The Practice of Clinical Autonomy in Hospitals: 20 000 Nurses Tell Their Story

How can autonomous practice affect nurses’ professional job satisfaction?

In a previous article,¹ we described how staff nurses, managers, and physicians working on units with confirmed healthy work environments judged “competent performance of nurses.” Although related to all of the essentials of a healthy work environment,² competent performance is a sine qua non for autonomous decision making, the essential professional work process we discuss in this article.

Autonomy has long been cited as 1 of the 3 cornerstones of excellent, magnetic work environments.³ Progress in identifying organizational structures and best practices that enable clinical autonomy has been inhibited by widespread confusion, lack of precise definition of clinical autonomy, and failure to distinguish between organizational and clinical autonomy. The following excerpt⁴ from groups of staff nurses illustrates this confusion:

In 2001, staff nurses in 14 magnet hospitals identified 8 essentials of a healthy (ie, job satisfying and...