thACCOUNTABILITY OF THE ADVANCED NURSE PRACTITIONER.
Over the last few years there has been a precipitous change in the delivery of healthcare within the National Health Service (NHS), which inevitably brought about modification of the nursing role and an adaptation in the professional nursing competencies. It was recognised that vital health improvements that the NHS required could not be made without the advancement of nursing skills and roles (Walsh & Crumbie 2003). In the early 1980s the nurse practitioner’s role was first introduced into general practice, the role has now further developed and changed. Advanced Nurse Practitioners (ANPs) are now working in diverse and varied roles within the National Health Service (Crumbie 2008). By accepting new areas of responsibility and accountability requires more from the advanced practitioner than simply a change of uniform and title. There is a need to safeguard the quality in the development and implementation of these roles and continuous evaluation of their success (Whiteing 2008). Since the 1980s there has been considerable amount written in nursing literature regarding the measurement and maintenance of quality nursing care and with the introduction of Clinical Governance (DOH 1998) and the NHS Plan (DOH 2000) the UK government has made it a quality high on the political agenda. The role of advanced nurse practitioner has developed over recent years to provide a high quality and cost effective care, but at times has caused confusion regarding title, professional boundaries and educational obligations which brings about the question of clinical accountability and the advanced nurse practitioner (Griffin & Mebly 2005). The Oxford Dictionary (1995) defines the term ‘accountable’ as being ‘responsible; required to account for one’s conduct, and is an integral part of professional practice (NMC 2006b). Accountability can be perceived as being an elevated activity to that of responsibility, as it requires not only designation of who is responsible of an action but also need for the individual who carries out the task is able to give an account, reason and or an explanation for their action. As the enhancement of advanced practice progresses, the ANPs could find themselves in a situation where they are solely responsible for a patient caseload without alternative medical input, although these situations are innovative and unusual Pennel 2008 stresses that these situations exemplifies the level of accountability that could be put upon the ANP, by performing a role of a medical consultant by maintaining absolute accountability for the patient’s clinical care. Clinical governance requires the ANP to be comprehensible in their judgement and decision-making, yet in some situations this could prove to be complicated for the ANP, since they may be fearful of being held responsible for the outcome of their decision. (Currie and Loftus-Hills 2002), however Caulfield (2005) views accountability with a more positive outlook and states: ‘A wider view of accountability is that 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. This definition reviews accountability as positive element in the development and validation of competent practice. Cornock (2011) also comments that accountability can be perceived as being essential for monitoring when things are going right and therefore necessary to distribute that information for the benefit and to enhance the knowledge of others. Nuttall (1993) verifies that there is a link with accountability and autonomy, and argues that without autonomy the practitioner is unable to be accountable if they are unable to make a decision about their choice of action freely. The Oxford Dictionary (1995) suggests that autonomy gives independence and freedom from control. In order for the ANP to be autonomous they need to have the ownership of all...
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