A couple of recent threads here have really brought to my attention that much of our pracitce isn't based on any sound evidence. We practice out of fear, or tradition, or even misinformation. We do intial, 90 min and 6 hour cardiac panels on 20 yo's with no risk factors and reproducable chest pain for example. Now in that case we as nurses may not have any say in the matter, but there are area's that we can make a difference in how care is delivered.
My question is, how do we as a proffesion, develop our practice to be based on sound evidence, tempered with the knowlege and gut feeling that is gained by experience? There is a lot of talk about Evidence Based practice and Critical Thinking, but in reading some of the recent thread, out practice is driven by dogma. I guess the first qustion should actually be, do we need to change how our proffesion advances the delivery of emergency nursing care.
Specializes in Critical Care, Emergency, Education, Informatics.
Change locally I can handle.
I"m asking for ideas and thoughts on how we can direct nursing as a corperate body to acept and embrase these principles to move out practice to the nexxt level.
Specializes in ICU, ER, High Risk L&D, PHN, Hospice RN,.
Are you asking what is nursing autonomy in your practice and do bedside nurses really have nursing autonomy? If you have a researched based evidenced practice then you could probably answer this question as yes. My simple feeling is until nursing expands in scope and practice none of us will practice autonomously. What will this take education, and more education. So as I finish my masters I look forward to more education until nurses are able to stand on their own.
Specializes in Spinal Cord injuries, Emergency+EMS.
autonomy is a bit of red herring here, as a body corporate we can abdicate autonomy e.g. by hiding behind ' doctor's orders' ... it doesn't change the fact that you are still accountable for things ...
All licensed medical professionals work under accepted standards derived from local, state, and federal laws as well as professional guidelines. Licensed nurses are no exception. Their scope of practice is defined by the Nurse Practice Act (NPA) of the state.
Specializes in Spinal Cord injuries, Emergency+EMS.
once again a wonderful dogmatic circular arguement is presented ...
legislation is not a reason to restrict practice, if changes in practice are going to be beneficial for practice in terms of system and patient outcomes then get the legislation revised ... ( e.g. Patient Group Directions, indepdent prescribing, none medical radiology referrals ... innovative roles which cross boundaries )
once again the legal framework in 'the land of the free' appears to be being used as a way o restrict freedom and autonomy.
Sure, there is dogma in patient care, which provides me with safe evidence based techniques and procedures in order to practice in the state I dwell in. I practice safely under these guidelines, and the patient has my best efforts because I do, and are in turn safely cared for. I have practiced in the medical arena 29 years in two different fields. Many changes have been made to medicine based on evidenced based changes to practice. I'm not sure why there is argument here. Lots of adjectives and run on sentences, and inciting remarks aren't going to change the fact that in the States medical professionals practice under guidelines by Law. Changes do happen, and the system gets better because of it, but at the end of the day evidenced based practice is how our care is provided, plain and simple...every day, all day.....until new evidence is found and the guidelines are changed. I do not consider being under the big thumb of the physician. We work together as a team for the betterment of the patient. Freedom to do what you choose in the care of patient's is not safe or sound...We have autonomy (to a point) in the ER where I work, and of course some docs trust some more than others as well.
Freedom to do what you choose in the care of patient's is not safe or sound...We have autonomy (to a point) in the ER where I work, and of course some docs trust some more than others as well.
CraigB-RN, MSN, RN
1,224 Posts
Change locally I can handle.
I"m asking for ideas and thoughts on how we can direct nursing as a corperate body to acept and embrase these principles to move out practice to the nexxt level.