Registered nurses' perception of their autonomy and the factors that influence their autonomy in rehabilitation and long-term care settings.

To determine attributes of the registered nurse and the working environment that influence registered nurses' perception of autonomy (defined as independence within one's own practice), data were collected from questionnaires completed by 85 full time registered nurses at a 601 bed chronic/rehabilitation hospital located on two sites in the city of Toronto, Ontario, Canada. Registered nurses experienced a higher perception of autonomy given a more participative management style on the part of their nurse managers. Place of basic nursing education, which was used as an indication of cultural origin, was found to contribute to registered nurse perception of autonomy where basic education was in Canada or the United States. Increased workload (acuity) was found to detract from registered nurse perception of autonomy. Baccalaureate education, and primary or modular nursing care delivery models contributed to high autonomy, whereas diploma education, and functional or team nursing were associated with the low autonomy group in discriminant analysis. Administrative recommendations for nursing include the promotion of a participative management style on the part of nurse managers; attention to cultural diversity of nursing staff; support of advanced education in nursing; support of primary or modular nursing care delivery models; and management of registered nurses' workload in order to encourage a balance between client-focused professional practice activities and the routinized, provider-focused, task-driven activities.