What is Autonomy in Nursing
The word “autonomy” is derived from the Greek terms “auto” (self) and “nomos” (custom or law). In the field of Nursing, the ability of a nurse to evaluate and implement nursing interventions based on competence, expert skill, and knowledge is referred to as autonomy.
With each patient care, the nurse is required to work autonomously and exercise critical decisions despite the absence of the physician’s directives. Indeed, nurses frequently collaborate with physicians and other healthcare professionals, but this is not always the case.
Autonomy is a nursing principle that allows nurses to make decisions about the patient’s care without needing to consult physicians or other members of the medical team.
It also allows nurses to make quick judgments without having to wait for review and approval from another health professional.
Not only does autonomy provide nurses more control and respect for their medical expertise, but it also enables patients to benefit from a faster decision-making process, which can contribute to the reduction of mortality tolls and better health services.
There are two types of autonomy in nursing:
- Clinical autonomy. This is the type of autonomy which empowers nurses to make decisions about patient care.
- Control over nursing practice. The second type refers to the nurses’ authority over their practice setting that suggests that nurses are involved in organizational structure, norms, policies, and operations judgment. Therefore, if something has a direct effect on nurses, they should be consulted.
Importance of Autonomy in Nursing
There are substantial benefits to developing autonomy in nursing. The following are some of the reasons why this nursing principle is so important.
- Enhanced quality of patient care. Autonomy in nursing has an advantage in terms of how it impacts patient care. Autonomy in nursing has a favorable influence on patient outcomes and quality of care. According to a study, hospitals with higher levels of autonomy for nurses had lower 30-day death rates and fewer rescue failure rates. Nurses are well-versed in the healthcare and clinical needs of their patients and encouraging them to perform what they do best improves the patients’ quality of life significantly.
- A sense of job fulfillment. Nurses will feel a lot more confident, respected, and valued at work if they have the authority to apply their medical knowledge and judgment in making decisions and taking action on patient care. According to studies, nurses who are granted higher autonomy are happier at work and report that autonomy is more valuable to them than their working environment. The nurses’ relationships with other medical experts were also strengthened as a result of their autonomy. Furthermore, the more nurses were trusted to make decisions about patient care on their own, the more they loved and appreciated their work.
- Lower rates of turnover. As previously stated, autonomy in nursing promotes job satisfaction. Most nurses feel moral discomfort when they are unable to turn their ethical judgments into action since they are unable to provide the treatment that they feel necessary to the patient. As one’s moral stress intensifies, so does one’s desire to quit. On the other hand, there will be fewer turnover rates, more effective care, and improved patient outcomes when autonomy in nursing is exercised. Empowering nurses and providing them with respect and decision-making power will surely have repercussions throughout the organization.
How to Demonstrate Autonomy in Nursing?
Nurses have autonomy across their field of practice, even without prescriptive power or medical diagnostic oversight. The education of a nurse allows them to assess if a patient has high blood pressure, is hyperventilating, or is sweating excessively. They are not only taught how to make these observations but also how to act on them.
Autonomy in nursing can be demonstrated in a variety of ways, including but not limited to the following:
1. Clinical Autonomy
- Deciding in emergency medical situations, such as administering CPR (Cardiopulmonary Resuscitation)
- Administration of PRN drugs and treatment
- Adjusting the bed position
- Taking the vital signs when there is a concern about the patient’s condition
- Delegation of tasks to other nurses and nursing assistants
- Interpretation of certain medical results and requiring diagnostic tests
- Handling of specific medical equipment or innovations
2. Control of Nursing Practice
- Participation in decision-making processes relating to the nurse’s field of practice, particularly in policies and procedures. If specific processes change, for example, the nurses should be consulted.
- Control over the nurses’ daily tasks and working environment. For instance, implementing a full-time work schedule selection system; discretion in extending the time and regularity of night shifts; and freedom in determining days of vacation.
- Offering suggestions for improving various aspects of the practices in an organizational structure. The nurse, for example, can raise the issue to the controllers if the supply room is not properly filled.
The above examples demonstrate how vital autonomy is in the healthcare delivery system. Clinical reasoning, evaluations, and actions performed by nurses are crucial and can signify a difference in people’s lives.
Consequences of Lack of Autonomy in Nursing
Diminished autonomy has a negative influence on nurses, as well as patients, the healthcare team, and the entire healthcare system.
Autonomous decision-making is a foundation of every profession, and nursing is not an exception. Decreased or lack of nursing autonomy in the workplace may have the following consequences:
- Job dissatisfaction due to increased levels of moral distress among nurses.
- Less effective collaboration between nurses and other members of the healthcare team.
- The high attrition rate for nurses.
- A higher chance of getting a disease
- Lack of confidence
- Poor quality of care and substandard patient outcomes
How to Enhance Autonomy in Nursing
A nurse’s degree of autonomy is directly proportionate to their level of education and skill. Nurses with more experience and enhanced competencies are more likely to have more autonomy in their practice, which will lead to more autonomy. Here are some of the most effective approaches for a nurse to get more autonomy:
- Advancing Nursing Education. In general, the higher a nurse’s level of education, the greater their level of skill, and, as a result, the more autonomy they will have in their profession. Nursing education strengthens the concept of nursing autonomy and competence in future nurses. Nurses will naturally strengthen their ability to make independent decisions regarding their clinical practice if they take steps to advance their education and knowledge. Nurses with a master’s degree or other higher education are considered to have the most control and influence over their work.
- Building Strong Nurse-Patient Connections. According to one study, nurses who build a great connection with their patients are better able to grasp their circumstances, needs, and desires. As a result, nurses are better equipped to advocate for their patients and deliver comprehensive care.
- Becoming a member of Professional Nursing Groups. Participating in professional nursing groups is another way for nurses to have more autonomy in the workplace. Becoming a member of a local or national nursing organization has a number of advantages such as mentorship programs, discounts on nursing conferences or subscriptions, and other benefits. All of which are good ways to improve nursing skills and competencies.
- Be a problem solver. Nurses play a vital role in improving health as they make up the greatest percentage of healthcare providers. When nurses make an autonomous clinical judgement, they are pushing for change and seeking methods to improve the healthcare system, improve health outcomes, minimize negative events, increase patient satisfaction, and improve quality. A nurse who desires more autonomy should think like a problem solver and suggest ways for the department or facility to improve their care environment. Nurses who are constantly looking for methods to improve themselves or their workplace practices may be authorized with a higher level of autonomy than others.
- Demonstrating Independence (even in small ways). There is nothing wrong with asking for help or affirmation from other members of the healthcare team on a regular basis, especially if it affects the patient’s care. However, exhibiting nurse independence in every scenario, no matter how minor, might increase one’s sense of autonomy.
- Having Effective Workload Management. Staying organized and demonstrating that workload is being managed effectively can lead to more opportunities for nurses to be given more autonomy.
- Being Proactive. On less challenging days, nurses who simply wait for orders from their superiors may not be viable candidates for autonomy. Nurses who ask where they can provide extra help at slower times, on the other hand, may have more opportunities than others.
- Having Open Communication with Superiors. Nurses who make sure to speak with their supervisors when they are ready for greater freedom have a better probability of having a lot more sense of autonomy than those who do not.
Participating in continuous learning and obtaining additional training, as well as having a positive attitude are components associated with greater levels of autonomy.
It is also essential for employers and nursing managers to advocate for increased autonomy in nursing by offering opportunities for nurses to advance their careers. In addition, they can also empower all members of the healthcare team to communicate and collaborate more effectively.
What measures do nursing supervisors and employers take to encourage nurses’ autonomy?
Nursing managers and supervisors play an important role in boosting nurses’ confidence by empowering them to make independent decisions.
They must review unit and hospital policies that support nursing autonomy and the potential to encourage nurse-physician collaboration. Patient-centered care is supported by actions that bring team members together to share knowledge and expertise.
There are several ways for a nursing supervisor, managers, or employers who work with nurses to advocate for their autonomy, such as the following:
- Allow them to demonstrate their ability to handle additional autonomy by allowing them to manage patient communications or deal with telehealth appointments, for example.
- Inquire about how to improve the quality of patient care, unit protocols, and more.
- In both trivial and big circumstances, ask for the nurses’ involvement in patient treatment.
- Trust them to complete the work assigned to them. Giving them a task and hovering over them while they complete it is not a proper way to establish confidence in the nurses’ abilities.
- Communicate and collaborate with nurses to see how they might be helped to achieve their autonomous nursing goals.
Nursing Jobs that Have the Highest Level of Autonomy
A few nursing positions allow for more autonomy than others. Some of the jobs that provide more control over nurses’ practice are as follows:
- Nurse Practitioners. This is unquestionably one of the nursing roles with the most autonomy. Nurse Practitioners must have at least a Master’s Degree in Nursing to begin their careers. They also have prescriptive authority in all 50 states, and most authorities allow them to practice totally independently. They can specialize in a particular field of nursing, such as mental health, geriatrics, or family practice.
- Home Health Nurse. Rather than transferring into an assisted living facility, some elderly individuals prefer to have a home nurse. In these situations, home nurses can provide assisted living care on a set schedule or 24 hours a day, 7 days a week. It’s a lot of work, but it enables them to have a more autonomous nursing experience and a more customized interaction with their patients.
- Nurse Midwives. Nurse Midwives, who have completed a Master’s degree in midwifery, are another Advanced Practice profession with a lot of autonomy. They are experts in guiding women through pregnancy, delivery, and beyond. Although their scope of practice varies by jurisdiction, Certified Nurse Midwives in most states have the freedom to practice autonomously or under a co-management agreement with a physician.
- Forensic Nurse. While forensic nursing still necessitates partnership with other medical experts and units, it also necessitates a high level of autonomy in order to handle a task that may involve caring for trauma victims and testifying in court trials. Nurse investigators and forensic correctional nurses are two examples of linked responsibilities for forensic nurses.
- Nurse Anesthetist. CRNAs (Certified Registered Nurse Anesthetists) are advanced practice nurses that have a lot of autonomy in their profession. They are qualified to make autonomous decisions about all areas of anesthetic care due to their rigorous education and certification experience.
- Telehealth Nurses. In addition to the above roles, Telehealth nurses have more control over their nursing practice. Their responsibilities include assisting and caring for patients via virtual healthcare platforms. Telehealth nurses must use their judgment while assessing a scenario and making appropriate decisions in this field of practice. They can assist the patient over the phone or via video, schedule an appointment with a physician, or dispatch an ambulance if necessary. Telehealth nurses require autonomy in order to determine the best course of action on the move.
Each of these nursing professions may require various certifications depending on which state a nurse will work in. A nurse must examine the state licensure criteria before starting a new, more autonomous nursing career to ensure that they have what it takes to get started on the right foot in their dream of autonomy.
Examples of Autonomy in Nursing
Each of a nurse’s assessments and accompanying judgments is an example of autonomous nursing practice that is often overlooked or given too little credit by others.
Here are some scenarios of how nurses may utilize their education and training to make important decisions on their own when they are appropriate.
- When the nurse enters the patient’s room, he/she discovers that the patient is having difficulty of breathing. The nurse immediately auscultates the patient’s lungs and determines that repositioning the patient to increase chest expansion and administering low levels of oxygen is the best course of action. Even without a doctor’s order, the nurse also checks for any problems with the prescription and assesses the patient’s hydration levels by measuring fluid input and output. In addition, the nurse informs the patient and caregiver about the risks of excessive salt intake and the repercussions of fluid buildup. The nurse also discusses which positions will make it easier for the patient to breathe, as well as the exercises that should be followed.
- The patient had only been out of surgery for an hour. When the patient arrives in his inpatient room, the nurse promptly assesses him. The nurse notices that the patient’s body temperature is rapidly rising. Luckily for this patient, the nurse did not feel it was essential to call a physician or the charge nurse and wait for direction to proceed with intervention. He/she quickly brought the patient’s temperature back to normal with wet washcloths and an electric fan.
- In the birthing ward, a nurse was assigned. He/she notices that a first-time mother is having difficulty attempting to breastfeed her baby. Despite the absence of authorization or instruction from the attending Obstetrician, the nurse provides patient education on how to properly breastfeed and the benefits of doing so. Similarly, when a nurse has a patient who is a known multi-gravid and is no longer interested in having an undesired pregnancy, the nurse teaches the patient about several methods of effective birth control.
- The attending physician has advised a 55-year-old male patient with constipation to boost his mobility and hydration intake. However, when the nurse arrives in the patient’s room, the patient is complaining of dizziness and has already vomited three times. Despite the lack of a physician’s directive, the nurse instructed the patient to halt mobility and instead raise his side rails to keep him from falling. In addition, the nurse advised the patient to stay on NPO (“nothing per orem” or NBM as in “nothing by mouth”) until the vomiting subsided, despite the physician’s orders to increase the patient’s fluid intake.
Given the aforementioned circumstances about autonomy in nursing, it is clear that a nurse can function independently when necessary.
However, autonomy in nursing does not imply abandoning collaboration with other members of the healthcare team, correcting ineffective physician orders, or displaying superiority.
The scenarios above simply indicate that there are times when the nurse must act without the physician’s permission in order to provide more effective and immediate patient care.
Autonomy is essential for effective nursing care. Giving nurses the opportunity to make decisions within their field of expertise is clearly helpful. It enhances patient outcomes and quality of care, as well as making nurses have a higher level of job satisfaction, which affects their work performance and well-being. Accountability and autonomy usually go together.
Nurses who want to be more independent in their work must assume responsibility for all of their decisions and actions. As a result, nurses must constantly enhance their skills and knowledge in order to act responsibly for their nursing profession.
Several variables influence nursing autonomy, but they may all be simplified to the following words: knowledge and confidence. Nurses’ knowledge and confidence are the most effective ways to improve autonomy in nursing.
Nurses, for example, can broaden their cultural, technical, and scientific understanding through further education and training, as well as gain confidence through professional experience, effective communication skills, and leadership possibilities. Similarly, hospital leadership should implement initiatives to boost nurse autonomy, such as allowing nurses to observe nurse leaders or pursue additional certifications.
Autonomy is a crucial part of the nursing profession; as a result, it’s critical for nurses to grasp the significance of autonomy and the variables that contribute to or detract from it in their career.
The capacity to make autonomous treatment choices provides a variety of benefits for health outcomes, patient satisfaction, work engagement, and the nurse’s health and well-being.
Nurses spend considerable time with patients of all the members of the healthcare team. Nurses also get to know their patients and their families, understanding their needs, desires, and objectives.
As a result, nurses are motivated to speak for their patients and make judgments that they are confident will achieve their patients’ objectives and result in beneficial results.
Everybody benefits when nurses work in an environment where they can make independent judgments based on patient needs.
Nurses achieve their objectives of providing patient-centered care, and the patient receives the appropriate, high-quality care that he or she deserves.
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Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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