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Abstract

Professional autonomy is critical for nursing practice and professional development. A clear understanding of the professional autonomy concept and its applications in the real world is warranted. This paper clarified the “professional autonomy in nursing” concept using Walker and Avant’s method and the PRISMA flowchart and checklist to conduct the current analysis. Five electronic databases were searched: PubMed, ScienceDirect, ProQuest, Web of Science, and CINAHL Plus with Full Text. The search yielded 21 articles on “professional autonomy in nursing” between 2019 and 2023—however, six old articles related to measurement tools or instruments. The elements that characterize “professional autonomy in nursing” fall into four categories: shared leadership, professional skills, inter- and intra-professional collaboration, and a healthy work environment. Professional autonomy in nursing is defined as the professional nurse’s competency and innovative performance to determine independent or interdependently nursing activities while conserving accountability for decisions and reflecting advocacy and caring. The consequences of the concept are positive outcomes such as high patient satisfaction with provided care, nurses’ accountability, empowerment, a sense of self-efficacy, commitment to the profession, career, and organization, as well as high quality of work. The definitions and measurements of “professional autonomy in nursing” have developed over time, which mandates a continued study and analysis of this concept. It is essential to understand the multidimensional nature of the concept in order to offer professional development programs.

Keywords

concept analysis professional autonomy autonomy nursing nurse

Introduction

Nursing autonomy is about nurses’ independence, self-governance, self-determination, and self-direction, whereas “professional autonomy” is the authority to make decisions and act based on professional knowledge and judgment; thus, nurses make clinical decisions based on their nursing scope of practice (Hsiu-Ying et al., 2022).

The key aspects of professional autonomy in nursing involve (1) decision-making, nurses’ authority to make decisions related to patient care and unit operations; (2) ethical considerations, nurses’ considerations of patient preferences and ethical principles; (3) accountability, nurses’ responsibility for the outcomes of those their patient care and unit operations decision, and (4) collaboration, nurses collaborate with other healthcare teams while maintaining their autonomy.

The importance of professional autonomy in nursing lies in three main domains: (1) patient-centered care meeting patients’ tailored needs (Pursio et al., 2021); (2) advocacy for patients’ rights and well-being (Setoodegan et al., 2019); (3) professional growth because autonomy fosters critical thinking and professional development and learning (Hsiu-Ying et al., 2022). Professional autonomy is critical for nursing practice and professional development (Hsiu-Ying et al., 2022). However, various factors are needed to promote nurses’ professional autonomy and job satisfaction, such as nurses’ knowledge and clinical judgment as well as a supportive work environment (Both-Nwabuwe et al., 2020; Hara et al., 2020; Pursio et al., 2021). It is well documented that nurses’ autonomy still faces many challenges that include (1) hierarchy within healthcare organizations that hinders nurses’ autonomy, (2) team dynamics; it is challenging to collaborate with other healthcare team members while asserting nurses’ autonomy, and (3) legal and ethical boundaries; nurses must balance autonomy with legal and ethical guidelines (Vaughn, 2023).

“Professional autonomy in nursing” is not about fulfilling routine tasks; it is about having self-direction and intellectual flexibility to decide on patient care based on the patient’s needs (Balasi et al., 2023; Rouhi-Balasi et al., 2020). Discretionary decision-making is critical for autonomous nursing practice (Pursio et al., 2021), as it involves judgments by professionals based on their training and experience (Balasi et al., 2023). Professional autonomy in nursing also means having the authority to decide unit operations based on the professional’s knowledge (Balasi et al., 2023; Hsiu-Ying et al., 2022; Oshodi et al., 2019). It is linked to nurses’ competency (Balasi et al., 2023) and their nurse managers’ leadership (Setoodegan et al., 2019). Increasing nursing skills could help them be more independent and help their nurse managers be better leaders (Balasi et al., 2023; Heinen et al., 2019; Junttila et al., 2023; Oshodi et al., 2019). Figure 1 shows a schematic presentation of the concept of professional autonomy in nursing.

Figure 1.

A schematic presentation of the concept of “professional autonomy in nursing.” Adapted from Weston (2008).

Purpose and Significance

There is an accelerated emphasis on high-quality nursing care (Labrague et al., 2019) and nurses’ professional development (Balasi et al., 2023). Nurses’ professional autonomy remains a vital element in achieving that goal. A clear understanding of the meaning and real-world applications of professional autonomy is urgently needed.

There have been many studies on “nurse autonomy” and “professional autonomy in nursing” (Abdolmaleki et al., 2019; Balasi et al., 2023; Both-Nwabuwe et al., 2020; Oshodi et al., 2019). These studies have examined how nurses can be more independent and autonomous. However, there is a gap in the reviewed studies; that is, “professional autonomy in nursing” is poorly delineated and overlooked (Rouhi-Balasi et al., 2020). Therefore, a comprehensive clarification of this concept is necessary (Rouhi-Balasi et al., 2020), and growing expertise in nursing is required (Pursio et al., 2021).

The current literature search in this analysis was limited to 2019 to 2023, except for the measuring instruments. No recent concept analyses on “nurse autonomy” or “professional autonomy in nursing.” However, one recent concept analysis was related to nursing practitioners (Peacock & Hernandez, 2020), which doesn’t reflect the autonomy of the nursing profession. Concept definitions and measurements develop over time, requiring a continuous exploration of concepts. Therefore, this concept analysis aims to clarify the concept’s definitions, uses, attributes, antecedents, and consequences. Various terms were used to describe “autonomy in nursing,” with different measurements. Thus, a thorough evaluation of this concept will establish a standardized meaning for “professional autonomy in nursing.” The progressive understanding of the studied concept will make it feasible to verify nurses’ autonomy objectively throughout the profession and offer interventions for nursing leaders to enhance nurses’ professional autonomy in practice.

Concept Analysis Method

Concept analysis helps validate what nurses already know, increases their knowledge, and creates new patient care methods. The eight-step method of Walker and Avant (2018) is commonly used for concept analysis in nursing (see Table 1) and is used in this paper. Walker and Avant’s (2018) method was used to explore professional autonomy in nursing because it is iterative and helps construct an operational definition of a concept. Walker and Avant (2018) recommend using all available information sources to compile a complete inventory of the concept’s characteristics and uses (Table 1).

Table 1.

Walker and Avant’s (2018) Eight-Step Method of Concept Analysis.

Walker and Avant’s (2018) eight-step method was used in this concept analysis:
1. Selecting a concept.
2. Identifying the goals of the concept analysis.
3. Identifying all of the concept’s applications.
4. Identifying the concept’s defining characteristics.
5. Create a model case.
6. Creating additional cases
7. Determining the concept’s antecedents and effects.
8. Identifying empirical referents.

Five online databases—PubMed, ScienceDirect, ProQuest, Web of Science, and CINAHL Plus with Full Text—were used to find the studies related to this analysis. Searching the bibliographies of previously cited papers revealed additional sources. “Concept Analysis,” AND “Autonomy,” OR “Professional Autonomy,” AND “Nursing” OR “Nurse” were among the Boolean operators analyzed in each database (See Supplemental File 1 Search Strategy). The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart (adopted from Moher et al., 2009) was used to determine included studies (Figure 2).

Figure 2.

PRISMA flowchart. Adapted for use from Moher et al. (2009).

This paper presents the constructed model, related, borderline, and contrary cases for professional autonomy in nursing (Table 2). PRISMA 2020 checklist was also used to facilitate transparent and complete reporting of the concept analysis (Supplemental File 2) (PRISMA Group, 2022). A summary of the 21 related articles is provided in Table 3.

Table 2.

Constructed Cases to Analyze the Concept of Professional Autonomy in Nursing.

Cases and their Definitions	Example	Analysis
Model case (a real case example) This case is an instance of the usage of the concept that demonstrates all of the concept-defining attributes and articulates the concept’s meaning (Walker & Avant, 2018).	MJ is a nurse who works in a nursing home. Mr. Ali is an 85-year-old male patient admitted to the nursing home with a diagnosis of Alzheimer’s dementia. Mr. Ali recovered from a fractured knee repair, became restless and agitated, and commenced to scratch his legs. MJ did a physical assessment and searched for applicable objective data because Mr. Ali couldn’t self-document and articulate his unmet needs. However, Mr. Ali’s family members insisted on no longer performing the physical assessment for Ali to keep away from bothering him. The family member asked MJ to give Mr. Ali medication to get snug and sleep. MJ explained to the family member that Mr. Ali’s continual conduct indicates the reason for such inconvenience. Sleeping medicine may fit inside the quick period because it could position Mr. Ali to sleep. MJ found dry skin during the further physical assessment and determined that this sign needed additional information. The medical record showed Mr. Ali has been on a multivitamin and Imipramine/Tofranil for depression. MJ consulted with the physician, who discontinued the Imipramine/Tofranil since it is known to cause paresthesia, a tingling sensation, specifically in the extremities. The drug was stopped, and within a week, Mr. Ali no longer scratched his legs. MJ dramatically improved Mr. Ali’s comfort and quality of life.	This case fully demonstrates the attributes of “professional autonomy in nursing”: self-confidence, initiative, activeness, discretionary decision-making, responsibility and accountability, devotion to their profession, receptive potential to others, collegial interdependence, creativity, caring, advocacy, cooperative relationships with clients, shared leadership, healthy work environment, professional skills, and inter-and intra-professional collaboration.
Related case (a fictional case example) It demonstrates key attributes connected to the concept but does not contain all its defining attributes (Walker & Avant, 2018). It elucidates the position of these attributes within the network of related concepts.	JR labored as the Intensive Care Unit (ICU) quality assurance department chairperson. The primary purpose of JR’s work was to ensure quality care for the patients. This department required all staff education, initiation of distinctive documentation, change in practices, and process improvement. Throughout her career, JR became answerable for comparing and re-comparing the unit’s healthcare system to see where it was failing and how it could be improved for patients and staff. JR evaluated the current lack of infection control protocol within the unit and carried out the desired modifications to ensure extra patient safety. JR sought to create a changing culture through education and reminders, such as placing signs reminding staff to apply antiseptic detergents and the way lengthy. JR educated all staff to follow through with paperwork and encouraged best practices throughout the unit. She additionally made antiseptic detergents more readily available for the staff. JR emphasized that it became the nurses’ duty to preserve physicians’ responsible and vice versa.	This case demonstrates clinical leadership, a concept closely related to clinical autonomy. In this case, JR supplied a fantastic example of clinical leadership. However, because the case provides direct communique in the team, it no longer implies a caring, advocacy, and cooperative relationship with patients. This case fails to illustrate the defining attributes of discretionary decision-making as JR kept focusing on nurses’ duty to keep physicians accountable and vice versa. Also, this case fails to illustrate the critical attribute of creativity; placing signs reminding staff to use antiseptic detergents and how long and making antiseptic detergents more readily available for the staff is a not unusual kind of work.
Borderline case (a real case example) This case contains most of the concept’s defining attributes (Walker & Avant, 2018). However, it reveals how some key concept characteristics are often missed.	Last year, SA had a 30-year-old female client with stage colorectal cancer IV. The patient turned coming to get palliative radiation on various parts of her body that have been inflicting her pain. This patient became an inpatient for 3 months, partially due to inadequate pain control and partially to better manage her nutritional status and various radiation burns. The patient sustained a few terrible radiation skin burns. However, what SA took issue with was that aside from placing the patient on patient-controlled analgesia, the hospital no longer seemed like the area where she needed to be. According to the patient, no one (i.e., doctors) got here to talk with her, and she spent her days looking forward to her radiation remedy and being told by her floor nurses to “push the button” if she turned into pain. The patient would come to radiation and demand to see SA (he was her doctor’s nurse) and then tell him that no one was helping her and she desired to move home to see her family. After discussing her case with the doctor SA, it has become obvious to SA that the patient is no longer going to get better, and SA questioned week after week why she is no longer allowed to move home to hospice. SA observed that this partially stemmed from her husband and family’s choice to keep treatments and partially from a loss of initiative on any of her attendings’ parts to begin this conversation and process. She was a patient who complained a lot, and the doctors seemed tired of constantly addressing the same changing concerns. SA met with the patient’s physician and unit manager and suggested two strategies to help. One was committing to maintaining regular multidisciplinary meetings regarding the patient with a complicated case with extended hospitalizations. The other was to have had every doctor, primarily the patient’s inpatient attending, deal with the problem with the patient and her family and discuss the ultimate treatment goals and the future.	Although this case demonstrates professional autonomy, it fails to illustrate some defining attributes of professional autonomy, self-confidence, discretionary decision-making, receptive capacity to others, caring, cooperative relationships with clients, and a healthy work environment. Any proposed care is no longer initiated until after discussing the patient’s case with the doctor SA. The nurse met with the patient’s physician and unit manager to address the two strategies that could help the patient imply little self-confidence and discretion. The patient’s needs and autonomy had been now no longer addressed, indicating the non-receptive potential to others, loss of care, and absence of a cooperative relationship with clients. All of these circumstances are not indicative of a healthy work environment.
Contrary case (a fictional case example) This case exemplifies an instance of “not the concept” and reflects the opposite characteristics of the concept under study (Walker & Avant, 2018).	AR is a registered nurse caring for a 75-year-old female patient who can verbally communicate with the staff regarding her unmet needs. The patient is on scheduled acetaminophen and as-needed tramadol. The patient stated that “she is feeling discomfort” and began withdrawing and refusing breakfast. The nurse was determined to offer PRN analgesics based on her self-reported need for prompt pain management. However, the patient’s caregiver insisted on extra evaluation, which he linked to great concern. AR defined that because the patient is communicating, using self-report tools to assess pain leads to prompt/timely pain management and avoids wasting more time using other complicated pain assessment types. The AR was under subtle pressure from the caregiver, so she looked for additional pain indicators and took a long time to manage analgesia. This resulted in the patient experiencing pain that was not scheduled.	AR illustrates how the registered nurse who has no longer confirmed professional autonomy in pain assessment and management decision-making has erred in clinical judgment, critical thinking, and actions required for an autonomous nurse. All those suggest inattentive and unethical work, especially concerning the patient’s delayed pain treatment.

Table 3.

A Summary of Related Articles on Professional Autonomy in Nursing.

The Order of the Study	Title	Year	Design	Major findings
1.	Abdolmaleki, M., Lakdizaji. S, Ghahramanian. A., Allahbakhshian. A., & Behshid. M. Relationship between autonomy and moral distress in emergency nurses.	2019	A Descriptive Correlational	Emergency nurses’ level of professional autonomy was low, and moral distress was moderate. A negative relationship was reported between professional independence and the frequency of moral distress. Age predicted moral distress and lack of autonomy could lead to moral distress. Increasing professional independence and the use of experienced nurses can reduce moral distress.
2.	Aghamohammadi, D., Dadkhah, B., & Aghamohammadi, M. Nurse-physician collaboration and the professional autonomy of Intensive Care Unit nurses.	2019	A Descriptive Correlational	Good collaboration between physicians and nurses in Intensive Care Units, and nurses reported moderate autonomy. There was no significant relationship between the nurse-physician collaboration and the nurses’ professional autonomy.
3.	Ahn, J., & Back, K. J. The role of autonomy, competence, and relatedness: Applying self determination theory to the integrated resort setting.	2019	A Structural Equation Modeling	Integrated experiences enhance autonomy, competence, and relatedness. Strong attachments and compatibility are predictive of behavioral intention.
4.	Asl, R. G., Taghinejad, R., Parizad, N., & Jasemi, M. The relationship between professional autonomy and job stress among intensive care unit nurses: A descriptive correlational study.	2022	A Descriptive Correlational	Nurses in Intensive Care Units had moderate autonomy and job stress, and their autonomy was a significant positive predictor of their job stress.
5.	Bădileanu, M., Ionel, I. P., Aurelian, J., Cristian, D. A., Jude, C., Georgescu, L. I., & Răpan, I. Perception and deception in nurses’ clinical and work-related professional autonomy: Case study for a hospital in Romania.	2023	A Descriptive Using A Developed Questionnaire-Based Survey	Autonomy was studied from three perspectives: clinical practice independence, autonomy concerning work, and autonomy through digitalization. The college graduate nurses perceived lower levels of independence than post-secondary nurses.
6.	Balasi, L. R., Elahi, N., Ebadi, A., HAzrati, M., & Jahani, S. Barriers and facilitators of professional autonomy of clinical nurses in Iran: A qualitative study.	2022	A Qualitative	Professional organizations can play a key role by enhancing professional autonomy facilitators and increasing professional support for nurses. Training nursing staff to be competent and autonomous should begin early in students’ lives at the college.
7.	Both-Nwabuwe, J. M. C., Lips-Wiersma, M., Dijkstra, M. T. M., & Beersma, B. Understanding the autonomy-meaningful work relationship in nursing: A theoretical framework.	2020	Drawing From Research and Theory in Nursing Literature, Organizational Sciences, and Business Ethics	The proposed model had four parts: the proposed relationships between perceived (1) professional autonomy, (2) individual autonomy, (3) group autonomy with core dimensions of meaningful work, and (4) the proposed relationships between these three forms of autonomy with the dimensions “inspiration” and “facing reality.” Autonomy influences different dimensions of meaningful work.
8.	Choi, S., & Kim, M. Effects of structural empowerment and professional governance on autonomy and job satisfaction of the Korean nurses.	2019	A Sequential, Explanatory, Mixed-Method	Professional governance directed by managers influences decision-making among Korean nurses. The mediating effects were significant between professional governance and the relationships between structural empowerment and autonomy and between structural empowerment and job satisfaction. Inhibitors and facilitators of professional governance were described.
9.	Hara, Y., Asakura, K., & Asakura, T. The impact of changes in professional autonomy and occupational commitment on nurses’ intention to leave: A two-wave longitudinal study in Japan.	2020	A Longitudinal	There were increased secular trends in control over work conditions, a subscale of attitudes toward professional autonomy, and increased intention to leave at Time 2, while increasing secular trends in all subscales of occupational commitment decreased intention to leave at Time 2. Nurses with a progressive attitude toward discretion of control over work conditions may have higher intentions to leave.
10.	Heinen, M., van Oostveen, C., Peters, J., Vermeulen, H., & Huis, A. An integrative review of leadership competencies and attributes in advanced nursing practice.	2019	An Integrative Review	Thirty core competencies in the clinical, professional health systems, and health policy leadership domains were identified. Most competencies fit in one single domain, the health policy domain.
11.	Hsiu-Ying, H. S. U., Heng-Hsin, T. U. N. G., Kevin, K. A. U., Huang, S. S., & Shiow-Luan, T. S. A. Y. Effects of professional autonomy and leadership style on the team-based practice of acute care nurse practitioners in Taiwan.	2022	A Cross-Sectional	No organization-level effects on team-based practice were identified. Nurse Practitioners with greater autonomy in actualization, empowerment, and readiness, and idealized influence leadership style enhanced the performance of the doctor of medicine–Nurse Practitioners team-based practice. Autonomy in actualization and empowerment were identified as the two most important predictors of doctor of medicine– Nurse Practitioners’ team-based practice.
12.	Kim, S. G., & Kang, D. H. S. The effect of perception the importance of patient safety management, professional autonomy and safety climate on patient safety nursing activity on hospital nurses.	2022	A Cross-Sectional	Factors affecting the patient safety nursing activity were safety climate, perception of the importance of patient safety management, and workplace.
13.	Junttila, K., Heikkilä, A., Heikkilä, A., Koivunen, M., Lehtikunnas, T., Mattila, E., … & Tervo-Heikkinen, T. The impact of leadership in the autonomy and engagement of nurses: A cross-sectional multicenter study among nurses outside the United States.	2023	A Cross-Sectional	Engagement increases when nurses actively participate in decision-making and their contributions are valued. The autonomy of nurses is strengthened by visible nurse managers and leaders who effectively represent nurses.
14.	Labrague, L. J., McEnroe-Petitte, D. M., & Tsaras, K. Predictors and outcomes of nurse professional autonomy: A cross-sectional study.	2019	A Cross-Sectional	Nurses’ level of professional autonomy was moderate, and education and the number of hospital beds available were significant predictors. Professional autonomy benefits nurses’ employment outcomes, including organizational commitment, job satisfaction, and work performance.
15.	Nabizadeh-Gharghozar, Z., Alavi, N. M., & Ajorpaz, N. M. Clinical competence in nursing: A hybrid concept analysis.	2021	A Concept Analysis	To bring creativity and innovation to nursing practice, clinical competence constantly requires knowledge, values, attitudes, and critical thinking abilities.
16.	Oshodi, T., Bruneau, B., Crockett, R., Kinchington, F., Nayar, S., & West, E. Registered nurses’ perceptions and experiences of autonomy: A descriptive phenomenological study.	2019	A Descriptive Phenomenological	The six themes found were working independently, working in a team, having professional skills and knowledge, participating in autonomy, setting boundaries for autonomy, and building autonomy requiring help. Rather than a broader professional context, nurses link autonomy to their clinical job and the particular work environment of their clinical settings. Additionally, nurses believed autonomy was a switchable feature rather than an integral part of care.
17.	Peacock, M., & Hernandez, S. (2020). A concept analysis of nurse practitioner autonomy.	2020	A Concept Analysis	In collaboration with other healthcare professionals, a nurse practitioner’s (NP) autonomy was characterized as the NP’s use of their experience, clinical judgment, and duty to practice without limitations. Having autonomy enables NPs to fully exercise their advanced training and engage in beneficial voluntary collaborations.
18.	Peres, M. A. D. A., Paim, L., & Brandão, M. A. G. Professional autonomy as centrality in best practices in nursing.	2020	A Theoretical-Reflective Study	The institutional commitment of health services to formal postgraduate nursing education and the possibility of greater autonomy and quality to express best nursing practices.
19.	Pursio, K., Kankkunen, P., Sanner-Stiehr, E., & Kvist, T. Professional autonomy in nursing –An integrative review.	2021	An Integrative Review	The ability to use one’s expertise and independence in decision-making describes a nurse’s professional autonomy. Shared leadership, professional expertise, inter- and intra-professional teamwork, and a healthy work environment were the themes connected to nurses’ professional autonomy.
20.	Rouhi-Balasi, L., Elahi, N., Ebadi, A., Jahani, S., & Hazrati M. Professional autonomy of nurses: A qualitative meta-synthesis study.	2020	A Qualitative Meta-Synthesis	The three themes of professional competence, professional decision-making, and professional relationships were used to convey the final interpretation of the clinical nurses’ professional autonomy.
21.	Setoodegan, E., Gholamzadeh, S., Rakhshan, M., & Peiravi, H. Nurses’ lived experiences of professional autonomy in Iran.	2019	A Qualitative	Patient and nurse advocacy, workplace independence, participation in professional decision-making, and professional accountability were the themes of professional autonomy.

Independently, two researchers assessed the titles and abstracts discovered using search techniques. The article was eliminated if it was judged after the initial evaluation of the abstract that it did not support the concept being investigated. When there was any doubt as to whether the abstract met the criteria for inclusion of the concept of professional autonomy in nursing, another two researchers decided whether or not it should be included. The whole texts of the chosen articles were then acquired. The full-text publications were independently reviewed by the authors, who then, where needed, confirmed and verified the findings against the inclusion criteria.

The selected reviewed studies had to meet the following criteria to be considered for inclusion: (a) relevance and alignment with the aim of the analysis; (b) use of theoretical and empirical approaches; (c) studies utilizing the concept of professional autonomy in nursing as a primary concept; and (d) full-text studies written in English and published in peer-reviewed journals. Studies not meeting the inclusion criteria were excluded (see Figure 1).

The initial search process yielded 2,000 articles. After screening the titles and abstracts, 1,500 papers were identified, of which 600 were duplicated, giving 900 papers. Of these 900 papers, 350 were retained as nursing studies. After the second title/abstract screening, we excluded another 120 publications since they had no relevance to the theme of professional autonomy in nursing. The 230 studies were assessed and selected for inclusion. Following the full-text screening, 140 articles were eliminated because they didn’t meet the inclusion criteria. After applying the eligibility criteria in the fourth stage, 70 articles were evaluated. Another 28 articles were excluded because they weren’t research papers, and 18 weren’t primary research, yielding 21 papers on nursing professional autonomy. There were six old articles related to measurement tools or instruments.

Results

Choosing the Concept

Different terms were used with the concept of “autonomy in nursing,” such as clinical autonomy, nursing practice autonomy, organizational autonomy, job autonomy, structural or work autonomy, attitudinal autonomy, and personal autonomy (Abdolmaleki et al., 2019; Balasi et al., 2023; Pursio et al., 2021; Rouhi-Balasi et al., 2020), which in turn have been measured differently. However, there were conflicting consequences regarding “professional autonomy in nursing,” and little is known about the development of this concept. As nurses who have worked in various clinical settings, the current researchers chose “professional autonomy” in this concept analysis because it focused on clinical and professional autonomy in decision-making.

Over the years, “professional autonomy in nursing” has had to be continuously assessed regarding many positive outcomes for patients, nurses, and organizations, including increases in nurses’ job satisfaction and retention (Balasi et al., 2023; Both-Nwabuwe et al., 2020; Hara et al., 2020), and work engagement (Junttila et al., 2023). In turn, that increases organizational commitment, perceived patient safety culture (Kim & Kang, 2022), patient satisfaction (Ferreira et al., 2023), and the value of organizations (Labrague et al., 2019).

Differences Between Autonomy and Professional Autonomy

The concept of autonomy is a multidimensional concept that addresses personal freedom, proper self-government, and freedom of will (Asl et al., 2022; Setoodegan et al., 2019), and it has different synonyms, inclusive of “self-determination,” “self-government,” “self-rule,” independence, freedom, liberty, and sovereignty. On the other hand, professional autonomy is the structural or attitudinal characteristic contributing to the concept’s foundation (Bădileanu et al., 2023). Structural autonomy is the employee’s freedom to make job-related decisions based on the job requirements, while attitudinal autonomy is the belief in proper decision-making (Bădileanu et al., 2023).

Professional Autonomy in Nursing and Competency

Nurses’ autonomy is linked to their competency (Ahn & Back, 2019; Nabizadeh-Gharghozar et al., 2021), as both concepts are linked to knowledge and capabilities (Oshodi et al., 2019). Strategies to boost nurses’ competence are needed to create a learning environment that could foster autonomy (Nabizadeh-Gharghozar et al., 2021; Oshodi et al., 2019). To be fully autonomous, nurses should participate in lifelong learning to increase their knowledge (Ahn & Back, 2019). Nurses should use their experience to enhance autonomy and competence (Ahn & Back, 2019; Nabizadeh-Gharghozar et al., 2021). Autonomous nurses provide nursing care based on knowledge, professional expertise, and competencies (Ahn & Back, 2019; Hsiu-Ying et al., 2022; Rouhi-Balasi et al., 2020). Specialization certification gives nurses advanced knowledge and complements competencies and skills (Hsiu-Ying et al., 2022; Rouhi-Balasi et al., 2020). Certification could improve autonomy in practice, empowerment, interprofessional collaboration, and professionalism. Furthermore, professional nursing organizations enhance nurses’ knowledge and increase their skills and competencies (Ahn & Back, 2019; Hsiu-Ying et al., 2022; Rouhi-Balasi et al., 2020).

Improving nurses’ clinical competency increases confidence when making clinical or patient care-related decisions (Ahn & Back, 2019; Hsiu-Ying et al., 2022; Rouhi-Balasi et al., 2020). Such decisions are also based on knowledge; autonomous decision-making improves as nurses increase their competencies and knowledge (Ahn & Back, 2019; Hsiu-Ying et al., 2022; Rouhi-Balasi et al., 2020). The longer the nursing experience, the greater competencies are received and practiced (Abdolmaleki et al., 2019; Hsiu-Ying et al., 2022; Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019). Thus, new knowledge is gained, and the practice will be preserved to become more autonomous over time (Ahn & Back, 2019). Over the years, nurses have been privy to the significance of their capabilities, knowledge, experience, and competency in working autonomously (Ahn & Back, 2019; Oshodi et al., 2019), which positioned them in the “assist and back” to be autonomous professionals.

Professional Autonomy in Nursing and Leadership

Well-trained and knowledgeable nurses and nurse leaders are needed due to the escalating developments in healthcare (Heinen et al., 2019). Leadership competencies and attributes enhance nurses’ autonomy (Heinen et al., 2019). As a newly used term in nursing leadership research, clinical leadership is needed to strengthen nurses’ autonomy (Heinen et al., 2019). Heinen et al. (2019 reported eight core competencies for the clinical leadership domain: (1) oversees the healthcare team’s efforts to improve self-care management and patient engagement, and prevent future negative outcomes such as readmissions. The clinical leaders act as valuable resources, preceptors, mentors/coaches, and role models, especially in terms of reflective and critical thinking; (2) demonstrates clinical expert leadership in organizing and tracking standards of practice aimed at improving patient care; (3) identifies organizational barriers to providing effective patient care; (4) engages in advanced nursing practice and provides evidence-based practice leadership, which necessitates competence in knowledge application activities such as translating studies into practice, improving the trustworthiness of healthcare outcomes, and practicability; (5) leads and acts as a liaison between different health professionals and organizations to improve patients’ outcomes; (6) collaborates with healthcare professionals in planning, putting things into action, looking for ways to improve; (7) aligns practice with the organization’s overall goals; and (8) starts new initiatives for standards, guidelines, and quality assurance, as well as for training and research.

Purpose of the Analysis

The current analysis aims to clarify the concept of “professional autonomy in nursing,” which helps propose an operational definition.

Definitions and Uses of the Concept

The definitions of “professional autonomy in nursing” have been modified. Definitions and measurements of concepts evolve along a continuum of various definitional approaches, necessitating perseverance in studying the concept. Different concepts are used in the literature to describe “nurse autonomy,” such as professional autonomy, independence, self-determination, and self-direction. According to Merriam-Webster Online (Merriam-Webster Dictionary, 2021), autonomy is “the quality or state of self-governing,” with different synonyms for choice, free will, accord, self-determination, will, and volition.

Two categories of “nurse autonomy” are generally recognized; “clinical autonomy” and “professional autonomy.” “Clinical autonomy” refers to the ability of nurses to provide patient care beyond standard practice. There are two sorts of autonomy referred to by the term “professional autonomy”: (1) clinical autonomy, which refers to nurses’ independent and accountable decision-making over patient care (Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019); (2) nursing practice autonomy which refers to nurses’ ability to work according to one’s knowledge and judgment, provide patient care within the nursing scope of practice set by administrative rules (Hara et al., 2020; Pursio et al., 2021; Rouhi-Balasi et al., 2020).

Professional autonomy has the following subsequent factors: (1) shared decision-making concerning patient care, which could positively influence patient safety and the quality of provided healthcare (Peres et al., 2020; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019) and (2) the ability to control conditions in the work environment (Pursio et al., 2021). An autonomous work environment includes performing work based on nurses’ judgment and clinical decision-making (Both-Nwabuwe et al., 2020; Peacock & Hernandez, 2020; Pursio et al., 2021; Rouhi-Balasi et al., 2020).

Pursio et al. (2021 recognized two themes that help in describing nurses’ professional autonomy: (1) independent decision-making (Rouhi-Balasi et al., 2020; Setoodegan et al., 2019) and (2) ability for own competence utilization (Nabizadeh-Gharghozar et al., 2021; Rouhi-Balasi et al., 2020). Independent decision-making over patient care and work is vital because it allows for unlimited usage of nurses’ knowledge in addition to talents (Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020). Independence in work is essential for independence in unit operations (Setoodegan et al., 2019). The ability to make independent decisions for the benefit of patients and on their behalf (Hsiu-Ying et al., 2022; Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019), and the ability to solve problems (Abdolmaleki et al., 2019). Independent decision-making involves control over practices such as self-scheduling, prioritizing work tasks, coordinating patient care, and coping with unit operations (Hara et al., 2020; Hsiu-Ying et al., 2022; Oshodi et al., 2019; Pursio et al., 2021).

Personal competence is defined as the flexibility and obligation to act according to one’s values (Nabizadeh-Gharghozar et al., 2021; Rouhi-Balasi et al., 2020), contributing to the development of nurses’ professional autonomy (Nabizadeh-Gharghozar et al., 2021; Pursio et al., 2021; Rouhi-Balasi et al., 2020). Personal competency encompasses abilities that grow with job experience (Nabizadeh-Gharghozar et al., 2021; Pursio et al., 2021; Rouhi-Balasi et al., 2020). The competency of nurses enables them to participate effectively in decision-making and problem-solving (Nabizadeh-Gharghozar et al., 2021; Pursio et al., 2021). Nurses’ expertise allows them to communicate and contribute to collaboration effectively (Nabizadeh-Gharghozar et al., 2021; Pursio et al., 2021; Rouhi-Balasi et al., 2020).

Attributes of Professional Autonomy in Nursing

The vital part of concept analysis is figuring out the concept’s defining attributes, which deliver a deep perception for the researcher (Walker & Avant, 2018). Attributes are the characteristics that have the most considerable relationship with the concept (Walker & Avant, 2018), and they aid in differentiating the intended concept from similar or related concepts (Walker & Avant, 2018).

The defining attributes of “professional autonomy in nursing” are self-confidence, initiative, activeness, discretionary decision-making (Setoodegan et al., 2019), responsibility and accountability (Setoodegan et al., 2019), devotion to their profession, receptive potential to others, collegial interdependence, creativity, and caring, advocacy (Setoodegan et al., 2019), and cooperative relationships with clients.

According to the reviewed literature and different resources, the defining attributes of “professional autonomy in nursing” are categorized into four themes: (1) shared leadership; (2) professional skills; (3) inter-and intra-professional collaboration; and (4) a healthy work environment (Pursio et al., 2021; Setoodegan et al., 2019).

Shared leadership is the supportive type of leadership that empowers nurses’ influence in their workplace and features a voice concerning practices within their work settings (Abdolmaleki et al., 2019; Pursio et al., 2021). It expands nurses’ authority; that’s the alternative while autocratic control is used.

Professional skills or personal competence are crucial to nurses’ professional autonomy (Rouhi-Balasi et al., 2020). It consists of knowledge, clinical skills, and the capacity to make decisions independently (Abdolmaleki et al., 2019; Hsiu-Ying et al., 2022; Nabizadeh-Gharghozar et al., 2021; Oshodi et al., 2019; Peres et al., 2020; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019). Education is an autonomy-promoting factor; it complements knowledge, skills, and self-reliance while making decisions (Bădileanu et al., 2023; Hsiu-Ying et al., 2022; Nabizadeh-Gharghozar et al., 2021; Peacock & Hernandez, 2020; Peres et al., 2020).

Inter-and intra-professional collaboration in which teamwork and equal nurse-physician collaboration promote nurses’ professional autonomy (Abdolmaleki et al., 2019; Aghamohammadi et al., 2019; Peacock & Hernandez, 2020; Rouhi-Balasi et al., 2020). Cooperation among a team of workers without authoritarian communication increases “professional autonomy in nursing” (Rouhi-Balasi et al., 2020). On the other hand, ignoring nurses’ knowledge associated with inequalities in work contributes negatively to “professional autonomy in nursing” (Abdolmaleki et al., 2019; Aghamohammadi et al., 2019).

A healthy work environment in which a safe and friendly work environment promotes nurses’ autonomy, teamwork, and respectful communication (Pursio et al., 2021). On the contrary, heavy workloads cause moral distress and decrease professional autonomy (Abdolmaleki et al., 2019).

Constructing Cases

Identifying a model case and additional cases represents another way of narrowing the critical attributes in concept analysis (Walker & Avant, 2018). This paper presents the constructed model, related, borderline, and contrary real or fictional cases for professional autonomy in nursing (Supplemental Table 1 [File 1]).

Antecedents

Antecedents are conditions that ought to be met for the concept to occur (Walker & Avant, 2018). The nurse’s autonomy is derived from four vital sources: (1) nursing knowledge (Abdolmaleki et al., 2019; Oshodi et al., 2019; Peacock & Hernandez, 2020; Pursio et al., 2021); (2) social relations (Bădileanu et al., 2023); and (3) positional authority (Bădileanu et al., 2023). (4) The authority of expert knowledge is exerted, positively impacting nurses’ professional autonomy (Abdolmaleki et al., 2019; Oshodi et al., 2019; Pursio et al., 2021). The first two sources suggest that “professional autonomy in nursing” originates from the organization and professional knowledge. “Professional autonomy in nursing” is connected with strongly supportive social relations, so weak or absent social support threatens professional autonomy (Bădileanu et al., 2023).

Bădileanu et al. (2023) reported factors affecting “professional autonomy in nursing.” Those factors were (1) personal factors and (2) work-related factors. Personal factors include nurses’ characteristics that influence “professional autonomy in nursing.” Characteristics include (a) age and experience years; (b) locus of control or self-efficacy or empowerment; (c) educational background; (d) professional role; and (e) gender-stereotyped personality traits. Age and years of experience boomed nurses’ professional autonomy. Locus of control/self-efficacy/ empowerment: the locus of control and empowerment was associated with professional autonomy. Bădileanu et al. (2023), Peacock and Hernandez (2020), and Peres et al. (2020) found that education positively correlates with professional nursing autonomy. Various professional roles in which nurses pursued better positions and better membership levels in professional organizations made them more autonomous than those who were not. Gender-stereotyped personality trait/ Androgyny: females were connected to dependence, passivity, nonaggression, non-competitiveness, empathy, sensitivity, subjectivity, and incapacity to risk. Males were connected to independence, aggression, and leadership. The existence of male personality traits expanded the sense of nurses’ professional autonomy.

Work-related factors or practice setting are the factors that encompass (a) organization structure/work environment: a higher decentralization led to better nurses’ professional autonomy, (b) better teamwork scores led to better degrees of professional autonomy (Rouhi-Balasi et al., 2020), and (c) increased workload contributed to a decrease in professional autonomy (Abdolmaleki et al., 2019).

Consequences

The concept’s consequences are the concept’s outcomes (Walker & Avant, 2018). In work practice, nurses’ accountability is the most important outcome of autonomy (Oshodi et al., 2019; Pursio et al., 2021; Setoodegan et al., 2019). Accountability is typically accompanied by responsibility (Oshodi et al., 2019; Pursio et al., 2021; Setoodegan et al., 2019). Accountability for acts and decisions entails complete disclosure to professionals, clients, and hiring agencies (Setoodegan et al., 2019). Accountability leads to empowerment and self-efficacy (Oshodi et al., 2019; Pursio et al., 2021; Setoodegan et al., 2019). Empowered individuals are enthusiastic about their employment and can impact their work settings (Oshodi et al., 2019; Pursio et al., 2021). Empowerment promotes nursing professionalization (Oshodi et al., 2019; Pursio et al., 2021).

However, the current researchers believe that the most important outcome of autonomy is patient satisfaction. It is contemporary to introduce the concepts of “one health” and the “modern philosophy of quality management.” “One health” is a multidisciplinary approach that helps in achieving optimal health outcomes for people (Abutarbush et al., 2022). These terms focused on patient satisfaction with the provided healthcare; patients are the essential milestone in the current healthcare environments. Ferreira et al. (2023) argued that focusing on the quality of healthcare services is important for meeting patients’ needs and satisfying their “one health.”

Other consequences of “professional autonomy in nursing” include a commitment to the profession and career (Labrague et al., 2019; Rouhi-Balasi et al., 2020). Occupationally dedicated and psychologically empowered nurses can prioritize and schedule tasks (Labrague et al., 2019; Pursio et al., 2021). Professional autonomy increases nurses’ satisfaction with work, and in turn, it results in a higher quality of work (Peres et al., 2020; Pursio et al., 2021), positive nursing outcomes, along with organizational commitment and work performance (Both-Nwabuwe et al., 2020; Pursio et al., 2021).

Empirical Referents

Empirical referents, which are classes or categories of actual phenomena that show the occurrence of the concept, allow for its quantification (Walker & Avant, 2018). Bădileanu et al. (2023) distinguished between the “structural” and “attitude” elements of autonomy. Nurses’ structural or work autonomy refers to their independence in making decisions largely in light of their professional obligations (Setoodegan et al., 2019). One confidence in one’s ability to make choices and use discretion is an example of an attitude of autonomy (Peacock & Hernandez, 2020; Setoodegan et al., 2019). Instruments commonly used to gauge “professional autonomy in nursing” include the Pankratz Nursing Attitude Scale (PNAS; Pankratz & Pankratz, 1974), the Nursing Activity Scale (NAS; Schutzenhofer, 1987), the Dempster Practice Behaviors Scale (DPBS; Dempster, 1990), the Autonomy, the Caring Perspective (ACP) instrument (Boughn, 1995), and the Attitude toward Professional Autonomy Scale for Nurses (Asakura et al., 2016). While the NAS is solely used to test “structural autonomy,” the PNAS, DPBS, and ACP are all used to assess both “structural autonomy” and “attitudinal autonomy” (Bădileanu et al., 2023).

The Pankratz Nursing Attitude Scale was established by Pankratz and Pankratz (1974, and it includes three subscales: (a) nurse autonomy and patient advocacy, (b) patients’ rights, and (c) rejection of nurses’ traditional role limits. The Nursing Activity Scale, a revised version of Schutzenhofer’s (1987) Professional Nursing Autonomy Scale 15 (SPNA), is a 30-item questionnaire that describes unique nursing settings and gives an important scale expressing varying levels of autonomy. The Dempster Practice Behaviors Scale (1990/0) assesses the level of autonomy in practice. It concentrated on the overt and covert behaviors, actions, and behaviors connected with the amount of autonomy an individual has in a clinical environment. There were four subscales in the DPBS: (1) preparation, (2) empowerment, (3) actualization, and (4) valuation. This instrument was used both inside and outside of nursing. The Caring Perspective Instrument (Boughn, 1995) examines the autonomy-related attitudes and behaviors specific to nursing students. In Japan, the Attitude Toward Professional Autonomy Scale for Nurses was recently established (Asakura et al., 2016). The scale measured the cognitive aspects of professional autonomy in nurses working in various clinical contexts. The scale was pilot-tested and psychometrically assessed in two versions: an initial (26-item) version and a revised version (19 items) that revealed excellent internal consistency (=0.85) and concurrent validity.

The Proposed Definition of the Concept

Based on the existing concept analysis, “professional autonomy in nursing” is the professional nurse’s competency and innovative performance to determine independent or interdependently nursing activities while conserving accountability for decisions and reflecting advocacy and caring.

Discussion

Concepts are the basic building blocks of the theoretical framework of every field, and the efficiency of the concept analysis determines the strength of a profession’s guiding theories. As it is the most important case, our model case showed that the attributes of “professional autonomy in nursing” include self-confidence, discretionary decision-making, responsibility and accountability, collegial interdependence, creativity, caring, advocacy, cooperative relationships with clients, shared leadership, healthy work environment; these attributes were consistent with the literature (Pursio et al., 2021; Setoodegan et al., 2019).

According to the findings of the current concept analysis, “professional autonomy in nursing” is highly associated with patient care decision-making (Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019). In clinical practice, nurses suffer numerous restraints, including work rules, regulations, and ethical norms that limit their full autonomy.

Independent decision-making and skills characterize nurses’ professional autonomy (Rouhi-Balasi et al., 2020; Setoodegan et al., 2019). “Professional autonomy in nursing” is often mistaken with “clinical autonomy,” therefore distinguishing the two notions could be beneficial (Pursio et al., 2021; Rouhi-Balasi et al., 2020). “Professional autonomy in nursing” includes clinical autonomy (Oshodi et al., 2019; Pursio et al., 2021; Rouhi-Balasi et al., 2020; Setoodegan et al., 2019). As a result, it is mostly a measuring issue, and the equipment precisely measures the dimensions and labels the concepts differently.

“Professional autonomy in nursing” is a complex and multidimensional concept resulting from life experiences that include education, one’s beliefs, and socialization (Bădileanu et al., 2023; Peres et al., 2020; Setoodegan et al., 2019). The emerged definitions of “professional autonomy in nursing” in the current concept analysis support the critical attributes of the concept, especially discretionary decision-making (Setoodegan et al., 2019). This professional autonomy will not suddenly happen; it is based on competence and professional skills, initiative, activeness, responsibility, and accountability (Nabizadeh-Gharghozar et al., 2021; Setoodegan et al., 2019). Furthermore, this autonomy requires the receptive potential to others, collegial interdependence, creativity, caring, advocacy (Setoodegan et al., 2019), and inter-and intra-professional collaboration (Peacock & Hernandez, 2020; Rouhi-Balasi et al., 2020). Understanding the multidimensionality of “professional autonomy in nursing” is critical in creating supportive work environments that promote nurses’ professional autonomy (Pursio et al., 2021). Supportive work environments encompass shared leadership that empower nurses (Oshodi et al., 2019; Pursio et al., 2021). However, shared leadership spreads slowly as healthcare organizations have a sturdy hierarchy (Pursio et al., 2021).

Antecedents of “professional autonomy in nursing” included nursing knowledge and certain personal factors (Abdolmaleki et al., 2019; Oshodi et al., 2019; Pursio et al., 2021). Autonomous nurses use their knowledge, experience, and courage to complete the task (Setoodegan et al., 2019). Based on knowledge and confidence, independent decision-making could be improved (Setoodegan et al., 2019). Social relations enhance the professional autonomy of nurses’ attributes of receptive capacity to others, collegial interdependence, cooperative relationships with clients, and inter-and intra-professional collaboration (Bădileanu et al., 2023; Peacock & Hernandez, 2020; Pursio et al., 2021; Rouhi-Balasi et al., 2020). Professional autonomy could grow with age, experience, and education (Bădileanu et al., 2023; Peres et al., 2020). A good way to promote professional autonomy is to ease conserving positions; that is, positional authority and higher management professional roles could increase nurses’ horizons and, in turn, promote “professional autonomy in nursing” (Bădileanu et al., 2023). Autonomous nurses have a more significant locus of control and self-efficacy (Bădileanu et al., 2023), and as their nurse managers empower them, they will empower other nurses. Regarding gender-stereotyped personality traits, autonomy is about power dynamics between physicians, nurses, and men and women (Aghamohammadi et al., 2019). These relationships are closely associated with nursing and medical inequality, and this trend has to be overcome by promoting a conducive work environment and a professional practice environment.

Among work-related factors, it is critical to empower nurses to participate in decision-making (Setoodegan et al., 2019), planning, and nursing development through shared leadership. Participatory decision-making improves the recruitment and retention of skilled nurses (Oshodi et al., 2019; Pursio et al., 2021). Managers must examine organizational policies that aid nurses’ professional autonomy and help them share knowledge and expertise with team members, improving patient-centered care (Pursio et al., 2021). Nurse managers and leaders have to support a high-quality and professional work environment because organizational constraints, which include autocratic management and hierarchy, absence of control over practice, and uncertain or strict organizational rules, are detrimental to nurses’ professional autonomy (Hara et al., 2020; Oshodi et al., 2019; Pursio et al., 2021; Setoodegan et al., 2019). Overload makes it hard for nurses to think positively about their professional autonomy (Bădileanu et al., 2023).

Accountability, empowerment of self and others, the ability to change the work environment, commitment to the profession, responsibility, personal efficacy, positive feelings about one’s job, and strengthened nursing professionalization were all consequences of “professional autonomy in nursing” (Bădileanu et al., 2023). A shared governance structure promotes nurses’ empowerment, fosters professional autonomy, and promotes evidence-based decision-making (Choi & Kim, 2019). Shared governance assists in recruiting and maintaining qualified nurses who value professional development and are highly committed to the profession and career (Labrague et al., 2019; Rouhi-Balasi et al., 2020). Nurses who work in organizations with shared governance are accountable and responsible (Bădileanu et al., 2023; Oshodi et al., 2019; Pursio et al., 2021; Setoodegan et al., 2019). Nurses’ self-efficacy is essential in motivating nurses to pursue nursing as a lifelong career (Hara et al., 2020; Oshodi et al., 2019; Pursio et al., 2021). Providing opportunities for mastering experiences and mentorship influences nurses’ self-efficacy (Oshodi et al., 2019; Pursio et al., 2021). As they are autonomous, nurses would like to work in environments that increase their professional capacity to practice autonomously (Oshodi et al., 2019; Pursio et al., 2021); this per se is a strengthening of nurses’ professionalism away from medical dominance (Oshodi et al., 2019; Pursio et al., 2021). Cao et al. (2023) reported that individuals who pursue excellence and autonomy in their workplace are more motivated and devoted to their work than their counterparts, which would result in high-quality care.

Conclusions

With the increased emphasis on healthcare quality, patient satisfaction, and professional development, nurses’ professional autonomy is still crucial; thus, “professional autonomy in nursing” is required. “Professional autonomy in nursing” evolves; it is continuous and dynamic. This concept analysis exhibits numerous meanings, instruments, and associated elements contributing to “professional autonomy in nursing.”

Implications of the Findings

The findings of the current concept analysis have many implications for practice, education, and research. The results can support nursing practice and empower nurses to be autonomous; therefore, they must use their knowledge and abilities fully. Additionally, nurse managers must constantly enhance their nurses’ job commitment by offering professional development programs (Hara et al., 2020). The current analysis results may increase the understanding of nurses’ professional autonomy and enhance the attractiveness of work environments. Pursio et al. (2021) reported that nurses’ autonomy is promoted by a safe and friendly work environment, which is engulfed with good team spirit, adequate resources, and staffing. In turn, nurses have more time to spend with their patients.

For education to promote “professional autonomy in nursing,” the curriculum needs a robust educational foundation. Education should prepare graduates who show off characteristics important to acting in the public interest and contributing to healthcare enhancements in general and nursing. With the accelerated use of the era and the modifications in clients’ demographics, including age, curricula must cope with state-of-the-art technical skills that include but are not limited to accurate assessment through evaluation, problem-solving, decision-making, and conflict management. Educators should help pre-registration students fully embrace autonomy as they move toward graduation and know that “owning their practice” in terms of accountability and responsibility is what practice professionals are keen to see. Furthermore, educators have to embrace the autonomy and responsibility of nursing students. Thus, educators should customize learning environments to best suit the social and professional dynamics in their society and the nursing profession (du Toit-Brits & Blignaut, 2023). Educators must empower their students to be self-directed learners through using technology-enabled lifelong learning (du Toit-Brits & Blignaut, 2023). The use of active methodologies would promote nursing students’ autonomy, taking into consideration that they the future practicing nurses (de Alcântara Thimóteo et al., 2022). The authors reported that active learning methodologies allow greater participation, and students’ engagement and collaboration in the learning process. These active methodologies aimed at producing autonomous students based on their abilities and needs (de Alcântara Thimóteo et al., 2022). An example of active methodologies in academia, Rotation by Stations, offers a relevant student the method that proposes proactivity, collaboration, and engagement of students in the proposed tasks or activities (de Alcântara Thimóteo et al., 2022).

The concept’s development exists at various times; thus, studies in this vicinity should be continued. Additional research is needed to clarify the concept and its values in improving nursing practice and education. The professional socialization of nurses and the socialization of women ought to be similarly studied as they have been stated to inhibit the improvement of “professional autonomy in nursing.” Future research is needed to promote “professional autonomy in nursing” by changing nurses’ roles due to the introduction and evolution of digital healthcare (Pursio et al., 2021; Setoodegan et al., 2019). Most of the existing tools examine “professional autonomy in nursing” from professionals’ perspectives; for this reason, new tools are needed to measure professional autonomy from patients’ and healthcare administrators’ perspectives.

Study’s Limitations

This analysis has a set of limitations that should be considered before interpreting the results. Walker and Avant’s (2018) eight-step method does not determine a specific strategy for identifying the uses of the concept under study. However, we sought to tackle this shortcoming by using a comprehensive methodology. Most constructed cases were created hypothetically, limiting their application in real-world situations.

Supplemental Material

sj-docx-1-sgo-10.1177_21582440241302129 – Supplemental material for Professional Autonomy in Nursing: A Concept Analysis

Supplemental material, sj-docx-1-sgo-10.1177_21582440241302129 for Professional Autonomy in Nursing: A Concept Analysis by Majd T. Mrayyan, Abdallah Abu Khait, Mohammad Rababa, Abdullah Algunmeeyn, Sami Al-Rawashdeh, Nijmeh AL-Atiyyat, Majdi Rababa, Ahmed Abu Saraya and Saleem Al-Rjoub in SAGE Open

Supplemental Material

sj-docx-2-sgo-10.1177_21582440241302129 – Supplemental material for Professional Autonomy in Nursing: A Concept Analysis

Supplemental material, sj-docx-2-sgo-10.1177_21582440241302129 for Professional Autonomy in Nursing: A Concept Analysis by Majd T. Mrayyan, Abdallah Abu Khait, Mohammad Rababa, Abdullah Algunmeeyn, Sami Al-Rawashdeh, Nijmeh AL-Atiyyat, Majdi Rababa, Ahmed Abu Saraya and Saleem Al-Rjoub in SAGE Open

Footnotes

Acknowledgements

The first researcher would like to thank all participants for their input in the current study.

CRediT Authorship Contribution Statement

All authors have agreed on the final version and meet at least one of the following criteria (recommended by the International Committee of Medical Journal Editors []): substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content.

Professor Mrayyan developed the study’s conception, literature review, method, and discussion, wrote the first and second drafts of the paper, and supervised the whole work.

Dr. Abu Khait and Dr. Mohammad Rababa developed other synthesizing concept analysis cases of professional autonomy, synthesizing cases to fit the concept analysis criteria’ elements, and did the critical revisions accordingly. Dr. Abu Khait, Dr. Al-Rawashdeh, and Dr. Algunmeeyn did the whole study’s critical revisions, synthesized the parts, and proofread the final paper. Dr. Abu Khait and Dr. Algunmeeyn revised the discussion section, wrote the limitations, and critically revised the constructed cases. Dr. Abu Khait, Dr. AL-Atiyyat, and Dr. Algunmeeyn helped integrate the whole parts, final critical revisions, final editing, and proofreading and applied the journal formatting. Dr. Abu Khait and Dr. Majdi Rababa applied the method part, developed some concept analysis cases, developed some concept analysis cases of professional autonomy, and did the critical revisions. Dr. Algunmeeyn worked and managed journal selection and worked as the corresponding author. Dr. Al-Rjoub proofread the whole work. Mr. Abu Saraya applied the method part and developed the cases of the concept analysis of competency in nursing, which gave the directions for the cases developed in the current autonomy concept analysis paper.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Ethics Approval

Ethical approval is not required for this concept analysis.

ORCID iDs

Majd T. Mrayyan

Mohammad Rababa

Sami Al-Rawashdeh

Majdi Rababa

Data Availability Statement

No additional data is available.

Supplemental Material

Supplemental material for this article is available online.

References

Abdolmaleki

Lakdizaji

Ghahramanian

Allahbakhshian

Behshid

(2019). Relationship between autonomy and moral distress in emergency nurses. Indian Journal of Medical Ethics, 4(1), 20–25. https://doi.org/10.20529/IJME.2018.076

Abutarbush

S. M.

Hamdallah

Hawawsheh

Alsawalha

Elizz

N. A.

Dodeen

(2022). Implementation of one health approach in Jordan: Review and mapping of ministerial mechanisms of zoonotic disease reporting and control, and inter-sectoral collaboration. One Health, 15, 100406. https://doi.org/10.1016/j.onehlt.2022.100406

Aghamohammadi

Dadkhah

Aghamohammadi

(2019). Nurse-physician collaboration and the professional autonomy of intensive care units nurses. Indian Journal of Critical Care Medicine, 23(4), 178–181. https://doi.org/10.5005/jp-journals-10071-23149

Ahn

Back

K. J.

(2019). The role of autonomy, competence and relatedness: Applying self determination theory to the integrated resort setting. International Journal of Contemporary Hospitality Management, 31(1), 87–104. https://doi.org/10.1108/ijchm-01-2018-0088

Asakura

Satoh

Watanabe

(2016). The development of the attitude toward professional autonomy scale for nurses in Japan. Psychological Reports, 119(3), 761–782. https://doi.org/10.1177/0033294116665178

Asl

R. G.

Taghinejad

Parizad

Jasemi

(2022). The relationship between professional autonomy and job stress among intensive care unit nurses: A descriptive correlational study. Iranian Journal of Nursing and Midwifery Research, 27(2), 119–124. https://doi.org/10.4103/ijnmr.ijnmr_375_20

Bădileanu

Ionel

I. P.

Aurelian

Cristian

D. A.

Jude

Georgescu

L. I.

Răpan

(2023). Perception and deception in nurses’ clinical and work-related professional autonomy: Case study for a hospital in Romania. Sustainability, 15(1), 355. https://doi.org/10.3390/su15010355

Balasi

L. R.

Elahi

Ebadi

Hazrati

Jahani

(2023). Barriers and facilitators of professional autonomy of clinical nurses in Iran: A qualitative study. Indian Journal of Medical Ethics, 8(1), 24–31. https://doi.org/10.20529/ijme.2022.027

Both-Nwabuwe

J. M. C.

Lips-Wiersma

Dijkstra

M. T. M.

Beersma

(2020). Understanding the autonomy–meaningful work relationship in nursing: A theoretical framework. Nursing Outlook, 68(1), 104–113. https://doi.org/10.1016/j.outlook.2019.05.008

10.

Boughn

(1995). An instrument for measuring autonomy-related attitudes and behaviors in women nursing students. Journal of Nursing Education, 34(3), 106–113. https://doi.org/10.3928/0148-4834-19950301-05

11.

Cao

Song

Chen

Wang

Yang

(2023). What is nursing professionalism? A concept analysis. BMC Nursing, 22(1), 34. https://doi.org/10.1186/s12912-022-01161-0

12.

Choi

Kim

(2019). Effects of structural empowerment and professional governance on autonomy and job satisfaction of the Korean nurses. Journal of Nursing Management, 27(8), 1664–1672. https://doi.org/10.1111/jonm.12855

13.

de Alcântara Thimóteo

A. C.

de Carvalho Fontana

C. G.

de Jesus

G. C.

Dos Santos

J. P.

Amaral

L. H.

Junger

A. P

. (2022). The use of active methodologies as a means of promoting autonomy to higher education students. Conjecturas, 22(10), 48–63. https://doi.org/10.53660/conj-1644-edu07

14.

Dempster

J. S.

(1990). Autonomy in practice: Conceptualization, construction, and psychometric evaluation of an empirical instrument. Dissertation Abstract International, 50(07), 3320A (UMI no. 9030752).

15.

du Toit-Brits

Blignaut

J. H

. (2023). Learning, teaching, and assessment methodologies in distance education research: A meaningful self-directed learning approach. Does distance education in the developing context need more research? Building practice into theory. ESI Press University of Pretoria.

16.

Ferreira

D. C.

Vieira

Pedro

M. I.

Caldas

Varela

(2023). Patient satisfaction with healthcare services and the techniques used for its assessment: A systematic literature review and a bibliometric analysis. Healthcare, 11(5), 639. https://doi.org/10.3390/healthcare11050639

17.

Hara

Asakura

(2020). The impact of changes in professional autonomy and occupational commitment on nurses’ intention to leave: A two-wave longitudinal study in Japan. International Journal of Environmental Research and Public Health, 17(17), 6120. https://doi.org/10.3390/ijerph17176120

18.

Heinen

van Oostveen

Peters

Vermeulen

Huis

(2019). An integrative review of leadership competencies and attributes in advanced nursing practice. Journal of Advanced Nursing, 75(11), 2378–2392. https://doi.org/10.1111/jan.14092

19.

Hsiu-Ying

H. S. U.

Heng-Hsin

T. U. N. G.

Kevin

K. A. U.

Huang

S. S.

Shiow-Luan

T. S. A. Y

. (2022). Effects of professional autonomy and leadership style on the team-based practice of acute care nurse practitioners in Taiwan. Journal of Nursing Research, 30(1), e191. https://doi.org/10.1097/jnr.0000000000000461

20.

Junttila

Heikkilä

Koivunen

Lehtikunnas

Mattila

Meriläinen

Peltokoski

Sneck

Tervo-Heikkinen

(2023). The impact of leadership in the autonomy and engagement of nurses: A cross-sectional multicenter study among nurses outside the United States. JONA: The Journal of Nursing Administration, 53(1), 19–26. https://doi.org/10.1097/nna.0000000000001237

21.

Kim

S. G.

Kang

D. H. S.

(2022). The effect of perception the importance of patient safety management, professional autonomy and safety climate on patient safety nursing activity on hospital nurses. Journal of Digital Convergence, 20(4), 715–724. https://doi.org/10.14400/JDC.2022.20.4.715

22.

Labrague

L. J.

McEnroe-Petitte

D. M.

Tsaras

(2019). Predictors and outcomes of nurse professional autonomy: A cross-sectional study. International Journal of Nursing Practice, 25(1), e12711. https://doi.org/10.1111/ijn.12711

23.

Merriam-Webster Dictionary. (2021). Merriam-Webster Online. https://www.merriam-webster.com/dictionary/autonomy.

24.

Moher

Liberati

Tetzlaff

Altman

D. G.

(2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. Plos Medicine, 6(7), e1000097. https://doi.org/10.1371/journal.pmed.1000097

25.

Nabizadeh-Gharghozar

Alavi

N. M.

Ajorpaz

N. M.

(2021). Clinical competence in nursing: A hybrid concept analysis. Nurse Education Today, 97, 104728. https://doi.org/10.1016/j.nedt.2020.104728

26.

Oshodi

T. O.

Bruneau

Crockett

Kinchington

Nayar

West

(2019). Registered nurses’ perceptions and experiences of autonomy: A descriptive phenomenological study. BMC Nursing, 18, 51.

27.

Pankratz

(1974). Nursing autonomy and patients’ rights: Development of a nursing attitude scale. Journal of Health and Social Behavior, 15(3), 211–216.

28.

Peacock

Hernandez

(2020). A concept analysis of nurse practitioner autonomy. Journal of the American Association of Nurse Practitioners, 32(2), 113–119. https://doi.org/10.1097/JXX.0000000000000374

29.

Peres

M. A. D. A.

Paim

Brandão

M. A. G.

(2020). Professional autonomy as centrality in best practices in nursing. Revista Brasileira de Enfermagem, 73(2), e20180373. https://doi.org/10.1590/0034-7167-2018-0373

30.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] Group. (2022). PRISMA checklist. http://www.prisma-statement.org/prisma-2020-checklist

31.

Pursio

Kankkunen

Sanner-Stiehr

Kvist

(2021). Professional autonomy in nursing: An integrative review. Journal of Nursing Management, 29(6), 1565–1577. https://doi.org/10.1111/jonm.13282

32.

Rouhi-Balasi

Elahi

Ebadi

Jahani

Hazrati

(2020). Professional autonomy of nurses: A qualitative meta-synthesis study. Iranian Journal of Nursing and Midwifery Research, 25(4), 273–281. https://doi.org/10.4103/ijnmr.IJNMR_213_19

33.

Schutzenhofer

K. K.

(1987). The measurement of professional autonomy. Journal of Professional Nursing, 3(5), 278–283. https://doi.org/10.1016/s8755-7223(87)80039-x

34.

Setoodegan

Gholamzadeh

Rakhshan

Peiravi

(2019). Nurses’ lived experiences of professional autonomy in Iran. International Journal of Nursing Science, 6(3), 315–321. https://doi.org/10.1016/j.ijnss.2019.05.002

35.

Vaughn

(2023). The call for greater autonomy in nursing. https://www.nurse.com/blog/autonomy-in-nursing/

36.

Walker

Avant

(Eds.). (2018). Strategies for theory construction in nursing (6th ed.). Pearson.

37.

Weston

M. J.

(2008). Defining control over nursing practice and autonomy. JONA: The Journal of Nursing Administration, 38(9), 404–408. https://doi.org/10.1097/01.nna.0000323960.29544.e5

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