NRS 430 Topic 4 DQ 2 Outline the concept of professional accountability as it pertains to nursing
NRS 430 Topic 4 DQ 2
Outline the concept of professional accountability as it pertains to nursing. Provide examples of how a nurse demonstrates professional accountability in clinical expertise, the nursing process, and evidence-based practice.
REPLY TO DISCUSSION
Please share a situation (no names or identifying information) when a nurse did not follow standards of professional accountability? What impact did that have on the patient (if any).
I recently learned about nurse that didn’t follow the standards of professional accountability when it came to medication administration and the out come resulted in death of the patient and much pain and suffering for that family after the loss of their family member. The nurse should have followed her 5 rights to medication administration. Right patient, right medication, right dose, right route, right time. In this instance this nurse overrode the pyxis and pulled vecuronium when she was supposed to pull versed. This mistake could have been prevented if the nurse followed the standards of professional accountability when it comes to patient safety and medication administration safety checks.
Nurses are given great responsibility when it comes to caring for the lives of others, the accountability that the general public places in nurses is so great that nurses must always follow the standard of professional accountability in their day to day work in order to create a safe practice that becomes their second nature. Yes, the system that is in place could often times fail a nurse resulting in a sentinel event although, as a licensed nurse it is imperative to fall back on always using safe patient standards no matter where you work in order to protect patient safety and the RN license.
IV fluid was given to children in a pediatric ward. The nurse failed to check the concentration of IV fluid. Five children received IV fluid and unfortunately one child died. The assigned staff and team leader was immediately terminated from service. This sentinel event could have been prevented by checking the concentration of IV fluid before starting the IV therapy, especially in pediatrics. There was no scanning system in use at the time.
Billie, I knew of a nurse in surgery who did not meet the standards of professional accountability when she did not verify that implants needed for the surgery were actually in the surgery suite! She was in such a hurry to get on with her day that she did not follow policy by verifying necessary equipment/implants prior to bringing the patient back to surgery. Fortunately, we had backup implants that were able to be processed and no harm was inflicted on the patient. That would have been a totally different outcome if we didn’t have backups! The patient could have been under anesthesia for a much longer time than necessary or the surgery could have even been cancelled.
NRS 430 Topic 4 DQ 2 Outline the concept of professional accountability as it pertains to nursing
A very critically ill baby arrived from an outside hospital. Intubated with limited access. The MDs could not get an arterial line on the patient. A nurse was placing a PIV in the hand and after further inspection the nurse realized she placed the PIV in the artery. The MD at bedside said to not take it out that we need to use it. It was later that someone in the facility reported her to management for not removing the line even though the MD told her to keep it. Management when on to report her to the BON for practicing out side of her scope. She did not lose her license and was not charged by the BON, though she was disciplined through her employer. She said in hindsight she should of removed it based on principle and practice but she also knew the patient need it. The physician made the call but didn’t take responsibility in the end.
“Accountability is defined as the acceptance of responsibility for honest and ethical conduct” ( Darby Faubion, 2022). I think that professional accountability in nursing refers to being aware and accountable for our nursing practice, work environment, and patient safety. Taking the responsibility to commit to and work through the nursing process to better the safety and health of our patients. The nurse is held to high standards, and I think we should be proud to obtain and keep these standards by being honest, ethical and accountable in our everyday practice.
From clocking in on time, to procedures such as donning sterile gloves correctly, to being honest if a medication error occurs. We should be willing to accept professional responsibility and be forthcoming when we do not work within standard of care, or when an error occurs. Feeling a sense of pride in the nursing profession while being fully engaged in the work will demonstrate a sense of ownership. When taking the oath to be a nurse, that nurse is accepting and dedicating themselves to being personally professionally accountable; thus, committing to their career to advance, grow, improve and adapt in the workplace (Sherman, Cohn, 2019).
Nursing is an autonomous profession and maintaining accountability for oneself can not only allow the nurse to grow but the patient to grow through the nursing process and evidence-based practice. When setting up a sterile field for delivery, I need to be professionally accountable to perform sterile technique keeping the field sterile. I need to educate the patient and visitor, through evidence-based practice, not to touch or disturb the sterile field; keeping both myself and the patient accountable in continuing this standard of care. This is being responsible by following policy and procedures to work within scope of practice while meeting expectations in standards of care through evidence-based practice.
Durby Faubion. (2022). 10 Ways to Demonstrate Accountability in Nursing Practice. https://www.nursingprocess.org/accountability-in-nursing.html
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Rose O. Sherman, Tanya M. Cohn. (2019, February, 20). Promoting Professional Accountability and Ownership.
It sounds good to know that accountability spans through every aspect of nursing practice; from using the time clock to basic nursing procedures.
Accountability is a key aspect of professional nursing practice and is frequently referred to as the “hallmark of professionalism” (Oyetunde & Brown, 2012).
Accountability is evident in numerous facets of nursing practice, including:
Providing/ensuring safe, high-quality care
Delegation
Policy and procedures are being followed (and questioned).
Following the Nurse Practice Act’s rules when practicing.
Confidentiality protection
Questioning the provider’s orders and the standard of care
Care is aligned with the organization’s methods and ideology.
Clinical skills proficiency
Learning continues throughout one’s life.
Patient advocacy(Battié & Steelman, 2014)
Accountability is a broad notion that is intertwined with many others such as responsibility, answerability, autonomy and authority.
Battié, R., & Steelman, V. M. (2016). Accountability in nursing practice: Why it is important for patient safety. ACORN: The Journal of Perioperative Nursing in Australia, 29(4), 11–14. http://doi.org/10.1016/j.aorn.2014.08.008
National library of medicine(2012).Professional accountability: implications for primary healthcare nursing practice written by Oyetunde and Brown. Retrieved fromhttps://pubmed.ncbi.nlm.nih.gov/23169184/
Lumencandela(n.d). Transition to professional nursing practice. Retrieved from
https://courses.lumenlearning.com/suny-delhi-professionalnursing/chapter/accountability/
Accountability in my opinion is not only important for ensuring the proper protection of the resources but, it also ensure that there is quality care offered. Accountability as you have mentioned and I absolutely agree promotes ethical conducts since in sincerity people do not want to get associated with bad habits. I think it also improves one responsibility since it creates an environment where I have to be answerable to the actions that I undertake. To be honest, most of the errors in the healthcare have occurred due to lack of accountability and irresponsibility in the care settings (Drach‐Zahavy, Leonenko & Srulovici, 2018). In order to make activities to flow in the organization, there is need to create an environment where nurse are accountable and responsible for their action. I therefore, believe that creating a team to look into these aspects can be of significant help to the patients and also create a flawless work environment.
References
Drach‐Zahavy, A., Leonenko, M., & Srulovici, E. (2018). Towards a measure of accountability in nursing: A three‐stage validation study. Journal of Advanced Nursing, 74(10), 2450-2464.Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.13735
Carly, I see a direct correlation between accountability and moral standard. Especially when talking about professional accountability. This should be intrinsically motivated but it also has an economic motivator. Sherman & Cohn report that “the current value-based healthcare reimbursement system requires professional accountability for quality outcomes” (2019). Patient outcomes and reimbursement are directly affected when accountability is not taken.
Sherman, R.O., Cohn, T.M. (February 1, 2019). Promoting professional accountability and ownership: Nursing
leaders set the tone for a culture of professional responsibility. American Nurse Today, 14(2).
Professional accountability as it pertains to nursing has many facets. When I think about professional accountability one of the first things that comes to my mind is the moment that I took the Florence Nightingale Pledge (Modified Version Hippocratic Oath) the day that I graduated from nursing school. To remind everyone of that pledge I am going to post it at the bottom of this post because I find it very powerful and true to what the professional nurse today should be.
Professional accountability as a nurse means that all nurses should stay educated, informed and current on the most recent nursing science and health care practices. Laal defined lifelong learning as a means of learning that should take place at all stages of life cycle (from the cradle to the grave) and, in more recent versions that it should be life-wide; that is embedded in all life contexts from the school to the workplace, the home and the community (Laal 2011). In doing that they must continue to learn and grow as lifelong learners of the nursing practice. Nurses must remain trustworthy and act with good integrity at every moment in their practice.
Nurses must remember to keep good ethics and values at the for front of their practice and remain ethical in their day to day work. Nurses must act with nonmaleficents, confidentiality and continue to advocate for the patient in any and all situations. Nurses are empowered to be the patient’s voice or advocate, protecting ethical principles of autonomy, nonmaleficence, confidentiality, and other ethical principles (Green 2018). An example of how a nurse demonstrates professional accountability in clinical expertise is when a nurse has to turn their bed-ridden patients. This is something that is expected to be done by all nurses for the bed bound patient based off of evidence based practice.
In the nursing process, if this is implemented it will decrease the likelihood of pressure sores and upon evaluation the patient will remain free of bedsores. A nurse must remain trust worthy that they truly are turning their patients to off set the weight to different areas to protect against pressure sores as this is something that can harm the patient over time and is hard to pinpoint on directly one person therefore all nurses must remain accountable to turning patients timely and properly. Another example of professional accountability in the clinical practice of nursing is when a nurse is inserting a foley catheter. The nurse must always remember how important the cleaning process prior to foley catheter insertion is as well as how incredibly important it is to maintain sterility throughout the foley catheter insertion process.
This would be to act with nonmaleficents because the nurse is acting to “do no harm” to the patient. When looking at this example with an evidence based practice lense; if the nurse was careless in the urethra cleaning process and carless with remaining sterile they could cause this patient a urinary tract infection that they didn’t already have prior to the catheter placement by the RN. Overall the nurse must use the nursing process and refer to evidence based practice routinely in their practice to remain professionally accountable in their work.
Florence Nightingale Nursing Pledge (modified version Hippocratic Oath)
“With full knowledge of the responsibilities I am undertaking, I pledge to care for my patients with all of the knowledge, skills, and understanding that I possess, without regard to race, color, creed, politics, or social status.
I will spare no effort to conserve meaningful life, to alleviate suffering, and to promote health.
I will refrain from any action which might be harmful to the quality of life or health of those I care for.
I will respect, at all times, the dignity and religious beliefs of the patients under my care, and hold in professional confidence all personal information entrusted to me.
I will endeavor to keep my professional knowledge and skills at the highest level and give my support and cooperation to all members of the health team.
With full awareness of my qualifications and limitations, I will do my utmost to maximize the potential of the nursing profession and to uphold and advance its standards.”
–Florence Nightingale 1983 (Van 2012)
Green, S. (2018). Advancing Professional Standards. CCC web books by AWS & CDD. https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/4
Laal, M. (2011). Lifelong learning: What does it mean? Procedia – Social and Behavioral Sciences 28, 470-474.
Van Ltd, F. (2012). Florence Nightingale’s pledge overview: Healthcare paper examples. Nursingbird.com. Retrieved April 29, 2022, from https://nursingbird.com/florence-nightingales-pledge-overview/
You provided great examples that describe nursing accountability. If a foley catheter becomes unsterile and the nurse proceeds to insert it into the urethra, a urinary tract infection is a huge risk. Typically, nurses insert foleys by themselves so no one is there to hold them accountable except for themselves. Being a trustworthy and ethical nurse is basically the difference causing good or harm to patients. Professional development and accountability evolve when nurses provide care within their scope and practice ethical boundaries (Green, S., 2018).
Green, S. (2018). Advancing Professional Standards. CCC web books by AWS & CDD. https://lc.gcumedia.com/nrs430v/dynamics-in-nursing-art-and-science-of-professional-practice/v1.1/#/chapter/4
Nursing is believed to be the most trusted profession and therefore it is important to keep up this trust in our daily health care. Nurses are accountable in their practice, work environment and patient safety. Whatever position a nurse holds, whether BSN or MSN, she is fully responsible for any changes or mistakes she may come across while performing patient care. One should be competent enough to practice high level skills and use nursing interventions by implementing evidence based practice (Davis, 2017).
Nurses must provide maximum comfort, respect cultural differences, comply to patient’s wishes and be honest with patients. Always try to practice thorough nursing process and evidence based practice to avoid errors. For example, follow the five rules while administer medicines to patients: right patient, right medicine, right dose, right route and right time.
Nurses must be accountable for their actions. These include recording patient care notes, medication and equipment readings. Evidence based practice is an excellent way to demonstrate accountability. When a patient is with 2 point soft restraints, they need to be checked every 2 hours for range of motion, toileting and offer of fluids. The rationale behind this care plan is to avoid complications.
It is also important to standardize reporting to ensure accountability and to allow easier comparison of reports between patients (Walsh, 2018). For medical–surgical units, incorporating bedside reporting can increase nurse satisfaction, accountability, and positive outcomes.
Topic 4 DQ 2
Accountability is the foundation of professional nursing practice and is often called the “hallmark of Professionalism. The concept of accountability can be described in different ways yet all essential for nurses. The American Nurses Association (ANA) defines accountability in nursing profession as requiring nurses to be answerable for both their actions and acts as defined by the ANA’s code of ethics (Nathalie & Karakashian, 2018). Ethical conduct for nurses implore them to adhere to the principles of beneficence, respect for human dignity, fidelity, justice, and patient autonomy. Accountability encompasses all aspects of nursing that impact patient care. These include daily living, promotion of health, teaching of patients, counseling and collaboration with other providers and inter-professional teams.
When nurses understand and appreciate the significance of professional accountability, they conduct all their activities on a manner that respects the practice and deliver safe, quality, and effective patient care. Nurses should strive for accountability as it helps to foster trusting relationships and interactions between them and patients leading to better patient outcomes. Secondly, nurses who hold themselves accountable succeed in their practice.
Employers value nurses with high levels of integrity that is a critical aspect of accountability in nursing practice. A culture of accountability reduces wastage of valuable healthcare resources and ensures that nurses promote a positive reputation for their facilities and the nursing profession in general (Faubion, 2022). The implication is accountability is a core aspect of the nursing profession and helps ensure that nurses offer their best and lead to quality care outcomes.
Nurses demonstrate professional accountability in clinical practice when they make decisions to promote quality care access by allowing patients have healthcare resources irrespective of the socioeconomic status. Secondly, nurses demonstrate accountability in the nursing process when they develop procedures that align with their healthcare organization’s policies (Rubio-Navarro et al., 2020). They also demonstrate accountability when the accept corrections for errors in medication administration and other aspects of care process. Finally, nurses demonstrate accountability in evidence-based practice (EBP) when they allow patient preferences to form part of the care interventions in their practice.
References
Faubion, D. (2022). 10 Ways to Demonstrate Accountability in Nursing Practice.
https://www.nursingprocess.org/accountability-in-nursing.html
Nathalie, S. & Karakashian, A. L. (2018). Accountability in Nursing Practice. CINAHL.
https://www.ebscohost.com/assets-sample-content/NRCP_EBCS_Accountability-in-NursingPractice.pdf
Rubio-Navarro, A., García-Capilla, D. J., Torralba-Madrid, M. J., & Rutty, J. (2020). Decision-
making in an emergency department: A nursing accountability model. Nursing ethics, 27(2), 567-586. DOI: 10.1177/0969733019851542.
Nursing professional accountability in clinical expertise is demonstrated by practicing within the scope of practice defined by the state licensing board, to mximize patient safety and health outcomes (Green, 2022). Other examples are as follows: Staying up-to-date with professional nursing standards, being aware of changes, joining a nursing association, and taking continuing education courses. An example of professional accountability in nursing is implementing critical thinking to assess the patient’s status. The patient’s care decisions are based on the evidence from assessing their status, which assists in the planning of care and implementation of their care. Evaluation is demonstrated by reassessing implemented patient care to assure the best positive outcome, including making any necessary updated changes to the patient care plan to adapt to the most current assessment. Nursing accountability in nursing evidence-based practice (EBP) is demonstrated by the nurse being accountable for expanding their skill set and implementing EBP findings to guide their nursing interventions (Green, 2022). Having focused interaction during all training sessions allows for clarification of key points that can impact client safety and outcomes. Monitoring and offering help to new nurses and peers who are learning new tasks to increase confidence and validate the practice to comply with organizational standards is another example of professional accountability in nursing EBP.
Improving spiritual well-being may not cure illness or injury but may help the patient feel better (Linton and Koonmen, 2020). Spirituality is a common factor in all religions, and it gives a sense of peace, purpose, honesty, patience, faith, hope, and forgiveness, helping to deal with stress and depression. Incorporating self-care that includes mental health and spiritual well-being for a nurse and their patients is demonstrated by getting good quality sleep, eating healthy foods and nourishing the body, following treatment plans for current illness or injury, exercising routines such as walking, listening to music, and building a support system. Spirituality is personal and unique to each person. It is a globally acknowledged concept involving belief, faith, and obedience to an all-powerful and higher power, usually known as God. Nursing interventions to provide spiritual support are offering patients opportunities to practice their religion and arrange visits with their spiritual advisor. The nurse can, also, encourage the patient to engage in spiritual or mind-body practice such as yoga or meditation which promotes spiritual and mental healing. According to the American Nurses Association (ANA) Code of Ethics for Nurses, nurses must adopt self-care in addition to their duty to provide care to patients (Linton and Koonmen, 2020).
The Bible does not directly address self-care but offers guidance for understanding the importance of physical and mental health. God values and commands rest (King James Bible, 2022, Ex. 34:21, Heb. 4:3-4) and care for our physical bodies (King James Bible, 2022, Ex. 22:26-27). Caring for our bodies and minds should not come from following our comfort and pleasure but from an act of worship to God (King James Bible, 2022, 1 Cor. 6:19-20). When we exercise and eat healthy, we show appreciation for the gifts of mind and body God has given us (King James Bible, 2022, Eph. 2:10). Recognizing that we cannot live self-sufficiently, we must intentionally care for our physical, mental, and spiritual health, understanding physical limitations.
References
Green, S. Z. (2022). Advancing professional standards. In Grand Canyon University (Eds.). Dynamics in nursing: Art and science of professional practice (2nd ed.). Grand Canyon University.
King James Bible (2022). Microsoft Technology Ltd. Online. (Original work published 1611). https://thekingsbible.com
Linton, M. and Koonmen, J. (2020, December). Self-care is an ethical obligation for nurses. Nursing Ethics, 227(8), 1694-1702.