The practice of clinical autonomy in hospitals: 20 000 nurses tell their story.

http://ccn.aacnjournals.org want it, but truthfully I’m not sure what it is . . . not having to follow bureaucratic rules and chain of command? . . . Autonomy is making decisions—not always having to ask? Autonomy must have something to do with bureaucracy and size because many nurses in this hospital said that as we merged and got bigger, we lost our autonomy. In 2001, staff nurses in 14 magnet hospitals identified 8 essentials of a healthy (ie, job satisfying and professionally productive) work environment, 1 of which is clinical autonomy. Six studies related to the 8 essentials of magnetism have been conducted (Table 1). In both the 2001 study on the dimensions of magnetism and the 3 studies to identify structures, interviewees provided hundreds of examples and descriptions in response to requests and questions such as the following: • Describe a situation in which you functioned autonomously. • What does the concept “autonomy” mean to you? Marlene Kramer, RN, PhD Claudia Schmalenberg, RN, MSN Healthy Work Environments