Magnet Hospital Nurses Describe Control Over Nursing Practice

Abstract

Staff nurses describe control over nursing practice (C/NP) as a professional nursing function made up of a variety of activities and outcomes. Greater acclaim, status, and prestige for nursing in the organization are viewed as a result, not a precursor, of C/NP. Interviews with 279 staff nurses working in 14 magnet hospitals indicated that effective C/NP requires some kind of empowered, formal organizational structure, extends beyond clinical decision making at the patient care interface, and is the same as or highly similar to what the literature describes as professional autonomy. From constant comparative analysis of nurses' descriptions of C/NP activities, five ranked categories of this real-life event emerged. The basis for the categories and ranking was “who owned the problem, issue, and solution” and the “degree of effectiveness of control” as reflected in visibility, viability, and recognition of a formal structure allowing and encouraging nurses' control over practice. Hospital mergers and structural reorganization were reported to negatively affect the structure needed for effective C/NP. Almost 60% of these magnet hospital staff nurses stated and/or described little or no C/NP.