title: Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue.
abstract: Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population.
  
  
  
  This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006-2007.
  
  
  
  Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls.
  
  
  
  Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01).
  
  
  
  Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR.
  
  
  
  Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes.
authors.affiliation: Director of Nursing Practice, Hospital of the University of Pennsylvania; Adjunct Assistant Professor, University of Pennsylvania School of Nursing, Center for Health Outcomes & Policy Research, Philadelphia, PA, USA.
authors.forename: Aditi D
authors.initials: AD
authors.lastname: Rao
authors.affiliation: Nurse Practitioner, Department of Child & Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia; University of Pennsylvania School of Nursing, Center for Health Outcomes & Policy Research, Philadelphia, PA, USA.
authors.forename: Aparna
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Associate Professor of Nursing, University of Pennsylvania School of Nursing, Center for Health Outcomes & Policy Research, Philadelphia, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: McHugh
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009741:Nursing Staff, Hospital; D013527:Perioperative Nursing; D017009:Professional Autonomy; D012307:Risk Factors
keywords: Autonomy; nursing; surgery; teamwork