Not Convinced Nursing is an Autonomous Profession

[Inspired By Silence]

I'm not trying to stir up a war. I realize I've just started a thread on a very controversial topic here. But I'm simply not convinced nurses have much autonomy. There are some aspects of nursing that appear independent, such as how nurses are governed by other nurses in terms of licenses, credentialing, certifying colleges, etc, but in the clinical setting, you do what the physician says. You can't giving a patient watered down nasal spray without a physician order. Catheterizing, wound dressing, dress removal, aside from taking vitals, recording the information, and advocating for the patient, you can't do anything a physician hasn't ordered in terms of providing care.

I understand I'm still young, and there are things about nursing I don't understand fully, so if you're willing to kindly explain how nurses can be considered autonomous health care providers, I'm more than willing to consider what you tell me.

[lvICU]

Working in the ICU, I feel that I have a lot of autonomy. Our critical care docs rely on the nurses to be autonomous and make decisions when a patient declines. We don't order order meds or anything, but if we hang a bolus or send labs, do EKGs, etc., they will back us up.

[SharonH, RN]

I'm not trying to stir up a war. I realize I've just started a thread on a very controversial topic here. But I'm simply not convinced nurses have much autonomy. There are some aspects of nursing that appear independent, such as how nurses are governed by other nurses in terms of licenses, credentialing, certifying colleges, etc, but in the clinical setting, you do what the physician says. You can't giving a patient watered down nasal spray without a physician order. Catheterizing, wound dressing, dress removal, aside from taking vitals, recording the information, and advocating for the patient, you can't do anything a physician hasn't ordered in terms of providing care.

I understand I'm still young, and there are things about nursing I don't understand fully, so if you're willing to kindly explain how nurses can be considered autonomous health care providers, I'm more than willing to consider what you tell me.

The profession of nursing is autonomous; the practice of nursing is autonomous in many ways, in others not. This varies depending on practice setting. In my experience, you have less autonomy in acute care settings. That does not mean that you are powerless to do nothing until the physician shows up and tells you what to do. Unfortunately many experienced nurses do not seem to understand this either and over the past few years, this is a worsening problem. If the physician doesn't write it, it does not get done. Basic assessment and nursing care which could prevent or alleviate a problem goes by the wayside because nurses think what they do does not matter.

Oh you probably want examples. OK. When I was doing my CNS clinicals few years back, I observed the care of an older gentleman who was post-op for a THA. Reviewed the chart, he was eating very, very little. They were considering placing a PEG tube. He was running a fever. Labs, CXR, UA were done. He was not doing well with PT. His BP was orthostatic. At first glance, there was no fault with the nursing care. They did everything the doctors wrote in the chart. Labs were ordered and drawn, abnormals called in. CXR was completed. IV was hanging. Meds were given. Pain was assessed. BUT...

His incentive spirometer was sitting waaaaay over in the window still in the plastic wrapping. Right next to his dentures. Which he needed to eat his regular diet. Which was sitting on a bedside table that he could not reach. Where his stale, half-empty water pitcher sat. Sheesh!!

[PostOpPrincess, BSN, RN]

This is a very convoluted question.

The best answer is to follow a nurse--in all the specialties.

I can't tell you that I am completely autonomous, but at the same time...I've had to BE extremely autonomous...not so much by governing bodies, as much as critical thinking.

I've had to tell physicians to come in on my word and assessment alone.

I've had to give medications for the indications of a situation based on a particular situation as a prudent caregiver would do, WITHOUT a physician directed order, just PRUDENT nursing.

The physicians I work with are very, very dependent on me and my word. I say "jump" and they "jump"--I say hold off, and they do.

This is true collaborative work...

I've never worked "under" a physician who is inclined to order me around like a servant. I do not know what that is like. Most of the time, they are asking me, having been with the patient the longest at that point, what to do. This happens ALL the time.

I do not know what it is like to be "orderered" around.

But my specialties are also extremely conducive to collaboration...so

that's my two cents.

[MassED, BSN, RN]

Nope, I am an attorney in nursing school.

wow, lawyer-ing would pay WAY more money than nursing! Of course, either profession has its share of sharks. Why not continue as a lawyer? Or are you?

[MassED, BSN, RN]

I've always thought of the autonomy of nurses as relating to not what you want to do but in the right to refuse to do something that has been ordered, but you believe is unsafe, like refusing to give a med the patient is allergic to.

Also, the nursing process is somewhat automous; assessment, diagnosis, ect.

questioning an order, perhaps when the MD doesn't have the entire clinical picture and ordered a drug that was inappropriate, only because they didn't have all the pertinent info....

[sofia2006]

There really aren't any truly autonomous professions. I'm a lawyer and I can't organize a business in any way I want unless the laws of the state or regulating body say I can. One must always answer to someone.

hello there

I wanted to ask you if you went to nursing school before you went to law school. I am a nursing student now, but at one point I took the lsat and wanted to go to law school, but was not sure if it would be good choice. I always have had an interest in law so I might eventually go to law school,,god willing. any advice would be appreciated!!

thanks

[GilaRRT]

Does defining the concept of autonomy and ensuring it is fully integrated into the definition of nursing really matter outside of nursing theorist think tanks?

[krimicrat]

wow, lawyer-ing would pay WAY more money than nursing! Of course, either profession has its share of sharks. Why not continue as a lawyer? Or are you?

Yes, I will maintain my law license. My reasons for becoming a nurse have nothing to do with money. I feel that I can help more people in a more tangible way as a nurse (who happens to be an attorney). I am very excited about it!

[krimicrat]

hello there

I wanted to ask you if you went to nursing school before you went to law school. I am a nursing student now, but at one point I took the lsat and wanted to go to law school, but was not sure if it would be good choice. I always have had an interest in law so I might eventually go to law school,,god willing. any advice would be appreciated!!

thanks

I graduated from law school in 2002. I start my first semester of nursing school on Monday (it's a BSN program, so I've been taking re-reqs).

My advice would be to work as a nurse for a few years, then decide if you want to spend $100K on a law degree. You may be fortunate enough to have the means to pay for it outright. But cost would be a serious consideration. There are wonderful ways a nurse attorney can help people - so if you are serious about it, it very well may be worth the investment to you and your future patients/clients. Good luck in school!

[Lovely_RN, MSN]

Does defining the concept of autonomy and ensuring it is fully integrated into the definition of nursing really matter outside of nursing theorist think tanks?

I was thinking this but you managed to state it far more eloquently than I could have.

Why does it matter and why should we care?

Some aspects of nursing are autonomous but you're right OP nursing is not a completely autonomous profession.

We are autonomous in using our assessment skills and making a decision to contact a provider about changes in patient conditions. We are also autonomous in that we have to be able to judge whether an order is therapeutic or safe for a patient and decide whether or not to carry that order out. Where we are not autonomous is in deciding treatment for patients and even at this point there are some experienced nurses who an MD will pretty much let write their own orders.

Is that not enough autonomy?

Why would nurses want complete autonomy for what we make? Please...it would so not be worth it.

Autonomy is great for the ego but hell on your stress level.

I feel stressed when someone is going down hill and I have to get orders from the doc. I can't imagine what it feels like to have to make a decision and give an order knowing that the wrong order may cause a poor outcome for a human being.

That's what autonomy means and that's why medical school never appealed to me.

[Lovely_RN, MSN]

Basic assessment and nursing care which could prevent or alleviate a problem goes by the wayside because nurses think what they do does not matter.

:up:

This is so on the money!

I haven't been a nurse for long but it seems to me that a huge problem with nursing is that no one wants to focus on providing basic care because it's perceived as lowly grunt work.

[SuesquatchRN, BSN, RN]

:up:

This is so on the money!

I haven't been a nurse for long but it seems to me that a huge problem with nursing is that no one wants to focus on providing basic care because it's perceived as lowly grunt work.

I have absolutely no problem with grunt work. I'm in a war against pressure sores right now and my physician likes to show up on second shift when none of the day nurses and unit managers, who take care of getting treatments ordered, are there. I have left her repeated requests and notes and things that she CAN NOT miss requesting simple prealbumins on the compromised residents so she can order a simple high-protein supplement that I, as an autonomously practicing nurse, can't get for my old residents who need some stinking extra protein and vitamins for healing. This is a high-protein drink that I can't start because it's considered a med. Autonomy my rear.

I can advocate up the wazoo but unless the physician responds I am hamstrung. And yes, mgmt is aware. But this sure throws a little cold water on the autonomy bit.