How much autonomy do nurses have??

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Hi. Can you all tell me how much autonomy do nurses have??

Regular RN's?? NP's? Do they get to make decisions about the patient on their own OR are they just "pill pushers" just following the docs. orders?? No offense here, but how much autonomy do you have as a nurse in making real decisions that impact the patient; besides "caring" for the patient-- baths, pills, cleaning up, IV's, etc... Do you just follow orders OR make the decisions ourselves??? What about interpreting labs?? Tests?? Can you offer advice to the patients?? Or is all that up to the docs.?? Do the nurses just do the "caring" part?? That is important no doubt about it, but I am curious as to what else we can do... thank you.. E :o

nurses do have a degree of autonomy but it all depends on your specialty and how much of your initiative you want to use.

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Specializes in Emergency & Trauma/Adult ICU.

My only other comment to the OP (Epona) is that you've repeatedly made references to your health condition(s) or physical limitations. I'm not inquiring what those might be, it's none of my business, but if you feel that it would prevent you from completing a residency as a physician, you'll want to be sure that you can meet the physical requirements of nursing to complete your nursing school clinical experiences and the employment experience as an RN that will likely be required before you can apply to an NP program.

Best of luck to you.

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Specializes in ICU/CCU, CVICU, Trauma.

"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."

Epona,

Bedside nurses also get a fair amount of autonomy & respect (quite a bit of respect). They also counsel patients & do quite a bit of teaching. All bedside nurses "make a difference and the like". Alas, we cannot prescribe meds. :nono: :nuke:

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Specializes in Education, Acute, Med/Surg, Tele, etc.

My best friend who was an RT chose PA to gain autonomy! He loves it! He also really would rather get away from the bed side having to suction secretions all day and cleaning pts (which he did) as an RT. It just wasn't his thing to deal with bodily fluids..and I don't think that is too bad to come to terms with that being something you yourself wish to avoid. He is still absolutely caring and one of the best PA's I know, and yes...does take the time to clean a pt if needed.

He thought about NP, but really preferred the PA program for time, money, and autonomy.

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Specializes in NICU.

I've never gotten the obsession some people have with autonomy. If I wanted to be the one to diagnose and order things for patients, I'd have become a doctor. Pure and simple. Not a nurse practitioner - because even before I started nursing school at age 18 I understood that a nurse practitioner was the highest level of nurse - someone who had worked at the bedside for years and then went back to school to do more after that. I have never had the desire for that kind of autonomy. Autonomy is not always what it's cracked up to be!!!

As they say in the Spiderman world...

"With great power comes great responsibility."

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Now, I may not have the autonomy to order things on my own for my patients (I work in an ICU where we have docs on the unit 24/7 so there is no need for me to order things because they're right there to do it first) but I sure as heck don't push pills all night! I do almost ALL the care for my patients - I am the one at the bedside doing all the work. That patient is my responsibility, and the fact that I wasn't the one to diagnose or order medications or treatments doesn't mean squat to me.

Let me do a rundown of my last shift - actually just ONE of my two patients from my last shift.

Here's what the docs did:

1. Came to the bedside when I told them that the baby was having apnea episodes.

2. Called the family to tell them that their baby was sick and our plan of care.

3. Came back to the bedside to intubate the baby because of the apnea.

4. Looked at the tube placement on x-ray and analyzed lab results.

5. Ordered labs, antibiotics, pain meds, transfusions, x-rays, and vent changes.

That is their job - ordering things, doing the "big" procedures, and updating the family.

This was my job, what I did from 11pm to 7am:

1. Cared for this baby by doing vital signs every hour.

2. Stimulated the baby to breathe every single time she stopped breathing.

3. Comforted the family and explained in layman's terms what was going on.

4. Obtained a blood count and blood culture by doing an arterial puncture.

5. Prepared and administered 2 IV antibiotics through the baby's central line.

6. Alerted the doctors that the baby was getting harder to arouse when she stopped breathing.

7. Assisted with the intubation - administered pain medication, suctioned airway, monitored vital signs, secured breathing tube, listened for breath sounds, repositioned baby back in bed, prepared for bedside x-ray.

8. Repositioned and retaped breathing tube per order.

9. Inserted nasogastric tube and attached to suction.

10. Decided to place the baby on a warming mattress as she was chilled.

11. Obtained a peripheral IV.

12. Administered a third IV antibiotic through the central line.

13. Obtained a blood gas through a capillary heelstick.

14. Administered a blood transfusion and monitored vital signs throughout.

15. Started a continuous pain medication drip per order.

16. Sent a stool culture.

17. Did a straight cath and sent a urine culture.

18. Suctioned endotracheal tube to clear lungs.

19. Obtained another blood gas through a capillary heelstick.

20. Charted and reported off to the oncoming RN, answered questions.

Plus, the whole time I cared for this decompensating patient, I was still taking care of another baby, a 1.5 pound preemie that needed vital signs and nasogastric feedings every two hours, not to mention IV antibiotics and respiratory treatments.

So while I may not have the autonomy or responsiblity of diagnosing my patients and ordering their treatments...I sure as heck didn't spend my night wiping butts and pushing pills like a robot. Not by a longshot.

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REMEMBER - before you can get a job (doctor, nurse practitioner) having autonomy, first you have to do your time in the trenches - residency for docs, a couple of years working as an RN for nurses (not nursing school, which is barely a taste of real nursing). If you haven't spent this time working hands-on with patients on a day-to-day basis, you will not have the education and experience needed to be the one to be writing these orders and diagnosing these patients. Medicine is a tough world. Just going to school isn't enough to make you smart enough to have autonomy off the bat.

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When I worked in the hospital, I probably had the most autonomy when I worked in ICU and worked mostly with the specialists. But that came with experience and gaining the respect of the doctors I worked with - and if I didn't understand something, I asked them.

Granted, I couldn't order meds, but I could point out to the docs symptoms that would lead to them ordering what was most appropriate.

Once they trusted my judgment, I could order labs, etc., as I thought appropriate before calling them - but then I would call them, tell them what the problem was, what I had ordered and what the results were. I never gave meds that weren't already on standing orders.

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WOW GOMPERS!! That is BY FAR the most I have learned about nursing while visiting this website. I am dually impressed. Wow! I had NO IDEA nurses did all that. What a great, informative post. Thank you and it makes me really think again if this is for me.

Thanks again for a real look into what nurses do. I had no idea and honestly was blown away.

Epona

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Specializes in OR.
We're just pill pushers who follow docs orders.

:angryfire

Go look at your state nursing website for all the pill pushing details.

i can't believe you came to a nursing board to ask this! Curious or not, the wording was very poorly thought out and completely inappropriate.

Just a suggestion : Drink Decaf.;) That poor girl was just asking a question. Maybe she's a new grad or a student- I'd like to think that all questions are welcome here and I've seen far more silly posts. Sheesh.
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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

why not go the pa route? probably faster if you haven't done any of the nursing prereqs. i am hearing that more and more pa schools aren't requiring the extensive health care experience, and they run off of the medical model of care. i suppose if you get into an accelerated np program because you already have a b.a./b.s. it could cut the time down, but that is going to be rough. good luck in your decisions.

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Specializes in NICU.
WOW GOMPERS!! That is BY FAR the most I have learned about nursing while visiting this website. I am dually impressed. Wow! I had NO IDEA nurses did all that. What a great, informative post. Thank you and it makes me really think again if this is for me.

Thanks again for a real look into what nurses do. I had no idea and honestly was blown away.

Epona

This is why I hope you are able to find a hospital willing to let you shadow some nurses for a few days. You might like ICU nursing (maybe cardiac, aka CCU) better than floor nursing. Instead of having 5-10 patients on the floors, you'll have 1-3 patients in the ICU areas. But be forewarned - in the ICU sometimes you won't have a nursing assistant to do all the bathing and toileting for your patients. You will deal with body fluids in these areas. There is no getting around it. But you'll be doing a helluva lot more than just cleaning patients and giving meds.

Overall, I still say if you are nervous about body fluids and the transmission of disease from patients to healthcare workers that maybe the entire field of healthcare is not for you. You will need hospital experience, and even in an office you'll be dealing with sick patients. Disease travels through the air and by touch, not just through body fluids. So if this fear of yours is really that bad, you will never feel comfortable in healthcare. There is just no way around it.

It reminds me of an episode of Gilmore Girls where this one girl refuses to take care of her flu-stricken boyfriend because sick people "freak her out" yet she's pre-med!!!

Good luck in whatever you choose. If you do decide to go to nursing school, you'll know well before graduation if you've made the right choice or not. But I agree that maybe physician's assistant programs might be more of what you're looking for in terms of autonomy - but again, you're still going to be surrounded by sick people there.

ETA: Now I thought you had been a patient for two months after you contracted a virus of some sort. Didn't you notice the nurses when you were a patient? I mean, you had all that hospital exposure so I wondered why this is all coming as a shock to you.

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Specializes in Infection Preventionist/ Occ Health.

To the OP: It seems that you are receptive to others advice, so I will a bit of my own. I can respect that you want to "be in charge". However, having this attitude can also be a barrier to learning. Remember that there are a lot of floor nurses out there from whom you can learn A LOT. If you always have this attitude of thinking that you want to "be more and do more", you will impair your ability to take advantage of their knowledge. In the end, you will only end up cheating yourself.

Now that I am doing clinicals, I have a lot more respect for the level of knowledge of the nurses working on the floor and in the OR, ER and ICU.

If you are interested in being an NP, realize that you will have to go through nursing school first. Even most of the direct-entry MSN programs recommend that you go part-time after passing the NCLEX and work as an RN to gain some experience.

Also, please be aware that most nurses will not appreciate it if you tell them that you wanted to be a doctor, but being an NP is the "next best thing". In fact, you will end up with a lot of nurses who are highly offended and might not like you a whole lot.

These professions are two completely different animals, and being a nurse is not just a backup plan for pre-med dropouts. I mean no offense when I say this, I just want you to be aware so that you can be more sensitive in the future.

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Perhaps the OP did not mean to offend, but I did not spend three years sweating blood and trying not to develop an ulcer about the Boards, then the next 18 doing what she thinks doctors do, only to be called a pill pusher. It would have been much less offensive to ask, "What do nurses do?" period. And she's been here long enough to read enough posts to have an idea that we do just an itty-bitty tad more than push pills and clean butts. As for just following doctors' orders, I have lost track of how many times I and other nurses have saved doctors' butts because we shook them by the scruffs of their necks until they listened to us. Those docs are usually the ones with the "I'm the doctor, you're the nurse" attitude, until they realize just how close their pts came to getting into trouble. If Epona wants to be someone who can prescribe, great, I hope she does well at it, but she'd best drop the "I like to be in charge" attitude.

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