Professional Autonomy, Professional Quality of Life, and Moral Courage Among Emergency Nurses: A Cross-Sectional Study in Northern Iran.

Background

AND

Aim

Emergency nurses operate in highly demanding environments where professional autonomy is crucial for delivering safe and effective patient care. While Moral Courage and Professional Quality of Life (ProQoL) have both been linked to professional outcomes, their relationships with autonomy remain insufficiently understood in high-acuity emergency settings. This study aimed to examine the relationships among professional autonomy, moral courage, and ProQoL among emergency nurses in northern Iran.

Materials And Methods

This multicenter cross-sectional study included 180 emergency nurses from 10 teaching hospitals in northern Iran in 2024. Participants were selected using proportionate stratified systematic random sampling. Autonomy, Moral Courage, and ProQoL were assessed using validated questionnaires. Data analysis employed descriptive statistics, Spearman's correlation, independent t-tests, one-way ANOVA, Mann-Whitney U tests, Kruskal-Wallis tests, and multiple linear regression in SPSS Version 27 (p < 0.05).

Results

The mean age of participants was 33.18 ± 7.35 years, with 55.0% being female. Emergency nurses reported high autonomy, moderate levels of moral courage, and moderate levels across all ProQoL dimensions. Autonomy was positively correlated with moral courage (ρ = 0.57, p < 0.001) and compassion satisfaction (ρ = 0.31, p < 0.001). Moral courage was also associated with compassion satisfaction (ρ = 0.31), burnout (ρ = 0.40), and secondary traumatic stress (ρ = 0.30) (p < 0.001). In multiple regression analysis, endurance of threats (β = 0.32, p = 0.001), multiple values (β = 0.26, p = 0.002), moral agency (β = 0.19, p = 0.004), and compassion satisfaction (β = 0.15, p = 0.032) were significant positive predictors of professional autonomy, explaining 39% of its variance (R2 = 0.39, p < 0.001).

Conclusion

Professional autonomy showed a stronger association with moral courage than with ProQoL, while compassion satisfaction was independently associated with greater autonomy. IMPLICATIONS FOR NURSING MANAGEMENT Nurse managers should strengthen ethical practice, nurse empowerment, and supportive practice environments to create conditions that facilitate autonomous nursing practice.