Professional Responsibility and Accountability

ProIessional accountability applies to everyone involved in the health care. Accountability is a

legal obligation; in the health care, it is also an ethical and moral responsibility. Within the realm
oI proIessional accountability, there are many Iactors. Assuming responsibility Ior one`s own
nursing practice is the most important. The American Nursing Association (ANA) states in its
code that the nurse will assume accountability Ior nursing judgment and actions. A proIessional
nurse has the responsibility to practice within his /her scope oI care, calling upon his/her
knowledge and skills to make decisions in the best interest oI the patient.
The level oI responsibility and accountability depends on proIessional levels. The charge Nurse
has the more responsibility than the StaII nurse, the staII nurse have the more responsibility than
the Student Nurse and thereIore their levels oI proIessional accountability are diIIerent.
ProIessional nursing is based on altruism, integrity, accountability and social justice. Judgment
and practice that are based with ethical values will always be in the best interest oI patient, no
matter what the proIessional level.
Definition:
Hurley deIines accountability as 'liability Ior reckoning oI the responsibilities received by
delegation oI authority.
When the concept oI authority and accountability is taken in this way, responsibility is mostly
deIined in terms oI duties and tasks rather then the obligation Ior the perIormance oI those tasks.
Robbins deIines 'Authority is the right to act, responsibility the obligation to carry out delegated
authority; and accountability establishes reliability Ior the proper discharge oI the duties delegated
to the subordinate. Responsibility and accountability may seem similar but they are diIIerent.
Thus accountability creates the obligation Ior the maintenance oI responsibility by the superior
(delegator oI authority) and an accompanying oI insistence that the work perIormed must meet his
expectations. Subordinates are responsible Ior the completion oI tasks assigned to them and are
accountable to their superiors Ior the satisIactory perIormance oI that work.
DIMENSIONS OF ACCOUNTABILITY

Eby (2000) says that the individual operates through 4 dimensions oI accountability.

1. Social accountability which sets norms Ior acceptable behavior within the society, relying
on the individual oIIering or being asked to provide accounts that explain their actions in an
attempt to shape the way others will perceive these.

. Ethical accountability relating to moral obligation to be answerable. This is derived Irom the
relationship oI implicit trust between nurse and the client. This dimension oI accountability
stresses values and principles identiIied with various ethical approaches as Iollows:

a) Duty- based: Focusing on the duty oI health care proIessionals to be accountable.

b) Consequences-based: Focusing not on the explanation or the individual but on the
consequences oI an account.

c) Virtue -based: Focusing on the integrity oI the accountable individual with implicit Iaith
in the person`s knowledge oI what is the right explanation to give.

d) Principle-based: Assuming that truth and honesty are the Iundamental principles on which to
base an account.

e) Emotive: Possibly Iocusing on the Iear surrounding accountability.

. Legal accountability being accountable is enshrined by law through acts oI parliament,
case law, tribunals, and enquires

. Professional accountability which is associated with individuals recognizing that they
are members oI a proIession and thereIore accepting the status, rights and
responsibilities.

ACCOUNTABILITY OF PROFESSIONAL NURSE:

O Accountability to Profession :

1. INC Code Ior Nurses

2. INC Standards oI Nursing Practice, Service & Education

3. Nursing Qualit y Assurance & Quality improvement Programs

4. Participate as a member oI proIessional nursing organization(s)

O Accountability to Clients :

1. Clinical competence: knowing how & why things are done

2. SaIe nursing care

3. Allow clients to participate in nursing care activities, including planning

4. Altruistic intentions

5. Serve as a client advocate when the need arises

O Accountability to Health Care Team

1. Bring specialized nursing knowledge & skills to the health care delivery situation

2. Share inIormation with team members

3. ConIront iI potential errors may occur

4. PerIorm nursing tasks with competence

5. Treat members with dignity & respect

O Accountability to employing agency

1. Quality oI work

2. Protect against unsaIe practice situations

3. Attitude conveyed about the agency

4. Use oI outside agency personnel

O Accountability to Self

1. Practice nursing to personal standards using proIessional standards as a basis

2. Be true to oneselI

3. Take care oI personal, physical, mental, & spiritual health

4. Protect selI Irom harm

The problem Ior nurse is that these lines oI accountability may cross and at times go in
opposite directions, leaving the nurse in serious dilemma as to which course oI action to take.
Most nurses will have Iaced the situation where staIIing is short and there is a lot oI pressure Irom
some very sick patients. Things become so bad that nurses Ieel patient saIety is compromised.
However, pulling in the opposite direction is your employer who merely tells you things are
tough, the Trust cannot aIIord or Iind any more staII so you will just have to get on with it
and do the best you can. Medical staII may be eroding your time Iurther by expecting you to
do their work as well. This Iamiliar situation leaves the nurse with two sets oI Iorces pulling
in opposite di rections along opposite lines oI accountability. At the heart oI this tug oI war is
the nurse trying to decide what to do and be accountable to him or herselI in the process.
DELEGATING ACCOUNTABILITY :

When a senior nurse assigns some duties to a junior nurse; she has to delegate corresponding
authority also. The junior nurse may, in turn, take the help oI a hospital aide working under
her in perIorming the work assigned. But the junior nurse will continue to be accountable Ior the
perIormance oI the senior nurse. That means iI the aide does not do the job properly, it is the
junior nurse who is responsibl e Ior t he seni or nurse. Thus accountability can`t be
delegated, it always moves upward. In simple words, an executive cannot escape the
responsibility (or answerability) Ior the perIormance oI tasks assigned to her by delegating
authority to her subordinates. However, he/she can take action against the subordinate Ior his/her
carelessness or negligence in doing the job.

Accountability moves upward because a person who is delegated the authority is always
accountable to the superior who delegated the authority. However, as obvious Irom the
mechanism oI the delegation process, responsibility and authority move down

The extent oI accountability depends on the extent oI delegation oI authority and responsibility.
A person cannot be held answerable Ior the jobs not assigned to her by the superior. For instance,
iI the production manager is given responsibility and authority to produce a speciIied
quantity and quality oI certain product and the personnel department is gi ven responsibilit y
and aut horit y Ior t he development oI workIorce, the production manager cannot be held
accountable Ior the development oI workIorce. 'Accountability is, by the act which creates, oI
the same quality and weight as the accompanying responsibility and authority. '
CASE STUDY

A physician has told a patient that she has metastatic pancreatic cancer and there is no cure. The
physician is a general practitioner. The patient is devastated.
oes the nurse tell the patient to accept the doctor`s diagnosis?
oes the nurse tell the patient and Iamily to insist on an Oncology consult?
The nurse has the obligation to act in the best interest oI the patient. This nurse is specialized in
oncology care, so using the knowledge that she has; she makes a judgment and tells the Iamily to
insist on getting an Oncologist on board. The Oncologist may not oIIer outcome but may have
options Ior a better quality oI liIe. The nurse has used her integrity. She has not given
Ialse hope but she has not destroyed all hope. The Oncologist suggests chemotherapy. He has
explained to the patient that it is not a cure but may extend her liIe. The patient has agreed to
the treatment. The nurse has never initiated chemotherapy. oes she give it? II she does she will
have to be accountable Ior her actions. She uses her judgment and seeks out the Charge Nurse
(CN), who is chemotherapy certiIied, to start medicine. II the nurse had started medicine, she
would have been practicing outside her scope. Her action to involve the charge nurse was the
most responsible decision Ior the patient.
Nine months later, the patient comes back into the hospital. The chemotherapy is no longer
working. The patient is in terrible pain. She is very thin and can no longer eat. The physician
wants to put in a Ieeding tube. The Iamily tells the nurse, they are not ready to loose their
mother yet. They have talked to her, consenting Ior a Ieeding tube placement. AIter the Iamily
leaves, the patient tells the nurse, she is tired and always in pain. She wants to die
peaceIully. The patient says her Iamily will not listen to her when she speaks oI dying. The patient
is Irustrated because she wants to spend the last moments at peace with her Iamily.
oes the nurse discuss the Hospice Care with the patient ?
She knows the physician is not a big supporter oI hospice and the Iamily is not ready. The
obligation is to the patient. The nurse tells the patient about the hospice. The patient tells
the nurse to please get the order so she can speak to them. She does and Hospice helps them all
get to the point where they can say good-bye. The patient can now dye with dignity. The
nurse called upon her knowledge and experience to do what was in the best interest oI the
patient. Ethically and legally she made the right decisions. What iI the patient was a pediatric
patient? The child is tired and the Iamily is not ready to let go. Where does the moral and
ethical responsibility lie, with the patient, the Iamily or both? It now becomes more diIIicult.
With all the regulatory agencies involved in health care today, the nurse needs to be very
careIul about the decisions she/he makes

'Act always in such a way to promote and saIeguard the well being and interests oI patients/
clients.
REASONS FOR NURSE MALPRACTICE SUITS:

ReasonExampIe
1 . Failure to document: Procedures, medications &Physicians interactions not documented
are considered not done in a court oI law.
2. Therapy error : Incorrect medication or treatment
3. Failure to follow standards of care outlined :Using alternative treatment or Procedures
Iailing to Iollow guidelines outlined by Institutional policy and procedure
manuals
. Communication failures: Not listening intently to patients concerns, inaccurate
discharge instructions, not notiIying a physician in a timely manner
5. Omitted assessment: Not perIorming routine assessments Ior various medical conditions
or procedures, or Iorgetting to document a required assessment.
6. Forgetting to be a client advocate: Not questioning physician`s orders when needed or
not providing a saIe environment
7. Breach of confidentiality: Sharing private inIormation with others.
8. Invasion of privacy: Failure to provide drapes Ior procedures requiring physical exposure
9. Release of medical information: Failure to get permission Irom clients without
permission when sharing medical inIormation with others
10. Assault and battery: PerIorming invasive procedures without client inIormed consent.
11. False imprisonment: Inappropriate use oI physical or chemical restraints
12. Defamation: Harming the reputation oI another person
13. Slander: Saying Ialse statements or misrepresentations that harm the reputation oI
another.
14. Libel: Any written or oral statement or other representation published without just
cause Ior the purpose oI exposing another to public contempt.

Nurses represent part oI the wider proIession and must uphold its standards oI practice while at
the same time remaining true to their own cultural values and belieIs. Above all, nurses have to
be able to demonstrate their accountability to their patients. This has been reIerred to as a
nurse`s primary accountability, and nurse should expect to be able to demonstrate clinical
decisions Ior their patients beneIit.
The proIessional regulator is concerned with monitoring whether standards oI practice are
upheld so that nurses satisIy their legally based duty oI care. When working as employees oI
a health service provider, nurses also have responsibilities to comply with local policies and
practices that constitute a visible expression oI the organizations Iunctions as a care provider.
References:
O Hazel B. M., Perry A. G., Potter and Perry`s Ioundations in nursing theory and
practice,(1995), Pp 234 35.
O Muller Journal oI Medical Sciences and Research, Vol.2 no.1, March 2011, Pp 39-46.
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