Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue

J Nurs Scholarsh. 2017 Jan;49(1):73-79. doi: 10.1111/jnu.12267. Epub 2016 Nov 4.


Research purpose: Autonomy is essential to professional nursing practice and is a core component of good nurse work environments. The primary objective of this study was to examine the relationship between nurse autonomy and 30-day mortality and failure to rescue (FTR) in a hospitalized surgical population.

Study design: This study was a secondary analysis of cross-sectional data. It included data from three sources: patient discharge data from state administrative databases, a survey of nurses from four states, and the American Hospital Association annual survey from 2006-2007.

Methods: Survey responses from 20,684 staff nurses across 570 hospitals were aggregated to the hospital level to assess autonomy measured by a standardized scale. Logistic regression models were used to estimate the relationship between nurse autonomy and 30-day mortality and FTR. Patient comorbidities, surgery type, and other hospital characteristics were included as controls.

Findings: Greater nurse autonomy at the hospital level was significantly associated with lower odds of 30-day mortality and FTR for surgical patients even after accounting for patient risk and structural hospital characteristics. Each additional point on the nurse autonomy scale was associated with approximately 19% lower odds of 30-day mortality (p < .001) and 17% lower odds of failure to rescue (p < .01).

Conclusions: Hospitals with lower levels of nurse autonomy place their surgical patients at an increased risk for mortality and FTR.

Clinical relevance: Patients receiving care within institutions that promote high levels of nurse autonomy have a lower risk for death within 30 days and complications leading to death within 30 days. Hospitals can actively take steps to encourage nurse autonomy to positively influence patient outcomes.

Keywords: Autonomy; nursing; surgery; teamwork.

MeSH terms

  • Adult
  • Aged
  • Cross-Sectional Studies
  • Failure to Rescue, Health Care / statistics & numerical data*
  • Female
  • Hospital Mortality / trends*
  • Humans
  • Male
  • Middle Aged
  • Nursing Staff, Hospital*
  • Perioperative Nursing*
  • Professional Autonomy*
  • Risk Factors