The Determinants of Professional Autonomy of Nurse Practitioners; A Systematic Review

Abstract

Professional autonomy is a core attribute of nurse practitioner practice and a critical determinant of workforce effectiveness, role sustainability, and quality of care, yet its realization varies substantially across clinical and policy contexts. This systematic review synthesizes contemporary evidence on the determinants of professional autonomy among nurse practitioners, focusing on behavioural, organizational, and contextual influences, as well as associated outcomes. Guided by PRISMA 2020 guidelines, peer-reviewed quantitative, qualitative, mixed-methods, and review studies were systematically identified, screened, and analysed using a standardized literature review matrix and narrative synthesis approach. The findings demonstrate that professional autonomy is shaped by the interaction of individual competence, self-efficacy, and professional identity; organizational factors such as leadership style, governance structures, interprofessional relationships, and work environments; and external regulatory and policy frameworks, particularly scope-of-practice regulations. Higher levels of autonomy were consistently linked to positive outcomes, including greater job satisfaction, enhanced professional fulfilment, improved patient safety activities, and more efficient utilization of nurse practitioner roles, whereas restrictive organizational cultures and regulatory constraints limited the translation of formal authority into everyday practice. Overall, the review highlights that professional autonomy is a dynamic and multidimensional capability that requires coordinated educational, organizational, and policy-level strategies to be effectively realized in modern healthcare systems.