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Learning Outcome By the end of this article, readers will: Understand the balance between the independent nursing decision-making and the compliance to physian orders in clinical settings. Also a nurse will Recognize the importance of collaboration with colleagues and other health professionals in healthcare. Be able to Identify scenarios or situations where a nurses must exercise critical thinking and professional judgment. Topic Contents Outline Definition of independent decision-making in nursing. Overview of following the physician orders. Importance of the discussed topic in modern healthcare settings. The Nurses Role in Decision-Making Understanding the Autonomy in nursing practice. Factors influencing independent decision-making (e.g., experience, training). The Role of Physician Orders in Clinical practices. Legal and professional obligations to follow physician directives. Benefits of adhering to the established medical protocols. Balancing Both Roles in Clinical Practices Collaboration between nurses and physicians. Situation and Scenarios requiring independent judgment (e.g., emergencies). Challenges and Ethical Considerations That a Nurse Need To Observe Navigating conflicts between autonomy and directives. Ethical dilemmas in patient care. The Way Forward to Improve as a nurse Education and training to empower nurses. Promoting interdisciplinary teamwork. Content Introduction The Nurse's independent Role, Nurses in our Healthcare settings play a vital role in rendering care to our patients (patient care), often serving as the primary point of contact for patients. Nurses in hospitals and other health fields are responsible for implementing physician orders while also making independent decisions to ensure optimal care to the patients. This dual responsibility requires a delicate balance between compliance to medical directives and exercising professional judgment as a nurse. The Role of a Nurse in Decision-Making During Patient care Because a registered nurse sometimes act independently without waiting for a doctor to write or order for patients treatment, this is crucial part in Nursing practice mostly evident in an Intensive Care Unit or emergencies. Understanding when to act independently and when to defer to physician orders is vital part of nursing for ensuring patient safety and effective outcomes. This is called Independent decision-making, which is a cornerstone in Nursing practices. Nurses are health professionals well trained to assess patient conditions, prioritize patient care, and take action based on their clinical judgment. This autonomy is particularly evident in specialized areas and units as we have mentioned like critical care unit, where nurses must make quick decisions in a high-pressure situations to save patient's life. However, nurses are not limited to act independently only in ICU, or any other emergency unit, it depends on patients need at the moment, a nurse can render care to a patient in need for patient care and act to prevent complications. In order for a nurse to assess patients quickly and to intervene confidently according to patient's need he/she need to be well experienced, educated and with adequate skills, below are some factors to consider helping nurses to intervene independently. Factors that influence independent decision-making include: Experience: In term of Expressing confidence in Nursing practice, seasoned nurses are often more confident in making decisions. Training and Education: Nurses who further studied or obtain degree or advanced certifications equipped nurses with the knowledge and practical experiences to act decisively. Scope of Nursing Practice: Laws and regulations plays an important role in patients care in all aspect of healthcare, as it for example in Nursing it define the extent of a nurse’s autonomy. Because of present laws in cities and developed countries are more strict than in rural settings, for example a nurses who practices Nursing in a rural Clinics might independently assess and treat minor ailments without doctors's orders due to the absence of a physician. The Role of Physician Orders in Patients treatment In this part we are going to see the role that doctor's orders in Patients care, physician or doctor's order are the key component of structured healthcare delivery. On the other hand, understand that nurses are legally and professionally obligated to follow these directives to ensure that patient care aligns with the physician's treatment plan. Adhering to orders reduces variability in care and helps maintain consistency across healthcare teams. However, this reliance on orders does not eliminate the need for nurses to use their critical thinking and act as well. As a nurse before you implement any prescribe orders by a doctor, you must verify the appropriateness of orders, and it's important to your patients especially if you notice potential risks to the patient. For example, some drugs may have some contraindications to the patient, if a physician prescribes a such medication and the nurse recognizes, it is the nurse's responsibility to question the order. DO NOT ADMINISTER and call the doctor's attention to review the prescription. Many similar examples like this do usually happen, like drugs overdose or underdose prescribed etc or unclear treatments all need for doctor's attention for reviewing and clarification. DO NOT FOLLOW UNCLEAR ORDERS, NURSE CAN TALK TO A SENIOR NURSES OR COLLEAGUES. Balancing Both the independent decision-making and physician orders Nurses need to understand that a doctor is a health professional colleague and they are working together in order to save patient lives. It is no matter of superiority, anyone among them can ask the other one for help during the patient care. As a nurse don't feel that the treatment plan is like an order from a doctor to do only. Doctors too do not think is an order of do this or not to do this, it is a team work. So, If we look in to the each role between independent decision-making and physician orders is more of collaborative work in healthcare settings for the benefits of patients, therefore nurses and doctors must work together, considering each other’s expertise to render comprehensive care that a patient needed. Situations that nurses may need to act independently include: We have taught about nurse can act independently without waiting for a doctor, here are some examples: Emergencies: In the presence of emergencies where immediate action is needed to save a patient's life, a nurse may have to act without waiting for a doctor’s order. For examples patient with Hypoglycemia - glucose level need to be corrected without waiting for a doctor to document "correct Hypoglycemia", Patients in need of oxygen too and a patient with low HB level or low PCV level a nurse can request for blood in laboratory to transfuse the patient also. Rapid Patient Deterioration: Nurses are the one who spent more time with their patients in healthcare facilities, they usually use to recognize subtle changes in a patient’s condition before other team members and therefore must respond accordingly and not wait until someone prescribe or document. In a Remote Settings: In some locations there is shortage of resources Including medical staffs, in places with limited access to physicians, nurses often take on expanded roles they can assess the patient and provide required care base on the patients need. Therfore, we encourage collaborative care to both the nurses and the doctors, as collaboration ensures that both independent actions and compliance to a doctor orders contribute to a shared goal— which is optimal patient outcomes. Challenges and Ethical Parts to Consider Balancing these roles usually comes with challenges, because nurses may face conflicts between their professional judgment and physician directives. For example, ethical dilemmas may arise when a nurse following a doctor order could harm a patient or when acting independently goes against protocol, to stay very safe here are key considerations we suggested for nurses. The key considerations include: Patient Advocacy: The most important person in a hospital is our patient we all know that, as a nurse you must prioritize patient safety, even if it means questioning a physician’s order or not even serving the prescribed treatment. Legal Implications: Understanding your job roles and responsibilities as a nurse is another key to consider, as acting outside one’s scope of practice can have serious consequences, you should know what is yours and what is not during patient care. Interpersonal Dynamics: Disagreements with physicians can strain professional relationships and results in stress. So much better when disagreements are resolved in professional manners. To overcome these challenges, nurses need practices their strong communication skills and also to ensure they have thorough understanding of their professional boundaries. The Way Forward Now we will look into what a nurses can do or know to promote their confidence and act independently during patient care. Empowering nurses to balance these roles requires: Continued Professional Development: Nurse need to engage in ongoing education, and purposely get advanced training programs that should focus on critical thinking and decision-making. To be honest every piece of education in nursing for a nurse may help to develop their confidence and increase their knowledge and skills. Interdisciplinary Collaboration: Managers and supervisors focus on improving team work, that is what holds many health care organizations, therefore nurse should know that most objectives of healthcare settings are easily met with collaborative team work. However, health facilities have their own part to play which is healthcare organizations should promote teamwork between nurses and physicians. Clear Guidelines: Should be in Written forms and made easy and obvious to the nurses, written policies should be made clear to clarify the scope of nursing autonomy while supporting collaboration (team work). What we are saying is nurses and doctors work together to cure patients, so healthcare facilities should comply with a culture of mutual respect and shared responsibility, by doing this the healthcare system can better support nurses in these dual role. The Goal of This Topic The goal of this discussion is to highlight the importance of balancing independent nursing decisions with adherence to physician orders. Understanding this dynamic enhances patient safety, maintain and improve team collaboration, and empowers nurses to deliver high-quality care to patients. Conclusion In the end, we need to understand that the nurse’s role in the healthcare facilities is multifaceted, which need a nurse to Involved in and practice both independent decision-making and also adhere to physician orders. Maintaining the right balance is essential for patient safety and effective care delivery. Remember this can be achieved by maintaining team work and collaboration, seeking and providing education for nurses, and promoting clear guidelines of practice by management, the healthcare industry can empower nurses to rule out these responsibilities confidently and ethically. Self-Assessment What are some situations where nurses might need to make independent decisions? How can nurses ensure they balance autonomy with compliance to physician orders? What strategies can healthcare organizations implement to support this balance? References American Nurses Association (ANA). (2021). Scope and Standards of Practice. Institute of Medicine (IOM). (2011). The Future of Nursing: Leading Change, Advancing Health. Jones, R. (2019). "Ethical Dilemmas in Nursing Practice." Nursing Ethics Journal. World Health Organization (WHO). (2020). Strengthening Nursing and Midwifery 2020–2030.

The Nurse’s Role: Independent Decision-Making vs. Physician Orders

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