According to Bahadori & Fitzpatrick (2009), NP perceived professional autonomy is most significantly impacted by which factor?

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The key idea is that autonomy in NP practice is shaped most by accountability structures. Bahadori and Fitzpatrick found that how much NPs feel they can act independently is most strongly influenced by the level of accountability they operate under—things like supervision requirements, performance monitoring, liability concerns, and formal expectations about outcomes and documentation. When accountability is heightened, NPs tend to perceive less freedom to make independent clinical decisions, because their choices are more tightly scrutinized and constrained by rules and potential sanctions. Conversely, clear, supportive accountability can actually protect autonomy by setting transparent expectations and boundaries within which independent judgment is exercised. While factors like scope of practice, productivity, and location matter, the study indicates that accountability mechanisms have the strongest impact on how autonomous NPs feel about their professional practice.