Nursings' lack of full professional status based on the criteria of autonomy coupled with the need for a more independent practitioner in today's complex health care system was the basis for this study. A comparison of senior nursing students from different educational programs was undertaken to determine if type of educational preparation was a predictor of professional autonomy. Schutzenhofer's (1988) Nursing Activity Scale (NAS) was used to measure and compare the level of professional autonomy of 306 senior nursing students who were within four weeks of graduation from nine nursing programs across Massachusetts. Further comparisons of students' professed autonomy as a function of demographic variables and students' perceptions of their level of participation in learning were compared. Thirty-six senior level nursing faculty were surveyed for identification of possible relationships between student and faculty scores on these variables. The majority of students surveyed (85%) scored in the high range of the autonomy scale, and the level of nursing education was not a predictor of the students' autonomy level. Variables that correlated with student autonomy levels were marriage, plans for earning an advanced nursing degree and perceived level of participation in learning. However, significant differences were found in student reported autonomy between schools at the associate degree level. Schools at the baccalaureate degree level did not differ significantly from each other. No clear relationship was found between student and faculty scores. More baccalaureate degree students reported their programs as having a more theoretical than practical focus, while the associate degree students perceived a more practical focus to their programs. Seventy-five percent of students from both programs planned to earn advanced nursing degrees. These findings have implications for nursing education. Increased opportunities for students to participate more fully in their educational process may facilitate the internalization of professional autonomy in nursing students. Such opportunities may ultimately provide the health care system with practitioners who possess the professional characteristics necessary for a more autonomous, successful practice.

The delivery system of health care to Americans is in crisis. As costs continue to escalate, and as access to services deteriorates, an increasing number of individuals in need of physical and mental health care are experiencing difficulty accessing the necessary services. Changes in economic resources have resulted in quantitative shifts in mental health service delivery. A greater number of individuals seek mental health services as a result of the stress and anxiety created from a threatened or actual loss of financial stability. This increase in demand for service comes at a time when mental health programs are experiencing a decrease in resources which has resulted in reduced access to services. The emergency mental health service utilization patterns and client characteristics have changed during the same period of time that the overall mental health care delivery system has undergone transformation. However, the changes in mental health care have not necessarily evolved out of careful rational planning, but rather as a response to chaotic shifts in the mental health system at large. The purpose of this study was to gather data about access to these mental health outpatient services as they related to client diagnostic characteristics, system ability to provide the service needed, and ability of the service to meet the client's perceived need. The implications of the findings are clear. Access to services during a crisis was dependent upon system response, degree of psychopathology and a supportive environment. Any reform effort must include adequate crisis intervention and social services to meet the need of the changing population. Education for the general population and the professional would enhance understanding of the needs of the mentally ill and service availability.

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