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

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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.

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.

Haha. What type of decisions do you make as a home health nurse?

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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.

Sounds like a lot of responsibility and autonomous work indeed.

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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. :)

That sounds very interesting. How did you become a pharmacy nurse manager?

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Dialysis nursing

Dialysis nurses aren't very common are they

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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.

Is it hard/stressful dealing with students? What, in your opinion is the downside to school nursing?

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Hi. Nope it's got nothing to do with lab/blood banking. It is "bloodless medicine" or "blood conservation". Simply put it is a program aimed at reducing the use of blood transfusions in hospitals, by making sure patients Hgb levels are optimized before surgery. Basically you run an outpatient assessment clinic, Monday to Friday days only. Englewood Hospital in New Jersey is one of the founding hospitals, but there are lots all over the U.S. Where there isn't one, you can easily prove cost savings to start one!:yes:

No wonder it's not something a lot of people would be familiar with.

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How was ICU for you? Was it overwhelming or stressful?

At the start, ICU is stressful and overwhelming, much like when a new nurse starts in any specialty.

But ICU is definitely my favourite specialty.

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most master degree levels -nurses have autonomy

nurse practitioner

nurse midwives

clinical nurse....

less ind: GENERAL RN, MED-SURG etc. (most with undergraduate degrees)

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Specializes in Med-surg, acute rehab, cardiac, oncology, dialysis.
Dialysis nurses aren't very common are they

Sure they are...found in any dialysis center near you :) or any hospital that provides inpatient dialysis services. With the aging of the population, and more and more people getting hypertension and diabetes (top two causes of end stage renal disease), there will be people on dialysis. There aren't as many people on peritoneal dialysis as on hemodialysis, and there are only a handful of patients who do hemodialysis at home; most do hemodialysis at outpatient centers. It's a wonderful mix of chronic nursing, in that you get to know your patients well, and acute nursing--when someone gets sick, they get sick in a hurry, and patients do code on the floor, and you can be giving CPR when the paras get there. Or, if you have a DNR, a patient can pass away while there. Dialysis nursing is not for the faint of heart, although it can look almost monotonous and humdrum. At the same time, it can be lots of fun--much depends on the clinic and the tone set by your manager.

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At the start, ICU is stressful and overwhelming, much like when a new nurse starts in any specialty.

But ICU is definitely my favourite specialty.

Alright. Cheers

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most master degree levels -nurses have autonomy

nurse practitioner

nurse midwives

clinical nurse....

less ind: GENERAL RN, MED-SURG etc. (most with undergraduate degrees)

What undergraduate nursing specialties would you say have autonomy?

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Sure they are...found in any dialysis center near you :) or any hospital that provides inpatient dialysis services. With the aging of the population, and more and more people getting hypertension and diabetes (top two causes of end stage renal disease), there will be people on dialysis. There aren't as many people on peritoneal dialysis as on hemodialysis, and there are only a handful of patients who do hemodialysis at home; most do hemodialysis at outpatient centers. It's a wonderful mix of chronic nursing, in that you get to know your patients well, and acute nursing--when someone gets sick, they get sick in a hurry, and patients do code on the floor, and you can be giving CPR when the paras get there. Or, if you have a DNR, a patient can pass away while there. Dialysis nursing is not for the faint of heart, although it can look almost monotonous and humdrum. At the same time, it can be lots of fun--much depends on the clinic and the tone set by your manager.

Definitely sounds like not for the faint of heart indeed. Haha, but it's a variety task so you'll never be bored.

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