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.