Protocols in Healthcare: Where Quality of Care and Nurses’ Autonomy Meet
Take home paper
Course Quality and Safety
Name Susanne Noteboom
Student ID 547576
Word count 2198
Date 28/02/2025
, Introduction
In the Netherlands, a significant part of nurses' work consists of adhering to protocols
and guidelines (Van Weel et al., 2012). Healthcare protocols offer numerous benefits.
Heymann (1994) describes that protocols contribute to improving the quality and
safety of care. For instance, they assist in making accurate diagnoses and selecting
the appropriate treatment. Additionally, they reduce variations in patient care through
standardized procedures, leading to greater efficiency in healthcare.
However, the use of protocols is not solely beneficial. Strict guidelines, rules, and
protocols can diminish nurses' professional autonomy—the participation in decision-
making regarding the care of individual patients and, more broadly, the development
of care processes to improve the quality of nursing care and patient safety (Pursio et
al., 2021). A practical example of this, described by KPMG (2020), occurred at
Spaarne Gasthuis, where nurses were required by protocol to ask patients three
times a day to rate their pain on a scale from 1 to 10. According to the nurses, this
was pointless in cases where patients were not experiencing any pain. Furthermore,
it undermined their expertise as nurses, as they stated that they would always take
action when they recognized pain.
Pursio et al. (2021) explain that a reduction in professional autonomy has several
negative consequences, such as an increase in job dissatisfaction among nurses.
Additionally, it leads to a rise in moral distress—a situation in which a healthcare
provider experiences emotional discomfort when they know the right course of action
but are unable to take it due to external constraints. These outcomes do not make
the nursing profession more attractive, which is undesirable in today's time of
increasing pressure on healthcare. Furthermore, restricting nurses’ professional
autonomy negatively impacts the quality and safety of care, as it limits their ability to
think critically. This contradicts one of the core values of protocols: improving the
quality and safety of care.
This paper examines how healthcare protocols can be structured to balance
standardization with nurses' professional autonomy. This gives rise to the research
question: "How can healthcare protocols be designed and used in a way that
ensures quality and safety while maintaining nurses' professional autonomy?"
Take home paper
Course Quality and Safety
Name Susanne Noteboom
Student ID 547576
Word count 2198
Date 28/02/2025
, Introduction
In the Netherlands, a significant part of nurses' work consists of adhering to protocols
and guidelines (Van Weel et al., 2012). Healthcare protocols offer numerous benefits.
Heymann (1994) describes that protocols contribute to improving the quality and
safety of care. For instance, they assist in making accurate diagnoses and selecting
the appropriate treatment. Additionally, they reduce variations in patient care through
standardized procedures, leading to greater efficiency in healthcare.
However, the use of protocols is not solely beneficial. Strict guidelines, rules, and
protocols can diminish nurses' professional autonomy—the participation in decision-
making regarding the care of individual patients and, more broadly, the development
of care processes to improve the quality of nursing care and patient safety (Pursio et
al., 2021). A practical example of this, described by KPMG (2020), occurred at
Spaarne Gasthuis, where nurses were required by protocol to ask patients three
times a day to rate their pain on a scale from 1 to 10. According to the nurses, this
was pointless in cases where patients were not experiencing any pain. Furthermore,
it undermined their expertise as nurses, as they stated that they would always take
action when they recognized pain.
Pursio et al. (2021) explain that a reduction in professional autonomy has several
negative consequences, such as an increase in job dissatisfaction among nurses.
Additionally, it leads to a rise in moral distress—a situation in which a healthcare
provider experiences emotional discomfort when they know the right course of action
but are unable to take it due to external constraints. These outcomes do not make
the nursing profession more attractive, which is undesirable in today's time of
increasing pressure on healthcare. Furthermore, restricting nurses’ professional
autonomy negatively impacts the quality and safety of care, as it limits their ability to
think critically. This contradicts one of the core values of protocols: improving the
quality and safety of care.
This paper examines how healthcare protocols can be structured to balance
standardization with nurses' professional autonomy. This gives rise to the research
question: "How can healthcare protocols be designed and used in a way that
ensures quality and safety while maintaining nurses' professional autonomy?"
