Which specialties of nursing have more autonomy and less micromanagement?

Specialties General Specialties

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I started work at a psychiatric facility nearly 3 months ago, and I'm starting to miss my old nursing job (I worked in acute inpatient dialysis). Sure, I had bad days as well as good days, but you were largely left to your own devices, and as long as you got the job done, you went home, no drama. I'm not asking for constant accolades or relentless (even false) positivity, but nastygram emails about "You forgot to hit 'complete' on a progress note" come off as annoying. Eventually I'm sure it'll become demoralizing to the point where I'll think, "You know what? Take it or leave it! My work is what it is!" and apply elsewhere!

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Specializes in OR, Nursing Professional Development.

That's not a job autonomy issue. That's a culture issue. However, I can see the point about incomplete or incorrect documentation. There's always someone using that info for one report or another and an anomaly will be looked into. But there's a good way to send the message of needing to correct something vs nastygram

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Specializes in ICU/community health/school nursing.

School nursing. I love my autonomy (right until I have the kiddo with the anaphylactic reaction to XXX and no EpiPen or the diabetic with no orders).

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Specializes in Critical Care; Cardiac; Professional Development.

Nurse educator. I create the curriculum, the objectives and do the teaching. I influence policy and contribute in a number of ways and the most management I get is via informing me of what initiatives are going to be needed. The rest is up to me.

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Specializes in Hospice, Palliative Care.

Home health and hospice visiting nurses; you drive solo the overwhelming majority of the time. My experience working in hospice, the doctors tend to take your recommendations either Carte Blanche or tweak them.

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Home infusion nursing. But you have to like driving a good majority of the day. I wouldn’t trade it. Could not work in a fish bowl ever again.

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On 8/23/2019 at 4:23 PM, ruby_jane said:

School nursing. I love my autonomy (right until I have the kiddo with the anaphylactic reaction to XXX and no EpiPen or the diabetic with no orders).

I feel more micromanaged in school than any other job I've worked, except maybe OR. There's no autonomy here. The lead nurse micromanages us, right or wrong, the principals micromanage us, the teachers try to micromanage us. I really can't stand to be told how to take care of kids at each step, how to set up my office, and when to contact parents by people with 0 nursing knowledge.

For me, it's camp. But that depends on the directors. Some are like my principal. ICU felt autonomous despite the fact that it is teamwork.

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On 8/23/2019 at 4:23 PM, ruby_jane said:

School nursing. I love my autonomy (right until I have the kiddo with the anaphylactic reaction to XXX and no EpiPen or the diabetic with no orders).

Haha, I was just about to say this exact thing. Unless you are one of the unlucky ones with admin who tries to micromanage everything...

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On 10/25/2019 at 11:56 AM, CampyCamp said:

The lead nurse micromanages us, right or wrong, the principals micromanage us, the teachers try to micromanage us. I really can't stand to be told how to take care of kids at each step, how to set up my office, and when to contact parents by people with 0 nursing knowledge.

This sounds like a culture issue to me. I think there are some of us who are in situations like yours, and many who have 100% autonomy. It really sucks to be in your situation. The Nurse Leaser should be a resource that the nurses can seek out when they need guidance, and the Admin should stick to admin and stay out of any medical decisions. The situations sounds awful.

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Specializes in L&D, Trauma, Ortho, Med/Surg.

I agree with the first reply that this is a culture issue 100%. Our charges do their audits and we get corrected every so often, but honestly it's like "add impaired mobility to this patient's care plan please." It's not a big deal. And personally, when I'm corrected once I usually don't have to be corrected again. I have experienced micromanaging with one charge nurse, however it didn't bother me and it was part of her personality. It did annoy some nurses though.

I agree with the first reply that this is a culture issue 100%. Our charges do their audits and we get corrected every so often, but honestly it's like "add impaired mobility to this patient's care plan please." It's not a big deal. And personally, when I'm corrected once I usually don't have to be corrected again. I have experienced micromanaging with one charge nurse, however it didn't bother me and it was part of her personality. It did annoy some nurses though.

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Specializes in ICU, ER, Home Health, Corrections, School Nurse.

The most autonomy I had was working in corrections. We had standing orders for certain meds , so after assessing our patients, we could dispense what we felt were appropriate meds, or we could refer the patient to a provider. If there was no provider on site, they would have to take our word for what we assessed (i.e. yes it's a rash, but I believe it's shingles). I loved being able to use my brain and my assessment skills and to make decisions.

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Specializes in Psychiatry, Community, Nurse Manager, hospice.

I have a lot of autonomy in my job now on an ACT team. I am very well respected by the whole team and no one ever overrides my decisions. My boss, an NP, always has my back and trusts my judgment.

Previously I worked on an inpatient psych unit and the micromanagement was ridiculous. It was mostly the culture, but also built into some of the policies. I had to get a doctor's order for every little thing, stuff like letting a patient wear a hat. At first, I was like okay, I'll get the order when the doc comes around. Then the techs who worked under me would tell me no hat until that actually happens. Like, are you serious? I was the charge nurse. One time I had a tech tell me that I had to get a doctor's order before I put a patient's pill in pudding. I told the tech to go ahead and report me to management, I don't need a doctor's order to put the pill in pudding to swallow. I then was pulled aside by my manager and asked why I put the pill in the pudding. Was I sure this 7 year old patient could not swallow pills without pudding?

It was a total nightmare and I'm so glad I.left.

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