Autonomy in Nursing: Why It Matters

August 29, 2023

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A nurse assesses a patient’s condition on a hospital ward.

When nurses have the flexibility to rely on their own expertise in making care decisions and establishing policies, that autonomy can benefit them and their patients alike.

Autonomy in nursing can help prevent burnout, for example — and that can lead to better health care. A study of care workers in Hawai‘i, published in a 2019 Educational Gerontology article, connects increased levels of autonomy to decreased levels of burnout. And a 2021 piece in the International Journal of Nursing Studies shows that high levels of nurse burnout have negative effects on the quality and safety of patient care.

Pursuing an advanced nursing education, such as a Master of Science in Nursing (MSN) degree, can provide nurses with the knowledge, skills, and leadership abilities that can help them achieve greater autonomy in their work.

What Is Autonomy in Nursing?

Exploring what autonomy in nursing is requires a look at the two different types of nursing autonomy: clinical and practice. Both can lead to a variety of positive outcomes, including streamlining patient care and reducing medical costs.

Clinical Autonomy

When nurses have clinical autonomy, they have the authority to make medical care decisions and take action according to their own judgment, based on their professional knowledge. They can provide treatment without relying on others for guidance or permission.

Practice Autonomy

When nurse administrators have practice autonomy, they take an active role in guiding administrative policies and procedures in a medical practice. These policies and procedures can relate to:

Organizational structure
Staff policies and rules
Operational procedures

Benefits of Nursing Autonomy

Nursing autonomy is what’s at the heart of a broad range of positive effects, not only for nurses but also for their patients and employers. Its benefits include the following:

Enhanced Job Satisfaction

TigerConnect, a provider of health care collaboration tools, notes that intensive care unit (ICU) nurses make a patient care decision every 30 seconds. When nursing professionals have the autonomy to make this type of decision based on their own expertise, they gain a sense of empowerment that can increase their job satisfaction.

A 2020 article in the International Journal of Environmental Research and Public Health lists the following positive effects on job satisfaction related to nurses having clinical and practice autonomy:

Less stress
Less depression
Lowered absenteeism rates

Improved Care

As the 2019 Educational Gerontology and 2021 International Journal of Nursing Studies articles reveal, nurses who have greater autonomy are likely to experience less burnout — and provide better care. But job satisfaction isn’t the only factor that can influence patient outcomes.

Nurses who have autonomy also have more latitude to administer medical treatments and establish staff policies they deem to be appropriate. The ability to take quick action, without waiting for approvals from physicians or other health care providers, has positive effects on the quality of patient care. Additionally, when nurses handle decision-making that’s within their scope of practice, physicians and other health care leaders can focus more of their attention on issues that require their own areas of expertise.

Greater Access

When patients can rely on nursing leaders like nurse practitioners (NPs) to provide more of their care, their access to effective, affordable treatments is streamlined.

In many states NPs — who, as advanced practice registered nurses (APRNs), have advanced levels of education — can practice independently from physicians. In these states, NPs can offer essential services to the millions of people living in areas lacking easy access to medical care.

In August 2022, the U.S. Department of Health and Human Services reported that 96 million people were living in federally designated primary care Health Professional Shortage Areas (HPSAs). These areas in particular can benefit from NPs who are permitted to provide primary care independently.

Stronger Communication

Greater autonomy gives nurses a stronger voice in directing patient care, with physicians and other medical personnel trusting them to make decisions within their scope of expertise and experience.

According to a 2021 article in the Journal of Nursing Management, this collaborative approach to decision-making encourages more productive interactions among medical professionals by promoting shared leadership and influence.

Decreased Costs

The American Association of Nurse Practitioners (AANP) notes that when NPs have the autonomy to make decisions and provide care, layers of billing for multiple testing orders, office visits, and services are eliminated. The care these NPs deliver often is more affordable than that provided by physicians.

A 2021 article in the International Journal of Nursing Studies supports this idea, citing cost-effective care among the benefits of NP autonomy. The Online Journal of Issues in Nursing in 2019 also notes that NPs who can provide care autonomously and nurse administrators who have flexibility in implementing new health care guidelines are lowering costs and making health care more affordable.

Examples of Autonomy in Nursing

Examples of autonomy in nursing can be found in the day-to-day decision-making about patient care (clinical autonomy), and in the design of large-scale policy directives (practice autonomy). Examples of nursing autonomy include the following.

Nursing Clinical Autonomy Examples

Whenever nurses can make decisions independently, without a physician’s guidance, they are exercising clinical autonomy. The range of these actions includes:

Administering pain medications
Providing vaccinations
Implementing treatment plans and postoperative care
Monitoring vital statistics
Offering noncritical care
Referring patients to other medical professionals and facilities
Checking and dressing wounds
Providing in-home care
Delegating tasks
Administering cardiopulmonary resuscitation (CPR)

Many APRNs have additional nursing autonomy. NPs, for example, generally have the authority to write prescriptions and order and evaluate tests.

Nursing Practice Autonomy Examples

With practice autonomy, nursing leaders have the freedom to provide input, establish policies, and direct the actions of staff. Nursing autonomy examples of this kind include:

Providing guidance on staffing and treatment practices and procedures
Evaluating whether nursing practices meet legal and ethical standards
Making decisions regarding nurses’ daily roles, responsibilities, and schedules
Suggesting improvements to help ensure high-quality care

How to Increase Your Level of Nursing Autonomy

From building on their education to practicing open communication, nurses can pursue a range of strategies to gain greater independence. Following are suggestions for how to increase your level of nursing autonomy:

Expanding Knowledge

Keeping up with emerging trends in nursing practice can set nurses apart from their peers, help them build trust among their colleagues — and increase their autonomy in making clinical and practice decisions.

For example, earning an advanced nursing degree, such as an MSN, can provide nurses with the high-level skills and expertise that can lead to greater levels of responsibility and autonomy. Finding a mentor and taking advantage of opportunities for continuing education are other means of gaining expertise.

Making Decisions

Nurses who want to build their autonomy also can assert themselves in decision-making, proactively presenting solutions to problems and advocating for their patients. Offering this type of input can help make nurses an invaluable resource whose knowledge and ability to act independently are recognized by their colleagues.

Demonstrating Abilities

Another action helpful in increasing levels of nursing autonomy is taking the initiative in patient care. When nurses begin with small autonomous actions and then increasingly take ownership for practices and procedures, they demonstrate that they can handle decisions without relying on physicians or other health care professionals.

Improving Communication

Effective communication about expectations and roles among nursing teams can help in identifying staff strengths and weaknesses. This understanding can help establish areas in which individuals are best suited to have autonomy. Open communication and collaboration also helps in developing the support system that’s vital in building staff members’ confidence in their work and decision-making.

Improving communication with patients also is valuable. By learning about patients’ preferences and needs, nurses can help build the expertise that can lead to enhanced autonomy.

Pursuing a Job with Autonomy

Pursuing a nursing career that typically offers more autonomy is another option for increasing your nursing autonomy. Advanced-level nursing roles, including NP and nurse administrator, are among those that provide many opportunities for independent decision-making.

Nursing Jobs with the Most Autonomy

While all nurses can seek opportunities to increase their autonomy in their current roles, some positions offer greater flexibility and can be a good choice for those selecting a new career path. The following are among the nursing jobs with the most autonomy:

Nurse Practitioner

NPs offer advanced nursing services in primary and specialty care. Their work can focus on a practice area such as family, psychiatric-mental health, or adult-gerontology acute care. They are registered nurses (RNs) who also must hold a postgraduate degree in a nursing-related discipline to qualify for an NP license.

NPs often work in physicians’ offices, but they also work in hospitals and nursing homes and — in some states — their own practices.

Nurse Practitioner Responsibilities

While their scope of practice varies by state, NPs are APRNs — and these nurses generally have greater autonomy to provide a broad range of services. In many states, NPs can provide care with limited or no supervision by physicians. Their responsibilities can include:

Assessing patients’ health
Determining treatment plans
Educating patients about healthy habits
Prescribing medications
Ordering and interpreting diagnostic tests

Nurse Practitioner Salary and Job Outlook

Along with greater autonomy, the NP role offers the potential for strong earnings and job growth. Salaries can vary according to factors like education, experience, and location. In May 2021, the median annual salary for this role in the United States was $120,680, according to the U.S. Bureau of Labor Statistics (BLS).

The agency projects 52% growth in NP jobs between 2020 and 2030, compared with 8% for all occupations. The BLS attributes this projected growth, in part, to increasing demand for APRNs as they gain autonomy to provide more types of care.

Nurse Administrator

Nurse administrators are executive leaders who may provide direct care to patients but generally spend most of their time overseeing the work of nurses or nurse managers. They frequently work in hospitals or in nursing homes or other long-term care facilities.

Nurse administrators are RNs who often hold an advanced nursing degree.

Nurse Administrator Responsibilities

Nurse administrators’ work offers high levels of practice autonomy. They have responsibilities such as:

Creating training procedures
Conducting performance reviews
Evaluating quality of care
Making budgeting and purchasing decisions
Establishing staff policies

Nurse Administrator Salary and Job Outlook

Medical and health services managers like nurse administrators had a median annual salary of $101,340 in May 2021, according to the BLS. Between 2020 and 2030, the BLS projects the number of nurse administrator jobs will grow by 32%, as demand increases for leaders to guide health care for the United States’ aging population.

Home Health Nurse

Another example of a nursing job with a lot of autonomy is home health nurse. Since they travel to homes to deliver care, home health nurses generally are the only health care provider present while they are with patients — which affords them high levels of clinical nursing autonomy.

While some home health nurses are licensed practical nurses (LPNs), many of these professionals have the education — an associate or bachelor’s degree — and licensing required to be RNs.

Home Health Nurse Responsibilities

Home health nurses’ work focuses on helping people maintain their independence, bridging the gap for patients between being in a hospital and moving into a long-term care facility. Among these professionals’ responsibilities are:

Assessing patients’ conditions
Checking vital signs
Administering medication as prescribed
Dressing wounds
Educating patients and families about care procedures

Home Health Nurse Salary and Job Outlook

The type of license a home health nurse holds can affect their salary. For LPNs, the BLS reported that the median annual salary in May 2021 was $48,070, with the highest 10% of salaries for this role reaching more than $63,790. For RNs, the median annual salary was $77,700, with top salaries of more than $120,250.

The BLS projects 9% job growth for LPNs and RNs, citing in particular the need for nursing professionals to provide in-home care for older adults.

Nurse Midwife

Nurse midwife is an APRN role. These nursing professionals provide a variety of health care services to women, often working in doctors’ offices, hospitals, or outpatient facilities. They have postgraduate degrees in nursing-related subjects.

Nurse Midwife Responsibilities

Nurse midwives often have autonomy as primary maternity care providers. Typical nurse midwife responsibilities include:

Conducting gynecological exams
Offering family planning services
Providing prenatal care
Delivering babies
Managing emergency situations during childbirth

Nurse Midwife Salary and Job Outlook

The median annual salary for nurse midwives in May 2021 was $112,830, according to the BLS. Projected job growth is 11% between 2020 and 2030. The BLS credits this additional demand to the fact that medical professionals like nurse midwives and NPs increasingly provide many of the same services as physicians.

Telehealth Nurse

Telehealth nurses, typically RNs, provide health care using virtual platforms. Their work offers them the autonomy to evaluate situations and determine appropriate plans for care in the telehealth setting. They generally assess and monitor health conditions using live teleconferencing or software and other tools.

Telehealth nurses often work for hospitals and clinics. This type of care generally is an option for initial assessment of lower-risk conditions, including those that patients often can treat at home.

Telehealth Nurse Responsibilities

Telehealth nurses often serve as intermediaries who can decide whether a patient’s condition requires them to follow up with an in-person visit to a health care provider. Their work often focuses on:

Assessing patients’ conditions
Observing patients’ progress
Explaining at-home treatment options
Educating patients about managing their health conditions

Telehealth Nurse Salary and Job Outlook

In May 2021, RNs had annual salaries that could reach above $120,250, according to the BLS. And, while the BLS projects 9% growth in all RN roles between 2020 and 2030, the explosion of telemedicine points to a bright future for telehealth nurses in particular. Market research provider Statista reports that the global telemedicine market was $50 billion in 2019 and projects it will jump to $460 billion by 2030.

Elevate Your Autonomy in Nursing

Nursing autonomy can lead to many positive outcomes for nurses and their patients. Nurses can take a variety of steps to bolster their autonomy and achieve those benefits, including pursuing advanced education and career opportunities.

If you’re an RN with a bachelor’s degree, and you’re seeking the additional education and training that can lead to greater autonomy, explore Hawai‘i Pacific University’s online Master of Science in Nursing program.

You’ll have the option to choose a track that can lead to a career as an NP in family, psychiatric-mental health, or adult-gerontology acute care. And you’ll have the opportunity to take advantage of 100% online coursework, strong student support, and programming you can complete in as little as 28 months.

Discover how HPU’s online MSN program can help you gain autonomy in your nursing career.

Recommended Reading:

APRN vs. PA: What’s the Difference?

FNP-BC vs. FNP-C: Certification Differences

Nursing Job Growth: Opportunities for Advancement

Sources:

American Association of Nurse Practitioners, Issues at a Glance: Full Practice Authority

Chron, "Nurse Administrator Duties"

Cliniconex, "Autonomy in Nursing: What It Is and Why It Matters"

Educational Gerontology, "Relationships Between Social Support, Job Autonomy, Job Satisfaction, and Burnout Among Care Workers in Long-Term Care Facilities in Hawaii"

Incredible Health, "How to Become a Home Health Nurse"

Indeed, Home Health Nurse Job Description: Top Duties and Qualifications