Accountability

NUR 125 Maria Bennallick Senior Lecturer

Historical perspective
In my estimation obedience is the first law and very cornerstone of good nursing. And here is the stumbling block for the beginner. No matter how gifted she may be she will never become a reliable nurse unless she can obey without question. The first and most helpful criticism I received from a doctor was when he told me that I was supposed to be simply an intelligent machine for the purposes of carrying out his orders. (Dock, 1917 cited in Humphries J. and Green J, 2002)

What is accountability?
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‘the requirement that each nurse is answerable and responsible for the outcome of his or her professional actions.’
(Pennels, 1997)

What is accountability?
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‘You are personally accountable for your practice. This means that you are answerable for your actions and omissions, regardless of advice or directions from another professional’
(NMC, 2004, Section 1.3)

Arenas of professional accountability
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Accountability to the public Accountability to the employer Accountability to the profession Accountability to the patient
(Dimond, 1995)

Accountability to the public
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Through taxation
• NHS is funded via public funds. Practitioners are accountable for providing a service and using resources appropriately

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Through criminal law
• A practitioner who deliberately or recklessly causes harm to a patient may face charges under criminal law. Also breaks NMC Code re serving the interests of society

Accountability to the employer
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Through contract of employment
• an implicit assumption that employee agrees to adhere to the organisation’s policies, procedures and guidelines • a breach can lead to internal disciplinary action and/or reporting to NMC Professional Conduct Committee

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Vicarious liability
• employer held responsible for nurse’s actions as long as appropriate policies etc. followed

Accountability to the profession
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Professional accountability requires the nurse to
• be up to date with current knowledge • work in a collaborative manner with healthcare professionals • care for colleagues where it appears their health and safety is at risk • assist professional colleagues to develop their professional competence

Accountability to the patient
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The legal duty of care
• practitioners have a duty of care to their patients by virtue of the nurse/patient relationship. Must be to ‘reasonable standard’

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The professional duty of care
• nurses have a duty of care to their patients and clients, who are entitled to receive safe and competent care (NMC, 2004)

What is a ‘reasonable standard’?
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The Bolam Test
• ‘The test is the standard of the ordinary skilled man exercising and professing to have that special skill. A man need not possess the highest expert skill at the risk of being found negligent…..it is sufficient if he exercises the ordinary skill of an ordinary competent man exercising that particular art…’ • Therefore in law being inexperienced is no defence to an action being brought.

Delegating care - who is accountable?
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The person who delegates an activity to another is responsible for ensuring that the task has been undertaken safely.
» (Pennels, 1997)

Scenario
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Staff Nurse Graves was under considerable pressure on the paediatric ward. A spate of very seriously ill patients being admitted and a few absences from ‘flu put great strains on the ward. A junior doctor wrote up a 4-year old child with suspected meningitis for a high dose of antibiotics, telling the nurse that he was prescribing a higher dose than was usual because of the severity of the child’s condition. Normally the staff nurse would have checked the dose in the BNF but since they were so busy, she took the doctor’s word for it and gave the dose as prescribed. Not long afterwards, the child showed signs of kidney failure and despite efforts to save him, he died. Subsequently, the post mortem investigations revealed that the child had been given a 1,000-fold overdose of the antibiotic

References
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Bolam v. Friern Barnet Management Committee (1957) ALL ER 118 Dimond, B. (1995) Legal Aspects of Nursing 2nd edn. London, Prentice Hall NMC (2004) Code of Professional Conduct Pennels, C. (1997) Professional Nurse 13.3, 162-164.