The level of responsibility and accountabilitydepends on professional levels. The Charge Nurse has more responsibility then the staff nurse, the RN has more responsibility then the LPN, and therefore their levels of professional judgment and practice are different. Their levels of professional accountability are not different.
Professional nursing is based on altruism, integrity, accountability and social justice. Judgments and practice that are based with those ethical values will always be in the best interest of the patient, no matter what the professional level.
The definition of altruism: individuals have the ethical obligation to serve others without self-interest. The nurse who comes from an altruistic place will make decisions that are in the best interest of the patient. A patient advocate.
Accountable to whom?
You are accountable to:
- Your patients, through a duty of care, underpinned by a common-law duty to promote safety and efficiency, and legal responsibility through civil law; - Your employer, as defined by your contract of employment and job description; - Your profession, as stated in the relevant codes of conduct; - The public (UKCC, 1992; Dimond, 1995).
Accountable to your employer
UK law stipulates that all workers must be issued with a written contract of employment within 13 weeks of starting a job. Your contract could include: - What was agreed at your interview;
- Any document you have signed;
- Any implied terms of your employment.
Implied terms are those that may not have been discussed but which the court could assume to exist unless there is evidence to the contrary. For example, it is an implied term of a contract of employment that an employee will obey the reasonable instructions of the employer and will use all care and skill. If you do something that contravenes the terms of your contract, for example by being grossly negligent, your employer can take disciplinary action against you for breach of contract. Accountable to the profession
The UKCC code of conduct (UKCC, 1992) sets out the position on your accountability to the profession. It forms the basis from which to challenge unacceptable standards of care and makes it clear that responsibility for your actions rests with you as an individual nurse. No one person, rule, code of practice or guideline can tell you what to do in every situation. But the UKCC code of conduct's clauses 4 and 5 (UKCC, 1992) do help by setting out important principles such as: - Maintaining and improving professional knowledge and competence; - Acknowledging limitations in knowledge and competence;
- Declining any duty or responsibility unless you are able to perform it in a safe and skilled manner. To be accountable to the nursing profession, you need to be accountable to yourself too. Keeping a reflective diary is one way of accounting to yourself for your thoughts and actions and questioning and improving the quality of the care you provide, perhaps through discussion with colleagues or with your manager or clinical supervisor. Reflective practice was considered in part 2 of this series (Nursing Times, March 1, p45-48). Accountability and autonomy
The UKCC report Project 2000: A new preparation for practice (UKCC, 1986) explained that autonomous practitioners were to exercise increasing clinical discretion and accept greater professional responsibility by making their own decisions. They were also required to carry out more direct care, research and management, and were expected to contribute to policy-making and strategy development. Many nurses cite autonomous practice as a professional aspiration. That is, you and your professional colleagues, not just your employer, make the decisions about your practice. You have your own caseload,...