Purpose This Gadamerian hermeneutic study was undertaken to understand the meaning of autonomy as interpreted by nurse practitioners (NPs) through their lived experiences of everyday practice in primary health care. Data sources A purposive sample of nine NPs practicing in primary health care was used. Network sampling achieved a broad swath of primary care NPs and practice settings. Data were collected by face‐to‐face interviews. Because NP autonomy is concerned with gender and marginalization, Gilligan's feminist perspective was utilized during interpretive analysis. Conclusions Having Genuine NP Practice was the major theme, reflecting the participants’ overall meaning of their autonomy. Practicing alone with the patient provided the context within which participants shaped the meaning of Having Genuine NP Practice. Having Genuine NP Practice had four subthemes: relationships, self‐reliance, self‐empowerment, and defending the NP role. Implications for practice The understanding of Having Genuine NP Practice will enable NPs to articulate their autonomy clearly and better influence healthcare reform. Implications for advanced practice nursing education include integrating findings into classroom discussion to prompt self‐reflection of what autonomy means and socialization to the NP role.

NPs will never be seen as members of a profession by either themselves or others without the practicality of independence and autonomy. Although legal independence is a fact, real practice independence in the pragmatic sense is contingent upon reimbursement. Without fiscal sustainability, practice independence is an impossibility. And, without professional autonomy, NPs will have only an employee's voice in the dynamic healthcare system in which they are really key players in providing healthcare services to the poor and undeserved populations.

Integration of the spiritual domain into the nursing plan of care positively influences health and wellness. Applying nursing theory to practice reinforces the advanced practice nurse's (APN's) responsibility to integrate spiritual care into the critical care environment. Indeed, all nurses have an obligation to integrate spiritual care because the focus of nursing care is beneficence. Moreover, the focus of APN care is not curing, but healing. Healing can be assisted by entering into the patient's suffering to help reconstruct life plans and facilitate realizing meaning from the despair of illness even while facing extreme adversity and death. This article describes spiritual care of the critically ill adult patient and the role that the APN must, can, and should take to assimilate spiritual care into care of these patients and their families.