Accountability is integral to professional practice.

Nurses make judgements in a wide

variety of circumstances. Nurses use their professional knowledge, judgement and
skills to make decision based on evidence for best practice and the person’s best
interests and they must be able to justify the decisions they make

 RN is accountable for the care and/or actions which he or she provides.

 �  An RN is accountable for the decision to delegate care to another health
professional such as an EN. However, the delegatee is responsible for accepting the
delegation, and for the actions they may take as a result of that delegation. (See Fact
Sheet 3 – The Enrolled Nurse).
 �  RNs are accountable for making professional judgements about when an activity
is beyond their own capacity or scope of practice and for initiating consultation with,
or referral to, other members of the health care team

3 spheres pf accountability – professional, ethical, lawful and employment/contractual

Professionally
Whilst delegating I will be accountable to the NMC in terms of standards of practice and
patient care. The NMC Code (2008b) states that as a professional, I am personally
accountable for actions and omissions in practice and I must always be able to justify my
decisions and I must always act lawfully, whether those laws relate to my professional
practice or personal life. Advice by the NMC (2008c) on delegation states that I must
establish that anyone I delegate to is able to carry out my instructions, and I must confirm that
the outcome of the delegated task meets the required standards and I must make sure that
everyone I am responsible for is supervised and supported.

Ethically
I must be aware of my own values. I am accountable if I do not stand up for high standards of
care in relation to religion, education and peoples values (Jasper 2006). Lawfully

I have a legal responsibility to have determined the knowledge and skill level required to
perform the delegated task such as taking a patients temperature. I am accountable to both the
criminal and civil courts to ensure my activities conform to the legal requirements.

Employment/Contractual
In the NHS, the Knowledge and Skills Framework (KSF) represents the staff development
element of Agenda for Change (AFC) (Department of Health 2004). It is concerned with
identifying the relevant competency levels required for job roles with the NHS. This can
provide me with evidence about the skills and knowledge of the health care assistant role. I
must ensure the decision made to delegate was appropriate following guidelines and
protocols of the workplace. I will be accountable for the decision to delegate and for its
implementation on an organisational and professional level. I have the authority to delegate
this task to distribute workload to achieve organisational effectiveness. It is the employer’s
responsibility to ensure that the health care assistant has sufficient education and training to
competently undertake aspects of care which I am expected to delegate to them (NMC
2008c). 

Nurses and midwives working as members of a multi-disciplinary health care team may be
required to delegate, supervise and educate students and regulated and unregulated health care
workers (HCW) in providing safe patient care.
Delegation takes place where the nurse or midwife (the delegator) who has the authority for the
delivery of healthcare, transfers to another person the responsibility of a particular role or activity
that is normally within the scope of practice of the delegator. Effective delegation is a skill that
“improves with education and practice”(Mueller and Vogelsmeier 2013:24). The delegator must
be available to provide the necessary and appropriate level of supervision required by the
delegate.
Nurses and midwives are professionally responsible and accountable for their practice,
attitudes and actions, including inactions and omissions. The nurse or midwife who is
delegating (the delegator) is accountable for the decision to delegate. This means that the
delegator is accountable for ensuring that the delegated role or activity is appropriate to the
level of competence of the student or the regulated or unregulated HCW to perform.

The delegator must also ensure that support and resources are available to the person to
whom the role or activity has been delegated. The nurse, midwife, student or other HCW to
whom the particular role or activity has been delegated is responsible for carrying out the
delegated role or activity in an appropriate manner and is accountable for the appropriate
performance of that role or activity.

Employers should support nurses and midwives in delegation and supervision of a student
or a regulated or unregulated HCW by providing appropriate organisational policy and
resources
When delegating a particular role or activity, the nurse or midwife must take account of
several principles. The individual nurse and midwife must:
1. Ensure that the primary motivation for delegation is to serve the interests and needs
of the patient.
2. Assess the degree of risk involved in the delegation.
3. Ensure that the delegation is appropriate with reference to the definitions and
philosophies of nursing or midwifery.
4. Take into account the level of experience, competence, role and scope of practice of
the person taking on the delegated task.
5. Not delegate to junior colleagues or other HCW tasks and responsibilities that are
beyond their colleagues’ competence to perform.
6. Ensure appropriate assessment, planning, implementation, monitoring and
evaluation of the delegated role or activity.
7. Communicate the details of the role or activity in a clear, understandable way.
8. Decide on the level of supervision and feedback required.
9. Ensure that the practice setting supports the delegation of the role or activity.

Delegation is an exercise in professional judgement by the RN/RM. It involves the transfer of

authority to a competent person to perform a specific activity in a specific context.
Considerations when delegating include:
• Patient health status (stability and complexity)
• Complexity of the delegated activity
• Context of care
• Level of knowledge, confidence, skill and experience of the person to
whom the task has been delegated
• The expected outcomes of the delegated task
• How outcomes will be monitored and communicated
• Legislative requirements
• Right Activity
• Right Circumstances
• Right Person
• Right Communication
• Right Supervision and Evaluation
Five rights of delegation

What is responsibility in nursing?

Professional responsibility as applied to nurses refers to the ethical and moral

obligations permeating the nursing profession. These standards relate to patient
care, collaboration with other medical professionals, integrity, morals and
the responsibility to effectuate social change.

 Accountability:
o Judgment and action on the part of the nurse

o Answerable to self and others for judgments and actions

(ANA, 2015a)
 Responsibility:
o Accountability or liability associated with performance of a
nursing task associated with one’s role
o Portion of the responsibility can be shared with others
involved in the situation 
 Considering the definitions given in a healthcare orientated dictionary provides the
following: responsibility as ‘the state of being answerable for one’s performance
according to the terms of reference of the Code of Professional Conduct. It involves
demonstrating commitment and trustworthiness during the performance of care
through devolved authority. Nurses (whether registered or not) are responsible for
their actions at all times’; and, accountability as ‘the obligation of being answerable
for one’s own judgments and actions to an appropriate person or authority recognized
as having the right to demand information and explanation, according to the terms of
reference of the Code of Professional Conduct. A registered practitioner
 (nurse, midwife, heath visitor) is accountable for her actions as a professional at all
times, on or off duty, whether engaged in current practice or not’ (McFerrran 1998).
 This does not adequately advance our understanding as there seems to be overlap
between the two terms with each having a degree of being answerable for one’s action
and there being no clear distinction between the two terms.
 Professional healthcare practice
Accountability suggests that a decision to carry out an act has been made by oneself,
whereas responsibility implies that one has been requested to carry out an act by another
person. The relationship between responsibility and accountability may be seen as
responsibility meaning to agree to undertake a task or role, once the task/role is accepted
the HCP is responsible for its implementation but is also accountable for it. If the task
was given by a senior, the health care professional is accountable to that person, for
ensuring that the care is undertaken is a safe, competent and professional manner.
Accepting an action means one is responsible for its undertaking, as well as being
accountable for its fulfilment.

This is the situation for many healthcare workers such as healthcare assistants and students in
training. Whilst they have high levels of skill for individual tasks, these tasks are given to
them to perform. They are responsible for ensuring that the tasks are completed to the
required standard but they are supervised by someone who has professional accountability for
that task. The healthcare professional uses the knowledge and competence they have to
decide whether to undertake an action. Their knowledge base is an integral aspect of being a
professional and sets the healthcare professional apart from the healthcare worker. It is the
acquisition of knowledge through training and education that allows the healthcare
professional to achieve the competence to become autonomous in their practice. The truly
accountable practitioner is able to plan and act upon their own professional judgment. This
autonomy is what sets the healthcare professional apart from the healthcare worker.

Professional accountability is one of the features of being a professional being able to accept
accountability for ones actions and being able to justify ones actions, knowing when to and
when not to do something. Only a professional with appropriate knowledge can be truly
accountable; this is the reason that health care professionals remain accountable for work
delegated to health care workers who are responsible for its fulfilment. In order to be truly
accountable one must be able to defend one’s actions. Because accountability implies a
greater degree of autonomy than responsibility with regard to, for instance, decision making,
there is an implied suggestion that standards are higher when undertaken by a heath care
professional who is professionally accountable. Thus, professional accountability refers to the
autonomous health care professional who has the knowledge, competence and authority to
practice in the way that they see appropriate, according to their professional training; to act or
not to act, using their own judgment to decide what treatment is necessary; the freedom to
decide how best to deliver that treatment; and, the ability to justify their action or inaction
based upon their knowledge and expertise.

. Improving Communication 

Describe a time when you received a handover from either a nurse, medical professional or allied
health where there was a discrepancy in communication about the patient’s status or plan of
care. 

•    What happened? 
•    Objectively, why might this have happened? 
•    Describe your feelings and actions at the time. 
•    How did this impact the patient and family? 
•    Could this have been preventable? How, why?
•    What will you do to improve your communication based on this experience?
•    Relate this to current literature

The effects of poor communication in healthcare can have extremely serious consequences.

Communication failures most commonly occur during shift changes, when care of a patient is
handed over to a different caregiver. When incomplete, inaccurate, or ambiguous information
is provided at the changeover it increases the probability of medical mistakes occurring. Poor
communication could lead to patients receiving the wrong treatment or procedure, being
given incorrect medication, or could result in delays to essential tests and treatments, all of
which will negatively affect patient outcomes

Considering the definitions of responsibility as "the state of being accountable for one's
performance in accordance with the Code of Professional Conduct's terms of reference." It
entails displaying dedication and integrity while providing care through delegated authority.
Accountability is defined as "the requirement of being answerable for one's own judgments
and acts to an authorised person or authority recognised as having the right to demand
information and explanation, pursuant to the terms of reference of the Code of Professional
Conduct." a licenced professional