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

enkwanta · Feb 20, 2015

That is scary. I sometimes cover my school which is elementary and one other, an high school. I will just be running back and forth for emergencies. Also, it becomes quite stressful because one does not know all the students.

HazelLPN, LPN · Feb 21, 2015

I'm going to say without the shadow of a doubt School Nursing.

I spent 54 years in the hospital, most of that time in critical care. In my retirement, I now work as a substitute assistant school nurse, mostly with special needs student who require skilled nursing care. I am NOT the actual school nurse. I am in no way qualified to do that job.

The school RN (again , not me) in the district where I work....a high poverty large urban district...is often times the only medical professional that our students see on a regular basis. Aside from the routine walk ins and health screenings, she (or he) is also responsible for identifying and reporting child abuse, substance abuse, dealing with STDs and sexual health, pregnancy, serving as the medical expert when students are referred to special education services, dealing with sexual orientation and gender identify issues, and often is the first person in the seen when there is a serious health risk to our students. We also have more medically fragile students than ever (that is where I come in) who are often on tube feeds, have to be cathed, and some who are even on vents that live in LTC facilities but can still come to school and learn. There is no attending physican, no resident, no intern, no charge nurse, no house supervisor and nobody in the next bed over to take a look at something. The school RN is THE medical expert in the building. Many of our school RNs are former ER,critical care or even flight nurses. It is not an easy job and they work very independently. I wouldn't be surprised if the role was taken over by advanced practice RNs in the future. We already have several in our district that travel.

SSDIBlackBoxRN · Feb 22, 2015

It's been my experience that the Critical Care arena has enabled me to have the most autonomy. My husband was a CRNA. Having worked as a OR Circulator, I would agree that that speciality has the most autonomy and respect within the nursing profession.

Bell13, ASN · Feb 22, 2015

There is an inpatient dialysis unit in every hospital in a 40 mile radius from me. Id say its pretty common

trinitymaster · Feb 26, 2015

I've always said that we go to nursing school seeking autonomy......but all we end up with is shame and doubt.

That said: Top 5 Nursing positions with the most Autonomy:

5. Fired

4. Laid-off

3. Quit

2. Retired

1. Dead

Bluebolt · Feb 26, 2015

Top 5 Non APRN Nursing positions with Autonomy:

1: Intensive Care Unit (CV, Cardiac, Neuro, Medical, Burn, Surgical, etc)

2: Flight RN (Although you won't be implementing much, just maintaining life from point A to B then unload it)

3: Dialysis RN (although they do have to be on the phone with the nephrologist often)

4: L&D (The MD usually shows up at the last second, literally and sometimes those patients can go bad quick)

5: ED (Don't get mad. I've floated to the ED. The MD's and CRNP's are all over the place telling you what to do all the time usually. You literally don't make the decisions, you follow their constant orders. When you complete one, they give you another. When report is called to the unit I often have to address issues like the patient is a fresh intubation, but don't yet have a foley. I ask why they don't and the ED nurse just blankly checks the chart and says "the doc didn't write an order so he must not have wanted one".) Then my eye begins twitching uncontrollably.

The least autonomous positions as an RN:

1: Long term care nurse (nursing home)

2: Medical/Surgical/Telemetry/Oncology/Renal/Ortho/Pediatric (floor nurse)

3: Doctors Office Nurse

4: Operating Room RN

5: Endoscopy/GI Lab (you always have a CRNA or MD there directing you. You essentially are just there to assist them)

Medic09, BSN, RN, EMT-P · Feb 26, 2015

I think you're characterization of Flight Nurse is really simplistic. While the statement may be true fairly often; it is often not true at all. Try working a RW job that does scene responses, especially for rural EMS services. Or try working FW that goes down to rural facilities or south of the border, and has to first prepare patients for the flight before heading back to the big city in the US or Canada. Sounds to me like you're only familiar with interfacility transfers in densely populated areas.

enchantmentdis, BSN, RN · Feb 28, 2015

I like hospice case management because I am alone practically all day; driving to/from pt's homes and facilities. If a patient's condition changes I text the doctor for the orders I need. It's great. I do have to go to meetings and IDT, but I can send the LVN to prn visits--actually I have the secretary decide who will do the prn visit, if I can't go. I usually need no one's help, and I prefer it this way. The only drama involved is with the pt and the family.

LadyJovial · Mar 25, 2015

flight nursing, ground transport nursing, home health, and i imagine legal nurse consulting(though Ive never done that one), remote case management or telephone triage. Other than that, you would need to get an advanced education as a practitioner or crna

NurseJacelyn · Jun 6, 2015

Home Health/Community Nursing for sure! Can be a little isolating unless you have great team communication (which mine does.) I don't think I could go back to working in a facility where every move I make has to have a Dr's OK.

PMFB-RN, RN · Jun 6, 2015

What specialty is rapid response?

Its a fairly new specialty. Back in the mid 2000's JACO wanted all hospitals to have a rapid response team. A very small number of hospitals created full time RRT positions. The vast majority simply designated the ICU charge nurse to carry an RRT pager. As data has been collected on the cost savings to the hospital of a full time RRT nurse more and more hospitals have converted from RRT being an additional duty for an ICU RN to a dedicated position. For example in my hospital RRT has cut the ICU bounce back rate in half. This has made us VERY popular among the physicians, in particular surgeons. Over the years, as we have proven ourselves, and gained the trust of the physicians, we have created more and more protocols that allow us to intervene earlier and more definitively. By now it's gotten to the point that with some emergent situations RRT will handle them independent of physician involvement. For example a patient is respiratory distress could be assessed, intubated and transferred to the ICU by RRT without having been seen by a provider. Once in the ICU the Tele ICU docs would take over care.

We carry a cell phone and doctors, nurses, patient families and others call us when concerned about a change in patient condition. We have a list of trigger for when a nurse MUST call us by policy. However nurses call us for a huge variety of things. From a second opinion on their tele strip, to a new nurse hanging her first amieoderone dripp and asking for guidance, combative patients, simple turning / boosting help, newer nurses asking if their concern needs to be communicated to the physician that night, or is it something that can wait until the morning. We also follow every patient transferred out of the ICUs. We assess them every 4 hours for 24 hours. Our noticing problems early and getting them addressed sooner has cut our bounce back rate in half.

All of us are also BLS, ACLS, PALS and other certification instructors. We teach classes to new grad nurses, provide training for all staff. We teach several different classes to the new residents. For example nobody can place an IO in our hospital until they have taken our class and been signed off by one of the RRT RNs. This is true for the physicians too.

When I come on at night I get report from the day RRT RN. Then the various medical and surgical teams will give me sign out on any of their patients they are concerned about and we put them on our "keep an eye on" list.

We now have a vast number of protocols that cover many different situations.

toomuchbaloney · Jun 6, 2015

I believe that we all enjoy roughly the same level of professional autonomy as RNs in the USA.

I believe that when our individual practices feel less autonomous it is related to a variety of things including individual state BON regulations, employer restrictions or expectations, or those restrictions which we allow to be placed upon us by those who are perceived to be in positions of authority over our employment.

Each of us practices nursing within the scope of our jobs and the nurse practice regulations of our state. We are all restricted from initiating medical orders without consulting with a medical professional unless some prior agreements and provisions have been made to specify medical algorithms in advance.

Most nurses work in collaboration with other disciplines and other nurses even when they don't necessarily work directly with others in a clinical setting. Most nurses work in a team sort of care delivery system, even though the members of many such teams all deliver their care independently of one another, on their own independent schedules, and with their own POCs. School nurses and Correctional nurses are the most isolated from other health professional, IMHO. Even home health and hospice nurses typically have nursing coworkers who will act as a sounding board should they need another nursing opinion.

Nursing jobs that involve an endless number of medical tasks often seem like jobs with little autonomy. The nursing process is often lost in the litany of "then do this..." repetition of task oriented work. I think this is why Med Surg nurses often don't feel very autonomous. Nursing jobs which are regulated in the most microscopic detail in both duties and in volume of work/schedule often feel less autonomous (OR, cath lab, etc).

Clinic and office nurses can have wonderfully autonomous jobs, dependent upon their employers.

I like hospice and home care.

Nursing is a terrific profession with room for all sort of personalities and lifestyles.