Contributor – Obidigwe Adaora Victoria
The year 2024 was supposed to be a turning point for North Carolina. Or at least that’s what Megan Conner and her colleagues thought. Instead, it put nursing back by decades.
The Safe, Accessible, Value-directed and Excellent Health Care Act (SAVE Act) could have kept Conner’s patients out of the emergency room, she tells NC Health News.
In 2026, a new version of the SAVE Act was introduced as Senate Bill 966, again proposing to modernize North Carolina’s nursing laws and grant full practice authority to APRNs.
As of now, SB 966 has been introduced but has not passed the North Carolina General Assembly and has not been signed into law.
So, where does that leave nurse practitioners? If anything, it’s reopened the conversation around autonomy in nursing.
From a nursing knowledge perspective, this debate can be examined through the lens of the Theory of Bureaucratic Caring. The theory recognizes that nursing practice occurs within organizational, legal, political, and economic systems that can either support or restrict professional decision-making. Questions about autonomy are therefore not only professional concerns but also reflections of how healthcare systems are structured.
What Do We Mean by ‘Autonomy’ in Nursing?
Autonomy in nursing isn’t working in isolation. It’s having the authority to apply clinical judgment without unnecessary barriers.
That includes:
- Making patient care decisions within the scope of practice
- Contributing to treatment plans
- Practicing without excessive oversight
Nursing Times reports that professional autonomy is directly linked to job satisfaction, confidence, and better patient outcomes. When nurses feel trusted to act, they perform better and stay longer in the profession.
The System Holding Nurses Back
Autonomy isn’t consistently built into healthcare systems. Hierarchical structures. Outdated policies. Rigid scope-of-practice laws. These factors limit what nurses can do, even when they’re fully qualified.
The American Medical Association (AMA) argues that NPs, in particular, face varying levels of practice authority, depending on location. In some regions, they can practice independently. In others, they’re required to work under physician supervision.
“It’s got to be confusing if I have to look 12 different places. I’m exaggerating, but only slightly, for what nurse practitioners can do and can’t do.” – Nurse anesthetist Kimberly Gordon via NC Health News.
That inconsistency creates confusion, and it restricts impact. The Theory of Bureaucratic Caring helps explain these barriers by highlighting how policies, regulations, and institutional hierarchies influence the delivery of care. Even highly trained nurses may find that their ability to act is limited by bureaucratic structures rather than clinical competence.
Autonomy Drives Better Outcomes
Research supports what many nurses already know from experience. In 2024, SAGE Journals published Professional Autonomy in Nursing: A Concept Analysis. The study reinforced the link between autonomy and improved clinical decision-making. Interestingly, its findings suggested that nurse managers enhance their knowledge by enrolling in professional development programs.
Most primary care providers are encouraged to earn a family nurse practitioner (FNP) degree. In many states, FNPs function as autonomous primary care providers. Some take the online degree route. It offers them flexibility (100% coursework online). This option also comes with financial aid or scholarships, such as the Texas Woman’s University online nurse practitioner program. Degrees like the online FNP program are responding directly to a growing demand. Not for more nurses, but for nurses who can operate with greater independence.
Nurses Are Speaking Up
This isn’t just an academic conversation anymore. Reddit’s Emergency Medicine Discussion openly talks about the erosion of autonomy in real-world settings. Many nurses describe feeling constrained by policies that don’t reflect their training or experience. Even in professional discussions, the question isn’t whether autonomy matters. It’s how to establish it more effectively in clinical practice. That shift from questioning to problem-solving is telling.
Autonomy Isn’t About Replacing Anyone
One of the biggest fallacies about nursing autonomy is that it creates tension between roles. In reality, it does the opposite.
When nurses are empowered:
- Physicians can focus on complex cases
- Care teams become more efficient
- Patients receive faster, more responsive treatment
Expanded autonomy doesn’t dilute care. It distributes it more effectively.
Why Has It Taken So Long?
The answer is complicated. Healthcare systems are slow to change. Regulations vary widely. Historically, nursing has been positioned as a support role rather than a leadership one.
That narrative is changing. Today’s healthcare challenges (staff shortages, rising patient loads, and increasing complexity) are forcing a reset. Systems can no longer afford to underutilize highly trained professionals.
From Assistance to Authority
What we’re seeing now is a professional identity shift. Nurses are moving from:
- Task-based roles → decision-based roles
- Following orders → shaping care plans
- Supporting systems → leading within them
And autonomy sits right at the center of that transformation. The ongoing push for autonomy also reflects a broader evolution in nursing’s professional identity. The Theory of Bureaucratic Caring suggests that effective nursing practice requires balancing caring relationships with the realities of organizational power, policy, and regulation. As healthcare grows more complex, nurses are increasingly expected to influence systems rather than simply function within them.
Undervalued and Underutilized
Nursing doesn’t have a talent problem. It has an autonomy problem.
The skills are there. The training is evolving. The demand is undeniable.
What’s changing now is the willingness to say it out loud. And to start building systems that finally reflect the reality of what nurses can do.
References
North Carolina Health News. (2024, August 29). This was the year advanced practice nurses thought they’d get full practice authority in NC. They were wrong.
Bill Summary for S 966 (2025-2026)
Newsweek. (2026, June 10). Trump’s SAVE Act Plan for Midterms Is Slipping Away.
Bureaucratic Caring/Transtheoretical evolution of Ray’s theory of Bureaucratic Caring. (2025, April 11). Nursology. https://nursology.net/nurse-theories/rays-theory-of-bureaucratic-caring-transtheoretical-evolution-of-rays-theory-of-bureacratic-caring/
Nursing Times. (2025, December 15). How professional autonomy helps nurses thrive and grow in the workplace.
American Medical Association (AMA). (2026, March 5). Expanded scope: Where do nurse practitioners practice? It’s not just primary care.
Younas, A., et al. (2024). Professional Autonomy in Nursing: A Concept Analysis. SAGE Open. https://doi.org/10.1177/21582440241302129
Reddit. (2025). The reduction in nursing autonomy: Anyone else noticing this trend? r/emergencymedicine community discussion.
The Heart Disease Crisis in the US: A clarion call for Nurse-Led Team-Based care models across clinical and community settings. (2026, May 13). Nursology. https://nursology.net/2026/06/02/34616/
Restoring the bridge between nursing theory and clinical practice: a call to Rebalance. (2025b, December 31). Nursology. https://nursology.net/2026/01/07/32265/
About Obidigwe Adaora Victoria
Obidigwe Victoria is a registered cardiothoracic nurse, health educator, and content creator passionate about making health knowledge simple and practical for everyday people. She is committed to helping nurses and healthcare professionals expand beyond the bedside by building visibility, leveraging their expertise, and creating additional income streams. As a Christian speaker and mentor, she inspires growth in purpose, career, and personal development, equipping her audience to thrive both within and beyond healthcare.