Accountability is a cardinal concern for nurses and accoucheuses in the National Health Service ( NHS ) today. Accountability means presuming duty for 1s actions ( Daniels 2004 ) . The modern construct of professional answerability, applied to nursing, assumes that the nurse is a member of a profession. It depends on single nurses being cognizant of their rank of a profession and accepting that position, with the rights and duties that go with it. With the passing of the Nurses Registration Act, in 1919, nurses in Britain achieved the position of an accountable profession, which meant that registered nurses were lawfully accountable for their work and can be struck off the registry for unprofessional behavior ( Tilley and Watson 2004 ) . The thrust to show professional answerability led to the creative activity of a organic structure that was responsible for puting criterions of behavior and pattern for nurses. This is the regulative organic structure for nurses and accoucheuses and is presently the Nursing and obstetrics Council ( NMC ) . One of the maps of the NMC is to make the bounds on professional answerability in nursing and obstetrics pattern ( Caulfield 2005 ) .
Accountability is built-in to professional pattern. Nurses make opinions in a broad assortment of fortunes. Nurses use their professional cognition, opinion and accomplishments to do determination based on grounds for best pattern and the individual ‘s best involvements and they must be able to warrant the determinations they make ( NMC 2008a ) .
Accountability can non be considered in isolation. Other footings such as ‘autonomy ‘ , ‘responsibility ‘ and ‘authority ‘ demand to be considered excessively ( Dewar 1999 ) . Walsh ( 1997 ) implies there should be a clear differentiation between answerability and duty in nursing pattern. He goes on to state that answerability involves explicating and warranting actions based on sound professional cognition and transparent, logical and replicable decision-making. Equally he believes that duty, in the traditional sense, means executing undertakings in an accurate and timely manner through deputation. Registered Nurses are responsible for all the actions they perform, whether they are dependent, mutualist or independent ( Rosdahl and Kowalski 2008 ) .
Keenan ( 1999 p.561 ) suggests that answerability is a effect of liberty. He defines autonomy as ‘the exercising of considered, independent opinion to impact a desirable result ‘ . Structural liberty exists when professional people are expected to utilize their opinion to find the proviso of patient services in the context of their work. Attitudinal liberty exists for people who believe themselves to be free to exert opinion in decision-making ( Savage and Moore 2004 ) ) . Batey and Lewis ( 1982 p.15 ) suggests there is a close relationship between liberty and certain signifiers of authorization, peculiarly positional authorization and the authorization associated with adept cognition. They go on to state authorization in nursing originates from a figure of beginnings including authorization of the state of affairs ( as in exigency state of affairss ) , of place ( where authorization is invested in a formal place instead than an person ) and of adept cognition ( as granted through professional enrollment ) .
‘Responsibility ‘ , ‘autonomy ‘ and ‘authority ‘ are of import footings, non merely in the manner they overlap with the construct of or be as stipulations for answerability. They are besides relevant for understanding lines of answerability ( Savage and Moore 2004 ) .
There are four ‘pillars ‘ that make up a model of professional answerability deducing from different types of authorization in nursing pattern these are professional, ethical, lawful and employment/contractual ( Caulfield 2005 ) .
Professional answerability and being responsible for your actions and for the results of these actions is portion of the model for clinical administration ( Tilley and Watson 2004 ) . ‘Clinical administration is a system through which NHS administrations are accountable for continuously bettering the quality of their services and safeguarding high criterions of attention by making an environment in which excellence in clinical attention will boom ‘ ( Scally and Donaldson 1998, p. 61 ) .
Ethical values come from the single practician, and consequence from facets such as faith, instruction and the values we grow up within our households and local communities. Bing able to stand up for high criterions of attention, or disputing others who may non hold the same value base, such as those who discriminate against other people or who are negligent in their pattern, or even do injuries to others intentionally. This may affect the nurse necessitating to pull attending to hapless pattern or criterions or even take to the demand for ‘whistle-blowing ‘ ( Jasper 2006 ) .
There are two systems of jurisprudence in the United Kingdom these are civil and condemnable jurisprudence, which provide a model of regulations, ordinances, and instances that determine how we live in society. Civil jurisprudence would use, in nursing in countries of carelessness or deficiency of consent. Legal answerability for nurses has deductions for the criterions of record maintaining, as these will supply grounds of the actions and determinations made by them if needed ( Jasper 2006 ) .
A contract of employment sets out the relationship between the nurse and the employer in footings of the duties and rights of each party. The contract is a legal contract, and hence can be enforced in jurisprudence, on both sides ( Jasper 2006 ) .
Registered Nurses can no longer anticipate to execute all patient attention activities in this age of decentralization, shared administration, and redefining of work responsibilities to include nurse extenders such as wellness attention helpers. Delegation is a much needed accomplishment for infirmary nurses, because it can liberate them to cover with professional activities of attention ( Adams 1995 ) . The nature of the NHS and the assorted activities undertaken within it dictate that the work load is distributed among assorted members of the work force ( Wheeler 2001 ) .
As a Registered Nurse, I am expected to depute facets of attention such as inquiring a wellness attention helper to take a patients temperature every hr. Before deputing the undertaking to the wellness attention helper I must be certain that he/she has the accomplishments, competency, attitudes and experience to transport out the undertaking involved and that it meets the demands of the patient involved. Using Caulfield ‘s ( 2005 ) four ‘pillars ‘ as a model I am accountable:
Professionally
Whilst deputing I will be accountable to the NMC in footings of criterions of pattern and patient attention. The NMC Code ( 2008b ) provinces that as a professional, I am personally accountable for actions and skips in pattern and I must ever be able to warrant my determinations and I must ever move legitimately, whether those Torahs relate to my professional pattern or personal life. Advice by the NMC ( 2008c ) on deputation provinces that I must set up that anyone I delegate to is able to transport out my instructions, and I must corroborate that the result of the delegated undertaking meets the needed criterions and I must do certain that everyone I am responsible for is supervised and supported.
Ethically
I must be cognizant of my ain values. I am accountable if I do non stand up for high criterions of attention in relation to faith, instruction and peoples values ( Jasper 2006 ) . Legitimately
I have a legal duty to hold determined the cognition and skill degree required to execute the delegated undertaking such as taking a patients temperature. I am accountable to both the felon and civil tribunals to guarantee my activities conform to the legal demands.
Employment/Contractual
In the NHS, the Knowledge and Skills Framework ( KSF ) represents the staff development component of Agenda for Change ( AFC ) ( Department of Health 2004 ) . It is concerned with placing the relevant competence degrees required for occupation functions with the NHS. This can supply me with grounds about the accomplishments and cognition of the wellness attention adjunct function. I must guarantee the determination made to depute was appropriate undermentioned guidelines and protocols of the workplace. I will be accountable for the determination to depute and for its execution on an organizational and professional degree. I have the authorization to depute this undertaking to administer work load to accomplish organizational effectivity. It is the employer ‘s duty to guarantee that the wellness attention helper has sufficient instruction and preparation to aptly undertake facets of attention which I am expected to depute to them ( NMC 2008c ) .
Where a Registered Nurse has the authorization to depute undertakings to another, they will retain duty and answerability for that deputation ( NMC 2008c ) . As the Registered Nurse I will stay accountable for the rightness of that deputation and for supplying the appropriate degree of supervising in order to guarantee competency.
Another illustration of my answerability as a Registered Nurse can be related to transporting out physicians ‘ orders that are incorrect. For illustration, I may give an falsely prescribed drug. Although the physician is accountable for ordering it wrongly, I will besides be held accountable for administrating it, as I must be certain of all drugs, doses, actions, contra-indications and side effects of the drugs that I give to patients. In the same manner if I perform falsely a process that a physician has asked me to make, I will be accountable. This is because I must be cognizant of my restrictions and non transport out any process unless I am suitably trained to make so. Even if I have received the recommended preparation, I may non hold performed the accomplishment for a period and will non hold practiced the undertaking ; hence, I will non be competent in that undertaking and will be held accountable if I perform the undertaking falsely ( Hole 2009 ) .
Decision
This essay has discussed what ‘accountability ‘ agencies and the job that the term ‘accountability ‘ conveys small significance in itself. The essay considers footings, such as ‘autonomy ‘ , ‘responsibility ‘ and ‘authority ‘ and how they are relevant for understanding the lines of answerability.
Registered Nurses are accountable for everything that they do within their function as they are members of a profession. The NMC codification ( 2008b ) provinces ‘that as a professional you are accountable for your actions and skips in pattern and you must ever be able to warrant your actions ‘ .
This essay goes on to explicate the different signifiers of answerability i.e. professionally, ethically, legitimately and contractually and has related these to pattern utilizing deputation as an illustration. Registered Nurses must be certain that they can warrant their actions at all times and that they are accountable for the actions of others to whom they delegate.
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