The nurses in this study relate autonomy to work situations of
their responsibility. The nurses strongly emphasise their
responsibility in the relationships with patients and next of
kin. The authority of holistic patient care meets constraints in
the ward culture when there is a lack of time with the patient
and problems with prioritising nursing tasks. Another challenge
is to manage expanded responsibilities as a consequence
of how the ward is organised. The nurses’ power in decisions in
patient care is connected to protection of the patient’s needs
and seem to be influenced by how the nurses manage to show
consideration for the patient’s autonomy and their cooperation
with next of kin and others in the health care team. The
freedom to make clinical judgements, choices and actions in
patient relationships depends on the possibility to get to know
the patient, as well as the capability to understand and grasp
situations and use knowledge and skills.
In the international debate about development of nursing
roles and expertise (Daly & Carnwell 2003, Christensen &
Hewitt-Taylor 2006, Carryer et al. 2007, Turner et al. 2007),
this study’s contribution is that professional autonomy does
not only follow from a connection to a specific nursing role or
setting, it also depends on a fundamental personal awareness
and responsibility in caring for others. These core elements in
nursing are important to create the highest quality of health
care and should be further investigated to find what constitutes
professional autonomy across different practice settings
and nursing roles. The study also highlights the need for more
knowledge about the connection between experience and
expertise when developing individual nurses’ competence in
creating autonomous practice.