Nurses' autonomy: influence of nurse managers' actions.
BACKGROUND: Autonomy plays an important part in nurses' job satisfaction and retention, but the literature shows that they are often dissatisfied with this aspect and want better working conditions and greater autonomy in decision-making. AIMS: The aim of this study was to examine the role that nurse managers have in enhancing hospital staff nurses' autonomy. METHODS: The study used a comparative descriptive survey design. Data collection took place over the Internet through the use of selective listservs in the United States of America (USA), Canada, and the United Kingdom. Of the 317 hospital nurses participating, 264 (83.3%) were from the USA. Differences relating to nurses, nurse managers, and hospital settings were controlled in the analysis. RESULTS: Nurses were more autonomous in making patient care decisions than unit operational decisions, and they perceived their autonomy to be at a moderate level. Those who were autonomous in patient care decision-making were also likely to be autonomous in unit operation decision-making. Nurse managers' actions had a strong relationship with nurses' autonomy in deciding on patient care and unit operation decisions, and with total autonomy. The three important variables that were reported by staff nurses to increase their autonomy were supportive management, education and experience. The three most important factors that were reported to decrease nurses' autonomy were autocratic management, doctors and workload. DISCUSSION: Technical issues such as the availability of listservs, valid e-mails, viruses, and familiarity with the Internet and its applications were the major limitations of this study. Nurses' autonomy over patient care and unit operations decisions needs to be enhanced, and nurse managers should promote this. Similarly, there is a role for nurse education, both in preregistration programmes and in continuing education for managers. Further research needs to explore the barriers that nurses face in autonomous decision-making and how nurses' participation in unit operational decisions can be promoted. CONCLUSIONS: Hospital staff nurses have moderate autonomy which could be increased by more effective support from nurse managers. The use of electronic questionnaires is a promising data collection method.