Perspectives of ICU Nurses on Professional Autonomy: A Descriptive Qualitative Study

Background: Professional autonomy is an essential component of intensive care unit (ICU) nursing practice. Working in rapidly changing clinical conditions, ICU nurses need to make decisions, advocate for their patients, and use their clinical judgment promptly. While professional autonomy has been linked to job satisfaction, retention, and patient safety, few studies have sought ICU nurses' perspectives on autonomy and its influences. Such understanding is needed to address the ongoing nursing workforce shortage. Method: A qualitative descriptive study guided by a naturalistic paradigm was used to explore ICU nurses’ views on professional autonomy and its impact. Ten ICU nurses with two or more years of critical care experience were purposefully sampled for the study. Data were collected through semi-structured online Zoom interviews. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed using Sandelowski’s analytic approach. Rigor was facilitated by reflexive journaling, member checking, and continuous faculty consultation. Results: Five themes emerged. Two themes reflected nurses’ perspectives on professional autonomy: (1) autonomy as exercising clinical judgment, patient advocacy, and prompt decision-making, and (2) autonomy built on experience, knowledge, and growing confidence. Three themes described influences on autonomy: (1) structural policies delineating boundaries of autonomy, (2) autonomy contingent on relationships, trust, and team culture, and (3) work environment pressures and nurse staffing shortages constraining autonomy. Autonomy was described as developmental and relational, and as exercised within institutional and regulatory boundaries. Supportive leadership, collaborative relationships, and adequate staffing facilitated autonomy, whereas fixed protocols, hierarchical dynamics, documentation burden, and staffing shortages limited its expression. Conclusion: Professional autonomy in ICUs is dynamic and relational. It varies between hospitals. Cooperative efforts in nursing practice, education, leadership, and policy are needed to support ICU nurses’ autonomy. Targeted actions must encourage autonomy and maintain collaborative cultures. Healthy work environments and adequate nurse staffing must be ensured.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Nursing Science

Grantor

Texas Woman's University

Year dc:date.issued

2026

Author dc:creator

• Okpaluba, Frances Chinyere

Advisor dc:contributor.advisor

• Liu, Fuqin

Committee members dc:contributor.committeemember

• Shin, Chanam
• Fredland, Nina

• ICU nurses
• Intensive care unit
• Patient advocacy
• Clinical judgment
• Qualitative descriptive research
• Nurse staffing
• Professional autonomy

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/11274/17838

OAI identifier oai:identifier

oai:twu-ir.tdl.org:11274/17838