An exploration of the levels of clinical autonomy amongst advanced nurse practitioners in Ireland.
Lockwood, Emily Bernadette
(2022)
An exploration of the levels of clinical autonomy amongst advanced nurse practitioners in Ireland.
PhD thesis, Dublin City University.
Background: In Ireland and across all continents, we are experiencing significant shifts in healthcare population profiles with longer life expectancies and people living with a myriad of chronic illnesses. Advanced nursing practice has been viewed as one ‘panacea’ for solutions to the healthcare crisis first established in Ireland in 2002. There is, however, a lack of understanding of advanced nurse practitioners (ANP) clinical autonomy.
Aim: This study set out to explore the levels of clinical autonomy amongst ANPs in Ireland.
Methods: A cross-sectional study design was used in a representative sample of ANPs in Ireland across the full range of healthcare settings. A bespoke quantitative survey instrument was developed and administered to the sample ANPs. This was informed by a literature review, an existing scale measuring ANP clinical autonomy and a new bespoke subscale developed for this study. As part of the survey, open comments about ANPs views of their clinical autonomy were captured and informed by thematic analysis.
Results: One hundred and forty-eight ANPs completed the survey giving a response rate 33% of all ANPs Nationally. The findings illustrate high and extremely high levels of clinical autonomy impact in areas such as self-mastery, completing full episodes of care without a physician, discharging patients with or without a physician’s consultation and independently referring onwards to other specialists. ANPs clinical autonomy requires clear understanding and collaboration to reduce
constraints to their role.
Recommendation for Education: Educational strategies at the undergraduate and postgraduate levels should foster ANP self-determination and resilience approaches. Increasingly experienced ANPs with a hybrid ability between educational and ANP active clinical practice is essential to improve ANP clinical autonomy to its fullest capacity.
Recommendation for Policy Makers: Encourage ANP structures with an ethos of embracing a generic advanced practice strategy rather than speciality or silo developments.
Recommendation for Organisational Policy: All Irish Healthcare organisations and universities should encourage their full utilisation and realistically prepare future ANP clinical
autonomy.
Conclusion: This study underlines several fundamental motivators required to encourage, fully utilise and sustain clinical autonomy: competence, relatedness, and autonomy.