Clinical nurses' understanding of autonomy: accomplishing patient goals through interdependent practice.
OBJECTIVE
The purpose of the study was to enable nurse managers to identify strategies to support and enhance autonomous practice based on clinical nurses' understanding of autonomy.


BACKGROUND
Findings from an organizational work-life satisfaction survey led a nursing management team to question how clinical nurses understand autonomy. The nursing literature offers inconsistent definitions of autonomy and interchangeable use of related concepts.


METHODS
Twelve focus groups involving 43 nurses working in cardiovascular service units discussed instances of satisfaction and dissatisfaction with autonomy in their clinical practice and work life. Verbatim transcripts of group discussions were interpreted by a research team to identify salient examples and descriptions of autonomy.


RESULTS
Nurses described autonomy as their ability to accomplish patient care goals in a timely manner by using their knowledge and skills to understand and contribute to the overall plan of care; assess patient needs and conditions; effectively communicate concerns and priorities regarding patient care; and access and coordinate the resources of the multidisciplinary team.


CONCLUSIONS
These findings challenge assumptions about autonomy as independent decision making and practice. They highlight nurses' contributions to patient care goals through knowledge of how to get things done within hospital systems and through interdisciplinary coordination and collaboration.
Stewart
Janice
J
Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada T2N 1N4.
Stansfield
Katherine
K
Tapp
Dianne
D
D000416:Alberta; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000451:nursing; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003299:Cooperative Behavior; D003659:Decision Making, Organizational; D005260:Female; D017144:Focus Groups; D006040:Goals; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D009718:Nurse Administrators / Q000458:organization & administration / Q000523:psychology; D024802:Nurse's Role; D015404:Nursing Methodology Research; D009741:Nursing Staff, Hospital / Q000193:education / Q000458:organization & administration / Q000523:psychology*; D009745:Nursing, Supervisory; D009937:Organizational Objectives; D010347:Patient Care Planning / Q000458:organization & administration*; D019555:Physician-Nurse Relations; D017009:Professional Autonomy; D036301:Qualitative Research