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Definition of Accountability and Professional Responsibility

Should Registered Nurses be Held Accountable for Their Own Practice?

Accountability means being answerable, liable, blame worth as well as possibility of explaining about a certain action (Migrant, 2017). According to the definition by the American Nurses Association’s code of ethics, accountability entails being answerable to one’s own and others’ actions (Battie and Steelman, 2014). With regard to nurses, they may be held accountable legally, ethically, and professionally for their actions, including omissions and inactions. On the other hand, professional responsibility refers to the moral and ethical obligations that permeate the nursing profession (Reid, n.d.). Accountability mainly entails competency, maintenance, safeguarding of quality patient care, outcomes and heeding to profession standards at the same time being answerable to those that are affected by one’s nursing actions  (Ireland, 2017). In this regard, nursing accountability is a complex but vital concept. Currently, accountability is a principle relevant to all healthcare professionals.

As the Royal College of Registered Nursing (n.d.) outlines, providers of health service are accountable to the criminal and civil courts. For RNS, they are accountable professionally to the Nursing and Midwifery Council (NMC). However, in many healthcare settings professional accountability has become an issue of concern. As Sherman (2013) claims, ethicists have observed as most healthcare aspects change, individuals’ willingness to accept accountability and responsibility has reduced.  As such, the current paper seeks to explore the issue on whether RNs should be held accountable for their own practice. Evidently, RNs should be held accountable for their practice this keeps them in check to deliver quality care to patients, encourage them to meet the set standards of care.

For an RN to be deemed accountable, they must depict various aspects. They must have the ability to carry out a certain intervention or activity, accept responsibility, and have the authority to perform it, through delegation, protocols, and policies of the organization (Royal College of Nursing, n.d.). According to the Australian Medicare Local Alliance (2013), RNs are accountable for their actions and care they provide. Additionally, they are accountable for the delegation of care decisions to another health care provider such as the EN. Also, RNs are accountable for arriving at professional judgments regarding when an activity goes beyond their scope of practice or their own capacity (Australian Medicare Local Alliance, 2013). 

The role of a registered nurse ranges from performing physical examinations to taking health history of patients (Aurora University, 2017). Registered nurses also provide health promotion, counseling and education to clients (Charter College, 2017). Additionally, registered nurses have other roles in the hospital to deal with the patients. They administer medications, do wound care and other personalized interventions to clients (Aurora University, 2017).In order to know what is required of a particular client registered nurses interpret patient information while making critical decisions about the needed actions (Registered Nurses, 2017). The registered nurses are also in coordinating care in collaboration with other health care professionals like doctors and enrolled nurses. They do this in order to ensure smooth running of all the nursing activities in the particular health facilities.

RN's Accountability

Apart from direct care for the patients’ activities, registered nurses also engage in other roles all of which contribute to the positive running of their overall responsibilities. For instance, the registered nurses are in charge of directing and supervising care delivered by other health care officers like nurse helps and other practical licenses nurses and supervises the less-skilled nurses or particular units (Charter College, 2017). The registered nurses also engage in conducting research for improved practice support and the betterment of the patient outcomes (Aurora University, 2017).

There are several areas of accountability that RNs should be held accountable for. These include accountability to the patient, employer, profession, and to the union (Philips, n.d.). Foremost, RNs’ accountability is to the client where they hold out as individuals with special training, knowledge, and skills necessary to provide the best care. As such RNs have a duty to the client to offer standards of care that are reasonable and prudent. Compromising these standards would be detrimental to the patient and one should be answerable to the consequences. RNs’ accountability is also to their employer. As Philips (n.d.) outlines, as an employee, every nurse has a responsibility to carry out their duties in the scope of employment as the employer provides. As such, RNs are responsible for knowing their employment terms and work within them, and to know the procedures and policies that govern their employment scope.  Failing to work within the defined scope may void the responsibility of the employer towards the RNs, thus leaving them to bear the liability cost of their activities Philips (n.d.).

In addition to accountability to the client and employer, RNs are accountable to the profession where they are expected to meet their profession’s standards (Philips, n.d.).  In this regard, RNs are required to carry out activities that are in the scope of their practice, and it is their responsibility to maintain as well as update the standards. With regard to accountability to the union, RNs should be aware of the union’s policies’ and decisions that may affect them as members and also their responsibilities towards the union. Thus, RNs should be aware of the many accountability areas they should consider prior to engaging in any actions and activities related to their profession.

Different factors in the society affect the way RNs’ practice in varying ways. The culture and beliefs of the RN is one of the factors that may affect how these professionals carry out their roles and make decisions. Some cultural beliefs may contradict with the acceptable standards of care. For instance, an RN’s culture may call for secrecy regarding revealing a patient’s serious condition. On the other hand, it is the right of the patients to be informed of their conditions and is supposed to make informed decisions. As such, if the RNs are unable to set aside their beliefs and act as per their professional standards they may be held accountable for their actions, similarly, personality of the RNs may impact on their practice in terms of the way they deal with human relations and their values and moral standpoints. As such, personality affects decision making and determines how health professionals react to issues. Additionally, RN’s own experience may also impact on their practice. More experienced nurses may be in a better position to address certain issues as opposed to newly recruited professionals. For instance, an experienced RN may be able to make a more accurate diagnosis. On the other hand, a nurse that is new in the profession may be at a better position to implement evidence-based practice as opposed to one that has been on the nursing industry for long. This is because it may take a while for the more experienced nurse to adopt to change and integrate the innovative practice in their nursing. Additionally, the one that has been in the nursing practice may be more experienced in other areas but may lack the evidence-based skills, knowledge, and experience. In this regard, it is important for RNs to be able to integrate values, ethics, and professionalism when making decisions and providing care, and be flexible. As such, different factors affect RN’s practice.

Factors Affecting RN's Practice

Accountability of RNs presents with certain benefits. As Rachel (2012) states, accountability is an energizing drive in any organization that allows healthcare professionals to fulfill their goals easily. Every care provider builds credibility by holding each other accountable. On the contrary, where healthcare professionals lack accountability, they present excuses for not fulfilling their objectives (Rachel, 2012). Additionally, accountability of nurses allows for continuity of care. For instance, perioperative nurses are accountable when they provide care after surgery since hand overs are an important component of the safety of the patient that ensures that care givers are given sufficient information regarding the patient. As a consequence, patients receive high quality and safe care after surgery (Battie and Steelman, 2014). Accountability also ensures that nurses advocate for patients by acting on their behalf when they are incapable of communicating their needs. This ensures that patients are satisfied with the care they receive and they develop a sense of trust towards the care providers. What is more, it is through accountability that lifelong learning is exercised where nurses are accountable for learning continually on using best and current evidence in providing care. Lifelong learning thus allows utilization of evidence based care, which has been shown to improve patient outcomes and promote health (Battie and Steelman, 2014). These positive outcomes arise from the quality care offered by responsible nurses. Thus, accountability presents with many advantages that cannot be guaranteed in its absence.

There are other advantages of accountability. As a nursing principle, accountability enhances performance and increases competency (OPM, n.d.). This occurs when clarity on how to accomplish tasks is offered to nurses and their roles and responsibilities are well defined. As Sherman (2013) states, professional accountability is achieved through making certain nurses’ professional responsibilities and roles, as well as clarity on how to accomplish tasks. Also, when nurses are provided with clear standards and metrics are set they guide the nurses’ actions, ensuring that their performance is improved.

For accountability to be forged there are elements that should characterize RNs. Firstly, there should be clarity as outlined by Rachel (2012). Here, the RNs should be guided by clear and specific goals and expectations. The other element is commitment where an accountable RN not only gives orders to their juniors but also listens, understands, and commit to achieving the goal (Rachel, 2012). In this regard, RNs should be held accountable for their actions to ensure proper advocacy for patients, allowing for continuity of adequate care for patients through out.

Benefits of Accountability in Healthcare Delivery

The aspect of accountability does not present with positivity only as it presents with some shortcomings. For instance, RNs face the liability threat on a daily basis as they seek to be accountable for all the four entities. Therefore, the aspect of accountability may add pressure to the RNs as they try to act with accountability to the patients, employers, unions, and their profession. Additionally, as stated by Savage and Moore, (2014), as nurses try to act with accountability, they may feel pressured as they take on tasks such as documentation of their activities, some of which take their time away from making it a priority to offer direct care to patients. What is more, pressure to act according to certain terms may increase errors and inaccuracies and decrease the RN’s level of competency (Savage and Moore, 2014). 

In addition to the accountability pressure that nurses have to put up with, there are other situations that make it difficult for nurses to act with accountability. For instance, if a nurse is working in a rural or remote area where the hospital fails to provide the necessary equipments that meet the standards of care, nurses may face a dilemma as to whether to compromise the set standards by the entities they are responsible for. In such a case, the issue of accountability poses questions such as whether the nurse should be held accountable for not providing care as per the set standards even when they are not provided with the necessary facilities.

Another controversial issue regarding accountability may arise from nurses’ collaborative relationships with physicians and doctors.  For instance, a nurse may receive erroneous directions from the doctors or physician in charge regarding the type of medication to offer a patient. Without their knowledge they may follow these orders and continue offering the wrong medication to a patient. As such, questions as to whether this nurse should be held accountable may arise. Notably, it is not the responsibility of a nurse to prescribe medication. Additionally, RNs may find themselves acting in contrary to defined roles. For example, as already stated, it is not up to nurses to make prescriptions. However, situations may force them to intervene when doctors are not in the hospital and prescribe medications in case of an emergency. Again, should they be held accountable for such acts even if they intervened to reduce risks to a patient? As such, there are other such factors that may compromise RNs’ ability to implement the accountability principle when they have to deal with issues such as understaffing, unqualified college staff, inadequate equipment and resources, and security and safety.

However, nurses should be able to uphold standards before acting while prioritizing accountability. For instance, to avoid situations where the RNs will not meet the necessary standards of their profession they can refuse to participate in such tasks.  Rejecting such tasks will reduce chances of uncertainties to the RNs thus maintaining the standards of their profession and concerns relating to accountability. As a result, this will influence the wider health system to maintain high standards of care.

Conclusion

Thus, accountability in nursing has become an issue of concern especially with the changing healthcare world. However, it still remains to be an integral element of nursing practice and helps to improve patient care, life-long learning, advocating for patients, and continuity of care.  As An preoperative RN, accountability may be advantageous since it ensures that patients are prepared efficiently for operations, leading to smooth surgery process. I should be held accountable for my actions since it will foster and motivate me to offer quality services. Accountability in nursing has been shown to improve the quality of care and patient outcomes. Additionally, it is through accountability as a principle that RNs are provided with guidelines through which they can prioritize and ensure that patient’s well-being is prioritized and the standards of care provided are acceptable. However, it also presents with detrimental impacts where it adds pressure on RNs, decreasing the time they spend directly caring for the patients as they act with accountability to other entities such as employers, and unions. Additionally, the aspect of accountability exposes RNs to liability threat in their day-to-day activities as they have to consider the entities they have to be accountable to, limiting the RNs’ competency and accuracy. However, the benefits of accountability seem to outweigh the shortcomings. In this regard, RNs should be held accountable for their own practice.

References

Aurora University. (2017). Responsibilities and duties of a registered nurse. Retrieved from https://online.aurora.edu/responsibilities-and-duties-of-a-registered-nurse/

Australian Medicare Local Alliance (2013). Clarifying the roles, responsibilities and accountabilities of Nursing Professionals and Aboriginal and Torres Strait Islander Health Practitioners in primary care, including general practice. Retrieved from https://www.google.com/url?sa=t&rct=j&q=&edata-src=s&source=web&cd=11&cad=rja&uact=8&ved=0ahUKEwis3ZbglN7WAhXT0RoKHeeHDo4QFghWMAo&url=http%3A%2F%2Fwww.ants.org.au%2Fants%2Fpluginfile.php%2F11%2Fmod_forum%2Fattachment%2F1437%2F20130620_doc_rolesandresponsibilitiesv1.pdf&usg=AOvVaw1PcrTOcm-J55-X1iFgEKZ3

Battie, R. & Steelman, V.M. (2014). Accountability in nursing practice: why it is important for patient care. AORN Journal. 100(5), 538=541.

Charter College. (2017). Registered Nurse. Retrieved from https://nursingschool.chartercollege.edu/

Migrant Month. (2017). Accountability in nursing profession. Retrieved from www.migrantmonth.com/the-means-of-accountability-in-nursing-profession-essay-example

Nursing and Midwifery Board of Ireland. (n.d.). Considerations in determining scope: responsibility, accountability & autonomy. Retrieved from https://www.nmbi.ie/Standards-Guidance/Scope-of-Practice/Considerations-in-Determining-Scope/Responsibility,-Accountability-Autonomy

Philips, E. (n.d.). Accountability, responsibility, liability. Canadian Nurses Protective Society. Retrieved from https://www.cnps.ca/index.php?page=88

Rachel, MM (2012). Accountability: a concept worth revisiting. American Nurses Association. 7(3).

Registered Nurse. (2017). Registered nurse responsibilities, duties and job prospects. Retrieved from https://www.topregisterednurse.com/registered-nurse-job-description-and-duties/

Reid, S. (n.d.). What is professional responsibility in nursing? Chron. Retrieved from work.chron.com/professional-responsibility-nursing-10086.html

Royal College of Nursing (n.d.). Accountability and delegation. Retrieved from https://www.rcn.org.uk/professional-development/accountability-and-delegation

Savage, J., & Moore, L. (2014). Interpreting accountability. RCN Institute. Retrieved from https://my.rcn.org.uk/__data/assets/pdf_file/0008/78605/002249.pdf

Sherman, R. (2013). 5 ways to promote professional accountability in nursing. Emerging RN Leader. Retrieved from https://www.emergingrnleader.com/professional-accountability-in-nursing/

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