• Elizabeth D E Papathanassoglou, Maria N K Karanikola, Maria Kalafati, Margarita Giannakopoulou, Chrysoula Lemonidou, and John W Albarran.
• Cyprus University of Technology, Department of Nursing, Siakolas Centre for Health Studies, Nicosia, Cyprus.
• Am. J. Crit. Care. 2012 Mar 1;21(2):e41-52.

BackgroundDiscretionary autonomy is a key factor in enhanced patient outcomes and nurses' work satisfaction. Among nurses, insufficient autonomy can result in moral distress.ObjectivesTo explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses' characteristics.MethodsDescriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses' autonomy, nurse-physician collaboration, and moral distress.ResultsThe mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P < .001). Greek and German nurses reported significantly higher moral distress (P < .001). Autonomy scores were associated with nurse-physician collaboration scores (P < .001) and with a higher frequency of moral distress (P = .04). Associations were noted between autonomy and work satisfaction (P = .001). Frequency of moral distress was associated inversely with collaboration (ρ = -0.339; P < .001) and autonomy (ρ = -0.210; P = .01) and positively with intention to quit (ρ = 0.257; P = .004).ConclusionsIn this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration.

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