Autonomy in district and community nursing

Nursing literature in the US contains a plethora of studies relating to autonomous decision-making in nursing practice. The expert views expressed on the subject tend to vary, often widely, according to whether the field of study concerns hospital practice, community practice or nurse education. There is much less literature in the UK.

The present article explores community nurses' willingness, or sometimes their lack of willingness, to make an autonomous practice decision. The author examines both the liberating opportunities of doing something ‘off one’s own bat’ and also the limits that can, and sometimes should, be imposed on such freedom. The law does come into play now and again, but not as frequently as practitioners might think.

To do something autonomously is to do it unbidden by others. Autonomy has shades of independence and self-governance, of not being interfered with in the making of a decision and even, in some cases, of not being pressed or even prevailed upon to make a particular choice. That is to state the matter in the most general terms. However, autonomy is a value that takes on a real meaning only when used in a specific context. As said, this context could be as a nurse practitioner in a hospital, or in the community, or as a student—as well as in many more practice settings.