PROMOTING NURSING STAFF PROFESSIONAL ACCOUNTABILITY Christine Smith Florida

PROMOTING NURSING STAFF PROFESSIONAL ACCOUNTABILITY Christine Smith Florida Atlantic University

WHAT IS ACCOUNTABILITY? v The act of being accountable means taking ownership for one’s actions and the consequences, good or bad that may be associated with those actions. v The words accountability and responsibility are similar and often used interchangeably, but accountability is considered to be internalized. v “Accountability is the result of a person’s commitment to advancing, improving, growing, adapting, and enhancing his or her own life experience” (Porter-O’Grady & Malloch, 2011, p. 393).

HOW IS ACCOUNTABILITY APPLIED TO NURSING? v According to the American Nursing Association (2015) under Provision 4 “the nurse has authority, accountability, and responsibility for nursing practice” and they are accountable for their decisions, judgments, and actions (p. 15). v Nurses are responsible for the quality of their practice and must adhere to state regulations and ANA’s Code of Ethics. v “To be accountable, nurses follow a code of ethical conduct that includes moral principles such as fidelity, loyalty, beneficence, and respect for the dignity, worth, and selfdetermination of patients” (ANA, 2015, p. 15). v Advancements in technology have played a large role in clinical practice, if technology fails nurses are still held accountable for retrieving patient data. For example if a vitals sign machine malfunctions, the nurse is still accountable to retrieve vital signs manually such as a heart rate or blood pressure. Likewise, if the computer system fails they are responsible for handwriting a head-to-toe assessment in a narrative note as a part of the patient’s medical record.

EXAMPLES OF NURSING STAFF EXHIBITING ACCOUNTABILITY A nurse reporting a medication error. Nurses performing duties only under their scope of practice. Continuing education and renewing certifications. Delegating a task to a unlicensed assistive personnel such as a CNA.

EXAMPLES OF NURSING STAFF EXHIBITING ACCOUNTABILITY Performing a head to toe assessment of patients. Scanning all medications prior to administration. Reporting abnormal lab or imaging results to a physician. Supervising and assessing the work and competency of UAP’s.

ACCOUNTABILITY IN NURSING LEADERSHIP v Nurse leaders need to be accountable for defining expected outcomes for all actions and activities and establishing collective performance measures for evaluating the work performed my teams (Porter-O’Grady & Malloch, 2011, p. 393). v Nurse managers are professionally accountable for maintaining prenegotiated staffing budgets (Marquis & Huston, 2014, p. 405). v Nurse leaders have a personal accountability to engage with staff and they should provide open communication, guidance, and encouragement. v An accountable nurse leader is well trained for their role, they ensure that staff is properly trained and assessed for competency in their position, and they must evaluate that all staff performs their duties with respect to the organization’s policies and state regulations.

ACCOUNTABILITY IN NURSING LEADERSHIP v “The nurse leader is both responsible for the direction of staff and accountable for the results” (Vestal, 2010, p. 8). v Although the nursing staff is accountable for their individual performance, the nurse leader is still ultimately responsible for validating that they are performing their job responsibilities accordingly. v “The unit leader then is accountable for the care delivered and must be able to ensure that all standards are being met and that neither untoward events have occurred nor potential negative events have been avoided” (Vestal, 2010, p. 8). v For instance, a charge nurse on a 40 bed unit in the hospital is accountable for ensuring the nursing staff completed their duties during the shift. Although not providing direct care, by reviewing the medical record they can ensure that the nurse completed any new physician orders, collected any pending specimens, and that the nursing assistant assisted with ADL’s and performed routine vitals.

HOW CAN NURSING ACCOUNTABILITY BE PROMOTED? Provide direction about how work should be accomplished. Be clear about professional role responsibilities and organizational goals. Develop clear standards and metrics against which professional performance is measured. Hold professionals accountable for their behavior. Build a culture of accountability. Sherman, R. (2013, May 30). 5 Ways to Promote Professional Accountability in Nursing[Web log post]. Retrieved from http: //www. emergingrnleader. com/professionalaccountability-in-nursing/

HOW CAN NURSING ACCOUNTABILITY BE PROMOTED? v. As a nurse if we delegate a task to a unlicensed assistive personnel (UAP), we cannot simply point the finger if the task is not carried out properly, because it is still our responsibility to supervise the UAP. v“Nurse administrators are advised to address individual staff nurses' personal esteem and professional worth, find ways to reward and recognize individual staff contributions, and develop multi-option retention strategies that encompass expectations of nurses of all ages”. (Kupperschmidt, 2004). v. When nurse leaders set boundaries, provide clear expectations for the responsibility of nursing personnel, and hold staff accountable for their behavior, it is easier to create a cohesive work environment with a culture of accountability.

REFERENCES v. American Nurses Association. (2015). Code of ethics for nurses: With interpretive statements. Silver Springs, MD: Nursebooks. org. v. Kupperschmidt, B. R. (2004). Making a Case for Shared Accountability. JONA: The Journal of Nursing Administration, 34(3), 114 -116. doi: 10. 1097/00005110 -200403000 -00002 v. Marquis, B. L. , & Huston, C. J. (2014). Leadership roles and management function in nursing: Theory and application (8 th ed. ). Hagerstown, MD: Lippincott Williams & Wilkins. v. Porter-O’Grady, T. & Malloch, K. (2011). Quantum leadership: Advancing innovation, transforming health care (3 rd ed. ). Sudbury, MA: Jones and Bartlett Learning. v. Sherman, R. (2013, May 30). 5 Ways to Promote Professional Accountability in Nursing [Web log post]. Retrieved from http: //www. emergingrnleader. com/professional-accountability-in-nursing/ v. Vestal, K. (2010). Accountability: Where to Start? Nurse Leader, 8(3), 8 -11. doi: 10. 1016/j. mnl. 2010. 03. 011