Nurses' Autonomy and Its Determinants in Clinical Practice: A Scoping Review

Introduction: Nurses' autonomy is a critical component of effective clinical practice, closely tied to professional competence, patient safety, job satisfaction, and organizational support. Despite its importance, autonomy remains variably defined and experienced across different healthcare systems and cultural contexts. This review explores the determinants, expressions, and implications of nurses’ autonomy based on an analysis of recent international studies. Methods: This research design uses a PRISMA-ScR in February 2024 based on PRISMA guidelines. Studies were taken from Esco, ScienceDirect, Google search, and PubMed and searched in English using the keywords nurse or nurses or registered nurse, clinical privilege or clinical autonomy or professional autonomy nurse, patient safety or quality of care from 2020 to 2024. Results: The findings reveal that nurses’ autonomy is positively associated with professional competence, role clarity, and supportive work environments. Autonomy enables nurses to participate in safety activities, advocate for patients, and contribute meaningfully to decision-making processes. Conversely, autonomy is often limited by hierarchical organizational structures, inadequate staffing, and a lack of managerial support. Studies also show that autonomy is context-dependent, with higher levels reported in critical care settings and among more experienced or specially trained nurses. Tools such as HSOPSC, SAQ, and NPC scales were commonly used to assess related variables. Conclusions: The review highlights that fostering nurses’ autonomy requires not only individual competence but also systemic change. Educational initiatives, leadership development, and non-punitive safety cultures are essential to empowering nurses.