Abstract
BackgroundProfessional autonomy is a key concept in understanding nurses’ roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England.MethodsA descriptive phenomenological analysis of data from 48 semi-structured interviews with registered nurses from two National Health Service (NHS) hospitals (purposive sample) was used to explore the concept of autonomy.ResultsSix themes were identified: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support. A key finding was that nurses related autonomy to their clinical work and to the immediate work environment of their ward, rather than to a wider professional context. Nurses also perceived that autonomy could be turned off and on rather than comprising an integrated aspect of nursing.ConclusionsFindings suggest that nurses in England, as framed by the sample, had a local ward-focused view of autonomy in comparison to nurses in America, who were reported to relate autonomy to a wider involvement in hospital level committees. Findings further indicate that autonomy was practiced occasionally, rather than incorporated into practice. Findings highlight the need for nurses in England to adopt a broader perspective and actively contribute to writing hospital guidelines and policies that recognise the importance of autonomy to nurse training and practice.
Highlights
Professional autonomy is a key concept in understanding nurses’ roles in delivering patient care
Six key themes emerged from the data analysis: working independently; working in a team; having professional skills and knowledge; involvement in autonomy; boundaries around autonomy; and developing autonomy requires support
Theme 1: working independently Participants defined their understanding of autonomy as: nurses’ ability to work on their own without external influence
Summary
Professional autonomy is a key concept in understanding nurses’ roles in delivering patient care. Recent research exploring the role of autonomy in the nursing work environment indicated that English and American nurses had differing perceptions of autonomy. This qualitative study aimed to explore the understanding and experiences of autonomy of nurses working in England. Kramer and colleagues [2] delineated three dimensions of autonomy in clinical practice settings. Kramer and colleagues [2] further warned that the impact of autonomy on patient outcomes cannot be determined when various concepts of autonomy are labelled the same but differ in meaning and are measured with tools or instruments that do not fit the concept. The need for clear, shared understanding of the meaning and an understanding of the empirical measurement of autonomy is critical
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