Autonomy, Job Satisfaction and Quality of Care: Barriers and Facilitators of a Role Based Approach to Practice within the Context of the Essentials of Magnetism

Wednesday, 1 August 2012: 8:50 AM

Nancy Loos, RN, MSN, PHN, NE-BC
Northridge Hospital Medical Center, Northridge, CA
Maria W. O'Rourke, DNSc, RN, FAAN, FAAHC
Role-Based Practice Solutions, Larkspur, CA

Learning Objective 1: Describe the barriers and facilitators of autonomous decision-making practice and the structures and processes that support it.

Learning Objective 2: Describe how a professional role orientation helps support autonomous practice that leads to improved patient outcomes.


To measure adult-critical care RNs self-report of practice autonomy and its relationship to organizational structures, job satisfaction (OJS), and quality of care (QC) in a Magnet context.

Innovative strategies that promote nursing practice excellence are essential for quality care and nurse satisfaction. Support for practice autonomy is key to advancing professional practice and realizing RN role capacity.  Using a role-clarity framework, identifying facilitators and barriers to structural and process support for decision-making autonomy is considered crucial to RN professional role enactment, work satisfaction, and evidence-based practice.


A quantitative, cross-sectional survey design was used in a convenience sample of all direct-care RNs in the adult ICU in a suburban Southern California hospital (N ~ 92). 63% previously completed a survey measuring professional role orientation. Participation included voluntary, one-time, anonymous completion of the 58-item Essentials of Magnetism II (EOMII). Instruments used are valid and reliable.


75% completed the survey. Mean Autonomy scale score was 69.09/112 (SD =12.56), >2 SD below the National Magnet Hospital medical/surgical ICU Profile.  Autonomy was positively related to both OJS (r=0.46) and QC (r=.58) (p<0001).  On a 10-point scale, mean OJS and QC scores were 5.38 and 6.0, respectively. Total EOMII scores were positively related to total OJS (r=0.507) and QC outcome indicators (r=.601; p<.01; n=64). 


Identifying barriers and facilitators of autonomous practice and structures and processes that support it help explain how professional role orientation serves as the catalyst for ensuring structural support for autonomous clinical decision-making needed to positively impact quality of care and nurses’ job satisfaction. Transformational leadership strategies that support nursing’s unique practice sphere and align their decision-making authority with that of other disciplines is foundational to practice excellence and quality care.

Schmalenberg, C., & Kramer, M. (2008). Essentials of a productive nurse work environment. Nursing Research, 57(1), 2-13.