In this study, Having Genuine NP Practice was the major
theme which reflected the overall meaning of autonomy
in everyday practice. The subthemes or individual parts
identified have separate meanings, but when woven together
as a whole, actualize the overall meaning of autonomy
as Having Genuine NP Practice.
Having Genuine NP Practice was interpreted as being
real and true, when the NP practices independently and
alone (in the examination room) with the patient. Language,
such as practicing without oversight, making independent
decisions, and doing it on my own, could have been understood
within the traditional stereotypical definition. However,
a feminist perspective was incorporated to contextualize
interpretation. The meaning of autonomy became
clearer through a feminist lens where the context of relationships,
responsibility, and providing NP care recast
the traditional meaning of autonomy from self-centered to
other-centered. Within this context, Having Genuine NP
Practice emerged as a meaning that was perhaps rediscovered,
or recovered, because of the centrality of the patient
to NP autonomy. Having Genuine NP Practice, then,
had meaning not only for the experience of practice autonomy
(what they do), but also for the everyday life of
being an NP (who they are). Further, the implication of
Having Genuine NP Practice is that it was not merely tasks
that defined their autonomy in everyday practice, but their
role as a competent primary care provider. This common
thread connected the parts to the whole and the whole to
the parts and demonstrated what autonomy means.
Having mutually respectful, trusting relationships with
physicians and others in the practice environment broadened
the genuineness of participant NP autonomy through
social power. Relationships with physicians that were
not as mutually respectful were confronted by shaping
the meaning of autonomy as equal to the autonomy of
coworkers who were themselves physicians. In this way,
participants found validation and authority for their NP
practice.
Self-reliance was found to be an important part of the
meaning of autonomy because of the NPs’ belief that they
had direct control over their practice. Self-reliance further
promoted understanding of how the NPs shaped their professional
identity in a restrictive practice environment—
an environment that is out of step with the level of education
and expertise the NP has. In this study, participants
balanced the requirement for physician supervision
of prescriptive authority against how autonomy in practice
is achieved, which is as a competent primary care provider
prescribing those drugs that are common in their everyday
practice. Kaplan and Brown (2007) also found that
NP perception of autonomy was unchanged by legislative
mandate. This study may provide insight inasmuch as a
legislative mandate may limit practice, but does not change
the NPs’ conceptualization of themselves as autonomous.
Self-empowerment was an integral part of the meaning
of autonomy because it reaffirmed the participants’
competence and impact on patient care. Embodied in
stories of “being right” and fulfilling professional duty, selfempowerment
was an intrinsic reward, both professionally
and personally. As an intrinsic reward, it was something
that the NPs conferred upon themselves, and could not be
taken away.