Nurse Practitioner Professional Autonomy: Relationship Between Structural Autonomy and Attitudinal Autonomy

The purpose of this study was to identify and describe the possible components of structural autonomy that influence Nurse Practitioners\u27 (NPs) perceptions of independence in practice. The components identified were NP state regulatory practices, educational background, and managed care environment. The study explored the relationship between NP structural autonomy as it relates to the above components and attitudinal autonomy as it relates to perceptions of independence in practice. A conceptual framework derived from a review of the literature demonstrated the possible relationships. The investigator employed a mail survey to collect data from certified NPs in six eastern and mid-eastern states. Current state regulations regarding advanced nursing practice were used to establish current state practice scores. The Nursing Autonomy Scale (Pankratz & Pankratz, 1974), the Index of Work Satisfaction (Stamps & Piedmonte, 1986), and the Professional Inventory (Hall, 1974) measured perceptions of autonomy. Additional information was collected to determine the NP demographic background, educational background, practice setting and managed care circumstances. Of 300 surveys mailed, 227 participants responded. Data analysis included correlation analysis, t-tests, analysis of variance, and multiple regression procedures. Demographic information was summarized with descriptive statistics. The major findings of the study were: (1) State regulatory guidelines do not affect perceptions of autonomy as measured on the scales used. (2) Preceptor experience during NP education does not affect perceptions of autonomy as measured on the scales used. (3) Pharmacology preparedness does not affect perceptions of autonomy as measured on the scales used. (4) Managed care circumstances do not affect autonomy as measured on the scales used. It was concluded that structural autonomy is a more complex and multi-dimensional experience than originally hypothesized. Many additional factors must be taken into consideration when exploring NPs\u27 perceptions of autonomy. It may be that most NPs are practicing in an independent, yet collaborative role, which provides opportunity for autonomy. The investigator also concluded that NP educational programs do not adequately prepare NPs for independent prescriptive authority. Variables related to NP autonomy were not determined in the study, yet it is evident that NPs\u27 perceptions of autonomy are affected by many variables. Further study is needed to ascertain these variables