
==== Front
Nurs Open
Nurs Open
10.1002/(ISSN)2054-1058
NOP2
Nursing Open
2054-1058
John Wiley and Sons Inc. Hoboken

10.1002/nop2.70011
NOP270011
NOP-2023-Jul-1374.R5
Empirical Research Quantitative
Empirical Research Quantitative
The status of professional autonomy and its predictors in clinical nurses in Iran
Balasi et al.
Balasi Leila Rouhi https://orcid.org/0000-0002-5088-9157
1
Hazrati Maryam 2
Ashouri Asieh 3
Ebadi Abbas 4
Elahi Nasrin 5 nasrinelahi137@gmail.com

1 Department of Nursing, School of Nursing and Midwifery Guilan University of Medical Sciences Rasht Iran
2 Community Based Psychiatric Care Research Center Shiraz University of Medical Sciences Shiraz Iran
3 Research Center of Health and Environment, School of Health Guilan University of Medical Sciences Rasht Iran
4 Nursing Research Center, Clinical Sciences Institute Baqiyatallah University of Medical Sciences Teheran Iran
5 Nursing Care Research Center in Chronic Diseases, Faculty of Nursing and Midwifery Ahvaz Jundishapur University of Medical Sciences Ahvaz Iran
* Correspondence
Nasrin Elahi, Nursing Care Research Center in Chronic Diseases, Faculty of nursing and midwifery, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
Email: nasrinelahi137@gmail.com

24 9 2024
9 2024
11 9 10.1002/nop2.v11.9 e7001102 7 2024
29 7 2023
04 8 2024
© 2024 The Author(s). Nursing Open published by John Wiley & Sons Ltd.
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

Abstract

Aim

The present study aimed to assess professional autonomy among clinical nurses and identify its predictors using a native and contemporary tool, which is in line with the recent advancement in nursing professionalism in Iran.

Design

The study used an analytical cross‐sectional design.

Methods

A total of 1601 nurses working in medical centres nationwide under the Ministry of Health participated in the study. The research instrument consisted of two parts, including individual and organizational characteristics and a questionnaire on clinical nurses' professional autonomy. Data analysis involved descriptive and inferential statistics as well as multiple logistic regression analysis using SPSS software.

Results

The results indicated that the total professional autonomy score among clinical nurses was 75.86 ± 12.03, with the majority (n = 1262, 78.9%) reporting high professional autonomy. Multiple logistic regression analysis revealed that nurses with 5–15 years of experience had 1.82 times higher odds (95% confidence interval: 2.47–1.35) of having high professional autonomy compared to those with less than 5 years of experience. Similarly, nurses with over 15 years of experience had 2.25 times higher odds (95% confidence interval: 1.56–3.26). Head nurses had 4.56 times higher odds (95% confidence interval: 2.60–7.99) of having high professional autonomy compared to clinical nurses.

Conclusion

Educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended. Additionally, measures such as supporting nurses, providing effective communication training and empowering nurses are essential to promote professional mutual respect among nurses.

No Patient or Public Contribution

This study explored professional autonomy in clinical nurses in Iran. No patient or public contribution was investigated.

clinical nurse
Iran
professional autonomy
professionalism
the Ministry of Health and Medical Education of Iran source-schema-version-number2.0
cover-dateSeptember 2024
details-of-publishers-convertorConverter:WILEY_ML3GV2_TO_JATSPMC version:6.4.8 mode:remove_FC converted:24.09.2024
Balasi, L. R. , Hazrati, M. , Ashouri, A. , Ebadi, A. , & Elahi, N. (2024). The status of professional autonomy and its predictors in clinical nurses in Iran. Nursing Open, 11 , e70011. 10.1002/nop2.70011
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pmc1 INTRODUCTION

Nursing has been striving to establish itself as a science through professional evaluation. Given the crucial role of nursing in patient care, ensuring nurses' professional autonomy is essential to empower them to have greater decision‐making authority (Costa et al., 2021). The findings revealed variations in the levels of professional autonomy among clinical nurses in various countries (Pursio et al., 2021). Professional autonomy typically involves participating in patient care decisions and enhancing care processes to improve nursing quality and patient safety (Pursio et al., 2021). A qualitative study highlighted that nurses with professional autonomy exhibit strong leadership and management skills, delivering quality nursing services through clinical reasoning and effective professional interactions (Rouhi‐Balasi, 2020). Autonomy is a key component of professional nursing practice (Rao et al., 2017). In a study exploring barriers and facilitators of professionalization among nurses, autonomy emerged as a significant factor influencing professional development from the nurses' perspective (Habibzadeh et al., 2013).

Professional autonomy enables nurses to make timely decisions at the patient's bedside, leading to improved patient safety, enhanced quality of care, reduced mortality rate, decreased stress levels, increased job satisfaction among nurses and improved retention and recruitment of nursing staff and fosters trust, respect and better communication with colleagues and physicians (AllahBakhshian et al., 2017; Enns et al., 2015; Paganini & Bousso, 2015).

Despite the increasing professionalism in nursing and a greater emphasis on responsibility in the clinical environment (Shohani et al., 2018), some studies have shown that nurses exhibit low to moderate levels of professional autonomy (Abdolmaleki et al., 2019; Aghamohammadi et al., 2019; AllahBakhshian et al., 2017; Labrague et al., 2019). This lack of autonomy can lead to negative outcomes such as burnout, depression, work burden, absenteeism and moral distress (Labrague et al., 2019). Various factors, including economic, political and sociocultural influences, can impact professional autonomy in nursing (Baykara & Şahinoğlu, 2014). Therefore, nursing autonomy is not a static state and individual and organizational factors play a significant role in determining nurses' ability to achieve professional autonomy (Labrague et al., 2019).

Today, nurses are witnessing a transformation in the image of nursing over the years, accompanied by a rise in professional autonomy and the establishment of clear definitions of professional roles and functions. However, the concept of professional autonomy can be affected by various factors, such as organizational, political and sociocultural influences (Baykara & Şahinoğlu, 2014). Therefore, it is essential to conduct a study to assess professional autonomy among clinical nurses and identify its predictors using a relevant and up‐to‐date tool that aligns with the evolving changes and advancements in the nursing profession in recent years. Moreover, no national study has been conducted to investigate the nurses' professional autonomy in Iran. Previous studies only focused on specific centres or provinces in Iran. Considering the influence of cultural and social factors on nurses' professional autonomy in healthcare systems, a national study can offer a comprehensive view of nurses' professional status in Iran. This study aimed to explore Iranian clinical nurses' professional autonomy and its predictors. The findings can inform future policies and planning in the nursing profession, ultimately enhancing the quality of patient care.

2 METHOD

2.1 Research design

This cross‐sectional study was conducted between 2021 and 2022 to assess the professional autonomy of clinical nurses in Iran and identify its predictors.

2.2 Samples and settings

The study was conducted in medical centres across the country under the Ministry of Health, with the research community comprising clinical nurses working in these centres. The inclusion criteria required participants to be nurses working in a hospital clinical department for at least 1 year and willing to participate in the study. Based on previous studies (Aghamohammadi et al., 2019; Amini et al., 2015), the sample size was calculated as 1613 across five geographical regions to estimate a 30% desirable professional autonomy ratio in nurses, with a 5% margin of error and 95% confidence level. However, at the end of data collection, 1601 out of 1952 completed questionnaires met the eligibility criteria and were included in the final analysis.

Out of the 32 provinces in Iran, 10 were randomly selected for sampling, including East Azerbaijan, Isfahan, Ilam, Tehran, Khorasan‐e‐Razavi, Khuzestan, Semnan, Fars, Kerman and Guilan representing the geographical regions of Northern, Southern, Eastern, Western and Central Iran. From the list of affiliated hospitals, two to four hospitals were randomly chosen based on the number of their hospital beds (less than or more than 100 beds) and ownership (public or private). Subsequently, all clinical nurses from various hospital wards were invited to participate in the study.

2.3 Instrumentation

The data was collected in two parts, including individual and organizational factors (age, gender, marital status, education, nursing experience, job position, type of ward, type of work shift, type of employment, type of hospital, membership in organizations and professional nursing associations) and the Professional Autonomy of Clinical Nurses' questionnaire (PACNQ) (3). The PACNQ consists of 31 items with seven dimensions: ‘professional care’ (6 items) (example statement: I use innovations to better implement patient care.), ‘professional mutual respect’ (7 items) (example statement: I am appreciated for my successful and independent performance.), ‘professional decision‐making’ (5 items) (example statement: I take responsibility for my own decisions.), ‘leadership role’ (5 items) (example statement: I am able to create good coordination between the members of the treatment team.), ‘professional discipline’ (3 items) (example statement: I am serious and precise in performing my professional duties.), ‘clinical skill’ (2 items) (example statement: I have enough clinical skills.) and ‘critical thinking’(3 items) (example statement: I can provide a proper nursing diagnosis according to my patient's problems.)

The questionnaire was developed as part of a thesis project by a research team member, and it enjoys desirable psychometric characteristics. It is the first questionnaire in Iran exclusively designed to measure professional autonomy in clinical nurses and has the potential to be used in various clinical departments based on nurses' experiences. The overall Content Validity Index (CVI) for the questionnaire was reported as 0.964, its reliability was 0.885 using the internal consistency method by Cronbach's alpha, and its stability was 0.840 using the intra‐cluster correlation coefficient. The questionnaire is scored on a scale of 0 to 100, where zero indicates the absence of professional autonomy, and higher scores indicate higher professional autonomy. The total score can be categorized as low, medium or high autonomy, with scores less than or equal to 33.3 considered low, scores between 33.4 and 66.6 considered medium autonomy, and scores 66.7 and above considered high levels of autonomy (Rouhi‐Balasi, 2020).

2.4 Data collection and ethical consideration

In order to expand the research community, an electronic questionnaire was designed to collect data. The questionnaire link was distributed to nurses in different wards of selected hospitals through the nursing management offices of universities. The electronic questionnaire link, which outlined the study objectives, inclusion criteria and confidentiality measures, was shared by a specific group of nurses in each hospital via the WhatsApp social network application. Data collection continued from August to November 2021 until the required number of samples was obtained. Data collection commenced after obtaining permission from the deputy of research and technology at universities, explaining the study objectives, obtaining consent for participation and data confidentiality, and securing participants' consent for the research. This study received financial support from the Ministry of Health and Medical Education of Iran and was approved by the ethics committee of ‘REDACTED’ University of Medical Sciences, with the ethics code ‘REDACTED’.

2.5 Data analysis

Frequency, percentage, median, mean and standard deviation (min and max) were used to describe the data. The professional autonomy score was also reported with a 95% confidence interval. The normality of quantitative variables was assessed using Q–Q plots, skewness, and kurtosis indices. Except for the variables of professional mutual respect and the total score of professional autonomy, other variables showed a non‐normal distribution. Therefore, non‐parametric tests were used for data analysis. Spearman's rank correlation coefficient test was conducted to examine the linear correlation between quantitative variables. Simple logistic regression analysis was used to compare the professional autonomy score based on demographic and organizational variables. Multiple logistic regression analysis was employed to determine the predictor variables of professional autonomy. The stepwise method of selecting variables based on the Hosmer–Lemeshow goodness of fit test was applied. To account for potential regional variation and isolate the effects of other independent variables more accurately, adjustments for provinces were made in the multiple logistic regression model. The data were analysed using SPSS‐26 with a significance level of 0.05 for all tests.

3 FINDINGS

In total, 1952 nurses from various provinces nationwide participated in this project, of whom 1601 were eligible to enter the study. Some samples, such as nursing supervisors or those working in administrative roles within department affairs (n = 300) or with less than 1 year of clinical ward experience (n = 51), were excluded from the study due to failing to meet the eligibility criteria. The demographic and job characteristics of the nurses are presented in Table 1. The data show that 87.1% (n = 1395) of the participants were women, and 12.9% (n = 206) were men. The majority of participants held a bachelor's degree (90.3%, n = 1445), worked in rotating shifts (75%, n = 1201), were employed in ICUs (25.4%, n = 407), worked in public hospitals (86.1%) and were based in educational‐medical centres (58.8%, n = 941). Approximately half of the nurses (55.3%, n = 885) reported being members of professional nursing organizations and associations. The mean and standard deviation of the nurses' nursing experience was 11.1 ± 0.7 years (ranging from 1 to 32 years).

TABLE 1 Sociodemographic characteristics and job characteristics of participants (n = 1601).

Variables	Groups	N a	%	
Sex	Female	1395	87.1	
Male	206	12.9	
Marital status	Married	1206	75.3	
Single	357	22.3	
Divorced	27	1.7	
Widow	11	0.7	
Job position	Clinical nurse	1264	79	
Substitute of head nurse	71	4.4	
Head nurse	266	16.6	
The type of work shift	Fixed night shifts	30	1.9	
Fixed morning shifts	363	22.7	
Fixed evening shifts	7	0.4	
Rotating shifts	1201	75	
Age (years) (M 36.71, SD 9.3)	20–29	431	27.3	
30–39	567	36	
40–49	454	28.8	
50 and above	125	7.9	
Nursing experience (years) (M 11.14, SD 7.0)	1–5	338	21.1	
5–14	738	46.1	
15 and above	525	32.8	
Work experience in the current position (year) (M 8.13, SD 6.0)	1–2	146	9.1	
2–9	861	53.8	
10 and above	592	37	
a A total of less than 1601 were due to missing data, which accounted for less than 1%.

Abbreviations: M, mean; SD, Standard deviation.

Tables 2 and 3 illustrate the professional autonomy score in general and its dimensions. The mean score for professional autonomy was 75.9, with a standard deviation of 12.0, which indicates that 78.9% (n = 1262) of the nurses had a high level of professional autonomy, 21% (n = 337) had a moderate level, and less than 1% (n = 2) had a low level.

TABLE 2 The professional autonomy score in general and its dimensions (n = 1601).

Factors	Mean ± SD	95% CI for the mean	Median	95% CI for the median	Min	Max	
Total Score	75.86 ± 12.03	75.27–76.45	76.50	75.75–77.25	24.25	100.00	
Professional care	80.04 ± 14.99	79.3–80.77	82.00	80.00–82.01	18.00	100.00	
Professional mutual respect	53.25 ± 19.83	52.27–54.22	53.64	52.73–55.45	0.00	94.55	
Professional decision‐making	88.92 ± 11.99	88.33–89.51	91.18	91.18–91.18	8.82	100.00	
Leadership role	77.44 ± 16.45	76.63–78.25	77.78	75.00–79.17	0.00	100.00	
Professional discipline	92.01 ± 11.70	91.44–92.59	100.00	100.00–100.00	0.00	100.00	
Clinical skill	84.05 ± 15.96	83.27–84.83	87.50	75.00–87.50	0.00	100.00	
Critical thinking	81.69 ± 16.57	80.87–82.50	87.50	81.25–87.50	6.25	100.00	

TABLE 3 Distribution of the levels of professional autonomy in general and its dimensions in participants (n = 1601).

Dimensions	Groups	N	%	
Professional care	Low	7	0.4	
Medium	293	18.3	
High	1301	81.3	
Professional mutual respect	Low	253	15.8	
Medium	940	58.7	
High	408	25.5	
Professional decision‐making	Low	2	0.1	
Medium	74	4.6	
High	1525	95.3	
Leadership role	Low	18	1.1	
Medium	330	20.6	
High	1253	78.3	
Professional discipline	Low	2	0.1	
Medium	33	2.1	
High	1566	97.8	
Clinical skill	Low	7	0.4	
Medium	179	11.2	
High	1415	88.4	
Critical thinking	Low	17	1.1	
Medium	254	15.9	
High	1330	83.1	
Professional autonomy in general	Low	2	0.1	
Medium	337	21	
High	1262	78.9	

In the dimensions of professional autonomy, nurses scored highest in professional discipline (median score: 100), professional decision‐making (median: 91.2), clinical skills (median: 87.5) and critical thinking (median: 87.5). They also scored well in professional care (median: 82), leadership role (median: 77.8) and professional mutual respect (median: 53.6). In the dimension of professional mutual respect, 15.8% (n = 253) of nurses reported a low level, 58.7% (n = 940) reported moderate level and only 25.5% (n = 408) reported a high level of autonomy.

Based on the results of univariate analysis, gender, age, education, nursing experience, job position, type of ward, work shift, type of employment and membership in professional nursing organizations and associations were found to have a statistically significant relationship with the nurse's professional autonomy level (p < 0.05 for all cases). Female nurses (unadjusted OR = 1.42, 95% CI: 1.02–1.99, p = 0.038), older nurses (unadjusted OR = 1.03, 95% CI: 1.02–1.05, p < 0.001) with more work experience (unadjusted OR = 1.07, 95% CI: 1.05–1.09, p < 0.001) and higher education (unadjusted OR = 2.00, 95% CI: 1.19–3.37, p = 0.034), head nurses (unadjusted OR = 5.48, 95% CI: 3.21–9.38, p < 0.001), nurses working morning shifts versus rotating shifts (unadjusted OR = 3.30, 95% CI: 2.25–4.83, p < 0.001), nurses with permanent contract employment (unadjusted OR = 2.25, 95% CI: 1.54–3.28, p < 0.001 compared with fixed‐term contract, unadjusted OR = 1.77, 95% CI: 1.16–2.70, p = 0.008 compared with temporary contract, unadjusted OR = 2.65, 95% CI: 1.92–3.65, p < 0.001 compared with internship, unadjusted OR = 1.43, 95% CI: 0.94–2.17, p = 0.091 compared with candidate of permanent contract) and members of professional organizations and associations (unadjusted OR = 1.49, 95% CI: 1.17–1.89, p < 0.001) reported higher professional autonomy. However, marital status (p = 0.672), type of hospital (p = 0.267), educational nature of the hospital (p = 0.597) and years of nursing experience in the current position (p = 0.275) showed no significant relationship with nurses' professional autonomy.

An analysis of demographic and job characteristics predicting clinical nurses' professional autonomy revealed that nursing experience and job position were the only independent predictors. According to the results of multiple logistic regression analysis, nursing experience and job position were significant factors that influenced professional autonomy. Controlling for other variables in the regression model, nurses with 5–15 years of experience had a 1.82 times higher chance of high professional autonomy (95% confidence interval: 1.35–2.47) compared to those with less than 5 years of experience. Similarly, nurses with more than 15 years of experience had a 2.25 times higher chance of high professional autonomy (95% confidence interval: 1.56–3.26). Head nurses were reported to have a 4.56 times higher chance of possessing high professional autonomy (95% confidence interval: 2.60–7.99) compared to clinical nurses. However, no significant difference was observed between nurses and substitute head nurses (See Table 4).

TABLE 4 Predictors of high professional autonomy of clinical nurses based on the multiple logistic regression model.

Predictors	Professional autonomy N (%)	Adjusted OR (95% CI)	p	
Low or medium (n = 39)	High (n = 1262)	
Job position	
Clinical nurse	312 (25)	952 (75)	1		
Substitute of head nurse	12 (17)	59 (83)	1.21 (0.63–2.32)	0.576	
Head nurse	15 (6)	251 (94)	4.56 (2.6–7.99)	<0.001	
Nursing experience (year)	
1–5	117 (35)	221 (65)	1		
5–14	151 (20)	587 (80)	1.82 (1.35–2.47)	<0.001	
15 or above	71 (14)	454 (86)	2.25 (1.56–3.26)	<0.001	
Note: The reference category was indicated by 1. The regression model is adjusted based on the province where the nurses work.

Abbreviations: CI; confidence interval; OR, odds ratio.

4 DISCUSSION

The present study, conducted to investigate the professional autonomy status among clinical nurses and its predictors, indicated that the total professional autonomy score of clinical nurses was 75.86 ± 12.03, with the majority reporting a high level of professional autonomy.

Influenced by cultural and organizational conditions, professional autonomy has led to varying findings in different studies. In Iran, diverse results have been observed in different studies. Yaganeh et al. found a high mean score of professional autonomy among ICU nurses (Yeganeh et al., 2019), while Shohani et al. reported high levels of professional autonomy among nurses (Shohani et al., 2018). However, Sarkoohi et al.'s study on nurses in paediatric wards and PICUs (Sarkoohijabalbarezi et al., 2017) and Mousavizadeh et al.'s research showed low levels of professional autonomy among nurses (Mousavizadeh & Mohtashami, 2018). Nursing autonomy varies based on organizational rules, regulations and/or personal factors (Nouri et al., 2017).

Professional autonomy is influenced by organizational, political and sociocultural factors (Finn, 2001; Valizadeh et al., 2013; Zamanzadeh et al., 2009). Using a native and up‐to‐date tool to measure, this concept aligned with recent advancements in the nursing field may explain the differences in findings. Merely, other countries may not accurately assess professional autonomy in our context. Additionally, previous studies focused on specific departments, while our study included various wards, potentially contributing to the difference in results.

The results of analysing the seven dimensions of professional autonomy, including ‘professional care’, ‘professional mutual respect’, ‘professional decision‐making’, ‘leadership role’, ‘professional discipline’, ‘clinical skills’ and ‘critical thinking’ suggest that nurses reported high levels of professional autonomy in all dimensions except for ‘professional mutual respect’. Medical dominance in specific clinical settings may play a role in this area. The dimension of professional mutual respect focuses on earning the trust and respect of the medical team, particularly nurse‐physician collaboration, based on successful work experiences. Communication in nursing is crucial and is considered a key component of care and a primary responsibility of nurses (Ghiyasvandian et al., 2015). Professional communication entails mutual respect for professional values and individual capabilities, utilizing colleagues' knowledge and experiences, seeking opinions and consulting with peers in decision‐making (Farhadi et al., 2017). Every nurse should establish and maintain professional communication, including medical communication with clients and professional communication with colleagues and healthcare team members. According to professional communication studies, this is likely to contribute to a stronger professional identity for nurses (Tabatabai et al., 2015). In general, professional communication, equality, teamwork, inter‐professional collaboration and respect without authoritarian impositions enhance nurses' professional autonomy, while disrespect can counteract (Pursio et al., 2021).

In the ‘professional discipline’ dimension, certain professional values and attitudes, such as discipline, honesty and seriousness, are evaluated. This aspect has not been explored in prior research. These elements have not been addressed in any existing tools pertaining to nurses' professional autonomy of nurses, indicating their significance in light of cultural and social influences. The elevated rating of nurses in the realm of ‘professional discipline’ in this study may be attributed to the prevalent professional and ethical dedication within the Iranian nursing community.

The results of the multiple logistic regression analysis showed that nurses with five to 15 years of work experience were 1.82 times more likely to have high professional autonomy compared to those with more than 15 years of experience. Similarly, nurses with more than 15 years of experience had a 2.25 times higher chance of having high professional autonomy. Head nurses were 4.56 times more likely to have high professional autonomy than clinical nurses, while there was no significant difference between nurses and substitute head nurses. The findings suggest that increased clinical experience can enhance nurses' professional competence, ultimately leading to higher levels of professional autonomy.

In an integrated review study, the findings highlighted personal competence as a crucial factor in the development of professional autonomy among nurses. This competence encompasses knowledge, clinical skills and the ability to make informed decisions and act appropriately. Education and experience, including the time spent in nursing and the current position, are identified as factors that can enhance autonomy (Pursio et al., 2021). The study also revealed a significant relationship between nurses' current positions and their level of professional autonomy, with head nurses scoring higher in autonomy. This correlation may be attributed to head nurses' work experience in clinical settings, which serves as another predictor of autonomy. In the nursing management system, head nurses are typically chosen from individuals with substantial work experience.

In a study conducted by Duong et al., a statistically significant relationship was found between nursing work experience and nurses' autonomy scores. Nurses with higher work experience achieved higher scores in nursing autonomy, indicating that more experienced nurses had better professional skills in their care performance (Duong et al., 2020). Similarly, a study on ICU nurses demonstrated a significant correlation between professional autonomy and work experience (Asl et al., 2022). Other studies have shown that work experience is a key factor in nurses' autonomy (Labrague et al., 2019; Motamed‐Jahromi et al., 2015). Professional experience can enhance self‐confidence, efficiency and autonomy in applying theoretical knowledge to professional practice (Motamed‐Jahromi et al., 2015).

4.1 Limitations

The study was conducted during the COVID‐19 pandemic. Due to the high workload in hospitals, nurses were less willing to participate and fill out the questionnaire. Efforts were made to address this issue through multiple follow‐ups and encouragement to participate. The self‐report nature of the questionnaire was a limitation of this study. Since the questionnaires were distributed online to nurses, there may have been doubts or questions that could not be addressed as the information was collected online. Another limitation of this study was its cross‐sectional design.

4.2 Nursing implications

The present study discusses the status of professional autonomy and its relevant factors, aiming to assist nursing policymakers in making decisions to enhance professional autonomy among nurses. Considering the multidimensional nature of professional autonomy, creating a supportive work environment for nurses to have autonomous performance can enable nurses to participate in decision‐making and planning. Also, in healthcare systems, nursing should be valued as an independent profession, and it seems that nursing managers should take effective measures to empower nurses and move towards professionalization of nurses.

Additionally, based on the study findings, it is crucial for healthcare and treatment managers, including nursing managers, to implement measures to enhance the status of the nursing profession in society, which includes improving professional mutual respect within the treatment team. Managers can organize retraining programs that focus on enhancing professional relationships within the treatment team, ultimately leading to improved quality of nursing care.

5 CONCLUSION

By implementing changes within healthcare organizations, steps can be taken to enhance nurses' professional autonomy through various means, such as providing support, offering effective professional communication and empowering nurses. Also, it can be inferred that having experience in the nursing field is a key factor in enhancing nurses' professional autonomy. Therefore, educational interventions to enhance the professional autonomy of less experienced nurses, with more experienced nurses serving as role models, are recommended.

AUTHOR CONTRIBUTIONS

L.R.‐B.: Conceptualization, Data collection, Methodology, Writing—Original draft preparation. M.H: Conceptualization, Supervision, Reviewing and Editing. A.A: Data analysis, Methodology, Writing—Original draft preparation. A.E: Supervision, Reviewing and Editing. N.E: Conceptualization, Supervision, Reviewing and Editing.

FUNDING INFORMATION

This research was Funded by the Ministry of Health and Medical Education of Iran.

CONFLICT OF INTEREST STATEMENT

Nothing to declare.

ETHICS STATEMENT

This study was approved by the ethics committee of Guilan university of medical Sciences, with the ethic code IR.GUMS.REC.1400.073.

ACKNOWLEDGEMENTS

We would like to sincerely appreciate all nurses participating in the study and the authorities of the nursing offices of the participating universities in the project.

DATA AVAILABILITY STATEMENT

The data that support the findings of this study are available from the corresponding author upon reasonable request.
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