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Cross-sectional study
Greater nurse autonomy associated with lower mortality and failure to rescue rates
  1. Catharina van Oostveen1,
  2. Hester Vermeulen2
  1. 1Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, Hoofddorp, The Netherlands
  2. 2IQ Healthcare Radboud Institute of Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, The Netherlands
  1. Correspondence to : Catharina van Oostveen, Spaarne Gasthuis Academy, Spaarne Gasthuis Hospital, PO Box 770, Hoofddorp 2130AT, The Netherlands; cvanoostveen{at}

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Implications for practice and research

  • Hospitals are responsible for providing the means necessary for nurses to act autonomously and positively influence patient outcomes.

  • To prove causality, the link between nurse autonomy and patient outcomes should be endorsed by using robust research designs, examining results over time to assess differences in autonomy levels.


There is a growing body of evidence linking professional work environments to improved patient, personnel and organisational outcomes. Since autonomy has been identified as an important attribute of a professional work environment for enhancing patient safety,1 a proven association between autonomy and patient-outcomes might be expected but, until now, had not been …

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