Professional Accountability

Prepared By:
Shaier Khan
Sr. Nursing Instructor
SWCON
 What is Accountability

“The ability and willingness to assume responsibility for

ones’ actions and accepting the consequences of one's
behavior.” (Fundamentals of Nursing; Concepts, Process and Practice:
Kozier, Erb, Blais, Wilkinson; AddisonWesley, Fifth Edition, p. 410)

Accountability means that you are answerable to others

for what you do.

“It is an inherent confidence as a professional that allows a

nurse to take pride in being transparent about the way he
or she has carried out their practice.” (Caulfield, 2005).
 Accountability
 The boundaries between healthcare staff continue to
shift.
 Registered nurses now undertake tasks traditionally
performed by medical staff while healthcare assistants
perform roles usually associated with registered nurses
(RCN et al 2006).

 There is inevitably some confusion as staff continue

to absorb the consequences of changes in their role.
(Mulryan, 2009)

 These changes continue against a background of public

expectations of health and social care.
 Cont…
 The duty of care applies whether the task involves
bathing a patient or complex surgery – in each case
there is the opportunity for harm to occur.
 In this context, the question that arises concerns the
standard of care expected of practitioners performing
these tasks.
 By accepting the responsibility to perform a task
the practitioner must ensure the task is performed
at least to the standard of the ordinarily competent
practitioner in that type of task.
 Cont…
 If a practitioner such as a registered nurse should
delegate a task, s/he must be sure that the delegation
is appropriate.

 The person performing the delegated task; e.g. HCA or

a nursing student, must understand the task & how it is
performed, have the skills & abilities to perform the task
competently & accept responsibility for carrying it out.

 The person performing the delegated task & the RN will

be held responsible & accountable for the outcome of the
task performed.
 Cont,,,

 Accountability is a legal obligation and an ethical

& moral responsibility in health care.
 Professional nursing is based on altruism,
accountability and social justice.
 Judgments & practices that are based on these
ethical values will always be in the best interest of
the patient, no matter what the professional level.
 Cont…

 A professional nurse has the responsibility to

practice within his/her scope of care, utilizing
his/her knowledge & skills to make decisions
in the best interest of the patient.
 The level of responsibility may differ at different
levels in nursing but the levels of professional
accountability are not different.
 Key concept definitions

 Accountability: “Being answerable to someone for

something done” (ANA, 2002)

 Autonomy: Person is reasonably independent and self-

governing in decision making and practice.
Increased autonomy=Increased responsibility

 Authority: Power to do something

 Responsibility: Acting in a reliable, trustworthy, credible
manner.
 Why accountability is needed?
 To develop & evaluate new professional practice
and to reevaluate existing ones.
 To maintain professional goals and standards
 To provide time for self reflection, ethical thought
and personal growth.
 To increase the profession’s reliability
 To establish boundaries for professional
accountability by using ethical codes
 To Whom is the Professional Nurse
Accountable?

To the profession

To clients
To other members of the health care team
To the employing agency
To self
 Accountability to
Profession

 ANA Code for Nurses

 ANA Standards of Nursing Practice, Service and
Education
 Nursing Quality Assurance & Quality Improvement
Programs
 Participate as a member of professional nursing
organization(s)
 Accountability to
Clients
1. Clinical competence: knowing how & why things are
done
2. Safe nursing care
3. Allow clients to participate in nursing care activities,
including planning
4. Respect individual client differences
5. Altruistic intentions
6. Serve as a client advocate when the need arises
Accountability to Health Care Team
 Bring specialized nursing knowledge and
skills to the health care delivery situation
 Share information with team members
 Confront if potential errors may occur
 Perform nursing tasks with competence
 Treat members with dignity and respect
 Accountability to
Employing Agency

 Quality of work

 Protect against unsafe practice situations

 Attitude conveyed about the agency

 Use of outside agency personnel

 Accountability to Self

 Practice nursing to personal standards

using professional standards as a basis
 Be true to oneself
 Take care of personal, physical, mental
and spiritual health
 Protect self from harm
 The Groundwork for Accountability

 Growth & development of theoretical base

for professional practice

 Clinical and professional competence

 Leadership skills

 Ethical framework

 Baccalaureate nursing education & beyond

 Accountability in the
Era of Cost Containment

 Unlicensed Health Care Worker (The nursing

shortage will also impact the future of health
care).
 Third-Party Payers
 Conflicts between Professional Values and
Cost Containment
 Accountability in the Future

 Primary nursing
 Team nursing
 Shared governance
 Advanced technology
 Increasing ambiguity as part of an interdisciplinary
health care team member
Positive Aspects of Accountability

 Increased respect
 Rewards
 Effectiveness (improved performance)
 Control
 Action
 Responsible & commended for maintaining
safe standards for client care
 Positive Aspects of Accountability

 More employee participation & involvement

 Increased feelings of competency
 Increased employee commitment to the work
 More creativity and innovation
 Higher employee morale & satisfaction with
the work.
 Measuring accountability
It is vital that each member of the nursing team can
demonstrate accountability. This may be achieved in
a variety of ways.
Competency
 It is important that staff can show evidence of
competence.
 Recognise & work within the limits of their
competence
 They must have the knowledge & skills for safe
& effective practice when working without direct
supervision
 Measuring accountability
Consent
 All individuals’ capacity to consent is assumed
unless there is evidence to the contrary.
 No adult can give consent for another adult unless
legally authorised to do so.
 It is not necessary to document consent to routine
& low-risk procedures e.g. taking a blood sample.
 However, if the procedure is of particular concern
to the patient it would be helpful to do so.
 Measuring accountability
Delegation
 You must establish that anyone you delegate,
is able to carry out your instructions
 You must confirm that the outcome of any
delegated task meets the required standards
 You must make sure that everyone you are
responsible for is supervised & supported
 Measuring accountability

 Job descriptions should state the range of duties

related to the role. This ensures that there
is clarity about roles in a nursing team.

 Ongoing professional development is key to all

staff development.
 References
Kozier, B., Erb, G., Blais, K., & Wilkinson, J. M. (1995).
Fundamentals of Nursing, Concepts, Process & Practice
(5th ed.). Redwood City: Addison-Wesley.

Mulryan, C. (2009). Accountability for HCAs & assistant

practitioners. British Journal of Healthcare Assistants. 3, 4,
182-184.

Royal College of Nursing, Royal College of Speech and Language

Therapists, British Dietetic Association, The Chartered Society
of Physiotherapy (2006). Supervision, Accountability and
Delegation of Activities to Support Workers: A Guide for
Registered Practitioners and Support Workers. Retrieved from
www.rcn.org.uk/__data/assets/pdf_file/0006/78720/003093.pdf