Managerial control versus professional autonomy: a paradox.
Explore the source record for details and available documents.
Decision Making↗
SEARCH · Search PubMed
Results for “Professional Autonomy”
Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.
Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.
The FTC's attack upon occupational licensure--a threat to professional autonomy.
Explore the source record for details and available documents.
Commerce↗
The meanings of autonomy for physical therapy.
The purpose of this article is to explore the social context and meanings of autonomy to physical therapy. Professional autonomy is a social contract based on public trust in an occupation to meet a significant social need and to preserve individual autonomy. Professional autonomy includes control over the decisions and procedures related to one's work (technical autonomy) and control over the economic resources necessary to complete one's work (socioeconomic autonomy). Professional autonomy is limited and weakened by the relationship of one profession to another (dominance), by the influence of other social institutions (rationalization and de-professionalization), and by the internal disposition of the profession itself (insularity). Professional autonomy for physical therapists is increasing as medical dominance has declined but is limited by the trends of rationalization and de-professionalization in health care. Physical therapists must recognize that professional autonomy represents a social contract based on public trust and service to meet the health needs of people who are experiencing disablement in order to maintain their individual autonomy.
Humans↗
Autonomy, job satisfaction and professional self-image among nurses in the context of a physicians' strike.
This paper tests the hypothesis that structural changes in nurses' work settings, which allow nurses to autonomously exercise their knowledge and skills will lead not only to an enhanced feeling of professional autonomy, but also to an improvement in their professional self-image and to an increase in job satisfaction. An opportunity to test this hypothesis arose when physicians in Israel went on a strike which lasted 116 days. Primary care (PC) clinics were completely abandoned by physicians, leaving nurses to operate them on their own, while in hospitals, nurses continued to work as usual under physicians' supervision. The study compares the effect of the strike on head nurses in the two sectors. Data were collected by means of self administered questionnaires. The findings indicate that during the strike, PC head nurses expanded their activities and responsibilities and consequently felt more professional autonomy and job satisfaction, as well as an improvement in professional self-image. Hospital head nurses experienced significantly less changes in their work situation and, as expected, less change in all work related attitudes. It is suggested that, when given the opportunity to define for themselves roles where they can use their experience, knowledge and skills, senior nurses stand up to the challenge and consequently are more satisfied and their professional self-image improves.
Humans↗
Professional nurse autonomy: concept analysis and application to nursing education.
Professional nurse autonomy, an essential attribute of a discipline striving for full professional status, is often confused with personal autonomy, work autonomy or aggregate professional autonomy. Using Walker & Avant's (1995) model for concept analysis, this paper presents an analysis of professional nurse autonomy. Professional nurse autonomy is defined as belief in the centrality of the client when making responsible discretionary decisions, both independently and interdependently, that reflect advocacy for the client. Critical attributes include caring, affiliative relationships with clients, responsible discretionary decision making, collegial interdependence, and proactive advocacy for clients. Antecedents include educational and personal qualities that promote professional nurse autonomy. Accountability is the primary consequence of professional nurse autonomy. Associated feelings of empowerment link work autonomy and professional autonomy and lead to job satisfaction, commitment to the profession, and the professionalization of nursing. A student-centred, process-orientated curricular design provides an environment for learning professional nurse autonomy. To support the development of professional nurse autonomy, the curriculum must emphasize knowledge development, understanding, and clinical decision making.
Curriculum↗
Autonomy or professionalism?
Explore the source record for details and available documents.
Leadership↗
Satisfaction with practices: emergency physicians versus internists.
No comparison has been made of satisfaction with practices of emergency physicians versus other specialists. We used a previously tested questionnaire that measures differences between current and preferred practice conditions, and with items regarding training and practice, and intention to change positions. It was sent to 250 physicians practicing emergency medicine and 250 practicing internal medicine in a metropolitan area. Both specialty types were defined by type of practice, rather than by specialty training or board certification. Ninety-five (38%) emergency physicians and 79 (32%) internists responded. Factor and correlation analyses identified six satisfaction indexes: resources, professional autonomy, administrative autonomy, patient relationships, professional relationships, and status. Physicians practicing emergency medicine were less satisfied, that is, reported more difference between current and preferred conditions, than physicians practicing internal medicine with professional autonomy, patient relations, and status (by t tests, P less than .01 for each). Emergency physicians were more satisfied with professional relationships (P less than .01). Only 40% of emergency physicians, versus 60% of internists, reported no intention to leave their present position within the next two years (P less than .02). Expectation of position change by physicians practicing emergency medicine was predicted by dissatisfaction with professional autonomy, lack of board certification, recency of graduation from medical school, and belief that monetary compensation would be higher elsewhere (R square, 0.35; P less than .01), while variables such as patient load, hours worked per week, and hospital size proved unimportant. We identified areas of dissatisfaction among emergency physicians that differed from those among internists.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Ethical issues in the handling of bloodborne pathogens: evaluating the Occupational Safety & Health Administration Bloodborne Pathogen Standard.
The Occupational Safety & Health Administration Bloodborne Pathogen Standard is designed to help provide protection from contamination in the workplace. Healthcare professionals must evaluate the standard and the behaviors mandated therein, according to the basic professional ethical principles of professional autonomy, beneficence, and cost-benefit considerations. The patient's wellbeing provides the focus for making such an assessment.
Beneficence↗
Job satisfaction among nursing staff in a military health care facility.
Job satisfaction in the workplace affects absenteeism, turnover, and performance. We conducted a cross-sectional study of 201 nursing personnel to assess satisfaction among nursing staff at a military hospital in the southwestern United States. Participants completed a self-administered survey in which they rated professional status, autonomy, pay, organizational policies, task requirements, and interaction by importance and satisfaction. Autonomy, professional status, and pay were the most important factors and organizational policies was the least important factor. Military staff were slightly more satisfied with staff interactions than civilian staff. Nursing personnel working in specialty care units were significantly more satisfied with interactions and professional status, but they valued organizational policies less than those working in general units. Professionals were significantly more satisfied with pay and autonomy, whereas nonprofessionals were more satisfied with task requirements and professional status.
Cross-Sectional Studies↗
A model of the attitudinal component of professional nurse autonomy.
This model-testing correlational study was designed to predict a causal model of the attitudinal component of professional nurse autonomy in female baccalaureate nursing students by testing three carative factors embedded in Watson's Theory of Transpersonal Caring. Proportional quota and convenience sampling were used to collect data from 317 senior nursing students enrolled in 20 National League for Nursing-accredited baccalaureate nursing programs. Path analysis revealed that the hypothesized model was not testable. With removal of nonsignificant paths, 19.1% of the variance in perceived clinical competence was explained by self-esteem and perceptions of instructor caring behaviors. Perceptions of instructor caring behaviors, self-esteem, and perceived clinical competence contributed 11.1% to the variance in the attitudinal component of professional nurse autonomy. These findings provide a baseline for understanding the attitudinal component of professional nurse autonomy. A large percentage of the variance in the model was unexplained, suggesting the need for further study of other contributing variables.
Adult↗
Autonomy: a professional issue of concern for nurse practitioners.
Autonomy has been a professional issue for nurses and for nurse practitioners (NPs). Health care reform will be critical to continuing and improving the autonomous roles of NPs. Without autonomy to practice their skills freely as primary health care providers, the roles of NPs will most likely be limited in any reformed health care system. Insights into the issue of autonomy for NPs are discussed.
Clinical Competence↗
Clinical guidelines and the fate of medical autonomy in Ontario.
Conceptually, clinical guidelines and professional autonomy have a paradoxical relationship. Despite being the quintessence of medical knowledge at the corporate level, guidelines diminish the clinical autonomy of individual practitioners, and therefore threaten medicine's justification for its autonomy. Theorists have argued that professional autonomy will be retained through elite dominance of practitioners, while comparative research suggests that economic autonomy can be traded off to retain clinical autonomy. Under government pressure to regulate the growth of Ontario physicians' fee-for-service public expenditure, the profession's representative organization, the Ontario Medical Association (OMA), promoted voluntary clinical guidelines, hoping to both constrain costs and preserve professional control over the content of medical care. The OMA collaborated with the Ministry of Health in developing guidelines and establishing a provincial centre for health service research. Ontario's practitioners disregarded the OMA's exhortations to implement clinical guidelines, suggesting that in the absence of external constraints, practitioners can subvert elite dominance. However, practitioners' unchecked clinical and economic autonomy, combined with evidence of wide provincial variations in medical care, served to legitimize the government's increasingly unilateral control over the schedule of insured medical services, and, in 1993, their imposition of a global cap on physicians' fee-for-service income pool. When analysed in the context of ongoing Ministry-OMA relations, the failure of the OMA's guidelines strategy to constrain medical service costs has expedited an overall decline in medical autonomy in Ontario. The emergence and course of Ontario's clinical guidelines movement is consistent with the view that medical autonomy is contingent upon broad class forces, and the conceptualization of professional organizations as instruments for mediated occupational control.
Attitude of Health Personnel↗
Professionalism, physician autonomy, and the new economics of medicine.
Explore the source record for details and available documents.
Economics, Medical↗
Autonomy in the medical profession in the United Kingdom--an historical perspective.
This paper reviews the concept of professional autonomy from an historical perspective. It became formalised in the United Kingdom only after a long struggle throughout most of the nineteenth century. In its pure form professional autonomy implies unlimited powers to undertake medical investigations and to prescribe treatment, irrespective of cost. Doctors alone should determine the quality of care and the levels of remuneration to which they should be entitled. In the second half of the twentieth century a steady erosion of professional autonomy occurred in the United Kingdom. The level of remuneration has been restricted for most doctors for nearly fifty years, whilst the costs of health care have steadily reduced the doctor's ability to provide unrestricted care within the health care system. Reorganisation of the National Health Service in 1983 and 1991 has substantially eroded professional autonomy, to the point where research developments, clinical judgement and ethical standards are all now being placed at risk.
Health Care Costs↗
EBM and risk: rhetorical resources in the articulation of professional identity.
Evidence-based medicine (EBM) has become a major theme within health care. This has fuelled a significant debate about its role in reducing risk and its possible impact on professional autonomy. Challenges arguments that propose that EBM is a threat to professional power and status by looking at how evidence, risk and professional knowledge come to have meaning. The objective is to deconstruct all three as discursive constructions whose meanings are malleable and embedded in social and power relations. By drawing on sociological debates about the social construction of evidence, risk and professional autonomy indicates the ways in which EBM is neither a rational alternative to the seemingly unending risks of contemporary medicine, nor in opposition to professional status. Instead it concludes by arguing that EBM and notions of risk are rhetorical resources in the articulation of professional autonomy and identity.
Evidence-Based Medicine↗
Beyond the rhetoric: benefits of a baccalaureate education for nursing.
This article examines the benefits and value of expanding the educational base for nursing. It argues that if nursing is to accept a broader mandate for the promotion of health, the educational preparation of the nurse must focus as much on the development of the nurse as a person, as on the knowledge, skills and attitudes that are specific to the profession. It suggests that to effect the changes required in the health care system nurses require increased levels of autonomy. A professional liberal education will contribute to a strong sense of professional autonomy and self-actualization; both are essential qualities for today's contemporary nurse.
Curriculum↗
Saint Martin of Tours in a new world of medical ethics.
I end with another parable, but it is also a true story. Harvey Cushing, the famous surgeon after whom the Cushing Lectures are named, made an international reputation in his allegiance to quality. He badgered his profession to a higher standard of self-effacement and railed against the debasement of clinical skills and overemphasis on research and pursuit of personal gain. We honor him to this day because those were, and remain, important points. Yet, Harvey Cushing served as a surgeon during World War I and at Ypres. Although the Allied mortality was as much as 50,000 soldiers a day, not counting the wounded, Cushing refused to operate on any more than two patients each day, arguing that to do so would have lowered his standard of care for his patients--a standard that made sense in one time but that became strikingly insensitive, and I suggest even unethical, in another when confronted with a different reality. The ethical claims for professional autonomy based on such standards of professional ethics has had the effect of supporting widespread distributional inequities. These inequities are clearly a form of rationing that have been condoned implicitly by the professional ethics in the name of professional autonomy. Many of the condemnations we hear today of prospective payment systems and how they will "ration" medicine contain a similar sense of unreality. The high standards are laudatory, but they should not be used as an excuse to not meet other pressing needs. High standards should never be used to make a problem worse.(ABSTRACT TRUNCATED AT 250 WORDS)
Christianity↗
Why I want to be a psychiatric nurse: constructing an identity through contrasts with general nursing.
The justification of psychiatric specialization among undergraduate nursing students is examined. The data highlight how students are able to produce a positive view of their initial entry into nursing and then later create a positive and distinctive specialist occupational identity through negative comparisons with general nursing. Their experience in both psychiatric and general settings is drawn upon to add credibility to their claims. Contrasts based on the work schedules, patient focus, professional autonomy, opportunity for professional development, and required skills are considered.
Career Choice↗