Magnet hospital staff nurses describe clinical autonomy.
BACKGROUND
Considerable and longstanding confusion abounds as to what is meant by the concept "autonomy." The 2 dimensions of autonomy-rooted in the clinical act and the autonomy of the discipline or profession-are used interchangeably and measured with the same tools.


OBJECTIVE
The purpose of this research was to ascertain staff nurses' concept of autonomy, to empirically quantify nurse autonomy, and to determine the relationship between degree of autonomy and staff nurses' rankings of quality care on their units and their own job satisfaction.


METHODS
Two hundred seventy-nine volunteer staff nurses from 14 magnet hospitals were interviewed individually with the open-ended question and request, "Can you practice autonomously? Give an example of a typical situation that illustrates that you practice autonomously," and with two 10-point rating scales on job satisfaction and quality of care given on their units. Responses were subjected to constant comparative and thematic analyses. On the basis of 3 themes-frequency, organizational sanction, and scope-a 5-category ranked autonomy scale was developed. These magnet hospital staff nurses restrict the concept of autonomy to the clinical act. There is a strong relationship between degree of autonomy as measured by the ranked scale and rankings of job satisfaction and quality of care. An unexpected finding was that 26% of these nurses working in magnet hospital reported situations of unsupported or no autonomy.


CONCLUSIONS
This research is particularly meaningful for nurse managers and researchers. Nurse managers must empower nurses, provide support, provide opportunities for nurses to increase competence, and reward and sanction staff nurse autonomy. After further refinement, the ranked-category scale will be useful in studying the effect of educational efforts and organizational support on the development of clinical autonomy.
Kramer
Marlene
M
Health Science Research Associates, Apache Junction, Arizona 85219, USA.
Schmalenberg
Claudia E
CE
D003657:Decision Making; D006801:Humans; D007588:Job Satisfaction; D009741:Nursing Staff, Hospital / Q000592:standards*; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D011361:Professional Competence; D011787:Quality of Health Care