Which nursing specialty has the most autonomy/independence? Apart from nursing practioner

[Zyrv]

Can someone please list the top 5 nursing specialties that have the most autonomy, where you can work on your own at least for most of the time without needing someone else's help or simply with nobody present with you?

And which specialties has the least autonomy? Just curious.

[KelRN215, BSN, RN]

I feel pretty autonomous working in home health. Except when insurance companies disagree with my decisions. Then I want to punch people in the face.

[michlynn, BSN, RN]

We have a really good rapport with most of our cardiologists and have standing chest pain orders for all of our patients so we usually don't have to call them for anything unless it's serious.

[calivianya, BSN, RN]

I feel pretty autonomous in ICU. Sure, I call physicians all the time to get things, but usually they just ask me what I want and give it to me, so it at least feels like I can make my own decisions.

[Medic09, BSN, RN, EMT-P]

Flight nursing certainly belongs on your list. Subset of transport, but I'm making a bit of different emphasis. With interfacility transports, we are usually continuing care that has been started at the sending facility; tweaking things along the way. It includes very high level critical care medicine, such as transporting patients on multiple drips, pacers, balloon pumps - even ECMO. But Rotor Wing/EMS flight medical crews have even more autonomy, in my opinion. In addition to interfacility transports, they may arrive at a scene such as an MVA and initiate interventions, including some pretty advanced skills that are normally left to mid-levels and MDs/DOs in-house. All flight medical crews typically have an expanded scope of practice/skills, including a wide range of critical care drugs.

When I work Fixed Wing interfacility transports, the medicine can be challenging but we don't do much initial decision making except for some really limited-capability sending facilities. In Rotor Wing/EMS flights the game can be wide open sometimes.

Another factor is location. On our long, cross-country flights it may not matter. But working within rural states means a lot more reliance on the flight crew's knowledge and ability. It also means flying patients that in more densely populated states might not warrant air medical attention. In our state, for instance, all the NICUs are in the one big city in the state. That means frequent calls for Fixed Wing crews to go to smaller cities to transfer premature labors and other high-risk OB patients to the big city. Same for patients needing advance cardiac care. Another example is Rotor Wing EMS crews being called to provide ALS/advanced level intercepts for rural emergency crews on calls with complicated traumas or medicals, or long transport times to hospital.

Once you're flying along with a patient in FW or RW, you are largely on your own. You and your partner have to shoulder total responsibility with limited communication and no other resources immediately available.

[dkl1234]

I'm a pharmacy nurse manager in a small critical access hospital. Most of my work I'm all by myself managing the department. I have to work with every deptarment in the hospital but my work is very autonomous. :)

[Bell13, ASN]

Dialysis nursing

[Tommy5677]

I don't want to work that hard after 33 years of nursing. I want an office with a door, a desk, a computer, and just leave me alone. No OT, a great salary. Is there such a thing?

[JJTBQ]

I worked in cardio-thoracic ICU unit for a World reknowned hospital. It was the best experience in my life and I truly miss that particular campus. The amount of autonomy and support was tremendous so I highly recommend ICU. However, I must say, I believe my experience had much to do with the fact that regardless of each staff member's position, the various teams throughout the units functioned together like a well-oiled machine and treating one another with mutual respect was present. I'm now in a small town hospital and protocols are limiting which frustrates me. Many limitations exist due to administration.

In a nutshell, I strongly encourage those who enjoy enhancing challenges to go to a LARGE teaching hospital ICU units. I've made friends over the years that are regular floor nurses who let their individual fears prevent them from such challenges that is only experienced in ICU. Should you choose ICU, the skills and knowledge you'll develop is invaluable and you will give back in more.......it is very hard, satisfying work!

[candiRN79]

I would say that I was very autonomous when I worked as a School Nurse. You are the only licensed medical person in the school building so the principal, teachers, and students look to you for medical advice. Sure, you can always call a co-worker or the nurse supervisor for help, but you are the only one that is able to visualize what is going on.

[passionflower, BSN, MSN, RN]

I'm surprised that L&d nurse isn't on here. In the hospital we are a team as most units but whatever patient you are assigned to is your patient. You coach them and teach, help manage their pain. You only see the provider when it is time to catch baby.

[1bigmedicRN]

I think autonomy comes from many different sources. First, each state is different. Second is the physicians you work with. There are some Docs I feel comfortable with and then there are others I won't even take verbal orders from. Third is how comfortable am I with the patient and the case. Even the slightest gut feeling says danger Will Robinson, I want the Doc at my side (self preservation). I know this doesn't answe your question about the top 6 positions, but like most position the answer varies.

[mapapete]

Most autonomy: ICU, ER, L&D, Home Care (Intermittent not Long Term).

Least autonomy: OR