The role of professional autonomy in a healthy work environment: a mixed-methods study on intensive care nurses

Professional autonomy is a key element of a healthy work environment, influencing nurses' job satisfaction, decision-making participation, and patient care quality. This study examines the level of professional autonomy among intensive care nurses in Türkiye and explores the individual and institutional factors that shape it.

A concurrent mixed-methods design was used. Quantitative data were collected online from 293 intensive care nurses using the Attitude Towards Professional Autonomy Scale for Nurses. Qualitative data were obtained through semi-structured interviews with 15 nurses selected from the same sample. Theoretical framework was based on Benner's Novice to Expert Model. Quantitative data were analyzed using statistical methods, and qualitative data were analyzed through thematic analysis. Findings were integrated accordingly.

Overall, nurses reported high levels of professional autonomy (X̄=72.29, SD = 10.91). Autonomy scores showed positive correlations with age, education, and professional experience. A negative relationship was found between intention to leave the job and autonomy perception. Qualitative analysis revealed three main themes: (1) nurses' definitions of autonomy and their expectations for the future, (2) the role of education and experience gained in healthy work environments, and (3) the influence of institutional factors and working conditions on autonomy.

Professional autonomy in intensive care nursing is shaped by both personal attributes and systemic factors. Supporting healthy work environments through organizational policies is essential to strengthen nurses' autonomy and improve care quality.