How much autonomy do nurses have??

crb613, BSN, RN · Jul 20, 2006

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

We as nurses are on the front line, so to speak. If the patient is in trouble we are usually the 1st to know...doctors rely on us & our assessments. Now we do give meds, and hold them as necessary...I am a patient advocate, I am warm, loving, & I care. The most important thing I do comes from the heart....I will hold, hug, listen,laugh, cry, and give comfort to those that so desperately need it....I am there in mind,body, & spirit for all who I come in contact with.....my patients are not just the ones I am assigned to. If they need to be cleaned up, have their pillow fluffed, their head held while they puke, taken to the bathroom, spoiled, made to feel important & that they matter to someone you can bet I will do that too! We are educated professionals.....that have compassionate hearts. A soft touch, a kind word, a warm smile, can heal things a pill won't even touch.

nsmith_rn · Jul 20, 2006

I think that nurses have very little autonomy. THe fact is that we all answe rot someone at the end of the day and in certian areas we are expected to know more than others

but when it boils down to it.... we all answer to the almighty nursing director, board or other liscnesing venue of the state in which you are in. If autonomy is what you are after i think that this is the wrong field to look in

PeachPie · Jul 20, 2006

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.

please let me make this clear: nurses are not halfa$$/underachieving/lazy/failed/unable/lesser doctors. please do not look at nursing as a plan b if med school doesn't work out or "the next best thing." i can guarantee that such an attitude towards nursing will make you unpopular with nurses. nurses are nurses, doctors are doctors. medicine and nursing have different approaches, and i hope that you choose the field that suits you the best. if you want to do medicine, become a doctor or a pa. if you want to do nursing, become a nurse or np. unfortunately, society mostly sees nurses as mini-doctors and doctors' helpers. many people think it's a compliment to tell a nurse that s/he is too smart to be a nurse (duh... so they'd rather have stupid people taking direct care of them?) when it's really just another reminder of the stereotype. i used to want to become a doctor back in the days before i knew how the healthcare system really works. most of this influence was based on teachers, friends, and family who also bought into the stereotype and told me, "you're smart, you should become a doctor." that's what they tell all kids with any intelligence. i then volunteered at a hospital and realized that nurses are not lesser doctors, and that the public's perception of doctors is clouded by glamour and money and that nursing was what i really wanted to do.

rach_nc_03 · Jul 20, 2006

epona,

I would suggest you look into areas of nursing outside of bedside hospital care. You implied that you're not fresh out of high school- a good number of us came into nursing from other careers, and we often take our strengths from previous work experience and apply it to nursing.

You might want to look into clinical research- pharma companies and research hospitals often hire RN's for a variety of positions: clinical research associate, clinical research coordinator, clinical site monitor, drug safety specialist, regulatory filing....and that's just in one specialty. Some want you to have multiple years as a direct-care RN, but others don't. I have no idea if you'd find that kind of work interesting, but you'd utilize nursing knowledge and assessment skills, but wouldn't neccesarily be dealing with sick people (I work at a place that does clinical drug trials on healthy adults).

I'm no longer physically able to work at the bedside, so I understand where you're coming from. just remember that there are other ways to be a nurse.

Nishas22 · Jul 20, 2006

true epona probably doesnt have any work experience and doesnt know much about nursing however isnt that what this site is for? to seek advice or find someone who probably has a better idea of it? or to ask questions? I'm really indifferent to this "troll" of an email as you call it, but at the same time, Epona is probably just interested in knowing more about it. Let's keep the rude comments to ourselves (including mine) =P

Epona, shaddowing a nurse would be very helpful and reading up on it or visiting your local hospitals/nursing homes would really help make your decision before definitly deciding you want to be an RN. Nursing isn't for everyone and if you're deathly afraid of a needle, this is not the field for you. But like I said, look into it and see if you really are interested in the field and not just for the pay because in order to be a good nurse, I believe you truly have to care for someone as if they were your own father, mother, freind, etc. Good luck! =)

Trauma Columnist · Jul 20, 2006

The question of autonomous practice is a biggie today as our society moves rapidly into the "me, me, me, I'm the center of the universe." Autonomy is what you make of it.

I do have to say that with autonomy comes big responsibility. The physicians I've worked with over the years (both residents and attendings) take their responsibilities VERY seriously. The same with the advanced practice nurses and PA's that I've been fortunate enough to work with.

That said, the professionals that did the best job of having a balanced life between work and play, had extensive experience and a large knowledge base.

Autonomy should not be the first thing to consider when changing careers. It takes many years of study and many more years of work to gain autonomy. It's not just a given right.

That said, Epona - in one of your posts you indicated your health was a consideration. I'm a nurse, a new advanced practice nurse. I have worked as a nurse for 14 years. I have cared for patients with communicable diseases many, many times. Using proper barrier protection works most of the time. However, if stamina is an issue for you, you might want to look elsewhere. I am almost 48 now and in excellent health. However, after three 12.5 hour shifts back to back without any breaks, literally running from one end of the unit to the other, it is hard and I am tired.

Please consider talking to some nurses you know personally to get a better handle on nursing. I doubt you will get a shadowing experience because of privacy issues. Good luck.

twinmommy+2, ADN, BSN, MSN · Jul 20, 2006

I'm not in the best of health with my thyroid, and I can tell you how run in I am from doing 3 days of 12 hour shifts. I wouldn't change it however, I like the action on my floor. But I love nursing, there isn't something else I'd really rather be doing. If you want to do something else in medicine because you couldn't do the residency of becoming an MD, why not look into nuclear medicine, radiographic technition, I don't know but anything other than nursing. It is sooo very physical.

As far as "pill pushing", I think that someone perhaps has been giving you false information out there. It sounds just like something my grandmother would have told me lol.

Gompers, BSN, RN · Jul 20, 2006

this whole thread has reminded me of one of my favorite nursing poems. i think it's appropriate to post it here, because it very nicely sums up what it feels like to be a nurse, at least to me. i think it might help epona as well...

being a nurse means ...

you will never be bored.

you will always be frustrated.

you will be surrounded by challenges.

so much to do and so little time.

you will carry immense responsibility

and very little authority.

you will step into people's lives

and you will make a difference.

some will bless you.

some will curse you.

you will see people at their worst -

and at their best.

you will never cease to be amazed

at people's capacity for

love, courage, and endurance.

you will see life begin - and end.

you will experience resounding triumphs

and devastating failures.

you will cry a lot.

you will laugh a lot.

you will know what it is to be human

and to be humane.

by melodie chenevert, rn

RN50, ASN, BSN · Jul 20, 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

epona,

you mentioned in your post that you wanted to do something that impacted lives and have respect. i feel that respect is something that is earned. it dosen't come with a title. you can be a ceo, a hairdresser, a cook, or even a dishwasher and have people respect you. many many doctors and nurses are also respected, because they take pride in what they do and the real reason they chose their profession is to help patients. you can also be a nurse or doctor and not be respected. nurses, aren't just "pill pushers" they impact lives in sooo many ways. you can protect yourself against poop, vomit, and blood by using standard precautions. i work with a nurse who goes in every other week for iv igg because she has an immune system disorder, yet she still comes to work every day and jumps right in to poop, vomit and blood, again, she uses standard precautions. i think a lot of the other posters described the various duties and ways that we have autonomy in our jobs. it sounds like nursing has all of the things that you wanted, autonomy, impact on lives, and yes it can earn you respect too. so, it sounds like you have a decision to make. i hope we have all helped in some way. best of luck to you!

catlady, BSN, RN · Jul 20, 2006

The question of autonomous practice is a biggie today as our society moves rapidly into the "me, me, me, I'm the center of the universe." Autonomy is what you make of it.
I do have to say that with autonomy comes big responsibility. The physicians I've worked with over the years (both residents and attendings) take their responsibilities VERY seriously. The same with the advanced practice nurses and PA's that I've been fortunate enough to work with.
That said, the professionals that did the best job of having a balanced life between work and play, had extensive experience and a large knowledge base.
Autonomy should not be the first thing to consider when changing careers. It takes many years of study and many more years of work to gain autonomy. It's not just a given right.

Well said.

ortess1971 · Jul 20, 2006

I think once Epona starts nursing school, she will truly realize just how smart, capable and hardworking nurses are. My mother knew nursing was my path long before I did..I wanted to be a doctor at one time because I think that many guidance couselors are misinformed about nursing as well. So, if they get someone with a scientific mindset, they tend to push them towards med school. I am quite capable of making it through med school but I chose to be a nurse because I like the advocacy mindset of nursing. Also, doctors today are at the mercy of insurance companies and I think they don't get the relationship with their patients that nurses do. Look at it this way-either she'll make it through nursing school or she won't. Nothing we say now is going to make an impression until she's lived it. I wasn't offended by her comments because it was obvious it was from someone who hasn't experienced the incredible experience of nursing. I for one am happy with my choice.

kersti · Jul 21, 2006

being a nurse means ...
you will never be bored.
you will always be frustrated.
you will be surrounded by challenges.
so much to do and so little time.
you will carry immense responsibility
and very little authority.
you will step into people's lives
and you will make a difference.
some will bless you.
some will curse you.
you will see people at their worst -
and at their best.
you will never cease to be amazed
at people's capacity for
love, courage, and endurance.
you will see life begin - and end.
you will experience resounding triumphs
and devastating failures.
you will cry a lot.
you will laugh a lot.
you will know what it is to be human
and to be humane.
by melodie chenevert, rn

i've never heard that poem- i really like it! and yep, it sure does some up our profession! thanks for posting it.