The Call for Greater Autonomy in Nursing

 In Nurses Weekly

Today’s health care system faces complex challenges, many brought to greater focus during the pandemic. Healthcare organizations continue to experience numerous challenges ranging from supply and demand issues, quality outcomes, and addressing the nursing workforce shortage. Transforming our current healthcare delivery model to address these challenges will require greater autonomy in nursing and flexibility built into nurse roles.

The future of healthcare will require a strong, capable nursing workforce prepared to provide care and promote health and well-being among fellow colleagues and patients. Ensuring nurses can practice to the fullest extent of their licensure and training is a first step.

Understanding autonomy in nursing

Like any profession, autonomy refers to one’s ability to think critically and act independently on the job. In healthcare, nursing autonomy is based on an individual nurse’s knowledge and training. With autonomy, a nurse can act on patient care matters without approval from other members of the healthcare team, including physicians.

As discussed in the Institute of Medicine’s (now the National Academy of Medicine) The Future of Nursing 2020-2030: Charting a Path To Achieve Health Equity report, nurses should be included as full partners (with physicians and other healthcare professionals) in redesigning healthcare in the U.S.

The report also specifically states the need for eliminating restrictions on the scope of practice of advanced practice registered nurses and registered nurses so they can practice to the full extent of their education and training. This would better position nurses to increase the types and amount of high-quality health care services that can be provided to those with complex health and social needs and improve both access to care and health equity.

How autonomy in nursing varies

A clear example of how nursing autonomy differs exists within the role of nurse practitioners (NPs) across the country. Currently, 26 states and the District of Columbia allow full practice authority for NPs. This authority includes the ability to provide treatment without the presence of a physician, prescribe medication, and diagnose patients. In 11 states, NPs require physician oversight for all practice and in 16 states, NPs need a physician’s authority to prescribe medication.

A well-known piece of legislation for registered nurses, the Nurse Licensure Compact (NLC), allows nurses to have one license and practice in multiple states. Currently, the majority of states within the U.S. belong to the NLC, making it easier for nurses to quickly transition from different travel assignments or new roles within the same health system. This type of license is an example of how autonomy in nursing can ensure alignment across the healthcare industry’s nearly four million nurses.

Less burnout

A recent study funded by the Agency for Healthcare Research and Quality reported that less burnout was noted in nurses who are engaged and involved in quality improvement measures. The nurses who received frequent patient experience reports and experienced quality improvement efforts as integrated into patient care did not report feeling burned out.

In a culture that does not value autonomy in nursing, nurses may feel unappreciated, undermined, and unmotivated for the very things that inspired them to enter nursing in the first place.

“Nurses want to share their expertise and ideas, and it’s important not only that they feel comfortable doing so, but are encouraged to,” noted Felicia Sadler, MJ, BSN, RN, CPHQ, LSSBB, Vice President of Quality at Relias. “When nurses are heard, they feel valued, more engaged, and more empowered to make improvements in patient care,” she added.

Impact on patient care

There’s been a well-documented shortage of nurses, but this shortage also extends to physicians. Studies have shown that the need for physicians will be far greater than the number of them available to work, and this shortage is predicted to continue. This deficit is estimated to be over 130,000 physicians by the year 2030, affecting both primary care and specialty areas.

Many factors are responsible for this shortage, with some physicians retiring early due to burnout, decreasing medical school enrollment, the cost of education, as well as fewer residency programs. Many solutions have been proposed to help improve the shortage. One of the ways healthcare systems are combatting this physician shortage is by filling the need for nurse practitioners (NPs) to provide care, thereby leveraging nursing autonomy.

Studies have shown that patients who receive care from nurse practitioners have outcomes just as good, if not better, than care provided by physicians. They also have shown to have better patient satisfaction when compared to physicians.

Because nurses make up the largest segment of the healthcare workforce and spend more one-on-one time with patients than any other role in the industry, it’s clear to see the undeniable impact that nurses have on patient care (positively or negatively). By increasing the level of autonomy in nursing, nurses will have the ability to grow and help shape smarter healthcare delivery of the future.

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