Autonomy in nursing: what it is and why it matters

autonomy in nursing

It’s well known that nurses are the backbone of a functioning healthcare organization. Not only do they provide patient care, but families, doctors, and administrators rely on their expertise and medical knowledge to help make critical decisions. 

Even with all their expertise and deep knowledge of the needs and wants of individual patients, nurses are often without the authority to make decisions – even in emergency situations. This is why autonomy in nursing is so essential – it can save lives. 

When nurses have the capacity to make and execute decisions without having to first seek approval, patient outcomes improve, job satisfaction increases and the overall delivery of care is transformed for the better

What is nursing autonomy?

At its core, nursing autonomy is exactly what the term suggests: it allows nurses to use their training, critical thinking and knowledge about a patient to make a decision without the approval of a doctor or member of the healthcare team.

This isn’t a new concept either. Back in 1990, the American Nurses Credentialing Center (ANCC) created the Magnet Recognition Program which provides a framework for both nursing practice and research. It has 14 pillars, the 9th of which states that autonomy is:

“The ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge.”

The inclusion of autonomy as one of the main principles of nursing suggests that even 30 years ago, before technology and the digital age had even begun to change how healthcare was delivered, the ANCC recognized how important it was for nurses to be in control of their decisions.

The two types of nursing autonomy 

In practice, there are two areas that can help define when and where autonomy is called for. They are:

  • Clinical autonomy: this is rather straightforward and refers to clinical decision-making in regard to patient care.
  • Autonomy in nursing practice: this allows nurses to have a say in policies, procedures, governance and organizational structures etc. which impact them. 

By being able to voice their opinions and knowledge in patient care and how events or decision-making unfolds in relation to them, nurses are able to inform larger structures and frameworks at an organizational level, thus removing barriers that may impede care on the floor.

Examples of nursing autonomy

Nurses are making hundreds of decisions a day. For example, each time they walk into a patient’s room, look at vital signs and re-adjust everything from oxygen levels, administering medication to the angle at which a patient is sitting or lying down – these are all small, autonomous decisions. Administering CPR? An autonomous clinical decision. Delegating tasks? An autonomous nursing practice decision.

Nursing staff have both the knowledge and skills to make more autonomous decisions in the workplace. Some of the benefits include:

A reduction in 30-day mortality rates

  • This study gave 570 hospitals, 100,000 nurses and 1.2 surgical patients to find an “autonomy score”. The results? That for every increase of 1 point of nursing autonomy, the 30-day post-surgery mortality rate dropped by 19%

Healthcare collaboration increases autonomy and outcomes

  • The American Journal of Critical Care published a study investigating whether autonomy was a key factor in enhanced patient outcomes and nurses’ work satisfaction. It was. 

Not only did effective collaboration between nurses and physicians result in better clinical outcomes; collaboration actually increased autonomy as many of the traditional power structures are broken down and trust and confidence are increased between colleagues. 

Increase in job satisfaction

  • When given the authority to use their knowledge and judgment to take action, nurses feel confident, respected and appreciated. In the midst of a global nursing staff shortage, keeping nurses happy and engaged is paramount.

Enhancing nursing autonomy

Like any job, the more educated and experienced an individual is in their role, the more confident they become in their abilities. That being said, there are many other methods and tools organizations can use to build upon the expertise of their nursing staff.

Promote teamwork

The importance of a collaborative healthcare team has already been discussed, but its importance cannot be understated. Not only does working in a team with a wide range of skills improve individual performance, but a team can also act as both a support system to provide guidance and a knowledge center to increase proficiency. 

Actively encouraging staff to collaborate and ensuring teams have members with different skill and experience levels is a stepping stone towards more autonomy. 

Provide boundaries and guidelines

Expectations and trust can vary among organizations, teams and people. Setting clear frameworks and policies around autonomy provides nurses with the confidence they need to do their job without second guessing whether their decision will be questioned. As much of a nurse’s responsibilities include patient advocacy, having the confidence to make decisions on their behalf is crucial.

Provide support

Knowing your superiors have your back is an important ingredient for the development and promotion of autonomy. This could be as simple as pairing a more junior team member with a senior one as a confidence booster, verbally affirming a decision that was made autonomously. Like any person, if someone fears criticism or prosecution for a mistake or doing something differently, they often feel undervalued which is a hindrance to autonomy. 

Be a trendsetter

Nurses got into nursing to provide care. Their days are full – even before the epic staff shortages currently facing the industry – administrative and non-clinical tasks being added to their workload is not why they went to school. 

As more digital natives enter the workforce, investing in digital tools and integrated technology can both help recruit and retain staff. Furthermore, streamlining workflows, automating repetitive tasks or leveraging data to increase collaboration and outcomes help nurses make better-informed decisions – increasing autonomy. 

Final thoughts

Healthcare is a team sport, and every role is essential, but nurses need to be able to practice autonomously and exercise independent judgment. The healthcare industry is on the cusp of change: in not just the workforce – but how they work. Autonomy is one of the main building blocks in creating this next phase of a healthy, engaged healthcare system.

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