How much autonomy do nurses have??

james_lankford · Jul 21, 2006

ok, I understand everyone's anger and frustration in their responses to the original poster, but I have the same question

I am a computer programmer who has been considering a career change for a long time. I have thought about physician assistant (PA), Respiratory Therapy (RTT) and Registered Nurse (RN) (duh)

I have been looking at the courses required for each and I still have no idea what a nursing student learns.

Let's look at the first course in nursing at a local community college

Nursing Process I: Fundamentals of Patient Care

http://www.bmcc.cuny.edu/catalog/NUR112.html

This course is an introduction to the bio-psycho-social and cultural factors that influence the nursing care of any patient/client who needs minimum assistance in the maintenance of health....

Seriously, what does that mean? Is there anything medical related in that course?

The description goes on to say "Clinical experiences are provided..."

And I ask "doing what"?

Do I learn to take blood pressure in this course, take a temperature or just change sheets?

I'm really being serious.

Now look at the description for the first course in Respiratory Therapy at the same community college.

Fundamentals of Respiratory Therapy RTT 100

http://www.bmcc.cuny.edu/catalog/RTT100.html

Students are given the knowledge, skills, and attitudes basic to all patient care, with special emphasis on the basic science principles applicable to medical gases, pressure breathing devices, gas exchange, artificial ventilation and respiration...

Now that sounds medical.

and I continue reading the description

"This course also involves the study and operation of basic respiratory therapy equipment such as cannulae, masks and tents, nebulizers, flowmeters and regulators, oxygen analyzers and oxygen supply systems."

So I don't even know if a nursing student learns how to use a stethascope, but the RT learns some pretty interesting equipment right off the bat.

The nursing course talks about bio-psycho-social and cultural factors. The RT course talks about patient care, with special emphasis on the basic science principles applicable to artificial ventilation and respiration

ok, maybe that's just the intro course. So I look at the more advanced courses.

What about the 3rd course in the 4 course sequence, Basic Medical-Surgical nursing? Surely this is advanced and medical.

Nursing Process III: Pediatric and Basic Medical-Surgical Nursing Care NUR 313

http://www.bmcc.cuny.edu/catalog/NUR313.html

.. Major emphasis is placed upon common recurring health problems. Psycho-social nursing techniques are emphasized as they relate to the care of the client with selected health problems...

?????Again, what does that mean?? Do i even get to see an operating room? The name of the course is Medical-SURGICAL nursing

How the 3rd semester of the RT program?

http://www.bmcc.cuny.edu/catalog/RTT301.html

Skills in patient care are further developed and emphasis is placed on continuous ventilation and acid-base chemistry. The physiology of the cardio-pulmonary system, the ethical and legal implications,...

ah, physiology, ventilation, acid-base chemistry. Now these are words I want to hear in an allied health course. Not psycho-social whatever wahtever.

I mean, seriously. I know RN's are trained professionals. They are highly skilled. But how would anyone ever know this by looking at the courses?

What are some of the other courses RT's take at that college?

Pulmonary Function Testing

...introduces students to the most common tests of pulmonary function in adults and children. Students will be required to perform these tests and interpret their significance...

Cardio-Respiratory Physiology

This course exceeds the scope of Anatomy and Physiology I & II, and stresses physiological properties of the heart, blood vessels and lungs, ...The material is taught in a clinically-oriented manner to reinforce those aspects of cardio-pulmonary physiology most relevant to the care of patients.

Fundamentals of Clinical Medicine

This course is an assimilation of the basic and clinical sciences from several areas of medicine, to help students develop a deeper understanding of the patho-physiological consequences of such diseases as asthma, atelectasis, pneumonia, pulmonary embolism, infant respiratory distress syndrome and others.

Did you see that?! They actualy mentioned a disease!! An allied health course that actually mentions a disease name! And all this is in the RT program, NOT the RN program.

So I'm not trying to disparage nurses. I just really have no idea what they learn or what they do. I think this is why there is a shortage in nursing. Students look through the college cataog, read the nursing courses, and go, "Huh"?

Do I actually learn anything? Will I actually be able to do anything ? Why spend all the time and money studying to be an RN when a CNA learns the same thing faster and cheaper? (Yeah, I know the two can't be compared, but I would never know that from the course descriptions. And that's my point.)

So back to the origianal question. How much autonomy do you, a highly trained, highly skilled RN with a 4 year degree have? Much thanks to those have already answered seriousy about the responsibility in the ICU and running codes. Would love to hear more stories like that.

Signed,

considering a career change

tridil2000, MSN, RN · Jul 21, 2006

not quoted for brevity....

james, you will learn EVERYTHING you just quoted. EVERYTHING. as you can see, the rt focuses on the respiratory system and disease. nursing focuses on ALL diseases, ALL systems, ALL equipment involved, ALL treatments for ALL the diseases, ALL medications for ALL those diseases, and ALL complications from the meds and/or the diseases. you will learn about ALL ages, from neonate to death AND learn how the familes of said patients deal, and interact with them. you will also learn how people cope with illness and struggle with maintaining health. you will learn about people who can NOT cope and have terrible ways of dealing with illness or life in general.

you will be empowered to interact with people and change their lives. you will be a coach, a parent, a healer, a role model and YOU control their perception of you through your interactions. not from a 60 minute tv show.

there's no nursing shortage james. there's a shortage of nurses who live up to these challenges in hospitals every day. but statistically, there are plenty of nurses.

Empress · Jul 21, 2006

Google medical model versus nursing care model. There are 2 different mindsets.

My take on nursing is that while you don't learn absolutely everything about medicine in nursing, doctors don't even learn everything, but you will learn how to learn about patient conditions, medications, procedures, etc KWIM? I think what nursing school does is give you a foundation in the nursing model of care to adequately care for a generic patient, and then through your clinicals and on-the-job-experience you will begin to learn how to take the generic information and apply them to the specific patient and tweak it, considering the diseases, medications, procedures, etc that you know how to learn about now.

Of course, I want to be an RT student, so take this with a grain of salt. :lol2:

Altra, BSN, RN · Jul 21, 2006

ok, I understand everyone's anger and frustration in their responses to the original poster, but I have the same question
I am a computer programmer who has been considering a career change for a long time. I have thought about physician assistant (PA), Respiratory Therapy (RTT) and Registered Nurse (RN) (duh)
I have been looking at the courses required for each and I still have no idea what a nursing student learns.
...
Students look through the college cataog, read the nursing courses, and go, "Huh"?
...
Do I actually learn anything? Will I actually be able to do anything ? So back to the origianal question. How much autonomy do you, a highly trained, highly skilled RN with a 4 year degree have? Much thanks to those have already answered seriousy about the responsibility in the ICU and running codes. Would love to hear more stories like that.
Signed,
considering a career change

I share your frustration with the wording of course descriptions, although persuing any college catalog you'll find many, many descriptions of courses in other disciplines which are equally cryptically worded. Verbosity has its limits ...

To answer your question: this highly trained, highly skilled diploma RN with one year experience has a meaningful degree of autonomy. I have suggested courses of action in codes, had give-and-take discussions (both calm and relatively heated) regarding diagnostic & treatment options with physicians and families, and am in one way or another assessing patients about 8 out of every 10 minutes of the work day. All diseases, all conditions, both medical and psychological, and every possible permutation of family function & dysfunction that can be imagined.

And I'm just getting started ... my more experienced co-workers are AWESOME.

I'm also a former coporate-cubicle escapee ...

Best of luck to you in your decision-making.

PM me or any current student (see General Student Discussion) for an overview of the typical content of nursing courses -- I'd be glad to help.

hospitalstaph · Jul 21, 2006

James,

Wow I would be confused too with that description! In Fundamentals, yes we do learn changing linens, giving baths, and basic hygiene care of clients. But we also learn injections, diagnostic testing and what the results mean, foley caths, vitals, wound care, ostomy care, medication administration, pain managment, IVs, documentation, delegation, communication skills, assessment skills, etc. I am sure that I have left many, many things out. It is a lot of information all shoved into one semester or quarter and everything that you learn is applied in your first clincal round. Very exciting stuff! Good luck with you decision,

T

firstaiddave907 · Jul 21, 2006

I give nurses a lot of credit keep up the great work. I am considering going and coming an LPN or I might just go for my RN i am not sure yet I was a cna for a little while now i am going to school to become a Medical Assistant and ill graduate in 2007. but I am 20 years old so i have some time to decide .

aliciaRN07 · Jul 21, 2006

I am a nursing student in AR and we had to take A&P 1 and 2 and pass both with a 77

AttagirlRN · Jul 21, 2006

James,

I recall a meeting where an administrator said "how can we identify problems within a field that has the most general of definitions and encompasses the largest group of health care employees?" Of course he was referring to nurses, and the definition remains difficult to quantify. In my current position my job description is over 9 pages long and it still doesn't scratch the surface. I've always had a suspicion that administrators like to keep this vague definition in order to continue expecting nurses to carry out every clinical program, new form, increased charting initiative, tracking device, wacky idea, etc., not to mention the wage control this takes out of our hands.

With that said, I still find nursing to be one of the most mentally challenging and difficult careers one could attain. I've never liked the catch phrase "it's a calling" or "it's so rewarding taking care of patients". It all sounds so light and fluffy, like all we do is float around touching the hands of patients, soothing their concerns. The inability to attach to us a concrete and well-defined job description only adds fuel to the fire.

Epona,

If your health is of concern, nursing may not be for you. It is 12-14 hours on your feet, running, bending, pushing, lifting, you name it. And as far as your back goes, it's not a matter of "if" but "when" you blow it out.

I have several NP friends and two PA buddies. The PA's make double what the NP's make, so if money is on your list of priorities, PA school may be the best route. One of these two friends had a BA in English, the other had a BS in Biology. Both were accepted into PA school upon their first attempt. With the NP's, all but one had over 5 years experience, and most of the graduate programs in my area require lengthy experience as an RN first. Besides, I can't imagine how difficult NP school would be if you hadn't worked as a nurse first.

I no longer do bedside nursing but instead work as a care manager. I am assigned to a physician for a week at a time and round with him/her on all their patients. He/she often asks my opinion, discusses the individual disease process or illness, has me write orders (under the MD name) or call family members to discuss the pt case. I often attend family meetings and speak on the MD's behalf. In my "spare time" between rounding I QA charts, do blood review, perform utilization review (insurance) on my case load, order all the DME or out patient workup...I could go on and on. I have a ton of authority and am respected by my peers. I am not an NP, but an RN with a BSN. So it's not always the title that gets the authority or respect.

I guess what I'm saying is you take that education/degree/experience and mold it into what you want out of your career. Should you end up not liking bedside nursing, there are hundreds of other jobs out there that would value a nursing background. The most highly regarded skill you'll learn being a nurse is the ability to multitask in a very stressful environment, a skill that will get you into a myraid of other fields should you find nursing isn't for you.

All my best to both of you!!

Lisa

kadokin, ASN, RN · Jul 22, 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.

:lol2: :lol2: Beat the dr over the head w/the telephone:lol2: :lol2:

It's funny because it's true:lol2: :lol2: :lol2:

But seriously OP, I just learned from my supervisor (I work in acute inpt psych) that Medicare requires the attending psychiatrist to spend 7 minutes of face time every 24 hours w/his pts who are in the inpt unit. THAT'S SEVEN, COUNT 'EM (7) MINUTES. Guess who takes care of the pt for the rest of that 24 hours? I don't know what the req't for a consulting physician might be if, say, the pt is diabetic, has pneumonia, acute cardiac sx, respiratory distress, experiences a fall, you name it. I do know that many psych pt's are also medically ill and their non-psychiatrist MD's don't always even check in by phone, much less actually physically see them q (that means every) 24 (hours). If you are seriously considering nursing, you must know this: In most cases, we have just enough autonomy to know when something needs to be done, but not enough autonomy to actually, legally get the job done w/o a physician's approval. In nursing school, we (at least I) learned that before we called an MD about a pt. who was in acute physical distress, we had to know what to ask for. Seriously, nurses right out of nursing school (some of us w/virtually NO clinical experience) were expected to hit the ground running and be able to call an MD and tell him how to do his job when a pt could well be on the brink of death. I'm not kidding. Autonomy, I don't know. Exploitation, maybe.

Whew!

Flame me if I'm wrong here. I just feel like the op needs to know that nursing is a BIG job. Big job!

kadokin, ASN, RN · Jul 22, 2006

In respone to James Lankford:

Good point!

Here's the deal: Nurses learn about Many physical ailments and ALL of the human body's systems. And, more importantly, how human beings can be educated and encouraged to maintain these systems and how they tend to react to disequillibrium in those systems. RT is highly specialized at the outset. You are dealing w/the respiratory system primarily. I am sure a good program also introduces you to all of the human body's functions. (Good ol' A&P, one of my favorites, seriously, I loved it). A degree in nursing is supposed to qualify you to be a competent practicioner of healthcare in any setting and help you decide what area you wish to specialize in. Even though MANY people believe that a newly minted nurse is supposed to be able to practice in any area, this is, I believe, unrealistic. A new nurse is a generalist that needs to understand the human reaction to disease states. Hence the bio/psycho/social/etc. gobbldeygook. I don't think a typical college catalog would have the space to list all of the specific concepts introduced in a nursing course. As for surgery, my BSN program concentrated more on post-op care and complications IN GENERAL. We had the opportunity to witness a few surgeries. Actual surgical nursing in the operating theatre requires much OJT, and ideally, further study and certification. As should ALL nursing specialties. We have a long way to go in standardizing our profession, but, by and large, we are good people who contiuously seek a higher level of competence.

Does this help?

Aquarius · Jul 25, 2006

A note about autonomy: Who really does work alone? No matter what profession or career you choose you will need to get along and take orders, advice, information, and instructions from a whole lot of other people. Every job has it's redundancies, so you will just have to decide what your level of tolerance is.

twotrees2 · Jul 27, 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

i would like to say that as for autonomy we need to use it a lot not just in decisions such as wether or not to give a med bbased on thier issues ( blood sugars, blood pressures etc as some have pointed out ) but we shoud use it continuosly and learn and if we see a docs order that we feel shoudl be changed to challenge the doc - in this day of lawsuits it isnt just the docs getting sued - its the nurses for not saying hey why would you give this instead of that - or wouldnt this trewtment work better. it really is a lot of responsibility to not just follow docs orders and takes up precious time but in the event of lawsits you will not regret having questioned - and documented your exchange with the docs - and whenever possible i try to get it by fax in writing that he said no use this only - to protect my butt. i have even on a rare occassion refused to do a treatment or med becasue i KNOW its wrong and i will not jeapordize my license cause a doc thiks he knows it all. remeber - we are the ones who see and deal with the patients on a daily hourly and minute by minte timeframe. i know docs are seeing patients in hospitals more but at the nursing home your lucky if they come monthly and many spend as little time as possible relying on our assessments and judgements - so yes autonomy is used - especially in the nursing home setting. id also like to pont out that all we do is caring - i do however know what you mean by "just caring" and honestly i wish there were more time in the day to "just care" - in my opinion that i sthe best opart of nursing - able to be there for your patient when they need a shoulder to cry on - hold the hand of a dying patient, rub the back of an extremely ill patient and let them know they arent alone, stay with the family of the ill so they do not feel alone - i dont think we get enough of that part of the deal as id like anyhow - due to the autonomy we have had to pick up in order to protect our license - as i said in this sue happy world it isnt the doc who gets hit hard anymore- the nurses go down right with them.

post note: that is my opinion - just to make that known - i am in no way responding to voice anyone elses opinion or attepmt to anger anyone - this is just how i see it and it is not going to be seen the same way as everone else.