An exploration of the levels of clinical autonomy of advanced nurse practitioners: A narrative literature review

Int J Nurs Pract. 2022 Feb;28(1):e12978. doi: 10.1111/ijn.12978. Epub 2021 Jun 9.


Aims and objectives: The aims of the review are to synthesise current evidence about advanced nurse practitioner clinical autonomy and consider how this may inform clinical practice and research.

Background: Clinical autonomy is one of the cornerstones of advanced nursing practice globally, yet there is limited synthesis of clinical autonomy in the literature.

Design: This is a narrative literature review.

Data sources: The databases Cumulative Index to Nursing and Allied Health Literature, EBSCO host, Cochrane Library, CINAHL and MEDLINE were searched for publications between 2005 and 2020 inclusive.

Review methods: A systematic approach was used to analyse the literature reviewed. Two reviewers undertook quality appraisal.

Results: Nineteen articles were selected. Four major themes emerged: (1) 'ANP Stepping Up'-moving into and accepting advanced nursing practice roles and clinical responsibilities; (2) 'ANP Living It'-ANPs' ability to act independently including an understanding of task mastery and self-determination; (3) 'ANP Bounce-back ability'-depicted in challenges that threaten their ability to practice clinically autonomously; (4) 'ANP Setting in Motion'-indirect care activities and service-level improvements.

Conclusion: A clearer understanding of advanced nurse practitioner clinical autonomy could help develop more in-depth knowledge. Research of advanced nurse practitioners' clinical autonomy would improve full utilisation in clinical practice.

Keywords: advanced nurse practitioners; advanced nursing practice; autonomy; levels of clinical autonomy; nurse practitioners.

Publication types

  • Review

MeSH terms

  • Advanced Practice Nursing*
  • Humans
  • Nurse Practitioners*
  • Nurse's Role