The patient had come out of surgery an hour earlier. As he arrived at his inpatient room, he felt his body temperature suddenly rising rapidly and knew his organs wouldn’t appreciate it. So, as calmly as he could, he asked (told) the nurse to cool him down.

She put her wrist to his forehead and knew right away he wasn’t overreacting.

Fortunately for this patient, this nurse didn’t feel it necessary to page a physician or contact the charge nurse and wait for guidance or permission to do something. Within minutes, she used wet washcloths and an electric fan to drop his temperature back to normal.

What Is Autonomy in Nursing?

The scenario above is an example of nursing autonomy, which is characterized by nurses thinking and acting by themselves without seeking approval.

A broader description comes from the American Nurses Association’s Magnet Recognition Program. This program identifies 14 Forces of Magnetism, and the ninth Force is nursing autonomy:

Autonomy in nursing is the ability of the nurse to assess and perform nursing actions for patient care based on competence, professional expertise, and knowledge. The nurse is expected to practice autonomously, exercising independent judgment within the context of interdisciplinary and multidisciplinary approaches to patient care.

Researchers have further identified two types of autonomy in nursing:

  1. Clinical autonomy is the authority, freedom, and discretion of nurses to make judgments about patient care.
  2. Control over nursing practice is the authority, freedom, and discretion of nurses to make decisions related to the practice setting, such as the organizational structure, governance, rules, policies, and operations. This second type of autonomy requires nurses to work within the administrative arena to impact the work environment.

Nursing autonomy requires a lot of resources, training, and work to develop and sustain. Is it worth all that effort?

video tigerconnect patient engagement

TigerConnect Patient Engagement: Video, Voice & Text in one Easy App

Simple and secure virtual communication for providers and patients.

Why Should We Even Care about Autonomy in Nursing?

Fortunately, there’s an easy answer, driven by more than 30 years of research and experience. Let’s look at three proof points.

Proof Point #1: Strong Autonomy Reduces 30-Day Mortality Rates

A study involving more than 100,000 nurses and 570 hospitals from four states (California, Florida, New Jersey, and Pennsylvania) established a nursing autonomy score at each hospital. Scores ranged from 2.03 to 3.56.

The study reviewed over 1.2 million surgical patients from 570 hospitals. The conclusion? Raising the nursing autonomy score by one point caused 30-day post-surgery mortality to drop by 19 percent.

To be clear, this study adjusted for all the other factors that could affect the 30-day mortality rate. This means that nearly every surgical patient at a hospital with a 2.3 nursing autonomy score would be 19 percent more likely to be alive after 30 days if they had gone to a hospital with a 3.3 nursing autonomy score. Autonomy in nursing has that much of an impact!

Proof Point #2: Weak Autonomy = Reduced Collaboration = Lower Quality of Care, Patient Satisfaction, and Reimbursement

Another study on autonomy in nursing focused on ICU nurses and showed a domino effect. Nurse autonomy and nurse-physician collaboration rise and fall together. When they fall, the quality of care is reduced. And when the quality of care drops, we see more metrics going down, such as patient satisfaction, HCAHPS scores, and the reimbursements tied to patient satisfaction scores.

Proof Point #3: Weak Autonomy and Weak Collaboration Raise Moral Distress and Intention to Quit

The study of ICU nurses revealed a second problem with limited autonomy and the linked drop-in nurse-physician collaboration. Yes, patients get a lower quality of care, but nurses suffer, too.

ICU nurses routinely make a patient care decision every 30 seconds and approximately nine important patient care decisions each hour. But when they are blocked from translating their moral decisions into moral action, many nurses report moral distress because they can’t give the care they believe is needed.

Furthermore, as moral distress climbs, it drags “intention to quit” along with it.

Some perspective: In a restaurant, we may endure small annoyances when our waiter is frustrated and wants to quit. His attitude may show as he serves us. But when the frustrated, disgruntled person is a nurse responsible for the medical care of our parent or our child, that’s an entirely different level of bad.

So we can see why nursing autonomy is important. How can hospitals, clinics, and nurse leaders enhance it?

3 Ways to Enhance Autonomy in Nursing

To be knowledgeable and confident was found to be the coherent meaning of autonomy in nursing practice. To gain autonomous practice, nurses must be competent and have the courage to take charge in situations where they are responsible. – The Meaning of Autonomy in Nursing Practice

Many factors affect nursing autonomy, but they can be summed up in two words: knowledge and confidence.

The best way to enhance nursing autonomy, then, is for nurses to grow in knowledge and confidence. For example, nurses can increase cultural, technical, and scientific knowledge through additional training and education. They can increase confidence through professional experience, effective communication skills, and leadership opportunities.

Obvious ways hospital leadership can improve nurse autonomy would be to encourage nurses to pursue new certifications or job-shadow nurse leaders. Leadership can also enhance nurse autonomy by improving the technology that supports it.

Tip 1: Embrace New Options for Communication with Patients

“Nurses who established a relationship with their patients led to a better understanding of the patient’s situation. Nurses were better positioned to advocate for their patient’s needs. A stronger nurse-patient relationship gave nurses the opportunity to provide holistic care and act autonomously.” – Dr. Jamie Murphy, “Transitions to Professional Nursing Practice

Whether we’re talking about registered nurses in the inpatient setting or advanced practice nurses in a primary care clinic, nurses can serve patients better when they know and understand more about them.

Nurses today have access to excellent training on how to communicate effectively with patients. Let’s look at two ways technology is complementing those communication techniques.

Alexa, the New Nurse Call Button

Push a button, get a nurse. It’s helpful, but it has its limits. For one thing, it depends on busy people to capture and relay the purpose of the call.

Replace the nurse call button with the Amazon Echo, integrated with secure texting and an always-updated care team list, and the nurse immediately gets a detailed message containing exactly what the patient requested. No delays waiting for a generic “come here I need you” message.

Secure Text, Images, and Video – Anywhere, Anytime

Nurses can communicate with patients through phone calls and simple text messages. But it takes a thousand words to describe a picture, and PHI in a non-secure text message is a no-no.

Today’s best mobile apps deliver rich interactions because patients and nurses can easily share the full story through HIPAA-compliant text messages, images, recorded videos, and live virtual visits. Each connection helps the nurse know the patient more personally and more deeply, enabling the nurse to understand and care for the whole person.

Tip 2: Facilitate Communication with Current Care Team Members

The second proof point explores the link between nurse-physician collaboration and nurse autonomy. When collaboration is improved, so is autonomy. And collaboration can be improved by giving nurses a superior method for clinical communication and collaboration with physicians and other team members.

A superior communication and collaboration solution is PERFECT:

  • Protected: Nurses need not worry about PHI escaping or being intercepted and exploited.
  • Easy: Nurses use their own smartphones and a simple-to-use mobile app.
  • Reliable: Nurses are rarely locked out – should have 99.99% uptime.
  • Fast: Nurses send detailed text messages, images, and videos without having to log in to a computer workstation.
  • Economical: Organizations can replace pager technology for a fraction of the cost, and training is minimal because nurses already know how to use smartphone apps.
  • Connected: Nurses can interact with the EHR from their phone, viewing radiology images and lab results wherever they are.
  • Targeted: Nurses always reach current care team members and on-call staff, even if other clinicians are away from the office or hospital, and even seconds after a shift change.

Tip 3: Speed the Flow of Timely Patient Information to Nurses

If nurses are to act autonomously, they must have access to accurate, timely clinical information. This is where they receive vital support from a PERFECT communication and collaboration solution.

An example of this support comes from the Protected and Fast elements. Since texting is secure, nurses can include detailed PHI in their questions. More importantly, physicians and nurse managers can text back immediately without concerns of a HIPAA violation. Nurses get accurate answers quickly.

Nurses experience a second example of this support through the Connected and Targeted elements. When a critical lab result is expected, the attending nurse does not have to check her EHR inbox continually. Instead, she receives an alert on her smartphone when the result is available.

And if the nurse needs to follow up with the attending physician, there’s no need to search for the physician’s name in a spreadsheet or on a whiteboard. No need to send a page without any way to know when it is gets read. The system knows who the attending is, and the system includes status indicators to tell the nurse what time her message was delivered and read.


Actions taken to advance knowledge and confidence will lead to improving a nurse’s ability to make independent decisions about clinical practice. – Dr. Jamie Murphy, “Transitions to Professional Nursing Practice

When nurses act autonomously, patients receive better care, and nurses experience higher job satisfaction.

Nurses become more autonomous as their knowledge and confidence increase. And PERFECT technology can improve nurses’ knowledge and confidence by enabling them to easily reach care team staff, collaborate, and access information about a patient.

Providing nurses PERFECT technology, such as the TigerConnect care team collaboration and patient communication platform, leads to greater autonomy in nursing, which in turn leads to improved outcomes for both nurses and their patients.

Learn more about TigerConnect’s Clinical Collaboration Software PlatformResident Scheduling SoftwarePhysician Scheduling SoftwareAlarm Management & Event Notification Software & Patient Engagement Software.

directive autonomy supporting assets blog header image

Stay Connected & Receive our Latest Healthcare Insights