Introduction
In the constantly changing healthcare landscape, the well-being of clinical nurses has become a critical area of focus [1]. As frontline caregivers, nurses are pivotal in shaping patient outcomes and experiences [2].
However, the pressures of the profession can lead to significant stress and dissatisfaction, adversely affecting their performance and the quality of care they provide [3]. These pressures can result in considerable mental and physical health issues for nurses, contributing to high levels of burnout, anxiety, and depression [4, 5]. Such adverse conditions affect the nurses themselves and compromise the quality of care provided to patients, resulting in poorer health outcomes and increased healthcare costs [6, 7]. Furthermore, the emotional toll of the profession can diminish nurses’ engagement and motivation, creating a cycle of dissatisfaction that leads to high turnover rates within the workforce [8]. Amidst these challenges, happiness emerges as a critical factor in mitigating stress and enhancing job satisfaction [8, 9].
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When nurses experience higher levels of joy, they not only exhibit increased engagement and resilience but also become more effective in their clinical roles [10]. Research illustrates that a joyful nursing workforce is linked to improved patient outcomes, as happiness fosters a supportive and collaborative workplace atmosphere. Nurses who take pride in their work are more likely to provide compassionate care, leading to a noticeable enhancement in patient satisfaction and safety [11, 12]. Understanding the intricate relationship between happiness and various influencing factors—such as professional autonomy, social support, and work-life balance—is essential for creating targeted interventions aimed at promoting nurses’ well-being [13]. For instance, studies have shown that nurses who feel a sense of autonomy in their decision-making processes report higher levels of job satisfaction and lower levels of burnout [14].
Happiness in nursing is multifaceted, encompassing emotional, psychological, and social dimensions [15]. It is not merely the absence of distress; it involves a positive state of mind that significantly influences a nurse’s engagement and effectiveness at work [16]. Singh et al. define happiness as a harmonious state where an individual’s physiological and psychological needs are satisfied, leading to a meaningful and contented life [17]. This concept is often accompanied by qualities such as generosity, optimism, hope, and trust, which can enhance creativity in the workplace [18]. In clinical settings, nurses must be altruistic, self-confident, dedicated, creative, kind, and energetic to provide patients with holistic and quality nursing care [15]. Thus, happiness is intrinsically related to these essential components, suggesting that happier nurses can deliver better quality care [19]. Moreover, fostering professional autonomy among nurses can further enhance their happiness, as it empowers them to make decisions, engage in their work more fully, and ultimately provide even higher quality care to their patients [20]. Research indicates that professional autonomy—the degree to which nurses can make independent decisions regarding their practice—is a key determinant of job satisfaction [21]. Theoretical frameworks such as Self-Determination Theory (SDT) [22] and the Job Demands-Resources (JD-R) Theory [23] provide valuable insights into why autonomy contributes to happiness. According to SDT, when nurses feel empowered to exercise their judgment and expertise, they fulfill their basic psychological needs for autonomy, competence, and relatedness, which fosters greater well-being and satisfaction [22]. Additionally, the JD-R Model suggests that autonomy is a crucial resource to buffer against job demands, enhancing nurses’ ability to cope with stressors and promoting a positive work environment. This empowerment leads to higher happiness levels, significantly improves their quality of life, and reduces psychological trauma during their careers [23]. Existing literature often emphasizes the importance of independence without adequately addressing its emotional implications for nurses [24]. This gap presents an opportunity to investigate further how autonomy influences the professional lives of nurses and their overall happiness [25].
Several factors can influence nurses’ happiness levels, including personal characteristics such as gender, physical and mental health, family circumstances, and individual achievements [13, 26]. Professional autonomy is particularly significant among these factors, enabling nurses to make clinical decisions and utilize their expertise in patient care [27]. Historically, achieving professional autonomy has posed substantial challenges in nursing, especially within the Iranian healthcare system, where hierarchical structures and specific nursing policies play a crucial role in shaping this dynamic [27]. In Iran, the hierarchical nature of the healthcare system often limits nurses’ decision-making capabilities, resulting in a diminished sense of professional autonomy. This limitation can lead to lower job satisfaction and an increased inclination among nurses to leave the profession. Furthermore, nursing policies that fail to adequately recognize or support nurses’ contributions can exacerbate feelings of disenchantment and hinder opportunities for professional growth [28].
In contrast, when nurses experience greater professional autonomy—bolstered by equitable policies and a collaborative work environment—they are more likely to report higher levels of happiness and job satisfaction, ultimately enhancing the quality of care they provide [29]. Comparatively, studies from other countries indicate that while the relationship between professional autonomy and job satisfaction varies, many international findings support the premise that enhanced autonomy contributes to increased nurse happiness. For example, research in countries like Greece [30] and Turkey [31] highlights a positive correlation between autonomy and job satisfaction, similar to what is observed in Iran. However, in some regions, different healthcare structures and cultural contexts may impact this relationship, suggesting that the dynamics between professional autonomy and nurses’ happiness may not be universally applicable [32, 33]. Therefore, understanding the unique factors of the Iranian healthcare system is essential while also considering the broader international context to understand how professional autonomy influences nurses’ happiness globally [24].
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This study aimed to assess the relationship between happiness and professional autonomy among clinical nurses, a critical aspect that remains underexplored in existing literature. Previous research has often focused on nurse job satisfaction and burnout in isolation without adequately considering how professional autonomy directly influences overall happiness in nursing practice. By examining this interplay, we address a significant gap by providing actionable insights that could assist healthcare organizations in fostering supportive work environments. Understanding this relationship is particularly important, given the high levels of stress and burnout that nurses frequently encounter. Promoting greater professional autonomy could not only enhance job satisfaction but also reduce turnover rates and improve the quality of patient care. This research serves as a call to action for healthcare leaders to prioritize the well-being of their nursing staff, emphasizing the importance of creating conditions that encourage both happiness and autonomy.
Methods
Setting and sample
This study utilized an analytical cross-sectional design to collect data from five hospitals in Ardabil, a city in northwestern Iran, from May to December 2022. The hospitals included Imam Hospital, Fatemi Hospital, Alavi Hospital, Boo Ali Hospital, and Imam Reza Hospital. To participate in the study, individuals needed to meet specific inclusion criteria: they must hold at least a bachelor’s degree in nursing and have a minimum of six months of clinical experience. Exclusion criteria included nurses unwilling to participate and those who submitted incomplete questionnaires.
The research analyzed various factors influencing nursing practices and patient outcomes within these healthcare settings. To determine an adequate sample size, the researchers calculated a need for 245 participants based on a 95% confidence level, a Type I error rate of 0.05, and an anticipated attribution ratio of 0.8. The sample size was derived using a following statistical formula:
$$\:n=\frac{{z}^{2}.p.\:(1-p)}{{d}^{2}}$$
In this equation, ‘n’ signifies the sample size, ‘z’ represents the z-score corresponding to the desired confidence level, ‘p’ denotes the estimated population proportion, and ‘d’ indicates the margin of error.
To accommodate an anticipated dropout rate of approximately 10%, the research team expanded the total sample size to 270 nurses. This proactive approach ensured that the final sample remained statistically robust and valid, enabling a comprehensive analysis of the collected data. By anticipating potential participant attrition, the researchers sought to enhance the reliability and credibility of their findings, ensuring adequate statistical power to identify significant effects, even in instances of non-responses or incomplete participation.
The eligible nursing population across the five hospitals amounted to approximately 1,080 professionals. The distribution of nurses was as follows: Imam Hospital had 475 nurses, Fatemi Hospital had 280, Alavi Hospital had 175, Bu Ali Hospital had 225, and Imam Reza Hospital had 195. Ninety-five participants were selected from Imam Hospital to create a representative sample of its nursing staff. Additionally, 56 participants were chosen from Fatemi Hospital, 35 from Alavi Hospital, 45 from Bu Ali Hospital, and 39 from Imam Reza Hospital. The selections were made proportionally to ensure that each hospital’s representation in the sample corresponded to its number of eligible nurses. The process utilized for selecting participants was simple random sampling, which was carried out within each hospital. This method ensured that every nurse within a hospital had an equal chance of being selected, thereby enhancing the fairness and reliability of the study’s findings.
Adherence to STROBE guidelines
The study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) checklist to ensure comprehensive and transparent reporting of the observational research methodology. All relevant items from the STROBE guidelines were followed, contributing to the rigor and credibility of the study.
Data collection tool
A three-part instrument was utilized for data collection, consisting of a demographic characteristics form, the Oxford Happiness Questionnaire, and the Dempster Professional Autonomy Scale. Participants were allowed to complete the survey at their convenience, promoting a more comfortable response environment. We employed stratified sampling techniques to ensure a representative sample, targeting specific demographic groups based on predefined criteria. Respondents were recruited through various channels, including social media, professional networks, and community organizations, which helped to reach a diverse participant pool.
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During the recruitment process, nurses received feedback regarding the clarity and relevance of the questionnaires. Many participants appreciated the opportunity to reflect on their professional autonomy and happiness levels, noting that the questionnaires prompted valuable self-assessment. Some nurses suggested minor adjustments to the wording of specific questions for better understanding, which were taken into consideration for our research.
Demographic characteristics form
This form was designed to gather information regarding nurses’ age, gender, marital status, education level, position, work experience, department of employment, overall job satisfaction, and length of experience in their current department.
The Oxford happiness questionnaire
The Oxford Happiness Questionnaire, consisting of 29 questions, assessed happiness levels. Developed by Hills and Argyle in 2002 [34], the questionnaire employs a 4-point Likert scale ranging from 0 to 3 for each response. Consequently, the possible scores range from a minimum of 0 to a maximum of 87. Examples of Questions: “I feel that life is worthwhile” and “I am happy with my life.” Scores below 28 indicate a low level of happiness, scores between 35 and 51 reflect an acceptable level, and scores above 58 suggest a high level of happiness [34]. The reliability and validity of this questionnaire were examined by Alipour and Agah Heris in 2007, who found it to possess good validity and reliability for measuring happiness within Iranian society. Their study indicated that the validity of the questionnaire was desirable, with a reliability score exceeding 0.90 [35]. In this peresnt study, the reliability coefficient, determined through Cronbach’s alpha test, was found to be 0.94.
The Dempster professional autonomy scale
The Dempster Behavioral Practice Scale 1990 was developed to evaluate nurses’ professional autonomy through a 30-item questionnaire [36]. This scale is divided into four subscales: Readiness, Empowerment, Actualization, and Valuation. The Readiness subscale includes 11 items (e.g., “I feel prepared to handle my responsibilities”) that assess participants’ skills, competencies, and mastery. The Empowerment subscale consists of seven items (e.g., “I believe my colleagues respect my role”) that evaluate the legitimacy of the individual’s role. The Actualization subscale has nine items (e.g., “I make decisions regarding patient care independently”) focused on decision-making, accountability, and responsibilities. Lastly, the Valuation subscale includes three items (e.g. “I find my work to be meaningful”) that assess the professional role’s value, worth, merit, and usefulness. Responses to the questionnaire are scored using a 5-point Likert scale, where one indicates “not at all true,” 2 means “slightly true,” 3 stands for “moderately true,” 4 represents “very true,” and five signifies “extremely true.” Total scores for nurses’ professional autonomy range from 30 to 150. A score ranging from 30 to 70 indicates low autonomy, while a score between 70 and 110 reflects moderate professional autonomy. A score of 110 to 150 signifies high autonomy [36]. Amini et al. evaluated the reliability of the questionnaire through internal consistency and test-retest approaches. The correlation coefficient between the two assessments was 0.87, and Cronbach’s alpha coefficient was 0.83, demonstrating sufficient consistency [37]. In our study, we found that Cronbach’s alpha for the entire instrument was 0.89.
Data analysis
The researchers utilized IBM SPSS, version 21.0, to conduct the data analysis for this study. Descriptive statistics, including frequency, percentage, mean, and standard deviation, were employed. Pearson’s correlation coefficient was used to investigate the relationship between happiness and professional autonomy. Prior to conducting the statistical tests, the normality of the data distribution was assessed using the Shapiro-Wilk test. Additionally, multiple linear regression analysis was performed to identify the predictors of happiness while controlling for participants’ demographic characteristics. Before executing the multiple linear regression, multicollinearity was evaluated using variance inflation factor (VIF) and tolerance values. It is widely accepted that a tolerance value below 0.1 and a VIF exceeding 5 indicate potential multicollinearity issues [38]. In this study, none of the predictor variables exhibited significant multicollinearity according to these criteria.
Results
A total of 270 clinical nurses participated in the study. The participants had a mean age of 33.71 years (SD = 7.29) and an average clinical experience of 9.48 years (SD = 6.38). The mean workplace experience among the participants was 4.90 years (SD = 2.20). In terms of gender distribution, 27.8% of the participants were male, while 72.2% were female. Regarding educational qualifications, 88.5% held bachelor’s degrees, and 11.5% had master’s degrees (Table 1).
Table 1
Demographic characteristics of the participants (n = 270)
Variable | Categories | Mean ± SD | |
|---|---|---|---|
Age (year) | 33.71 ± 7.29 | ||
clinical experience (year) | 9.48 ± 6.38 | ||
Work experience in workplace (year) | 4.90 ± 2.20 | ||
No. | % | ||
Gender | Male | 75 | 27.8 |
Female | 195 | 72.2 | |
Marital status | Single | 107 | 39.6 |
Married | 163 | 60.4 | |
Position | Head nurse | 10 | 3.7 |
Shift nurse | 5 | 1.9 | |
Staff nurse | 255 | 94.4 | |
Education level | Bachelor’s degree | 239 | 88.5 |
Master’s degree | 31 | 11.5 | |
Working department | Medical | 52 | 19.3 |
Surgical | 49 | 18.1 | |
Emergency | 46 | 17.0 | |
ICU | 44 | 16.3 | |
Other | 79 | 29.3 | |
Job satisfaction | Yes | 163 | 60.4 |
No | 107 | 39.6 | |
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The mean scores of happiness and professional autonomy are presented in Table 2. For the Readiness subscale, the mean was 3.08 with a standard deviation of 0.55 (range: 20–48). The empowerment subscale had a mean of 2.80 and a standard deviation of 0.41 (range: 11–29). In the case of actualization, the mean was 3.34, and the standard deviation was 0.50 (range: 17–42). For the valuation subscale, the mean was 3.03, and the standard deviation was 0.82 (range: 3–15). Regarding the overall scores, the professional autonomy had a mean of 92.72 and a standard deviation of 12.83 (range: 64–120). The total score of happiness showed a mean of 65.62 and a standard deviation of 14.11 (range: 35–104) (Table 2).
Table 2
Descriptive statistics of the main variables (n = 270)
Variables | No. of items | Possible range | Observed range | Item Mean ± SD | Total Mean ± SD |
|---|---|---|---|---|---|
Readiness | 11 | 11–77 | 20–48 | 3.08 ± 0.55 | 33.91 ± 6.12 |
Empowerment | 7 | 7–35 | 11–29 | 2.80 ± 0.41 | 19.64 ± 2.90 |
Actualization | 9 | 9–45 | 17–42 | 3.34 ± 0.50 | 30.06 ± 4.53 |
Valuation | 3 | 3–15 | 3–15 | 3.03 ± 0.82 | 9.10 ± 2.48 |
Professional autonomy (Total) | 30 | 30–150 | 64–120 | 3.09 ± 0.42 | 92.72 ± 12.83 |
Happiness (Total) | 29 | 29–116 | 35–104 | 2.26 ± 0.48 | 65.62 ± 14.11 |
The results revealed significant associations between various participant characteristics and their levels of happiness. Specifically, age demonstrated a significant positive correlation with happiness (r = 0.21, p < 0.001), indicating that older participants tended to report higher levels of happiness. Similarly, clinical experience was positively correlated with happiness (r = 0.17, p < 0.001), suggesting that greater clinical experience was associated with increased happiness.
Moreover, the working department was significantly related to happiness (F = 1.54, p = 0.04), indicating that participants’ happiness levels varied across different departments. Finally, job satisfaction was found to have a significant impact on happiness (F = 3.06, p < 0.001), highlighting that those who were satisfied with their jobs reported higher levels of happiness (Table 3).
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Table 3
Relationship between the participants’ characteristics and happiness (n = 270)
Variable | Mean ± SD | r/t/F-value | p-value |
|---|---|---|---|
Age (year) | 0.21 | < 0.001* | |
Clinical experience (year) | 0.17 | < 0.001* | |
Work experience in workplace (year) | 0.08 | 0.18 | |
Gender | -1.32 | 0.18 | |
Male | 67.45 ± 15.01 | ||
Female | 64.92 ± 13.73 | ||
Marital status | -1.49 | 0.13 | |
Single | 64.04 ± 13.45 | ||
Married | 66.66 ± 14.48 | ||
Position | 2.71 | 0.06 | |
Head nurse | 75.30 ± 10.80 | ||
Shift nurse | 69.60 ± 13.44 | ||
Staff nurse | 65.16 ± 14.13 | ||
Education level | -0.27 | 0.78 | |
Bachelor’s degree | 84.36 ± 12.62 | ||
Master’s degree | 90.77 ± 12.51 | ||
Working department | 1.54 | 0.04* | |
Medical | 63.20 ± 13.59 | ||
Surgical | 65.83 ± 12.42 | ||
Emergency | 67.40 ± 14.08 | ||
ICU | 71.43 ± 12.73 | ||
Other | 61.83 ± 7.25 | ||
Job satisfaction | 3.06 | < 0.001* | |
Yes | 67.72 ± 14.24 | ||
No | 62.42 ± 13.36 | ||
The results presented in Table 4 indicated significant correlations between overall happiness and various dimensions of professional autonomy among the participants. The total score of professional autonomy showed a significant positive correlation with happiness (r = 0.29, p < 0.001), indicating that greater professional autonomy was associated with higher levels of happiness.
Table 4
Correlation of happiness and professional autonomy (n = 270)
Variable | Happiness | |
|---|---|---|
r | p-value | |
Readiness | 0.25 | < 0.001* |
Empowerment | 0.19 | < 0.001* |
Actualization | 0.21 | < 0.001* |
Valuation | 0.29 | < 0.001* |
Professional autonomy (Total) | 0.29 | < 0.001* |
We used multiple linear regression to explain the impact of predictors on the happiness. In block 1 of the hierarchical linear regression analysis, several control variables were examined as predictors of happiness among participants. Age emerged as a significant predictor, with an unstandardized coefficient (B) of 0.85 (p = 0.02), indicating that older participants tend to report higher levels of happiness. Conversely, clinical experience showed a significant negative relationship with happiness (B = 0.30, p = 0.02). Other variables, including clinical experience, gender, marital status, position, education, and working department, did not demonstrate significant effects on happiness, resulting in a model with an R² of 0.18 (F = 3.50, p < 0.001).
In block 2, the analysis included independent variables related to professional autonomy. Among these, empowerment was found to significantly predict happiness, with a B of 0.72 (p = 0.01), suggesting that higher levels of empowerment are associated with increased happiness. Valuation also showed a significant positive relationship (B = 1.34, p = 0.01). Readiness and actualization, however, did not yield significant results. The addition of these independent variables improved the model, resulting in an R² of 0.28, with a change in R² of 0.09 and a significant change in F (ΔF = 4.98, p < 0.001), indicating that professional autonomy contributes to explaining additional variance in happiness beyond the control variables (Table 5).
Table 5
The hierarchical linear regression analysis to examine predictors of the happiness (n = 270)
Variable | B | SE | Beta | p-value | 95.0% CI for B | |
|---|---|---|---|---|---|---|
LB | UB | |||||
Block 1: Control variables | ||||||
Age | 0.85 | 0.38 | 0.44 | 0.02 | 0.10 | 1.61 |
Clinical experience | 0.30 | 0.44 | 0.13 | 0.02 | -1.18 | 0.57 |
Work experience in workplace | 0.72 | 0.31 | 0.21 | 0.49 | -1.34 | -0.10 |
Gender (Male = 0a) | 2.73 | 1.87 | 0.08 | 0.14 | -0.95 | 6.41 |
Marital status (Single = 0a) | 0.84 | 1.92 | 0.02 | 0.66 | -2.94 | 4.62 |
Position (Head nurse = 0a) | ||||||
Shift nurse | -4.01 | 7.53 | -0.03 | 0.59 | -18.84 | 10.81 |
Staff nurse | -7.87 | 4.87 | -0.12 | 0.10 | -17.47 | 1.72 |
Education (Bachelor’s degree = 0a) | -0.36 | 2.62 | -0.008 | 0.89 | -5.52 | 4.80 |
Working department (Medical = 0a) | ||||||
Surgical | -0.37 | 1.19 | -0.01 | 0.07 | -2.71 | 1.97 |
Emergency | -0.31 | 1.31 | -0.006 | 0.12 | -2.88 | 2.26 |
ICU | -0.93 | 1.40 | -0.02 | 0.50 | -3.69 | 1.81 |
Other | -0.25 | 1.23 | -0.008 | 0.32 | -2.17 | 2.69 |
Job satisfaction (Yes = 0a) | -5.04 | 1.71 | -0.17 | 0.004 | -8.43 | 1.66 |
Model characteristics | R2 = 0.18, F = 3.50, p < 0.001 | |||||
Block 2: Independent variables | ||||||
Readiness | 0.16 | 0.29 | 0.07 | 0.57 | -0.73 | 0.40 |
Empowerment | 0.72 | 0.29 | 0.14 | 0.01 | 0.13 | 1.30 |
Actualization | 0.19 | 0.30 | 0.06 | 0.53 | -0.40 | 0.79 |
Valuation | 1.34 | 0.54 | 0.23 | 0.01 | 0.27 | 2.41 |
Model characteristics | R2 = 0.28, ΔR2 = 0.09, ΔF = 4.98, p < 0.001 | |||||
Discussion
The assessment of happiness among clinical nurses represents a vital area of research, particularly within the context of healthcare systems in Iran. Happiness not only plays a crucial role in individual well-being but also significantly impacts job performance, patient care, and overall organizational effectiveness [4, 39‐42]. In a demanding profession like nursing, where emotional and physical challenges are common, understanding the factors that contribute to nurses’ happiness becomes essential [43]. This study explored the relationship between professional autonomy and happiness among clinical nurses in Iran, filling a critical gap in the literature. It aims to provide insights that can improve the work environment for nurses, leading to increased job satisfaction and better patient outcomes.
In our study, we identified a significant positive relationship between age and happiness among clinical nurses. This finding aligns with numerous related studies that suggest older nurses tend to report higher levels of happiness. For example, a systematic review [39] indicated that age serves as a predictor of happiness, suggesting that older nurses may have developed more effective coping mechanisms and resilience in dealing with job-related stressors, thereby enhancing their happiness levels. Furthermore, Khosrojerdi et al. [28] emphasized that age positively correlates with various quality-of-life factors, which in turn influence happiness. Older nurses typically possess greater experience and often enjoy improved job stability and social support, further contributing to their overall sense of happiness.
However, contrasting findings have emerged from non-aligned studies, such as the study conducted by Javadi Sharif et al. [44], which indicated no significant correlation between age and happiness among Iranian nurses. This discrepancy suggests that demographic factors like age do not consistently predict happiness levels, highlighting variability based on individual circumstances or cultural contexts. The differences in findings may arise from cultural attitudes toward aging and happiness, variations in workplace environments, or the specific methodologies used in these studies [45]. Therefore, while our findings align with certain literature, they also underscore the complexity of the relationship between age and happiness, indicating that further research is necessary to explore the nuances of this relationship across diverse populations and settings.
Our findings revealed a significant relationship between work experience and happiness among clinical nurses. Specifically, as nursing experience increases, overall happiness tends to rise, suggesting that experience plays a crucial role in enhancing job satisfaction and overall well-being. Experienced nurses are generally better equipped to manage work-related challenges, which aids in fostering positive interactions within the workplace. These results are consistent with existing literature. A systematic review has demonstrated that various work-related factors—including job position, working style, and unit satisfaction—significantly impact the happiness of nurses. As nurses accumulate experience, they become adept at navigating these factors, which contributes positively to their overall happiness [39]. Additionally, a study by Rasooli et al. [46] supports the notion that longer work experience correlates positively with higher levels of happiness among nurses, thereby reinforcing the argument that experience enhances both personal well-being and the quality of care provided to patients. A study by Javadi Sharif et al. [44] revealed that work-family conflict negatively impacts job satisfaction and overall happiness. While our findings suggest that experience generally increases happiness, this research highlights that external stressor, particularly family obligations, can undermine those positive effects.
The discrepancy in findings between our study and that of Javadi Sharif et al. [44] can be attributed to the multifaceted nature of happiness and the context in which nurses operate [47, 48]. While experience may equip nurses with skills and resilience that promote general happiness and job satisfaction, external factors such as work-family conflict may introduce significant challenges that can counterbalance these benefits [49, 50]. The happiness of experienced nurses depends on their skills and coping mechanisms and the balance between work demands and personal responsibilities. While work experience typically boosts job satisfaction, it’s essential to recognize that external stressors, like work-family conflict, significantly impact overall happiness [51]. This complexity necessitates a more nuanced understanding of happiness in the nursing profession, emphasizing the need for holistic approaches to support nurse well-being in both their professional and personal lives.
Our study identified a significant relationship between job satisfaction and happiness among clinical nurses, aligning with multiple relevant studies. For example, research conducted on nurses at hospitals affiliated with the Tehran University of Medical Sciences revealed a strong positive correlation between job satisfaction and happiness [52]. These findings highlight the vital role of job satisfaction in the well-being of nurses. A study by Javanmardnejad et al. on emergency department nurses revealed that job satisfaction significantly affects their happiness [15]. The research emphasizes the importance of supportive work environments and positive colleague relationships, which foster a sense of belonging and enhance the overall well-being of healthcare professionals.
In contrast, some non-aligned studies reveal a wider range of findings. Khosrojerdi et al. [28] noted that, despite experiencing moderate levels of job satisfaction, many nurses working in emergency departments reported low levels of happiness. This indicates that external factors, such as economic conditions and workload, may adversely affect happiness, even in the presence of job satisfaction. Such external pressures can create a disconnect between job satisfaction and overall happiness, illustrating a more intricate relationship between these variables [43]. Our results align with studies showing a positive link between job satisfaction and happiness, but differing outcomes highlight the influence of external factors and workplace stressors. These variations may arise from differences in work environments, coping strategies, and outside pressures that can overshadow job satisfaction. Therefore, it’s essential to take a holistic approach to enhance nurses’ well-being by considering their overall work experiences, not just job satisfaction.
Our study highlights a noteworthy correlation between professional autonomy and the happiness of clinical nurses, providing valuable insights into existing literature. While prior research, such as that conducted by Mousavi et al. [24], identified a positive relationship between professional autonomy and happiness, our findings take this further by showing that professional autonomy and its dimensions account for 28.3% of the total variance in happiness—an increase from the 23% variance reported in Mousavi et al.’s study. These results indicate that fostering professional autonomy could significantly enhance nurse happiness in Iran. Additionally, we discovered strong connections between empowerment and recognition—crucial components of independence—and overall well-being among nurses. Self-Determination Theory (SDT) emphasizes that autonomy enhances intrinsic motivation and highlights the importance of empowerment within the nursing profession [53].
In contrast, non-aligned studies, such as that by Tavani et al. [54], provide a more nuanced perspective by indicating that some nurses may experience high levels of professional autonomy yet report low happiness due to external stressors like workplace demands and insufficient management support. This complexity emphasizes the need to consider contextual factors in Iranian nursing practice, suggesting that while professional autonomy is crucial, it must be supported by organizational structures to truly enhance nurse well-being. Our findings not only fill a gap in the literature regarding the specific contributions of professional autonomy to nurse happiness but also contextualize these insights within the frameworks of SDT and Job Demands-Resources (JD-R) Theory, enriching the discussion of how these theoretical perspectives apply to our results.
Our study’s findings contradict prior research, suggesting that low happiness levels could coexist with professional autonomy due to external stressors. We found a direct link between autonomy and job satisfaction, with nurses reporting greater emotional well-being when they experienced high autonomy. Additionally, our research highlighted the significance of supportive workplace environments, indicating that management support can enhance the positive effects of autonomy. Unlike earlier studies that linked workplace demands to adverse outcomes, our results suggest that effective management practices can reduce these demands and improve the experience of autonomy.
In examining the relationship between happiness and professional autonomy among clinical nurses, exploring alternative factors that may influence these dynamics is essential. Two significant aspects that deserve attention are personal resilience and organizational culture. Personal resilience—nurses’ ability to adapt and thrive in challenging environments—could greatly impact overall happiness levels. Nurses with greater resilience may be better equipped to manage workplace stressors, potentially lessening the adverse effects of restricted autonomy [55]. Furthermore, organizational culture is critical; a supportive and positive culture can enhance job satisfaction and foster a sense of autonomy, regardless of structural limitations [56]. By recognizing these alternative explanations, we can better understand the complex nature of happiness in nursing and highlight the importance of fostering resilience and cultivating a positive workplace environment to improve overall well-being.
To effectively translate findings into practice, healthcare organizations should enhance clinical nurses’ professional autonomy. Implementing shared governance empowers nurses by involving them in decision-making processes through councils that foster ownership and responsibility, leading to improved morale [57]. Tailored leadership training programs can also enhance autonomy by equipping nurses with essential skills in communication, conflict resolution, and decision-making. Encouraging nurses to take on leadership roles, even informally, can empower them to drive meaningful changes in practice and policy [58].
Creating opportunities for ongoing professional development reinforces nurses’ skills and confidence. Workshops, mentorship programs, and access to continuing education can foster a culture of growth and innovation, allowing nurses to feel more competent and autonomous in their roles. Implementing these strategies enhances professional autonomy and contributes to overall organizational effectiveness and patient care quality. By prioritizing nurses’ autonomy through shared governance and leadership training, healthcare organizations can cultivate a more engaged and satisfied nursing workforce.
Implications for policy
To examine the relationship between happiness and professional autonomy in clinical nurses, understanding how policies impact various nursing specialties, such as those in the ICU and emergency departments. Tailoring policies to address specific challenges within these environments can significantly enhance autonomy and job satisfaction. For example, in high-pressure settings like the ICU, developing policies that support nurses’ decision-making—such as providing advanced training in critical patient management—can foster greater confidence and independence. In emergency departments, empowering nurses to make rapid decisions through flexible protocols and ensuring adequate support during peak times can also improve autonomy and job satisfaction.
Additionally, specialized areas like pediatrics and geriatrics require unique policy considerations focusing on professional development tailored to their specific patient populations. By acknowledging and addressing the distinct needs of various nursing specialties in policy-making, healthcare organizations can cultivate an environment that promotes professional autonomy and boosts overall job satisfaction and happiness among clinical nurses.
Limitations
This analytical cross-sectional study examined the relationship between happiness and professional autonomy among clinical nurses. However, we acknowledge several significant limitations of our research design that warrant explicit mention. The cross-sectional nature of this study inherently restricts our ability to establish causal relationships between professional autonomy and happiness. While we can observe associations, it remains ambiguous whether increased professional independence leads to greater happiness or if more content individuals are simply more likely to report higher levels of autonomy. Furthermore, while our sample includes 270 clinical nurses, it may not adequately represent all nursing populations across diverse regions or healthcare settings. This limitation could constrain the generalizability of our findings to nurses in different countries or those working in specialties outside of clinical environments.
Additionally, reliance on self-reported measures to assess happiness and professional autonomy could introduce bias. Participants may respond based on their subjective perceptions rather than objective criteria, which raises concerns about social desirability bias. This bias could lead participants to provide responses that they believe are socially acceptable or favorable, potentially skewing the results. To address these limitations, we recommend that future research utilize longitudinal designs better to assess the causal relationship between professional autonomy and happiness. Intervention studies, implementing initiatives like leadership training for nurse managers or enacting policy reforms to improve professional autonomy could reinforce our findings. Addressing these limitations would enable future research to provide a deeper insight into nurse happiness and professional autonomy, thereby enhancing the significance and influence of this vital area of study.
Conclusion
Our study revealed a significant connection between professional autonomy and happiness among clinical nurses, indicating that greater professional independence is associated with higher happiness levels. The findings emphasized the importance of key dimensions of professional autonomy, particularly empowerment and recognition, in enhancing nurses’ overall well-being. However, we must acknowledge potential self-reporting bias in our data, as social desirability may have influenced participants’ responses. This aspect warrants further discussion to understand its implications on the validity of our findings.
We highlight the necessity of cultivating an environment that supports professional autonomy within healthcare settings to improve nurses’ job satisfaction and mental health. Future research should explore the long-term effects of professional autonomy on happiness across various nursing specialties and environments. Additionally, investigating how different elements of empowerment and recognition influence specific job-related outcomes could provide valuable strategies for promoting autonomy in clinical practice. To enhance our study’s relevance and potential impact, we suggest interventions such as leadership training for nurse managers and policy reforms that prioritize professional autonomy. Qualitative research capturing nurses’ personal experiences with professional autonomy could also deepen our understanding of its impact on overall well-being. Such studies may evaluate the effectiveness of targeted interventions to enhance autonomy, ultimately improving nurses’ job satisfaction and mental health.
Acknowledgements
The researchers appreciate all retired male nurses participating in the study and those who assisted and cooperated in this study.
Declarations
Ethics approval and consent to participate
The study received ethical approval from the Ethics Committee of Ardabil University of Medical Sciences under the approval code IR.ARUMS.REC.1401.050. It was conducted by the Ethical principles outlined in the Declaration of Helsinki. Informed written consent was obtained from all participants, who received comprehensive information about the study’s purpose, procedures, potential risks, and benefits. We rigorously maintained the confidentiality of participants by anonymizing all data and securely storing it. Participation was entirely voluntary, and individuals had the right to withdraw from the study without facing any repercussions. Researchers tried to minimize potential harm and were trained to address sensitive topics carefully. The results will be reported honestly and transparently to positively impact the nursing field and enhance healthcare quality while respecting the dignity and rights of all participants.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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