Provision 4
Nurses have authority over nursing practice and are responsible and accountable for their practice consistent with their obligations to promote health, prevent illness, and provide optimal care.
4.2 Addressing Barriers to Exercising Nursing Practice Authority
Nurses are responsible for identifying and navigating negative influences on patient care. They work individually and collectively within their expertise and scope of practice. Nurses often face challenges in exercising their authority due to hierarchical structures, rigid protocols, and other oppressive influences in healthcare systems. Economic priorities and institutional interests focused primarily on profit, efficiency, or budgetary constraints can lead to inadequate human and material resources that interfere with the nurse’s ability to provide optimal nursing care. Nursing practice authority can be constrained by social, environmental, political, legislative, and economic factors. Contemporary examples include the extraordinary demands of managing emerging infectious diseases and system pressure to discharge patients to unsafe environments. Nurses who experience workplace violence, aggression, or hostility may have difficulty exercising their nursing practice authority. Nursing practice authority can also be affected by technological advances such as the implementation and use of augmented intelligence or artificial intelligence (AI), especially when integrated without careful consideration of potential harmful consequences. To maintain nursing practice authority, nurses address barriers surrounding rapid and evolving technologies; lack of experience, exposure, and knowledge; poor representation by those in leadership roles; and unsupportive work environments.
Given the complexity and changing patterns of healthcare delivery, emerging evidence, and ongoing nursing knowledge development, the scope of nursing practice and authority continues to evolve. Nurses build inclusive, supportive environments and engage in team and institutional decision-making to exercise their authority. Nurses in leadership roles should be aware of recurring problems in order to support and encourage nurses to articulate their perspectives. When institutional constraints are beyond nurses’ abilities to remedy, resources such as relevant literature, other members of the interprofessional team, healthcare ethics experts, and nursing organizations may provide guidance. Nurses seek a meaningful voice in decision-making processes with health systems. When nurses’ perspectives are not considered, patient care, the work environment, and systems that impact healthcare cannot flourish.