Professional autonomy in any field refers to the freedom and discipline of professionals to make decisions in accordance with their knowledge base. The meaning of autonomy in the nursing career demands clarity, given the dynamic nature of the healthcare environment.
The subject of professional autonomy is particularly vital for the nursing profession as it has faced various challenges in claiming its rightful place and establishing its credibility in the healthcare system. From history to gender and its traditional subservience compared to other specialist roles in the medical field, the evolution has been tremendous. We can agree that nurses’ autonomous capabilities are better than they were a couple of decades ago.
The evolution of professional autonomy in nursing practice
Professional autonomy is at the center of decision-making and can influence work practice and experiences. Aside from their expert knowledge, nurses must commit to their patients ethically. However, the shift of focus to the nursing profession began in the 1990s when central governments such as the US and the UK started efforts to strengthen managerial and bureaucratic control over doctors in their health systems. The formalization of the profession may have promoted interprofessional collaboration, but it also introduced government influence and new challenges of control over the decision-making process.
In response to the growing managerialism and evidence-based practice, critical issues arose, including the extent of participation of nurses in the field. Doctors come higher in the structure and often limit nurses’ control in the decision-making process. Consequently, nurses are forced to find alternative mechanisms, including local strategies, to reclaim the power of their role in the wake of medical dominance.
Recent discoveries reveal the use of ‘guerrilla’ tactics by nurses to push for control and the inclusion of other subversive actions such as withholding information and using humor to challenge the overbearing authority of doctors. These struggles continue to motivate renewed studies on understanding the nursing profession’s autonomy in modern medicine and the rising impetus for evidence-based practice and interprofessional collaboration in a field dominated by managerial power relations.
Understanding the types of professional autonomy
Professional autonomy bestows a vital responsibility on nurses to practice self-determination, independence, self-governance and self-direction. The authority to implement professional knowledge and decision-making transcends beyond patient care. It takes a holistic approach that gives the nurse the power to make decisions in the relationship between the patient and the next of kin. Various works on nursing explore the crucial elements of decision-making, which can vary based on the practice setting.
The following are the two types of autonomy that lay the foundation of most nursing decisions.
Clinical autonomy refers to the freedom, authority and discretion, in this case within the nursing context, to exercise clinical judgment about patient care. Nurses can experience clinical autonomy by advancing their knowledge, which improves with experience and interdisciplinary collaboration. It widely depends on the clinical competence of the practitioner, in which a nurse sources courage from their advanced knowledge to not only make care decisions but also discover what they need to know and how to pursue it.
Clinical autonomy often leads to conflict in the practice as physicians inherently adopt a higher level of autonomy regarding patient care. Regardless, a nurse’s autonomy goes beyond their scope of practice. Scenarios that require a nurse to practice clinical autonomy can include simple decisions such as changing the position of the patient’s bed, managing medical equipment and other medical devices such as smart beds, administering PRN medications, and making other medical decisions during emergencies.
Control over practice
Control over practice autonomy refers to how nurses influence decisions in the nursing profession and the entire practice setting, including rules, policies, governance, operations and the organizational structure.
The environment plays a huge role in determining whether or not nurses can exert control over their practice. As significant stakeholders in the healthcare systems, nurses can question the potency of policies and procedures and recommend solutions. For example, if a supply room is frequently inefficient, nurses can raise questions about the stocking procedures and suggest ways to mitigate this challenge or necessary improvements.
Regardless of the type of autonomy, nurses remain accountable for their judgments and actions during their practice. Professional autonomy demands a lifelong commitment to developing their skills.
Benefits of nursing autonomy
Autonomous nursing practice requires an accurate assessment before decision-making. Although nurses do not get enough credit, they must be autonomous for a substantial part of their practice. Several studies show that hospitals with highly autonomous nurses considerably reduce mortality and failure-to-rescue rates. Autonomy and overall self-governance, when practiced efficiently and effectively, qualify as benefits of being a nurse practitioner. After completing an advanced nursing program, such as the ones offered by Marymount University, nurse practitioners can capitalize on their expertise to affirm confidence, which is crucial to practice autonomy and, consequently, a positive impact on the quality of patient care and patient outcomes.
Here is a deeper dive into the benefits of autonomy to nursing practice.
Enhanced professional satisfaction
While several factors could influence job satisfaction, autonomy is an integral contributor. In an index of work satisfaction conducted in Australia, the majority of the nurses from a sample size of 178 felt that their tasks were static and programmed for them, leaving them with little room for input. They admitted that the nature of their practice had created more responsibilities but did not give them enough authority.
The global shortage of nurses may also create negative experiences whereby the reduced staffing leads to reduced autonomy in decision-making. Therefore, there is indeed a correlation between autonomy and job satisfaction. The quantitative review of the same indicates that distinct specialties perceive higher levels of autonomy. This means that higher-level medical physicians, such as doctors, are likely to experience better job satisfaction than their nursing colleagues. Job satisfaction often translates into a lower risk of burnout and lower turnover.
Better nursing performance
A crucial measure of nurses’ performance is closely associated with 30-day mortality and failure-to-rescue (FTR) rates. The latter refers to the failure or delay in recognizing or responding to a patient facing medical intervention or disease process complications.
The prime goal of the nurse is to ensure patient safety by adapting actions unique to the needs of the patient in a given situation. Nursing autonomy in this context refers to the ability of the nurse to draw confidence from their professional knowledge to make a decision that leads to action for the sake of patient care. When these actions are appreciated at the workplace, nurses can embrace interdisciplinary collaboration and relate better with other healthcare team members, thus promoting their overall performance during practice.
Reduced mortality rates
Between enhanced job satisfaction and better performance, autonomy empowers nurses to deliver their best at the workplace. Despite the patient risk and the structural characteristics of the medical institution, nurse autonomy can lower the odds of 30-day mortality by about 19% and the FTR by up to 17%. Although nursing autonomy can influence patient outcomes, there is limited empirical evidence demonstrating the relationship between these two entities.
What are the consequences of lower levels of nurse autonomy?
Autonomy lays the foundation for professional and interprofessional practice in most fields, including healthcare. Delivering competence in patient care is necessary, especially as nurses have the most significant stake in determining patient satisfaction. Reduced autonomy is a recipe for disaster within the organization and may lead to the following.
Nursing autonomy is highly dependent on the nature of the environment. The absence of freedom to practice autonomy in the workplace considerably affects job satisfaction. A study showed that unsatisfied nurses were more than 2.5 times more likely to leave their job or change hospitals than satisfied ones.
Lower levels of interprofessional collaboration
Nurses want to feel part of the fraternity. The best way to make them feel this is by engaging them in decision-making and promoting an environment that’s flexible enough to accommodate even the most straightforward decisions. The trust in a nurse’s knowledge and ability to discern situations makes it easier for them to offer participation and remain open to collaborating with other team members.
Increased moral distress
Automation largely relies on the confidence to practice knowledge. A lack of this leads to self-doubt. Moral distress in nurses is dangerous as they are the first point of contact with patients.
The nursing profession is often attributed to empathy and compassion. These attributes highly depend on the professional’s ability to connect with the patient. Lower autonomy may cause a disconnection between the nurse and their patients as most decisions come from elsewhere.
Poor patient outcomes
There is an undeniable relationship between nursing autonomy and the performance of nurses. A higher level of nursing autonomy leads to higher performance, thus affecting patient satisfaction. Although numerous factors affect the patient’s perception of competence, nurses with low autonomy are likely to increase the risk of an adverse patient outcome.
Burnout and predisposition to physical illness
Low-level autonomy affects a professional’s power or control over their practice. The shortage of nurses worldwide also affects their ability to maintain high levels of professional autonomy. From long work hours to physically and emotionally draining tasks, nurses are at a higher risk of mental health issues and physical illness that affect their ability to make sound decisions concerning patient care.
How to promote nursing autonomy
Professional autonomy provides the blueprint for a successful career. Highly autonomous nurses are highly appreciated in the medical space. However, this appreciation is earned with proof of competency, often the balance between knowledge and confidence in your expertise in the area. Here are ways that nurses can increase their level of autonomy.
Strengthen their relationship with patients
Nurses are responsible for understanding their patients and advocating for their needs and wants. When these relationships are strong, nurses are motivated to speak up for their patients and sometimes their kin, thus promoting autonomy.
Pursue specialty certifications
Research has found that specialized professionals are likely more autonomous due to their trust in their skills and abilities. Certifications can help nurses collect various skills within a shorter period and pursue specific areas of interest in their profession, boosting autonomy in their practice. Certified nurses quickly earn respect in the field, boosting their confidence and, consequently, their performance.
Advance their nursing education
The best way for nurses to boost the longevity of their careers is by committing to advancing their knowledge. The nursing education system has evolved to encourage professional autonomy. Therefore, the level of nursing education is often used as a predictor of professional autonomy. Nurses should take action to advance their knowledge as it is a natural way to increase their career opportunities and their ability to make independent decisions.
Become members of professional nursing organizations
Most local, regional or national associations offer their members the chance to participate in mentorship programs and access first-hand information on matters affecting the practice. These resources and tools are crucial for developing the desired competency level and improving workplace autonomy.
Participate in nursing conferences
Nursing conferences and other healthcare programs offer great opportunities for nurses to expand their knowledge while acquiring or claiming their professional identity. Nurses can participate in lifelong learning from their peers and seniors in the field, who often exhibit higher degrees of autonomy. These avenues also allow nurses to practice autonomy within the safe confines of a less restrictive space. Consequently, they can practice their authority and participate in the assessment and formulation of institutional assessment policies, contributing to the enhancement of autonomy. The ability to network and communicate effectively with other conference members also helps nurses discover ways to communicate effectively and improve their collaboration with other healthcare team members.
Autonomy amplifies the benefits of being a nursing practitioner, which come with exposure to challenging experiences and an even wider opportunity for growth. Nurses can improve their autonomous capability by advancing their knowledge and leveraging these experiences to reclaim their power in the health sector.