American Nursing: Quo Vadis?

Abstract

Autonomy is generally diminished within society. The effects of this diminution are examined in two groups: hospitalized patients and hospital nurses. Hospitalized patients experience reduced or absent autonomy as a result of 1) impaired physiological functioning; 2) impaired psychological functioning; 3) insufficient medical information upon which to make informed choices; and 4) expectations imposed upon them by health care personnel who view patients according to Parsons sick role. When health care professionals provide patients with salient medical data, these impairments are ameliorated and improved health care outcomes are obtained. Hospital nurses suffer diminished autonomy due to 1) lack of a precise definition of nursing and its scope of practice; 2) unstandardized educational processes; and 3) employee status which demands subjugation of nurses to hospital administrators and physicians. When nurses practice with greater independence as in, for example, a primary care structure, higher levels of patient care and nurse and physician job satisfaction are achieved. That recognition of nursing autonomy will assure patient autonomy is demonstrated.