Professional Autonomy in Nursing Practice: A Qualitative Study From the Perspective of Nurse Managers

The aim of this study was to examine nurse managers' perceptions of nurses' professional autonomy, how professional autonomy is enacted and supported in clinical care settings, and the managerial and organizational processes influencing autonomous nursing practice.

A qualitative descriptive study.

Professional autonomy is a core component of nursing practice and is associated with care quality. While previous studies have predominantly examined autonomy from nurses' perspectives, evidence remains limited regarding nurse managers' views and their role in shaping organizational conditions that enable or constrain autonomous nursing practice.

This study was conducted in a 300-bed public hospital in Türkiye. Fifteen nurse managers working in acute care units participated in semistructured interviews. Data were analyzed using inductive qualitative content analysis and reported in accordance with the COREQ guidelines.

Three main categories emerged: (1) integration of nurses' professional autonomy into the clinical care process; (2) nurse managers' strategies for strengthening professional autonomy; and (3) balancing nurses' professional autonomy with physician-centered care in clinical practice. Nurse managers described professional autonomy as most visible in routine and individualized nursing care, particularly in complex clinical situations. Educational support, mentoring, participatory leadership, fair workload distribution, feedback, and a supportive organizational climate were identified as key facilitators. In contrast, physician-centered organizational structures, hierarchical norms, heavy workloads, and limited resources were perceived as major constraints on nurses' autonomous decision-making.

According to nurse managers, professional autonomy emerged as a dynamic process shaped by managerial practices, organizational conditions, and interprofessional relationships rather than solely an individual competence. Nurse managers play a critical role in fostering work environments that support nurses' autonomous clinical judgment while maintaining safe and collaborative care.

Nurse managers should strengthen professional autonomy through structured orientation, competency-based mentoring, participatory decision-making, and equitable workload distribution. Creating psychologically safe environments that support open communication may enhance nurses' autonomous judgment and improve outcomes.