Understanding Accountability (ENs Part 3)

Accountability

All nurses are answerable for her/his decisions, actions and behaviours and for the consequences of those decisions, actions and behaviours. 

All nurses are accountable for all decisions, actions and delegation decisions, the accountability for which cannot be delegated.  Professional accountability requires that the nurse considers and weighs up the interests of the client in complex, changing situations, using professional knowledge, skills and judgement to make a decision enabling them to account for their actions.

All nurses are answerable for her/his own decisions, actions and behaviours and for the consequences of these decisions, actions and behaviours. This accountability is not delegable transferable/rescindable. 

All nurses are accountable to the;

·       client

·       supervisor/manager

·       employer

·       regulator

·       profession

·       public

In meeting their accountability a nurse must be prepared to answer to others, such as health care consumers, regulatory authority, employers/public for their decisions, actions, behaviours and the responsibilities that are inherent in their roles which cannot be delegated

The registered nurse who delegates is accountable, not only for their delegation decision but also for monitoring the standard of performance of the activity by the other person, and for evaluating the outcomes of the delegation

The Registered Nurse is accountable for:

·       autonomous decision-making within their own scope of practice

·       their own decisions and actions (including the decision to delegate)

·       the consequences and outcomes of their decisions and actions

·       supervision of the enrolled nurse

·       delegation to the enrolled nurse

The Enrolled Nurse is accountable for:

·       practicing under the supervision of a registered nurse within their own scope of    practice

·       their own decisions and actions (including the decision to accept delegation)

·       the consequences of their decisions and actions

This is a pro-active and professional relationship with equal accountability for the maintenance of the professional relationship and for determining appropriate supervision and delegation.

Enrolled nurses (however called) practice under the supervision (direct or indirect) of a registered nurse. The enrolled nurse retains responsibility for their actions and remains accountable to the registered nurse for all delegated decisions and functions. However they are equally responsible for making clear decisions within their scope of practice and are accountable for these decisions and their practice.

All nurses accepting delegation must have an understanding of their professional competence and not accept delegated functions that are beyond their preparation and competence.

Therefore    

No nurse (registered or enrolled) may be directed, pressured or compelled by an employer, or any other person in a position of authority 

·       to delegate (or accept delegated) care that the nurse determines in their professional judgement is inappropriate

·       to engage in any practice that falls short of, or is in breach of any professional standard and/or code of conduct or practice