What Is Autonomy in Nursing?

Nurses are a vital part of any healthcare facility. They deliver expert care that directly improves patient safety and recovery while simultaneously supporting doctors, surgeons, and other healthcare professionals. However, nurses' autonomy, meaning their ability to make independent clinical decisions, is limited. Traditional hierarchical structures often restrict decision-making authority, leading many to question whether this limitation truly benefits patients. As nursing shortages continue and the U.S. population ages, there has been a push to increase nurses’ autonomy so they can better meet critical healthcare needs. 

Comparing Autonomy Levels in Different Professions   

State law, licensing body regulations, nursing credentials, and employer policy influence autonomy in healthcare. Physicians have the widest authority, allowing them to diagnose conditions, order tests, perform procedures, and prescribe medications independently. Nurse practitioners (NPs) may serve as providers, but their level of independence varies by state. Some states grant full practice authority to NPs, while others require collaboration or supervision. Registered nurses carry out a wide range of tasks, from wound care and medication administration to managing medical equipment and explaining treatment plans. Independent nursing interventions can be performed without a physician's approval while dependent nursing interventions require a provider’s order.  

What Are Some Examples of Autonomy in Nursing?  

Nursing autonomy empowers nurses to make independent decisions within their scope of practice. Examples of what nursing autonomy looks like in everyday clinical settings include: 

• Ordering routine lab tests. Some organizations allow nurses to order basic lab tests when patients exhibit symptoms that justify these tests, while others require a physician's order for every test. More nursing autonomy in lab ordering would enable nurses to act promptly when symptoms arise, thereby reducing delays in diagnosis.  
• Nurse-driven sepsis protocols. Giving nurses the authority to initiate sepsis interventions without waiting for physician orders has been shown to reduce delays and improve patient survival rates.  
• Starting or adjusting oxygen. Proponents of increased autonomy in nursing say that nurses shouldn’t have to wait for a doctor’s orders to start or adjust oxygen when it's within safe limits.   
• Urinary catheter removal. Many hospitals permit nurses to remove patients’ catheters, when necessary, based on their discretion. However, some organizations still require a doctor’s order. Allowing nurses to remove catheters sooner can lower the risk of infection and other complications.  

Characteristics of Autonomy in Nursing 

In the medical industry, a clear chain of command dictates the scope of practice for different types of healthcare workers. This hierarchy is designed to keep patients safe, delegate tasks effectively, and promote consistent care coordination. However, many responsibilities fall into gray areas. While state law dictates what nurses can do, organizational policies often decide how much they can do on their own. Autonomy in nursing means that RNs can use their own clinical judgment to act independently without seeking permission when established laws and protocols allow it. This may include the following: 

• Acting independently to make time-sensitive decisions in emergency situations.  
• Using discernment for post-op and preventative care without additional oversight.  
• Relying on their own clinical judgment when carrying out patient tasks. 
• Managing daily healthcare duties with more freedom and greater respect from other healthcare workers.  
• Having a voice in decision-making, including decisions about policy, operations, and workflow structure.  

What Is the Value of Autonomy in Nursing?  

Proponents of increased autonomy in nursing argue that it benefits patients, and research supports this claim. One study examining patients across 570 hospitals found a direct link between increased nursing autonomy and improved patient outcomes. In the study, researchers asked nurses about their freedom to make care decisions, staff involvement in hospital governance, whether new ideas about patient care were supported, and other aspects of nursing autonomy. Next, the nurses’ answers were scored on a four-point scale to establish each hospital’s autonomy score. Researchers discovered that for every one-point increase in nurses’ autonomy, there was a 19% reduction in patient mortality.  

Research has also shown that giving nurses more autonomy reduces nurse burnout, a phenomenon that’s associated with higher patient safety risks, more frequent adverse events, and lower patient satisfaction. Giving nurses more autonomy also helps curb turnover. A 2025 study found that, when nurse managers promoted autonomy, nurses experienced lower emotional exhaustion and were less likely to leave their jobs. Another recent study also found that professional autonomy had a profound effect on nurses’ job satisfaction.  

How to Improve Autonomy in Nursing 

Nurses seeking more freedom and independence recognize the benefits that increased autonomy provides to both patients and healthcare processes. Organizations can promote greater nursing autonomy by: 

• Outlining policies and procedures that clearly define roles, list approved actions, and establish escalation channels. 
• Fostering a culture of trust and respect that recognizes the expertise and frontline insights nurses bring to the table.  
• Providing comprehensive training to nurses and coaching nurses who are not demonstrating expected behaviors.  
• Creating opportunities for nurses to learn and grow, whether through formal or informal educational opportunities.  
• Including nurses in policy design, strategic decision-making, and staffing discussions through shared governance.  

Nurses can gain more autonomy by exercising sound judgment and consistently delivering safe, timely, protocol-aligned care. By demonstrating their ability to act independently, nurses can establish trust with healthcare leaders and create opportunities for expanded responsibility. Some strategies that support this goal include:  

• Approaching challenges with a problem-solving mindset and presenting solutions that can improve the care environment. 
• Showcasing the ability to work independently, even through small but meaningful contributions. 
• Maintaining strong organizational skills to demonstrate effective workload management. 
• Taking the initiative by offering additional support during slower periods. 
• Communicating desire for greater responsibility through words and actions. 

If you’re a nurse seeking more autonomy, gaining additional education and credentials is an effective way to both expand your skill set and demonstrate your readiness for greater responsibility. If you’ve not yet earned a bachelor’s degree in nursing, consider an RN to BSN program that builds on your existing expertise and helps you develop stronger clinical judgment, leadership, and communication skills. If you want to advance your education even further, consider earning a master’s degree in nursing leadership and management, nursing education, or nursing informatics. You may even want to pursue an advanced practice role through a family nurse practitioner degree or a psychiatric-mental health nurse practitioner degree.  

Nursing Roles with the Most Autonomy 

Some nursing positions offer more independence than others. The amount of autonomy involved in a nursing role depends on state laws, employer policies, the nurse’s credentials, and the nature of the job. Nursing roles that tend to have higher autonomy include:  

• Home health nurse. Home health nurses provide one-on-one care to patients in their homes, meaning much of their daily work is performed independently. They often have more day-to-day autonomy, but they can’t diagnose, prescribe, change medications, or alter treatment plans without the provider’s permission.  
• Nurse practitioner (NP). Because they’re advanced practice registered nurses (APRNs), NPs have a much broader scope of responsibility and greater autonomy than RNs. They’re qualified to diagnose conditions, prescribe medications, and perform certain medical procedures. To become an NP, you’ll need to complete a graduate-level nursing program and obtain state licensure. 
• Certified nurse midwife (CNM). These advanced practice nurses support mothers before, during, and after childbirth. They can independently manage many of their daily patient care tasks, and in many states, they can diagnose, manage medications, and interpret lab tests. To become a CNM, you’ll need to complete at least a master’s degree in nursing, pass the American Midwifery Certification Board certification exam, and obtain state APRN licensure.  
• Nurse anesthetist. Unlike other RNs and APRNs, nurse anesthetists focus primarily on administering anesthesia and monitoring patients during surgery. As of 2025, all new certified registered nurse anesthetists must graduate from a doctoral-level program before entering clinical practice.  
• Forensic nurse. Forensic nurses provide trauma-informed care to patients who have experienced sexual assault or other crimes. They’re trained to perform medical-forensic exams, collect evidence, and document injuries. They work fairly independently but must remain within the RN scope of practice and consult providers as needed.  

Clinical Autonomy Versus Professional Autonomy  

Clinical autonomy refers to a nurse’s ability to make moment-to-moment patient care decisions at the bedside. Practicing autonomously in this sense means acting without case-by-case permission when an action is within the scope of an RN’s job duties and permitted by state law. Multiple studies have shown that clinical autonomy supports continuity of care by reducing delays, which can significantly improve the overall quality of care.  

Professional autonomy refers to nurses’ ability to have a voice in organizational policies, procedures, and structures. Including nurses in high-level decision-making gives nurses a sense of belonging and loyalty to their healthcare organizations. It has also been shown to increase morale and job performance. 

Challenges in Achieving Full Autonomy   

From staffing shortages and worker burnout to rising rates of chronic disease and access inequalities, the medical industry faces a range of complex challenges. Many believe that giving nurses more autonomy will help tackle these issues by enabling them to work more independently.  

However, increasing autonomy in nursing faces significant barriers. State laws impose strict limitations on what RNs can do without a physician’s order, and modifying these laws is a complex and time-consuming process. Additionally, some hospitals and insurers worry that increased autonomy may bring higher legal liability. Concerns about lawsuits or compliance violations can make organizations hesitant to support these changes.  

Another challenge is the risk of “scope creep,” where nurses take on responsibilities traditionally reserved for nurse practitioners and doctors. RNs do not undergo the same level of advanced training or lengthy residency as these providers. As a result, some healthcare leaders worry that expanded autonomy could compromise patient safety, lower the quality of care, and increase risks to patients. Advocates of increasing autonomy in nursing believe that providing nurses with more training and opportunities to earn advanced certifications will enable them to make more independent decisions without sacrificing patient safety or care quality.  

Explore WGU Nursing Degrees Today 

At WGU, you can earn an accredited healthcare degree that builds your expertise and strengthens your voice as a healthcare professional. Whether you’re taking the first step to become an RN or you’ve worked as a nurse for years, our degree programs help you step into roles where your knowledge, insight, and skills shape real change. Explore our nursing degree programs today and find out how flexible online learning can lead to real-world career advancement.