Autonomy in healthcare: how advanced practice nurses enhance their patients’ lives through autonomy

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A recent study indicated a 45% growth in advanced practice nurses (APRNs) by 2029. The population of advanced practice nurses is steadily increasing as more people take advantage of the wonderful opportunities in this profession. One of the many benefits of being an APRN is the increasing levels of autonomy. As healthcare evolves, so have the roles of nurses. Physicians have traditionally been given the authority in healthcare settings, but more recently, an advanced degree nurse has the opportunity to demonstrate similar authority. Nurses in positions with more autonomy have positively impacted the healthcare system’s overall efficacy and safety. Having an ARNP available improves access to health advice. ARNPs can lighten the patient load for physicians because they are also able to treat and diagnose patients. Autonomous nurses foster the diversity that is essential for a thriving healthcare industry. ARNPs have the hands-on patient experience and bedside-care knowledge to serve as a viable asset to any medical team.

Autonomy in healthcare

The four pillars of medical ethics are beneficence, non-maleficence, justice, and autonomy. To be autonomous is to be the decision maker. Autonomy is defined as the right to make an independent decision free from outside interference. Autonomy is important because it provides the ethical framework necessary to make important healthcare decisions. Without a clear understanding of autonomy, it will be unclear who has the decision-making capacity in a healthcare setting. It’s important to have a diverse group of autonomous individuals in a healthcare setting because it mitigates opportunities for poor outcomes and provides a more even distribution of risk. If you would like to learn more about the importance of autonomy in nursing, click here.

Nurses that demonstrate the most autonomy are APRNs. APRNs are registered nurses who have completed a graduate program and typically have a few years of experience as registered nurses. The four types of advanced practice nurses include, nurse practitioners, certified registered nurse anesthetists, certified nurse midwives, and clinical nurse specialists. Nurses in advanced practice increase the cost-effectiveness of a healthcare organization. ARNPs also increase patient access to primary, emergency, and critical care. All four APRNs play a vital role in the healthcare community as they have a significant influence on healthcare outcomes. Continue reading below to learn more about the exciting career opportunities that advanced practice nursing provides.

Nurse Practitioner

A nurse practitioner commonly referred to as NP is an advanced practice nurse who works directly with patients in a variety of healthcare settings. Similar to a medical doctor, nurse practitioners examine, diagnose, and treat patients. Typically, NPs work in hospitals, skilled nursing facilities, urgent care centers, or medical offices. In many states, NPs can operate their private practice, but in most cases, NPs work under the supervision of a physician. NPs have the exciting option to work in a range of subspecialties including family health, women’s health, adult gerontology, pediatrics, etc.

NPs have established themselves as autonomous healthcare providers. NPs demonstrate their autonomy in just about every aspect of their career. NPs can prescribe, order tests, and educate patients just as a physician would.  Imagine a patient comes into the ER and complains of chest pain. An NP can examine that patient, order the necessary diagnostic test, review any lab results, make a diagnosis, and execute a treatment plan. If another patient showed signs of high blood pressure, the NP can write a prescription for anti-hypertensive medication. In both examples, the NP demonstrates autonomy in its purest form.

Certified Nurse Midwife

A Certified Nurse Midwife is an advanced practice nurse that specializes in women’s health. Nurse midwives can practice in several settings including hospitals, doctor’s offices, and birthing centers. Professionals in this specialty are responsible for the primary care of women and expectant mothers. certified nurse midwives are expected to monitor maternal health and fetal growth during pregnancy, educate women on different forms of contraception, attend vaginal births, and assist with surgical births. Nurse midwives are also responsible for diagnosing and treating medical conditions that may develop during a woman’s child-bearing years or pregnancy.

While some states allow nurse midwives full autonomy, other states require some level of physician supervision. Because of the additional training and skills of nurse midwives, there are still many opportunities for them to practice autonomy. It is well within a nurse midwives’ jurisdiction to diagnose and treat gynecologic or reproductive conditions autonomously. Nurse midwives also demonstrate autonomy when they attend vaginal births. A certified nurse midwife often serves as the primary care provider for women in all stages of life and development.

Certified Registered Nurse Anesthetist 

Certified Registered Nurse Anesthetists (CRNA) are commonly referred to as Nurse Anesthetists. These are highly trained advanced practice nurses who are primarily responsible for administering anesthesia and monitoring patients’ post-administration. In addition to an advanced degree, CRNAs are also required to have clinical care experience. CRNAs typically work in the operating room or intensive care unit at hospitals. Nurse anesthetists may also accompany surgical teams in surgical centers.  The duties of a CRNA can include administering anesthesia, monitoring patients’ post-anesthesia, and performing preoperative assessments.

CRNAs display autonomy through multiple avenues in their day-to-day routine. Nurse anesthetists are responsible for determining the correct dosage of medication before administration; this would be performed autonomously without the supervision of a physician. Like a certified nurse midwife, a CRNA’s autonomy varies by state.

Clinical Nurse Specialist 

A Clinical Nurse Specialist is a unique role that typically involves research and healthcare management. The five major responsibilities of this role include clinical practice, teaching, research, management, and consulting. The primary focus is to improve gaps within a healthcare organization or community. They often serve as consultants and implement interventions to improve the overall efficacy of a healthcare structure. In many cases, a clinical nurse specialist will serve as a patient advocate. There is less direct patient care in this role, so a clinical nurse specialist does not experience the same level of clinical autonomy as the previously mentioned ARNP. These professionals still serve as leaders in the healthcare community as they develop treatment plans, implement new healthcare strategies, and incorporate practices to improve functionality.

To become an APRN you must first earn a bachelor’s degree and have an active RN license. There are two routes to becoming a registered nurse: (1) You can attend a two-year college and earn an associate degree in nursing. This way, you will be able to work as a registered nurse while simultaneously pursuing further education. (2) You can attend a four-year college and earn a Bachelor of Science in nursing.  Some people may choose the first option as a means to earn an income while completing the remainder of their education requirements. Others may have the opportunity to proceed with the second option and complete all four years of undergraduate coursework at once. Choose the route that accommodates your lifestyle best.

Earning a college degree is the first step to becoming an advanced practice registered nurse. To be admitted into any bachelor’s program you will need a high school diploma and, in most cases, college admission test scores (SAT, ACT, PERT, etc.). You can expect the same admittance requirements for a two-year associate degree. While training to become a nurse, you will have the opportunity to participate in clinical practice before entering the workforce. Although not required, it is recommended that you major in nursing or any other life science discipline. There are online resources available to help make sure you have all that’s necessary to be admitted to college.

To gain entry into an APRN program, you will need a bachelor’s degree and an unencumbered RN license. Some programs require experience as an RN, especially CRNA programs which typically require at least one year of critical care experience. The additional years of experience as an RN contribute to the extensive knowledge and expertise that APRNs hold. It could take 24 months to earn an APRN degree as a full-time student. It could take up to 48 months to complete an APRN graduate degree as a part-time student. Online degree programs make it possible for many APRN students to study while also being employed as registered nurses. Most APRN students currently work as registered nurses and take classes online. This is also a great option for working mothers or anyone who has additional responsibilities at home.

The person with the most autonomy in any healthcare setting is the patient. Autonomy, in this case, means that a medical practitioner cannot force or impose any treatment without the patient’s consent. The overriding logic is that the patient has the right to choose which medical interventions they will receive. Autonomy allows the patient to be actively involved in their course of treatment. If the patient is unable to provide autonomy, due to mental impairment or unconsciousness, then that responsibility will typically be given to a spouse or family member. As a rule, if the patient is at full mental capacity, then they can make informed decisions. The patient and/or patient’s family has the ultimate decision-making capacity. Clinicians are required to respect the wishes of their patients without interference. It is also imperative that the clinician provide accurate information so that the patient and their family can make an informed decision.

To ensure patient autonomy is present, practitioners are encouraged to be fully transparent about medical procedures. The medical practitioners are required to provide the patient with all of the information to make an informed decision. Nurses are required to inform the patient of the medication they will receive before administration. Physicians are required to notify the patient of any diagnostic or lab findings related to their condition. Patient autonomy prevents the patient from simply deferring to their doctor but makes the patient an active participant in their diagnosis and treatment. This is imperative to ensure patient safety and satisfaction. Autonomy empowers the patient to ask questions about their health because it provides a sense of authority. As an example, if a clinician were to suggest that a patient undergo a blood transfusion, the patient has the right to refuse this procedure. Even if the clinician understands the procedure to be lifesaving, the decision is ultimately up to the patient. It is the clinician’s responsibility to ensure the patient is up to date with all the essential information to make an informed decision

Autonomy in nursing has a positive impact on the healthcare community because it provides the diversity that is essential to an inclusive system. Autonomous nurses also improve the overall efficacy of a healthcare system. The nurses that can demonstrate the most autonomy are advanced practice registered nurses (APRNs). Essentially, an ARNP is a registered nurse with a graduate degree and a few years of prior clinical experience. Because advanced practice nurses have a more patient-centered approach, it has been established that their presence improves patient safety. The journey to becoming an APRN may seem daunting because of the additional years of education and training required. However, the positive impact that APRNs have on society will make every step of the process rewarding.

Autonomy is at the center of medical ethics. This ethical principle is valuable to both clinicians and patients. Physicians and APRNs are at the forefront of the medical community, so their level of autonomy is greater than most. It is the clinician’s responsibility to educate the patient about their medical condition, provide accurate information about treatment options, and respect the patient wishes regarding their health. All practitioners within a healthcare team practice some level of autonomy, but the most autonomous individual is the patient. Historically, clinicians had a reputation of undermining a patient’s concerns, which presented a negative outcome. In recent years, there has been a great effort to involve patients in their healthcare plans. When all members of the healthcare community make a concerted effort to respect the autonomy of the patient and other members of their team, they uphold the ethical standards that are vital to society.

 

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