Not Convinced Nursing is an Autonomous Profession

Nurses General Nursing

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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.

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.

This is pretty much what I meant about the limit's of a nurses autonomy. You acted autonomously in using your assessment skills and notifying the doctor but you are limited because you can't prescribe treatment. I think this sums up nursing and it's frustrating at times but what is the cure? More autonomy at this level of education and with it all of the responsibility and headaches that goes with it?

Well, I'm going on for an NP probably. This irritates the poop outta me.

Doctors need to be held accountable. If this goes bad WE will get dinged, not the doc. And that frosts my cookies. I am doing a LOT of "MD notified" charting these days.

I always thought autonomy more as being able to organize your day as you see fit. And I also thought that hospice nurses seem to have a lot of autonomy! My clincal experience with hospice was great. If you want autonomy, I think that is the way to go. But I'm just a student here. Any hospice nurses want to weigh in on this one?

Specializes in Operating Room Nursing.

I can see how this would apply in some nursing settings. On the wards I too felt like I just carried out someone's orders.

In the OR I consider myself to be fairly independent. I look at the lists and organize everything the surgical team needs. The way I see it they depend on me to do my job properly so their list runs smoothly.

Specializes in ER.

Durin my nursing career I've found that we earn autonomy.

As a new grad, and some old grads need everything spelled out and they will carefully follow every physician order as it's written, but miss the obvious, like water at bedside, and getting the patient to advance in activity.

As I got more experienced I've found more and more nursing skills I can use to benefit my patient. I'm more proactive, and when I can discuss issues with the doc intelligently they trust me more. I can push/pamper the patient according to my asessment, and request meds that will assist them.

The more advanced specialties have more nurse intitated protocols, because you've got confident, smart nurses that are comfortable going ahead on their own assessment. So if I get a DKA in triage I draw the blood, start the IV fluid, take a sugar, and then go to the doc with my assessment and request an insulin order. As labs and subsequent sugars come back I'm reevaluating the pt and updating the doc. Possibly DC from triage after a couple hours, or the doc is ready to write orders to admit. As a new grad, I'd note the sugar, and call the doc for advice, then do whatever they said...big difference.

Remember that an experienced nurse has a lot of drag when they do an assessment. Autonomy wise they can have a pt transferred to ICU just on gut feeling (but they'd better be right).

I think you are looking for formally recognized autonomy...but not all nurses are ready for a lot of it. We need the give and take of docs/support staff that know us and our abilities for the patient to get the best care. The same give and take occurs around other professions. A new doc has all the autonomy of an old experienced one, but they get a lot more help, and people are double checking them behind the scenes a bit more.

I love nurse internships where new grads get to be on the job without full autonomy for a few months. A nursing apprenticeship is the best idea anyone has had for our baby nurses- you can't just toss them in and expect them to swim without panicking.

Specializes in pulm/cardiology pcu, surgical onc.

I work with a lot of nurses who don't want autonomy, it's too difficult for them to see any further than the end of their shift. I've seen orders written by the doc to specifically d/c a foley since earlier nurses hadn't bothered to look at original post op orders that state in bold letters to d/c foley POD #2. It makes all the nurses on our unit look like lazy #%%*%%.

I've also seen orders written to get patient OOB TID. Well duh that's common protocol for our post op patients. But there have been nurses who don't think to call doc for a PT eval when LOL is not able to get up for whatever reason, they just don't get up! I'm thinking critical thinking, autonomy and how you use it go hand in hand.

Specializes in pulm/cardiology pcu, surgical onc.

Not to get into too many details here but I took over on a patient who had a definite change in condition and when we finally got someone up to see him (he had 3 different services following him, ts,hosp,surgery), I tactfully suggested ABG's d/t prolonged tacypnea (at least 6 hrs as I could tell from previous charting). Docs looked at chest x-ray and said "well the lungs are clear". I swear I paged at least 10 times during the night to get that patient to the unit before I had to call a code. Drew am labs way early though and found out the patient was severely septic but by then was too late and the code wasn't successful.

It's too bad the family didn't want autopsy, I know in my heart I did everything in my power and scope to get that patient where they needed to be.

Fast forward to the next night I get a patient from the ED that complained of increased abdominal pain during a morphine push. Promptly got vs, paged the doc who came right in too see the patient to assess more fully. Patient told me she felt that way in the ED but was told it was d/t dehydration. Long story short patient went down STAT for an abdomen CT and had a bowel perf and transferred to the unit within 3 hours. What a definite difference I saw in those 2 instances. I made sure to thank the 2nd MD for responding to the patient so quickly.

Specializes in ER.
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!

you're definitely different, in that respect, than any lawyers I have known! Good luck!

Wow. This thread really sparked discussion over the night. Thanks, guys (and gals).

Specializes in Community Health, Med-Surg, Home Health.

I have to agree...nursing has not, nor will ever be autonomous. Feel free to disagree, but sorry, I stand on that.

Specializes in M/S, MICU, CVICU, SICU, ER, Trauma, NICU.

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.

I have to address this....

Having worked multiple years of nights and not having contact with physicians who do not CALL back and there is no one else around....

I HAVE FELT THAT STRESS SEVERELY.

Whatever the doc orders are implemented by ME, also a licensed professional and I better darn well know what I am doing because the last time I checked, I cannot "defer" prudent thinking to someone over a telephone. There are also times when the doc has said, "I'll be right there....do what you have to do..." knowing full well that it is beyond my scope of practice but with the implicit understanding that I will do what is prudent and he will back me up. After seventeen years of being in EXTREME conditions, this has never failed to happen.

Those who are experienced with multiple years behind them and in seriously stressful specialties understand what I am saying.

I am the LAST ROUTE.

I HAVE to be extremely aware of what I am doing....and the stressors I have faced...are a LOT more than some physician over the phone....

This profession is EXTREMELY, EXTREMELY important and requires BRAINS and INTESTINAL fortitude.

(and I know no one is saying it doesn't)...

But when it comes to autonomy.....

O-M-G...

IT IS SOOOO there......

Specializes in Oncology/Haemetology/HIV.

In answer to the question....another question.

What made you think that nursing should be considered "autonomous" and why is it important to you?

Nursing is nursing. Autonomous is a label.

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