Jul 19, 2006

LoLz about the comment about nurses being mad and being women.:D

Yes, pill pushers is a bad name for our profession, especially since many of us have worked hard to get where we are.

That being said, if you want to have a high level of autonomy then you should seek becoming a MD, and not a nurse. Nurses although do have autonomy in making decisions depending on the situation, particularly if the doctor is not around, but for the most part Nurses and everybody else in the hospital, PTs, pharmacists, supply techs do gennerally follow the docs lead, that really is how it is, at least in the hospital setting.

But just because the doctor takes the lead does not mean our profession does not require a lot of skill or knowledge or that we make some decisions on our own.

Nurses are the ones that ensure the patients survive, like a gardian angel. The doctor for the most part just thinks of the solution as in what meds to give etc, nurses make it happen.

It seems like you want respect and money over helping people, and if this is the case you should not pursue a healthcare career, because it will be the patients who suffer.

TazziRN, RN · Jul 19, 2006

I'm sorry, but even someone who is truly wondering about nursing knows that our skills go beyond pushing pills. I highly resent the term and will point out that those orders written by doctors that we as nurses have to follow are often written after a nurse calls the doc and beats him over the head with the telephone because he tried to ignore the first two phone calls about the same problem. I have seen nurses desperately try to keep someone alive until the doc could get there to take over. And not to brag, I myself (just like so many here) have been directly responsible for saving lives because of my knowledge base and skills.

If Epona truly did contemplate an MSN program, she KNOWS that we are way more than pill pushers.

dorimar, BSN, RN · Jul 19, 2006

I have pushed epi, atropine, lido, defibrillated, cardioverted, paced, hung fluids wide open, gotten Stat labs , abg's, 12 ld EKG & CXR's,hung &titrated drips, ordered blood products,all before i got the docs order. I have screamed at docs on the phone when they weren't giving me what i needed. I know to do these things from EXPERIENCE. However, "caring" for the patient is also a VERY important part of my job. I do: bathe, shave, shampoo, give oral care, skin care, linen changes, poop partol, and emotional support. It is ALL part of my job. I take offense at the presumption that patient care demeans us.

begalli · Jul 19, 2006

I don't get what the big offense is in the op's question or wording. Face it, s/he reflects what the majority of society thinks nurses do. Instead of bashing someone who reflects this misnomer, why not educate? Why chase him/her away from nursing???? S/he is obviously going through a decision making process.

OP - yes, there is autonomy in nursing. It's there, but you have to find it. I agree that there is definitely much more autonomy in critical care and the personality type of a person determines if they are a follower or a leader.

A lot depends on what type of nurse YOU want to be. The opportunities are endless, the pay and benefits/retirement/etc. can be great, and the personal rewards outstanding.

dougRN2BE · Jul 19, 2006

I don't get what the big offense is in the op's question or wording. Face it, s/he reflects what the majority of society thinks nurses do. Instead of bashing someone who reflects this misnomer, why not educate? Why chase him/her away from nursing???? S/he is obviously going through a decision making process.
OP - yes, there is autonomy in nursing. It's there, but you have to find it. I agree that there is definitely much more autonomy in critical care and the personality type of a person determines if they are a follower or a leader.
A lot depends on what type of nurse YOU want to be. The opportunities are endless, the pay and benefits/retirement/etc. can be great, and the personal rewards outstanding.

Begalli...as a previous poster mentioned, I think the OP's comments (and subsequent frustration from other members) are best understood when placed in context with previous posts. In one of the other threads regarding needle sticks many posters were very, very cordial...showed a lot of restraint and had encouraging words (not all, but most)...however, when the same people see someone posting things that are worded in a less-than flattering way (eg "pill-pushers") the patience and willingness to educate tends to run thin.

Altra, BSN, RN · Jul 19, 2006

I have pushed epi, atropine, lido, defibrillated, cardioverted, paced, hung fluids wide open, gotten Stat labs , abg's, 12 ld EKG & CXR's,hung &titrated drips, ordered blood products,all before i got the docs order. I have screamed at docs on the phone when they weren't giving me what i needed. I know to do these things from EXPERIENCE. However, "caring" for the patient is also a VERY important part of my job. I do: bathe, shave, shampoo, give oral care, skin care, linen changes, poop partol, and emotional support. It is ALL part of my job. I take offense at the presumption that patient care demeans us.

Excellent post.

DutchgirlRN, ASN, RN · Jul 19, 2006

For me autonomy is equal to critical thinking. As nurses we have to posses good critical thinking skills.

I give tons of meds but at times I hold meds because a BP is too low, hold R insulin because the BS is too low and/or the pt is NPO, increase IV rates, reduce IV rates, the list goes on and on. 99% of the time it is reported to the MD who says "Gee...Thanks". At the hospital where I work I think the docs actually count on our critical thinking skills and certainly appreciate our decisions which benefit their patients when they are not there.

I'll be the first to admit that at times I do feel like a pill pusher but thankfully no one has ever referred to me as one because that would really hurt my feelings. As nurses we are professionals in every sense of the word.

tridil2000, MSN, RN · Jul 19, 2006

I wondered, too, at the harshness of the responses; then I went back and reviewed the OP's posting history. Here is someone who, in a very short span of time, has claimed to want to be a nurse, then she wants to be an NP, then she wants to try every medical field under the sun depending on how well they pay; but at the same time, she doesn't want any hospital experience, doesn't want to handle poop, and is deathly afraid of a needle stick. A week ago she was torn between a nursing diploma program and an MSN. Now she's asking if nurses are really just pill-pushers, or if they only (insert list of standard CNA duties). Clearly this is a person who has not one single clue about what it takes to become a nurse or why she has any business becoming one.
I don't really blame the respondents for getting irritated. Perhaps it's because we're mostly women, but we nurses spend too much time trying to be nice when it's not always warranted.

because i am restraining myself from adding more fuel to this thread, all i'll add is:

:yelclap: :yelclap: :yelclap:

Antikigirl, ASN, RN · Jul 19, 2006

When it comes to autonomy, I have had jobs with a ton of autonomy, and those where I have less. It depends on many factors.

I was working as a camp nurse, and the only medic within 40 miles. I had 200 campers a week, and 60 staff. There was ALWAYS something happening, and it was up to me and a large protocol book that I had read to figure out the best plan of action. This was almost 100% autonomy on my behalf...and I loved it! My protocols were basically CPR/ACLS stuff and OTC med rules (like you would find on the lable anyway). SO it truely was up to me...which was great and a bit scary!

Now in Med surge, I do follow the MD orders...that is my job as a team player for my patient's well being. However, there are times when I need to make choices for them when the MD is not available, education to do, emergencies that pop up, meds that maybe under question that I must make decisions about giving or not, side effects I have to treat (like should I use a cold compress for that itch from their pain meds, a benadryl as ordered PRN, call in if that isn't available, or call MD straight away?). The list goes on.

It is never as simple as just following MD orders, if it was most days would go so much smoother...LOL! But we have to get degrees for a reason, we have to use our skills and judgement constantly for the safety and well being of our patients...and we have to know how to work autonomously and as a team player to get the best results in any given situation. And working with human beings..pts or not...is always an interesting challenge daily!

Epona · Jul 19, 2006

hello everyone... epona here.

i did not mean to offend anyone with my original post. a lot of folks were upset. i am really sorry about that. i am just trying to get a realistic sense of what nursing is all about before i make leap into a career field that could change the rest of my life.

i have come on here to chat with you all and get good advice, which i have thus far and i thank you for that.

this has been a hard decision for me. very hard. i have talked about going into nursing with my family, husband, doctors, friends, etc. as i have health concerns that have founded merit, yet the discipline calls...

as you may have seen in my earlier posts, i wanted to do to med. school, but cannot do the grueling residency due to my health. in my book, being a np is the next best thing. i believe, after talking with you, that as a np you get a fair amount of autonomy, respect, can cousel patients, prescribe meds to an extent, make a difference and the like.

i love medicine and feel this is a calling for me. i was a pre-med and journalsim student in college. was going to be a doctor then went the way of journalsim. wish i had stayed the course for medicine... the discipline still calls me even after a decade. i can't be a doctor now. my body just can't do it. so what can i do that is similar?? np. my personlaity type fits the "be in-charge type, call the shots, order and read the labs," etc. that is just me and i want to make sure as a nurse i can have that.. that is why i asked the question. i am the "let's do it person, dominant personlaity." i can't be a doc. now. that fit my personality. what can i do?? np is the next best thing. i have to make sure the job fits my peronality as anyone should do when making a life changing decision.

i want to work in a docs. office where i am away (for the most part) from the poop, urine, vomit, etc. the stuff does not bother me as i had a horse that i adminstered shots to regularly, shovled manure, and put tubes down his nose when he was collicking... blood everywhere.... does not bother me. the person to person transmission i have to be careful of though because of my health. i will do it for school, but do not want a daily diet of it. it's not just "oh she does not want to clean poop".....

begalli said it best. society as a whole, and this is for the most part probably true, see nurses as following orders and dispensing pills. they follow orders. yes, they do make life and death decisions for patients and there is not doubt about that. i have seen nurses stablizing someone in caridac arrest. they are on the front lines. but, it's known for the most part, that they follow the orders. i want to make the orders or have a good hand in them. being an np will allow for more of that. since i can't do the doc. thing...the np is the next best thing. autonomy and making the decisions are very important to me. i will not have that in school and that is understandle and fine, but my goal in the long run is to have that. i have to be very realistic with myself and i am. that is why i asked the question.

i am sorry if i offened anyone. i did not mean too.. just asking realistic questions before i plunge into something that will cost time, lots of work, money and dedication. i want to make the best decision for me. a decision that will make me happy, feel somewhat safe, impact lives and have respect. in the end, that's what we all want. i am in my middle 30's and money and time are not on my side. so i have to be as knowledgeable as i can in decisions that will affect the rest of my life.

take care and god speed... e

rstewart · Jul 19, 2006

Excellent post.

At the risking of appearing argumentative, the decision/judgement to perform those actions before contacting a physician for a medical order may well illustrate one sort of autonomy; but without previously approved "standing" medical orders you would be practicing medicine without a licence and likely be terminated from employment for those same actions. And yet ironically doing things like ordering meds/labs etc. without an order may be illustrative of professional autonomy since doing so would no doubt raise the ire of the nursing board which regulates the profession.

My point is there are different types of autonomy and in the workplace, particularly in the hospital setting, I believe that one could reasonably argue that staff nurse's have very limited autonomy, at least in the sense that the word is usually used and understood.

In my opinion, the original question was not at all unreasonable. The existence of professional autonomy when severely restricted as it so often is by workplace conditions is of small comfort to the staff nurse. Indeed, even the lay public's "perceptions" are given precedence over the professional nurse's judgement. And in some institutions "scripting" of verbal responses is expected with each client/family interaction.

In today's health care environment I would never advise an individual considering nursing that they might expect a high degree of autonomy. To do so I believe would be terribly misleading. Now that is certainly not to say nurses are not important----good nursing saves lives (among other things) no doubt about that. But they quite often practice under a repressive system with unrealistic demands placed upon them by other professions, institutions, the public, quality organizations etc etc.

Empress · Jul 19, 2006

Epona, it sounds you like want the "easy" route to be in medicine. There is no easy way. You have to do your time and training, period. Whether it is becoming a doctor, a NP, or even a PA.