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 don't want that autonomy while lawyers are prowling our boards too! I also don't want to be responsible for other people's actions, e.g. I was held responsible because RT skipped a treatment and never informed me why.
I believe the autonomy depends on the type of nursing that you do. I have found much greater autonomy in Home health, Hospice and Correctional nursing. In these positions, you often have standing orders that you can work under. You can then determine what they need. If you need something above and beyond the standing orders, you then contact the MD. Therefore, the simple basic things are already addressed. In order to work in these areas you need strong assessment skills and a good deal of nursing experience to draw on. You are the only one there, so your assessments better be right. I have worked this way for so many years that I honestly don't think I could go back to having to call the doctor to get Ibuprofen for a patient.
When you have the first threat, or God forbid, the first actual lawsuit involving you or a patient you were helping (!), you will be glad there was a person (MD) who is the RESPONSIBLE one.
Although now, I'm sure the lawyer who posted the first reply will tell you that people will go after anyone and everyone whose name is on their chart, or was even a person in the room while they visited your facility.
I love my work and I feel I have a lot of autonomy, but I always keep in mind that I HAVE to have orders, or approved Policy/Procedure, or Protocol, to back me in what I do to and with patients.
Specializes in PICU, NICU, L&D, Public Health, Hospice.
When you have the first threat, or God forbid, the first actual lawsuit involving you or a patient you were helping (!), you will be glad there was a person (MD) who is the RESPONSIBLE one.
Although now, I'm sure the lawyer who posted the first reply will tell you that people will go after anyone and everyone whose name is on their chart, or was even a person in the room while they visited your facility.
I love my work and I feel I have a lot of autonomy, but I always keep in mind that I HAVE to have orders, or approved Policy/Procedure, or Protocol, to back me in what I do to and with patients.
Linda
I completely agree with the policy/procedure/protocol portion...we absolutely need to practice within our scope as defined by the BON and our employer. Having said that...being named in a lawsuit and participating in depositions, etc. cured me of the thought that the MD was the RESPONSIBLE professional. It was very clear to me as a PICU and L&D RN that I was very much professionally responsible to insure that my patients were safe, regardless of the MD order and sometimes inspite of the orders. This is surely a reflection of the elusive "professional autonomy", IMHO.
here is a true story i heard from an RN named in a lawsuit, the MD gives her an order, she disagrees with his treatment. the MD gives her a hard time and demands that she follow through, the RN does follow through on the demand of the MD, and the Patient DIES. The RN lost her license, the MD did not, B/C the RN followed through and is the person who ultimately decided to follow through the incorrect order. SO,,,,, That just shows that the RN has to use their judgement in following through order. this is the autonomy that The RN's don't want, but have to Take!!!!!
I graduated from nursing school in 1964. I am still working in nursing and have worked in many venues. You are correct. There are areas where you have more freedom to make decisions but we still operate under standing orders and still have to "do what the Dr. says" if we want to keep our jobs. The most autonomy I have had has been with hospice but I was still working within a framework of physician orders. I think the autonomy is what nursing professors think we have.
Autonomy = having the ability / authority to do what you think needs to be done. You can dress up the word in pretty ribbons and platitudes to sooth hurt feelings or egos but thats what it means. That being said, even a doctor has restrictions in acordance with his scope of practice i.e. a ED Doc will stabilize but then pass a nuero pt, heart cath , dic pt to the appropriate specialist. They have only rudementary training in such situations and pass the pt appropriately. Until RN education reaches the level needed to have a good basic idea of what needs to be done and starts moving from the palitive model to the diagnosis and treatment model (please no jokes about nursing care plans), we will be doing the same thing for a long time. Sure many experienced nurses "know" much of what needs to be done and even how to do it to a degree, butthat comes from riding coat tails and self study more than from our core nursing courses. Our education is complimentary more than it is primary regardless of our impact on pt outcomes.
NP programs are the only way I can see us moving into the "autonomous" direction. The continued development of a secondary "independant" practitioner is inevitable imho. So much of what the PCPs do is well within the abilities of many a well rounded RN now. They just need the educational model to back them up and develope our profession to it's potential.
The term autonomy is so broadly applied, most any job could be considered to offer some autonomy. Even call center personnel have to 'assess' the situation to correctly address the concern and they get to choose if they will respond with a friendly voice (many may not, but they are exercising choice). And if autonomy means the choice to quit instead of being forced to act unprofessionally, that's certainly not unique to nursing.
When you have the first threat, or God forbid, the first actual lawsuit involving you or a patient you were helping (!), you will be glad there was a person (MD) who is the RESPONSIBLE one.
Although now, I'm sure the lawyer who posted the first reply will tell you that people will go after anyone and everyone whose name is on their chart, or was even a person in the room while they visited your facility.
I love my work and I feel I have a lot of autonomy, but I always keep in mind that I HAVE to have orders, or approved Policy/Procedure, or Protocol, to back me in what I do to and with patients.
Linda
We certainly cannot do anything beyond the scope of our practice. However ,I caution the misconception that the (MD) is THE responsible one. We must also utliize our knowledge and expertise to discern when a physicians orders are erroneous and could result in harm. We are responsible for not carrying out such an order and alerting physicians when an order is incorrect and could potentially cause harm. We are held accountable for following a physicians order that did cause harm. MD does not denote infaliable and does not neccesssarily mean he/she will be held accountable in the event of an adverse result. The best defense a nurse has is documentation. Specifics such as repeating a verbal order to whoever is giving it or questioning a written order that is not clear or:nurse: correctly written. Charting immediately to ensure that details are not lost when an order is given over the phone. If a nurse ascertains an order is incorrect she/he should immediately contact physician and report the order ,then document throughly . We are responsible for our actions as nurses and will be held fully accountable if we do not use prudent judgement .
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Autonomy = having the ability / authority to do what you think needs to be done. You can dress up the word in pretty ribbons and platitudes to sooth hurt feelings or egos but thats what it means. That being said, even a doctor has restrictions in acordance with his scope of practice i.e. a ED Doc will stabilize but then pass a nuero pt, heart cath , dic pt to the appropriate specialist. They have only rudementary training in such situations and pass the pt appropriately. Until RN education reaches the level needed to have a good basic idea of what needs to be done and starts moving from the palitive model to the diagnosis and treatment model (please no jokes about nursing care plans), we will be doing the same thing for a long time. Sure many experienced nurses "know" much of what needs to be done and even how to do it to a degree, butthat comes from riding coat tails and self study more than from our core nursing courses. Our education is complimentary more than it is primary regardless of our impact on pt outcomes.
NP programs are the only way I can see us moving into the "autonomous" direction. The continued development of a secondary "independant" practitioner is inevitable imho. So much of what the PCPs do is well within the abilities of many a well rounded RN now. They just need the educational model to back them up and develope our profession to it's potential.
$0.02
It sounds to me like you equate professional autonomy with ability to make medical diagnosis and prescribe medications. If I understand your post, nurses can only be considered autonomous if we are practicing in more of a advanced practice role. It makes me sad that, assuming you are a nurse, you feel that your education and position does not allow you to implement meaningful nursing processes which improve the quality of life of your patients. It is most unfortunate, IMHO, that you apparently do not value the nursing process and plans of care. I wonder why you minimize the importance of the fact that we DO impact pt outcomes...that is HUGELY important...and frankly, continuous nursing care is the primary reason that people remain in the hospital...they need OUR assessment, support, and intervention 24/7.
My suggestion would be that you pursue an APN for yourself.
I'm an operating room nurse and I can tell you that nurses in our institution operate to some extent in an autonomous wAy. when a case is scheduled, we prepare the needed instruments, we prepare the patient so that when the doctor arrives, everything is in smooth working order. However, nurses couldn't function without doctors orders. And doctors couldn't do their task without us nurses. I think this is what modern medicine is, collaboration between different expertise to bring about the best outcome for the patient.
You just now figuring this out??!!!!!!! Ever heard of PRN? Pee on RN!!!!!!Nurses are nothing more than sweat labor who are as disposable as yesterdays bath water.
It's fine to lump yourself into your own so-called low class category.
We certainly cannot do anything beyond the scope of our practice. However ,I caution the misconception that the (MD) is THE responsible one. We must also utliize our knowledge and expertise to discern when a physicians orders are erroneous and could result in harm. We are responsible for not carrying out such an order and alerting physicians when an order is incorrect and could potentially cause harm. We are held accountable for following a physicians order that did cause harm. MD does not denote infaliable and does not neccesssarily mean he/she will be held accountable in the event of an adverse result. The best defense a nurse has is documentation. Specifics such as repeating a verbal order to whoever is giving it or questioning a written order that is not clear or:nurse:
shah
201 Posts
I don't want that autonomy while lawyers are prowling our boards too! I also don't want to be responsible for other people's actions, e.g. I was held responsible because RT skipped a treatment and never informed me why.