Hi all, I'm a new grad and I have been orienting to my new RN position this week and something just keeps bothering me. As a student I spent so much time in school working on critical thinking and the APIE model because I was told that the main function of an RN was to use their nursing judgment to assess and plan for the patient's care. But as I learn the ropes of my new job it seems all I am to do is fill out form after form and those forms are what tell me what my patient needs. There is a form to tell me if a patient is a fall risk, suicide risk, elopement risk, violence risk, skin breakdown risk, sepsis risk, .... I could go on all day.
And if I happen to disagree with what the form says? Nope, sorry, policy states that we do what the form says. Here is an example. I'm filling out a risk assessment on a new admit. 21 y\o, strong, healthy, no ETOH or drug intox, a little irritated at being court ordered to be there. I fill out the fall risk assessment, and he scored as a medium fall because one of the questions is "Have you fallen more than 2 x in 6 months?" and he answered "Yes" So according to my friend Mr. Assessment Form. I have to place him on fall precautions. Mind you, In my opinion, this guy meet no criteria to be considered a fall risk. So when it comes time for bed, he gets a little more irritated at the idea of having a bed alarm on, so I ask my preceptor if can just cancel the fall precautions on him because he obviously has no gait or balance impairment. She states, "No he has to be on them because he scored a 5."
It's not really a big deal, it just made me wonder if there is actually a need for nursing judgment. It feels like all my decisions are already made for me in the form of forms, protocols, standing orders. Honestly, I don't feel like I am using my education at all. A trained monkey could fill out all this paper work and follow the instructions on the bottom of the page.
What do you guys think? Do you feel like you use your nursing judgment daily? Do you feel like your judgment means more than established protocol. Or has nursing judgment been micro-managed out of the profession?
Sorry this is so long, I guess I have been a little disappointed this week by the lack of opportunity to apply my education to my work. Thanks all for any replies.