which nursing (RN) specialty has the most autonomous practice

kat7464 · May 18, 2011

I was hired as a home health nurse right prior to graduating with my (anticipated) RN license. I had had 2 years LTC experience as a LVN, but even that did not prepare me much for the autonomy of home health nursing! (Love it, though :-)

AgentBeast, MSN, RN · May 18, 2011

All RN's are autonomous and practice with the scope of practice of an RN.

PAERRN20 · May 18, 2011

Well in the ER I often start the IV, draw/order labs, start a fluid bolus, order an Xray, and sometimes give meds before the MD even got to see the patient. I was still within scope since these labs/meds/xray is all on a standing order protocol. But I will often suggest what med I want and the MD will write the order for me. ER nurses often have close relationships with the docs which allows this kind of thing. I find they trust our clinical judgement more often than not.

sourapril · May 18, 2011

Thank you. I am more and more drawn to ER :)

Well in the ER I often start the IV, draw/order labs, start a fluid bolus, order an Xray, and sometimes give meds before the MD even got to see the patient. I was still within scope since these labs/meds/xray is all on a standing order protocol. But I will often suggest what med I want and the MD will write the order for me. ER nurses often have close relationships with the docs which allows this kind of thing. I find they trust our clinical judgement more often than not.

Five&Two Will Do · May 18, 2011

I work in an ICU we also have good order sets which allow us to order labs and imaging as well as titrate IV medications for effect. This can be sedation such as propofol or ativan or pressors such as epi and norepi. I like this sort of things very much and also agree with what others have said about the MD's trusting clinical judgement.

Biffbradford · May 18, 2011

I work in an ICU we also have good order sets which allow us to order labs and imaging as well as titrate IV medications for effect. This can be sedation such as propofol or ativan or pressors such as epi and norepi. I like this sort of things very much and also agree with what others have said about the MD's trusting clinical judgement.

Agreed. On night shift, *sometimes* you'll get the order: "keep up the good work, do whatever you need to keep 'em alive until morning" - just write your 'verbal' orders in the chart, and get 'em signed in the morning during rounds. Not that this happens very often, but it does happen. :cool:

EmergencyNrse · May 18, 2011

Transport Nursing! -Fixed-wing, Rotary-Wing or Ground Transport

Really raises the bar when it comes to autonomy and competency.

Protocols are well established. A doctor is almost NEVER along. The immediacy of situation requires that you actually DO something rather than call for an order. You actually get to use the gray matter between your ears and make decisions.

Neb Tx's as required, ACLS protocol, Sedation, Tx- for nausea, Hypotension, Hypertension, Hypoglycemia, Seizures... Even IO's, intubation, and chest decompression. YOUR call! Too much fun.

(Except precipitous deliveries. I don't like birthin' no babies.)

Every company I know of has ongoing training to further better your decision making in the field. If it's autonomy and excitement you like this is where you want to be. There's nothing I know of quite like it...

Five&Two Will Do · May 18, 2011

Transport Nursing! -Fixed-wing, Rotary-Wing or Ground Transport
Really raises the bar when it comes to autonomy and competency.
Protocols are well established. A doctor is almost NEVER along. The immediacy of situation requires that you actually DO something rather than call for an order. You actually get to use the gray matter between your ears and make decisions.
Neb Tx's as required, ACLS protocol, Sedation, Tx- for nausea, Hypotension, Hypertension, Hypoglycemia, Seizures... Even IO's, intubation, and chest decompression. YOUR call! Too much fun.
(Except precipitous deliveries. I don't like birthin' no babies.)
Every company I know of has ongoing training to further better your decision making in the field. If it's autonomy and excitement you like this is where you want to be. There's nothing I know of quite like it...

That does sound like much fun! :yeah:

PMFB-RN, RN · May 18, 2011

In my experience the most autonomy possible by an RN are in theres jobs in this order:

1. Transport (as previously mentioned, need high qualiety ICU experience, not ER to get in)

2. Rapid response nurse / team. My current position is a full time rapid response nurse for a pretty good sized hospital on NOC shift. I have a ton of protocals and standing orders that allow me to use my judgement and do what needs to be done in emergent situations.

3. SICU, though highly dependant on the hospital. Can range from nearly total autonomy ("do what you need to do, I will sign the "telephone" orders in the morning" to having a physician just sitting around in the unit to deal with everything, not much thinking required by RNs.

4. MICU, though same situation as SICU, hospital dependant.

5. ER, very much depends on the physicians you work with and their level of trust in the RNs.

joanna73, BSN, RN · May 18, 2011

LTC also. You're on your own with 30 residents and aides to supervise. The Drs hate to be called unless its an emergency, and we have various standing orders for each resident.

madwife2002, BSN, RN · May 18, 2011

Dialysis nurses