Leadership and Management (3)

Role Accountability

Definition: Accountability in nursing refers to being answerable for one’s actions and their impact on others.
Core Accountabilities as per ANA Nursing Administration Scope and Standards of Practice (2016):
- Role Qualifications and Competence: Adhering to educational and skill proficiency as a foundational requirement.
- Health Advocacy: Supporting patient self-determination and advocating for the rights of all healthcare participants, including patients and providers.
- Quality, Safety, and Risk Management: Ensuring a safe environment that fulfills ethical obligations and protects the organization from legal liability.
- Clinical Care Delivery: Knowledge of healthcare settings to model effective care practices.
- Healthy Work Environment: Creating an optimal work setting where staff feel respected and safe.
- Resource Management Accountability: Strategic management of financial and human resources.
- Legal and Regulatory Compliance: Maintaining compliance with various local, state, and federal requirements.
- Networking and Collaboration: Building alliances and collaborating across a broad spectrum of influence.

Licensed Practical Nurses (LPN): Education can be in the form of certificates, diplomas, or associate degrees.
Registered Nurses (RN): Generally earn degrees through associate, diploma, or baccalaureate programs.
- Importance of Baccalaureate Education: Essential due to the increasing complexity of nursing practice.
- Associate Degree Programs: Vital for increasing accessibility for students with location or scheduling constraints.
- Institute of Medicine Report (2010): Emphasizes a seamless progression in nursing education.
Current Trends:
- Increase in RN-BSN and distance learning programs.
- 2010 IOM recommendation: At least 80% of nurses should have a BSN by 2020.
- The 2016 IOM report acknowledged this goal as ambitious, citing an increase from 49% to 51% of RNs holding a BSN or higher.

Nurse Licensure Compact (NLC): Allows for multistate practice and streamlines licensure across states.
Broader Regulatory Environment:
- Each state defines its own nursing education, licensure, and practice laws.
- Nurses need to understand the regulations for the state in which they practice.
State Licensing Authority: Boards can issue, suspend, or revoke nursing licenses based on various criteria, including legal violations and professional negligence.

Ongoing Learning: The evolution of nursing through continuous professional development is emphasized, with the Enhanced Nurse Licensure Compact (eNLC) aiming for consistent licensing standards.
Recognition Programs:
- Magnet Recognition: Awarded by the American Nurses Credentialing Center to facilities demonstrating high-quality care and exemplary nursing practices.
- Pathway to Excellence: Facilities creating a supportive work environment under specific standards receive recognition.

Understanding Legal Responsibilities:
- Knowledge of pertinent laws aids in protecting client rights and minimizing legal risks.
Criminal vs. Civil Laws:
- Criminal law involves government relations; civil law protects individual rights.
- Torts in nursing care can be categorized as unintentional (negligence, malpractice) or intentional (assault, battery).

Importance of Advocacy:
- Professional advocacy includes active participation in the political process and addressing health legislation impacts.
Collective Action: Nurses must unite to have a greater influence in shaping healthcare policies.
- Engaging in lobbying, education, and participatory mentorship in health policies allows nurses to shape the healthcare system.

Nature of Ethical Practice:
- Ethical principles such as autonomy, beneficence, fidelity, justice, and nonmaleficence guide nursing practice.
- Conflict resolutions often require balancing ethical dilemmas against scientific data.
Ethical Decision-Making Steps:
1. Identify the ethical dilemma.
2. Analyze possible options for resolution.
3. Select and justify the option aligning with ethical principles.
4. Evaluate outcomes post-implementation.

Reporting Obligations: Nurses have a duty to report suspected substance misuse by colleagues to ensure patient safety.
Board of Nursing Regulations: State boards may require treatment programs for nurses found with substance issues.

Situations Necessitating Reporting: Nurses are legally obliged to report suspected abuse, communicable diseases, and mistreatment of vulnerable individuals.

Standards of Care: Derived from established guidelines, these dictate the level of care expected from nursing professionals.
Preventing Malpractice: Adherence to professional standards, effective communication, and comprehensive documentation are vital in safeguarding against legal issues.