Exploring Nurses' Experiences of Autonomy in Intensive Care Units: A Qualitative Descriptive Study.

BACKGROUND

Nursing autonomy is essential in intensive care units (ICUs). However, there is limited understanding of how nurses perceive autonomy within their practice.

AIM: To explore nurses' perception and experience of autonomy in ICUs.

DESIGN

A qualitative descriptive study.

METHODS

The study was conducted with 14 ICU nurses through interviews from May to August 2025. Nurses' characteristics were described, and interviews were transcribed verbatim and analyzed using a primarily inductive, semantic codebook thematic analysis informed by Braun and Clarke's six-phase framework.

RESULTS

Seven main themes and 25 subthemes emerged from the interviews, revealing personal and organizational factors that influence nursing autonomy in ICUs. The themes were as follows: nursing autonomy's definition and perception, clinical practices, facilitators, barriers, perceived influence on patient care, perceived influence on nurse personal and professional development, and future advancements.

CONCLUSION

The findings provide insight into ICU nurses' experiences and perceptions of autonomy. Nurses reported that autonomy was influenced by clinical competence, organizational support, and clear guidelines. Nurses perceived that independent nursing care and timely actions undertaken under approved protocols could support patient care, professional confidence, and job satisfaction. Limited decision-making authority, inadequate staffing, and unclear institutional support were reported as barriers. Nursing autonomy could strengthen nurses' confidence and job satisfaction, which nurses perceived as contributing to better patient care.

IMPLICATIONS FOR NURSING MANAGEMENT: The findings can guide nurse managers in implementing structured competency-based education, reinforcing clearly defined scopes of practice that are consistent with institutional policies, and adopting supportive leadership practices to promote nursing autonomy. Hospital administrators and national policymakers can further use the findings to advance nursing practice through developing organizational and regulatory frameworks required to authorize and safely support expanded autonomous practice.