(Now here's a legit question... do nurses practice using a doctors license like we do?)
A lot will depend on their work environment, job description, state board and medical director for their unit. Nursing is a very broad field with many different opportunities to grow or coast through one's career.
Nurses, RRTs, Radiology and a lot of other medical professionals practice under quidelines and protocols written by the medical directors of their unit or department as well as the nationally accepted clinical practice guidelines. There are also many nurse initiated protocols established by national standardizing organization the filter down to state and local regions as well as each hospital's RN initiated protocols. RNs who work in the ED, ICU or on code and rapid response teams may have a very elaborate set of protocols to follow. RNs that work med-surg also have various standing orders and protocols for emergencies or daily care.
The various member of the medical board (physicians) and medical directors of each unit will also dictate what the scope of practice will be for RNs (or RRTs) in each unit provided it is allowed by the state. That can include A-line or central line insertions, PICCs, intubations and conscious sedation procedures or various meds that once required a physician to give. One would be surprised by the equipment and procedures they do besides just the ones that are commonly used by Paramedics. Many are not aware of them because it is just part of a day in some ICUs. Healthcare professionals in the hospitals don't constantly count the number of procedures they do. Some could care less if they are the ones intubating because there is so many other things to do and patients they also are responsible for at the same time.
As an RRT, my medical directors, of both my direct overall practice and for whatever specialty unit I am working in, have also written many protocols and guidelines for RTs to follow for many different situations. I do work directly under the license of my medical director(s). The same on CCT, Flight and Specialty transprort. RNs are also included under the medical director of those teams.
Here is the part that many Paramedics don't get a chance to see about medicine in a hospital or critical care setting. There is so much going on for the long term that a physician must act as a team leader to cordinate the patient care. It is not that he/she much write or direct every order some one does. Emergencies are sometimes the easiest if they are just with the ACLS guidelines or for a very short term stabilization. HEMS or Flight from a prehospital scene can sometimes be easier than picking up a disaster in the making at a hospital for interfacility.
The long term stabilization and diagnostics require much more effort. It is when you have a patient for the long haul and resuscitation may go on for hours or days. There can be an overwhelming amount of information that may need to be processed. It is sometimes nice to have a physician around to make that decision before giving a medication that you know will put the patient on dialysis for the rest of their life even if it may save their life at the moment. There could be alternatives but would they work or should you really mess with a study drug or break protocol and go with plan C or D?
Autonomy is good for some things, but when total patient care is expected to increase the patient's chance for survival and recovery to function somewhat normally, a multidisciplinary approach is the most successful. It also reduces medical errors if everyone is watching out for the patient's best interest.
