Nurse Autonomy in Cancer Care

Gagnon, Lissa MScN, RN; Bakker, Debra PhD, RN; Montgomery, Phyllis PhD, RN; Palkovits, Jo-Anne BScN, MA, RN, CHE


Cancer Nurs. 2010;33(3):E21-28. 

In This Article

Abstract and Introduction


Background: The concept of autonomy is regarded as an essential element for gaining professional status. Yet, it remains poorly defined and understood. To date, there is little research that has focused on exploring how nurses in different specialty areas perceive autonomy.
Objective: The purpose of this research was to explore oncology nurses' perceptions of autonomy and understand how they develop and exhibit autonomy in their everyday practice.
Methods: Using Leininger's ethnonursing method, data were collected from 15 oncology nurses using semistructured interviews. Participant observation was also carried out through job shadowing to complement interview data.
Results: Three themes emerged from the findings: autonomy is an unspoken opportunity in the workplace; autonomy is developed through professional and personal growth acquired over time; and demonstrating autonomous behaviors is a conscious choice.
Conclusion: The findings provide insight into how oncology nurses perceive, develop, and exhibit autonomy in everyday practice and how autonomous and collaborative clinical decision making contributes to quality cancer care.
Implications for Practice: Descriptions of the meaning of autonomy and its explication in a nursing specialty practice can add to nursing knowledge by clarifying nurse autonomy and its relevance to nurses' work life. Descriptive studies can identify nurse behaviors and attitudes related to autonomy that may be measurable and relevant to real life.


The phenomenon of autonomous clinical practice originated with Florence Nightingale. She described it as the essential feature distinguishing professional nursing practice from care provided by the layperson.[1] Since that time, autonomy continues to receive much attention in the nursing literature,[2–12] and its acceptance as an essential attribute of professionalism is supported by nursing professional regulatory bodies.[12–15]

Contemporary clinical nurses are expected to work collaboratively as part of a team of healthcare professionals and also fulfill a variety of independent functions to address the health promotion, illness prevention, and biopsychosocial needs of patients and their families. Furthermore, nurses working in specialized areas such as oncology associate enhanced knowledge and skills with increased clinical responsibility and autonomy.[16,17] Autonomous clinical practice has also been associated with different models of nursing care delivery.[18,19] For example, the primary nursing model, where one nurse is assigned the care responsibilities for an individual patient from the time of hospital admission until discharge, includes not only continuity of patient care but also increased opportunities for nurse autonomy and control.

A prevailing message in the nursing literature is that autonomous practice is desired and benefits nurses, patients, employers, and the discipline.[6,7,10,12] Staff nurses have ranked autonomy high in relation to the provision of quality nursing care[20–23] and job satisfaction.[10,24–26] However, autonomy remains poorly defined and understood for nurses in everyday practice.[8,9,12,16,20–22] Furthermore, there is little research that has focused on exploring how nurses in specialized areas of practice perceive autonomy.[17,22,23,27] This study explored the concept of autonomy from the perspective of oncology primary nurses.


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