Are Teamwork and Professional Autonomy Compatible, and Do They Result in Improved Hospital Care?

The increasing complexity of health care has resulted in greater responsibilities for health professionals, blurred boundaries between professions, and the need for interdependence among professionals and other support and managerial personnel. Simultaneously, health professionals perceive a decrease in personal autonomy that undermines worker satisfaction and contributes to an unstable workforce. This article presents results from a survey of staff nurses in 32 hospitals in England that explored the relationship between interdisciplinary teamwork and nurse autonomy and its impact on patient and nurse outcomes and nurse-assessed quality of care. Data from the 1998 to 1999 study are based on 5,006 completed nursing staff surveys. Survey questions focused on the key variables of nursing autonomy, control over resources, relationship with doctors, emotional exhaustion, and decision-making. These variables were found to correlate with one another and were also positively related to nurse-assessed quality of care and nurse satisfaction. Nursing autonomy was positively correlated with better perceptions of the quality of care delivered and higher levels of job satisfaction. Nurses with higher teamwork scores were significantly more likely to be satisfied with their jobs, planned to stay in them, and had lower burnout scores. Higher teamwork scores were associated with higher levels of nurse-assessed quality of care, perceived quality improvement over the last year, and confidence that patients could manage their care when discharged. Nurses with higher teamwork scores also exhibited higher levels of autonomy; suggesting a positive relationship. Organizations should be encouraged to promote nurse autonomy without fearing that it might undermine teamwork.