Accountability in Nursing – Study Notes

The Concept of Accountability

• Accountability: being answerable for the outcomes of a task or assignment.

• Nurses are accountable for their own actions and may also be accountable for the actions of subordinates or trainees.

• Responsibility: a specific obligation associated with the performance of duties of a particular role.

• Key relationship: accountability guides performance and ultimately patient outcomes.

• Accountability requires clear definitions of accepted standards of care; this clarity influences how errors are handled and how incident reporting occurs.

• Acknowledging accountability for both successes and errors helps maintain a positive professional culture; honoring successes is as important as examining and correcting errors.

• QSEN (Quality and Safety Education for Nurses): an initiative to improve quality and safety in nursing education and practice.

Standards and Foundations of Accountability

• Standards of practice / standards of care: professional standards or guidelines that determine what a nurse should or should not do.

• Established by organizations:

  • The Joint Commission

  • American Nurses Association (ANA)

  • National League for Nursing (NLN)

• Describe responsibilities for which nurses are accountable.

• Accountability for successes and errors supports a positive professional culture; corrective actions should occur alongside recognition of positive performance.

• Responsibility requires alignment with accepted standards of care and appropriate incident reporting when errors occur.

• The concept of accountability is linked to the broader framework of quality and safety in healthcare.

• QSEN emphasizes preparation of nurses to contribute to safer, higher-quality care.

National Guidance on Accountability

• Guidance comes from national organizations and includes:

  • Benchmarks of patient care

  • Standards of nursing practice

  • Codes of ethics

• Bodies involved:

  • The Joint Commission (healthcare organization focus)

  • American Nurses Association (ANA) Standards of Nursing Practice

  • Nurse Practice Acts (state-level regulation)

• Relationship to the nursing process: accountability follows the nursing process and Standards of Professional Performance.

• Nurse Practice Acts: each state regulates nursing practice and defines scope of practice.

• Codes of Ethics: emphasize respect for the inherent worth and dignity of all people; nurses must do what is right even at personal cost; ethical codes evolve as society’s needs and values change.

Components of Accountability (1 of 3)

• Aspects that promote accountability within the nursing profession:

  • Successful completion of a program that provides the body of knowledge required for performance of the role.

  • A focus toward service (community or organizational).

  • Allegiance to a code of ethics.

  • Autonomy of the role.

  • Membership in a professional organization.

Components of Accountability (2 of 3)

• Education:

  • Earned hospital diploma or associate’s, bachelor’s, master’s, or doctorate degree in nursing.

  • Subsequently passed the NCLEX examination.

• Body of knowledge:

  • Well-defined, expanding body of knowledge and expertise.

  • Knowledge base as a product of various conceptual frameworks.

  • Evidence-based practice based on current research.

• Service orientation:

  • Differentiates nursing from occupations pursued primarily for profit.

  • Emphasizes service to others as a matter of tradition and basis for accountability.

• Guided by rules, policies, and codes of ethics.

Components of Accountability (3 of 3)

• Autonomy: the profession can regulate itself, setting standards of practice for its members; professional status depends on the ability to function autonomously in formulating nursing policy and in exercising control over its practice.

• Legal authority to define scope of practice.

• Independence at work, responsibility, and accountability for one’s actions.

• Professional organization: organizational structures govern the nursing profession.

• Social, political, and economic arrangements to promote professional affairs.

Concepts Related to Accountability

• Comfort

• Evidence-Based Practice

• Health, Wellness, Illness, and Injury

• Infection

• Safety

• Teaching and Learning

• Trauma

Socialization to Nursing (1 of 2)

• Entering a profession is similar to entering a new society: socialization is the process of learning to become a member of a group and to learn social rules.

• Professional socialization is more complex and requires understanding of cultures that promote high performance and safe practice.

• A high-performance culture is dynamic and ever-changing.

• Components of a dynamic learning culture:

  • Transparency

  • Avoidance of blame

  • Use of best-practice guidelines

  • Staff input

Socialization to Nursing (2 of 2)

• Successful socialization requires:

  • Clear expectations, followed-through practice, and rewards/consequences

  • Interaction with fellow students as a powerful driver for professional socialization

  • Clear expectations for preparation and performance

  • Understanding mistakes and consequences through reflective practice

  • Focus on student strengths

• The National Student Nurses Association code addresses students’ responsibilities in academic environments and in society at large

Factors Influencing Nursing Practice and Accountability (1 of 7) Economics

• Economics influence: health care demand and the work environment.

• Changes in public and private health insurance programs affect demand for nursing care.

• Shift from inpatient to outpatient care; acute care remains the primary nursing practice area.

• More nurses are employed in community-based health settings.

• Specialty areas have developed to meet patient needs.

• Various models of integrative care to better control rising health care costs.

Factors Influencing Nursing Practice and Accountability (2 of 7) Consumer Demand

• Consumers of healthcare drive markets:

  • Consumer needs drive market/service delivery.

  • Drive for integrative health services is motivated by cost and consolidation concerns, plus interest in complementary health approaches.

• Patients today are more knowledgeable and vocal about their needs, partly due to internet information.

Factors Influencing Nursing Practice and Accountability (3 of 7) Science and Technology

• Advances affect nursing practice, competence, and accountability.

• Genetic testing available outside traditional health care systems.

• Nurses must expand knowledge base and technical skills.

• Practitioners must learn to use technology (e.g., sophisticated computerized equipment).

• Requires use of online Electronic Health Record (EHR) systems and data-sharing capabilities.

• Requires systems for safe sharing, storage, protection, ownership, and control of data in ethical and responsible manners.

Factors Influencing Nursing Practice and Accountability (4 of 7) Information Availability and Telecommunications

• Increased use of the internet affects healthcare.

• Patients become better informed about health concerns.

• Nurses must be knowledgeable about accurate and reliable websites.

• Forms of telecommunication: videoconferencing, virtual visits, telehealth, telenursing, and mHealth (mobile health).

• Telehealth and related technologies are increasing in popularity.

• Care is provided through mobile devices.

• Considerations: HIPAA privacy and security concerns.

Factors Influencing Nursing Practice and Accountability (5 of 7) Legislation

• Legislation affecting health care and consumers:

  • Patient Self-Determination Act (PSDA): all competent adults must be informed in writing at admission about rights to accept or refuse medical care and to use advance directives.

• In many organizations, nurses are responsible for ensuring compliance with this law and related regulatory requirements.

Factors Influencing Nursing Practice and Accountability (6 of 7) Nursing Workforce Capacity

• RNs are the largest group of healthcare providers, but the workforce is not projected to meet demand.

• Shortages are influenced by several factors:

  • Shortage of nursing faculty

  • Current nurses reaching retirement

  • Changing demographics and aging population

  • High turnover rates

• Visual/formatting notes omitted; content focuses on structural workforce challenges

Factors Influencing Nursing Practice and Accountability (7 of 7) Addressing the Shortage

• Collaboration among healthcare systems, policymakers, nursing educators, and professional organizations is needed to address shortages.

• Recommendations to address shortages include:

  • Provide means for nursing students to enter and progress rapidly through educational programs

  • Recruit younger people earlier in education (middle school, high school)

  • Provide more scheduling flexibility

  • Offer better rewards for experienced nurses who serve as mentors

  • Improve staffing levels and salaries

  • Increase funding for nursing education

Summary implications for practice and ethics

• Accountability integrates standards, ethics, and professional responsibilities across education, autonomy, and organizational governance.

• Effective socialization and workforce planning support safe, high-quality patient care.

• Legislation and ethics codes guide practice while adapting to evolving societal values and technological advances.

• Continuous emphasis on evidence-based practice and QSEN principles anchors accountability in measurable quality and safety outcomes.