An exploration of the levels of clinical autonomy of advanced nurse practitioners: A narrative literature review

Abstract

Aims and Objectives The aims of the review are to synthesise current evidence about advanced nurse practitioner clinical autonomy and consider how this may inform clinical practice and research. Background Clinical autonomy is one of the cornerstones of advanced nursing practice globally, yet there is limited synthesis of clinical autonomy in the literature. Design This is a narrative literature review. Data sources The databases Cumulative Index to Nursing and Allied Health Literature, EBSCO host, Cochrane Library, CINAHL and MEDLINE were searched for publications between 2005 and 2020 inclusive. Review methods A systematic approach was used to analyse the literature reviewed. Two reviewers undertook quality appraisal. Results Nineteen articles were selected. Four major themes emerged: (1) ‘ANP Stepping Up’—moving into and accepting advanced nursing practice roles and clinical responsibilities; (2) ‘ANP Living It’—ANPs' ability to act independently including an understanding of task mastery and self‐determination; (3) ‘ANP Bounce‐back ability’—depicted in challenges that threaten their ability to practice clinically autonomously; (4) ‘ANP Setting in Motion’—indirect care activities and service‐level improvements. Conclusion A clearer understanding of advanced nurse practitioner clinical autonomy could help develop more in‐depth knowledge. Research of advanced nurse practitioners' clinical autonomy would improve full utilisation in clinical practice.

APN nurses' core competencies for general clinical health assessment in primary health care. A scoping review

“…Furthermore, in alignment with our map, studies describe that a central role of APN nurses is to manage patient care. This central role is about leading and managing care interventions in a collaborative way with other team members, with a view to collect and share knowledge relevant to the situation of the service user and the continuity of care [13,36,37]. Carnwell et al describe in an interview study how the quality of collaboration with, for example, the GP can either increase or decrease the APN nurse's access to service users.…”

“…Furthermore, in alignment with our map, studies describe that a central role of APN nurses is to manage patient care. This central role is about leading and managing care interventions in a collaborative way with other team members, with a view to collect and share knowledge relevant to the situation of the service user and the continuity of care [13, 36, 37].…”

“…The authors find that the GP and the GP's receptionist function as a kind of gatekeeper for the APN nurse's access to fulfilling his/her role, for example in relation to performing general clinical health assessments [38]. However, as we illustrate in the map ‘Collaborative, leadership and management skills’, it is also described that insight and positive relationships between the members of the interdisciplinary team, such as the GP and the APN nurse, increase the united effort and the quality of care for the service user [36, 39, 40].…”

Effect of Nurses’ Autonomy Levels and Problem-Solving Skills on Job Satisfaction

“…Factors enhancing job satisfaction and professional development were found to be positively associated with autonomy (10). Enhancing nursing skills with full autonomy is among the factors that affect job satisfaction the most (11)(12)(13)(14). While lack of nurses' job descriptions despite the heavy workload has negative effects on their job satisfaction (15), job satisfaction levels were reported to be higher in nurses working in institutions that provide nurses with opportunities to improve their knowledge and skills and include clear role definitions (16).…”

Factors Influencing the impact of nurse practitioners’ clinical autonomy: a self determining perspective

“…This suggests the goal of human development is 'self-actualisation' . Dworkin (1988) and Kant (1785) proposed attaining autonomy is the ability to make independent choices and freedom with adequate information and knowledge base. The empirical literature reviewed reported a lack of understanding between autonomy, professional autonomy and NP clinical autonomy, creating difficulties in recognising what this means in clinical practice (Lockwood et al, 2021;Oshodi et al, 2019).…”