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"Professional Autonomy"
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In the Public Interest
How do we know when physicians practice medicine safely? Can we trust doctors to discipline their own? What is a proper role of experts in a democracy?In the Public Interestraises these provocative questions, using medical licensing and discipline to advocate for a needed overhaul of how we decide public good in a society dominated by private interest groups. Throughout the twentieth century, American physicians built a powerful profession, but their drive toward professional autonomy has made outside observers increasingly concerned about physicians' ability to separate their own interests from those of the general public.Ruth Horowitz traces the history of medical licensure and the mechanisms that democratic societies have developed to certify doctors to deliver critical services. Combining her skills as a public member of medical licensing boards and as an ethnographer, Horowitz illuminates the workings of the crucial public institutions charged with maintaining public safety. She demonstrates the complex agendas different actors bring to board deliberations, the variations in the board authority across the country, the unevenly distributed institutional resources available to board members, and the difficulties non-physician members face as they struggle to balance interests of the parties involved.In the Public Interestsuggests new procedures, resource allocation, and educational initiatives to increase physician oversight. Horowitz makes the case for regulations modeled after deliberative democracy that promise to open debates to the general public and allow public members to take a more active part in the decision-making process that affects vital community interests.
eBook
Head Nurses’ Leadership Styles and Emergency Department Nurses’ Clinical Professional Autonomy in Iranian University Hospitals: A Cross‐Sectional Study
Nurses' clinical professional autonomy is strongly influenced by organizational management and leadership environments. This study aims to examine the relationship between head nurses' leadership styles and the level of clinical autonomy perceived by emergency department (ED) nurses in Iranian university hospitals.
This cross-sectional study recruited 221 ED nurses from Alborz province (Iran) university hospitals through convenience sampling from February to March 2022. Data were collected using a three-section questionnaire that covered demographic and work-related characteristics, the Multifactor Leadership Questionnaire (MLQ), and the Clinical Professional Autonomy Scale. Following psychometric validation in our sample, the MLQ consisted of 32 items assessing transformational, transactional, and laissez-faire leadership (Cronbach's
= 0.71-0.95). Clinical professional autonomy was measured with the 31-item Clinical Professional Autonomy Scale (
> 0.70), with total scores classified as low, moderate, or high.
The mean (SD) of clinical professional autonomy (0-100 scale) was 78.68 (12.73). Transformational leadership was reported as the dominant style among head nurses (72.41 ± 18.58). The results showed the strongest correlation between transformational leadership style and clinical professional autonomy (
= 0.57). Furthermore, the multivariable linear regression analysis showed that clinical professional autonomy was significantly associated with job satisfaction (
= 0.17,
=0.026) and nurses' years of work experience (
= 0.23,
=0.002).
This study highlights that head nurses' transformational leadership style significantly enhances nurses' clinical professional autonomy. The findings underscore the need for targeted leadership development programs to strengthen head nurses' transformational leadership competencies. By fostering a supportive leadership environment, clinical professional nursing autonomy can be promoted, contributing to improved patient care quality and overall organizational performance.
Journal Article
Pathways to Student Motivation: A Meta-Analysis of Antecedents of Autonomous and Controlled Motivations
Students' self-determined motivation (acting out of interest, curiosity, and abiding values) is associated with higher academic well-being, persistence, and achievement. Self-determination theory posits that self-determined motivation is dependent on the satisfaction of three psychological needs (relatedness, competence, and autonomy), which are in turn facilitated through need-supportive behaviors from notable others. In this meta-analysis, conducted over 144 studies and more than 79,000 students, we sought to overview pathways to student motivation in order to verify (1) how do psychological needs rank in the strength of their prediction of self-determined motivation and (2) which autonomy-support providers (parents or teachers) are the most relevant for psychological need satisfaction in students and self-determined motivation. Results show that teacher autonomy support predicts students' need satisfaction and self-determined motivation more strongly than parental autonomy support. In addition, competence is the most positive predictor of self-determined motivation, followed by autonomy and then by relatedness.
Journal Article
Audit Culture Revisited
The spread of the principles and techniques of financial accounting into new systems for measuring, ranking, and auditing performance represents one of the most important and defining features of contemporary governance. Audit procedures are redefining accountability, transparency, and good governance and reshaping the way organizations and individuals have to operate. They also undermine professional autonomy and have unanticipated and dysfunctional consequences. Taking up the concept of audit culture as an analytical framework, we examine the origins, spread, and rationality driving these new financialized techniques of governance, not least through the work of the Big Four accountancy firms, and trace their impact across a number of fields, from administration and the military to business corporations and universities. We ask, what new kinds of ethics of accountability does audit produce? Building on Mitchell (1999), Strathern (2000a), Trouillot (2001), and Merry (2011), we identify how the techniques and logics of financial accountancy have five audit effects. These are “domaining,” “classificatory,” “individualizing and totalizing,” “governance,” and “perverse” effects. We conclude by reflecting on the problems of audit culture and suggest ways to reclaim the professional values and democratic spaces that are being eroded by these new systems of governing by numbers.
Journal Article
The developmental trajectories of teacherautonomy support and adolescent mental well-being and academic stress
This study investigated the developmental impact of teacher autonomy support on changes in students’ mental well-being and academic stress throughout upper secondary school. The sample consisted of 1453 Norwegian students (baseline Mage = 17.00; 60.6% girls; 80.9% Norwegian-born). The unconditional latent growth curve model results showed that perceived teacher autonomy support and mental well-being decreased during the three-year-long education. Academic stress, on the other hand, increased during this period. Findings from the parallel process latent growth curve model indicated that the initial status and change in teacher autonomy support were positively and negatively related to the initial levels and trajectories of mental well-being and academic stress, respectively. Girls experienced a higher level of academic stress and lower mental well-being and teacher autonomy support at the beginning of upper secondary school. Students with a higher socioeconomic status reported higher initial mental well-being and teacher autonomy support than others but also a more rapid decline in teacher autonomy support throughout upper secondary school. This study provides new insights into academic, psychological, and affective processes and their interrelationships during upper secondary school.
Journal Article
Understanding performance management in schools: a dialectical approach
Purpose
– The purpose of this paper is to provide a dialectical framework for the examination of performance management in schools.
Design/methodology/approach
– The paper is based upon a qualitative study of ten headteachers that involved in-depth semi-structured interviews.
Findings
– The findings identified four dialectical tensions that underpin performance management in schools: the responsibility to teachers and the responsibility to pupils; external accountability and professional autonomy; discipline of teachers and support of teachers; fixed processes and improvisational practices.
Research limitations/implications
– This paper provides a means of examining the performance management of teachers from an alternative perspective, one that embraces tensions and contradictions and gives headteachers a richer understanding of how teachers are evaluated and judged.
Originality/value
– This paper moves beyond the traditional perspective of performance management in schools as a means of subjugation and control and offers an original dialectical framework within which to examine the phenomenon.
Journal Article
Professional Autonomy and Perceived Organizational Support as Predictors of Adherence to Ethical Codes Among Emergency Nurses
Identifying the factors influencing emergency nurses’ adherence to ethical codes is a crucial strategy for enhancing compliance with these standards. This study aimed to examine the determinants affecting emergency nurses’ adherence to ethical codes.
This descriptive cross-sectional study was conducted among 291 nurses working in emergency departments in Iran. Data were collected using the nurses’ professional autonomy questionnaire, the perceived organizational support questionnaire, and the adherence to ethical codes questionnaire. Approval for the study was obtained from the ethics committee at the school of nursing. Privacy and confidentiality of the data were ensured, and an informed consent was obtained from all participants before data collection.
The mean scores for adherence to ethical codes, professional autonomy, and perceived organizational support were 53.45 ± 5.62 (above moderate levels), 115.99 ± 10.17 (above moderate levels), and 7.78 ± 5.31 (at weak levels), respectively. Professional autonomy (P<.001) demonstrated a significant positive impact on adherence to ethical codes but perceived organizational supports’ predictive role was borderline (P = .06). In addition, the variables of sex (female) (P<.05) and previous experience in ethics workshops (P<.002) had a significant positive effect on adherence to ethical codes.
Professional autonomy, sex, and experience in ethics workshops were identified as positive predictors of emergency nurses’ adherence to ethical codes. These findings can serve as a guide for nursing managers and policy makers in creating an environment conducive to the implementation of ethical principles in clinical practice. In particular, they highlight the importance of empowerment programs and support strategies aimed at enhancing nurses’ professional autonomy and decision making, particularly in emergency department settings.
Journal Article
How teachers can support students' agentic engagement
Agentic engagement represents students' constructive contribution into the flow of instruction they receive, as students express their interests and offer their input. It is a purposive, proactive, and reciprocal type of engagement that is integral to promoting important student outcomes (e.g., learning, achievement), but its essential purpose is to recruit greater autonomy support from the teacher. We first highlight the different ways that teachers typically respond to student displays of agentic engagement (i.e., support, indifference, or control). We then recommend that teachers adopt an autonomy-supportive motivating style that will allow teachers to become increasingly in sync with their students as agents. Thus, the purpose of the article is to explain how teachers might best support students' agentic engagement during classroom instruction.
Journal Article
Special Education Teacher Attrition and Retention: A Review of the Literature
High rates of attrition make it challenging for schools to provide qualified special education teachers for students with disabilities, especially given chronic teacher shortages. We synthesize 30 studies from 2002 to 2017, examining factors associated with special educator attrition and retention, including (a) teacher preparation and qualifications, (b) school characteristics, (c) working conditions, and (d) teacher demographic and nonwork factors. Most studies examined working conditions (e.g., demands, administrative and collegial supports, resources, compensation) among special educators who left teaching, moved to other positions, transferred to general education teaching, or indicated that they intended to stay or leave. The majority of researchers used quantitative methods to analyze national, state, or other survey data, while eight used qualitative methods. Our critique identifies both strengths and weaknesses of this literature, suggests research priorities, and outlines specific implications for policy makers and leaders.
Journal Article