Nurses’ experiences of expanded responsibilities, independent decision-making and action in specialized outpatient palliative care: a qualitative interview study

Abstract Background Given an increasing demand for patient care, healthcare systems worldwide focus on expanding nursing practice. Nurses in specialized outpatient palliative care (SOPC) take on expanded responsibilities requiring independent clinical decision-making and action, while little is known about how nurses themselves experience this practice. Therefore, this study aims to explore how nurses experience these aspects of their practice when delivering care in complex healthcare situations. Methods A qualitative interview study was conducted with nurses who had current or previous work experience in SOPC (N=20) between June and August 2025. Data were collected through individual interviews, following a semi-structured format. Data analysis was guided by grounded theory methodology according to Strauss and Corbin. Strauss’s coding paradigm was used to develop an explanatory model of the phenomenon and its underlying conditions. Results The core phenomenon identified is “responsibility borne in relationship-based autonomy.” Nurses describe being able to make decisions and act independently while remaining embedded in trusting interprofessional relationships and supportive team structures. The core phenomenon is influenced by the need to respond promptly to patients’ healthcare needs while applying and developing nursing competences. Intervening conditions include attitudes toward autonomy in nursing practice, self-confidence, and trust from colleagues, physicians, patients, and families. Nurses respond through strategies such as engaging in interprofessional collaboration to promote multi-perspective dialogue, applying specialized knowledge and work experience, and establishing direct contact with patients to assess and manage care situations. Consequences include experiencing meaningful work, perceiving improvements in care quality, and navigating ambivalence between professional empowerment and stressors. Contextual factors include managing complex care situations in patients’ homes, understanding patients’ situations holistically, and being strongly committed to patients and their families. Conclusion Nurses’ experiences of expanded responsibilities performing independent decision-making and action in SOPC suggest that professional autonomy emerges within a relational and collaborative context. Confidence in one’s professional competence, interprofessional recognition, trust, and supportive organizational structures appear important for feeling safe when exercising professional judgment. Consequently, efforts to create the relational and organizational conditions that enable nurses to exercise their expertise safely and effectively are recommended.