Accountability in Nursing: Nursing Ethics Breakdown

• Continuing NCC’s Nursing Code of Ethics Breakdown, Nurse Luggar-Scmit explores the role of accountability in nursing.
• Summarize the six other nursing ethics: accountability, justice, autonomy, beneficence, fidelity, and veracity, as well as the history of their development. 
• Recognize the importance of accountability through practical examples in nursing and examples of consequences if accountability is not followed. 

As a nurse, you are probably familiar with the term accountability. Accountability in simple terms is the action of taking responsibility for one’s decisions, including any errors that were made.  

Accountability is an essential aspect of being a professional nurse and one of the ethical principles in nursing. Nurses should always hold themselves to a high standard of accountability in their careers.  

Nurses are human, and mistakes will be made on occasion. The willingness and ability to take ownership of those mistakes is vital in healthcare.  

Being able to admit when a mistake is made is just one of the important aspects of accountability. Let’s discuss accountability and all it encompasses in further detail.   

What Does Accountability in Nursing Mean? 

Accountability is defined as the acceptance of responsibility for honest and ethical conduct. Accountability in nursing is essential to professional practice.  

It is concerned with the interests of patients with diverse health issues while using professional judgment, knowledge, skills, and evidence-based practices to make decisions that promote positive patient outcomes. 

Why is Accountability Important to Nursing? 

When nurses understand and appreciate the importance of professional accountability and nursing, that awareness is naturally carried over in every aspect of practice. Nursing accountability is essential for the delivery of safe, effective patient care.  

What are the Seven Ethical Principles in Nursing? 

Accountability 

Accountability is one of the most important ethical principles in nursing. Each nurse must be responsible for his or her own choices and actions during patient care. Nurses who hold themselves accountable often provide higher-quality patient care. 

Justice 

Every nurse has a responsibility to make care decisions based only on the facts, not on other factors like the patient’s age, ethnicity, religion, socioeconomic status, or sexual orientation. To uphold this principle, nurses should act as fairly and objectively as possible, which can help patients feel more valued. Treating each patient fairly, regardless of their circumstances, is essential for helping patients accept and participate in their own health care. 

Nonmaleficence 

This means to do no harm. Nurses have a critical responsibility to prevent further harm from coming to all their patients. Each nurse must take action to prevent harm. This is essential to ensure safe and effective patient care is delivered to the best of a nurse’s ability. 

Autonomy 

Each nurse should be able to perform their duties using their own knowledge and professional judgment appropriate for each patient. Nurses must act only within their scope of practice yet continue to provide high-quality nursing care. Autonomy is an essential part of all aspects of nursing practice, helping nurses make appropriate decisions based on critical thinking. This principle goes hand in hand with accountability. 

Beneficence 

Actions that are performed with the intention of benefiting other people. An example of this is a nurse caring for a patient and putting the patient’s needs above their own in the best interests of the patient.  

Fidelity 

This means keeping your word to your patients. Nurses should be honest and loyal to each patient. Without fidelity, more trusting relationships cannot be formed, which leads to less positive patient outcomes and trust. 

Veracity 

Working in healthcare is challenging for many reasons, and in some cases, nurses must communicate unpleasant information to a patient. Veracity in nursing is the ethical principle of being completely open and honest with patients, even if the truth causes distress. Veracity helps patients become more autonomous, making decisions for their care based on all relevant and factual information. 

Four Reasons All Nurses Should Strive to Practice Accountability

1. Accountability in nursing helps foster trusting relationships between patients and nurses which can positively influence patient outcomes. When patients believe their nurses are trustworthy and dependable, they’re more likely to divulge sensitive information, which helps nurses develop appropriate care plans and promotes better outcomes. 
2. Nurses who hold themselves accountable set themselves up for success. Employers value nurses with high levels of integrity, which is a crucial characteristic of accountability in nursing. The reliability and trustworthiness that comes with accountability leads to increased chances for success in your current job and future professional endeavors. When you take accountability for your actions, patients and employers can depend on you. 
3. Nurses who practice accountability can promote a positive reputation for the facilities where they are employed. When a patient is satisfied with the care they receive, it increases the likelihood of them providing positive feedback, which positively impacts the reputation of the healthcare team and facility. 
4. The culture of accountability and nursing reduces the misuse of valuable healthcare resources. One way to demonstrate accountability in nursing is to use resources for their intended purpose. Taking care of equipment, administering medications as prescribed, and documenting any supplies used in patient care also demonstrate accountability to your patients and employer. When resources are used wisely, it contributes to reducing healthcare costs making healthcare services more affordable for all patients. 

There Are Four Components to Accountability and Nursing

1. Professional accountability: professional accountability means being answerable to oneself and others for one’s own actions. 
2. Legal accountability: nurses are personally accountable by law for their actions and or omissions and have a legal obligation to provide care within their scope of practice. 
3. Ethical accountability: this relates to the nurse’s responsibility to provide for patients and to maintain the patient’s best interest as a priority. 
4. Employment accountability: nurses should conduct themselves in a manner that follows legal and ethical guidelines for nursing Practice at their place of employment. 

How Can Nurses Demonstrate Accountability in Nursing? 

• Work within the scope of practice 
• Accept responsibility for yourself and your actions 
• Follow policies and procedures as established by your employer 
• Accept correction or instruction from supervisors when necessary 
• Stay up to date with professional nursing standards 
• Use evidence-based practices when providing patient care 
• Complete tasks assigned to you before leaving work 
• Set personal and professional goals 
• Provide safe quality care to all patients 

What Are the Consequences of a Lack of Accountability in Nursing? 

• Increased risks of patient safety 
• Increased healthcare costs 
• Poor nurse-patient interprofessional relationship 
• Loss of job and our nursing license 

A Personal Example of Accountability in My Nursing Career: 

Very early on in my nursing career, I was completing an evening medication pass on the unit I was assigned. I remember it being an especially chaotic shift, and I was overwhelmed.  

I ended up administering melatonin to a resident who was not prescribed the medication. I instantly felt terrible and panicked as this was my first medication error. Melatonin is an over-the-counter medication, and it was a low dosage.  

The resident would be ok and likely not experience any adverse effects from the medication error. However, knowing I committed the error as a nurse, I had an ethical responsibility to report my error.  

I filled out a medication error report, and because of making that error, I made sure to be more focused during medication passes. This is an example of taking accountability.  

It is important to take accountability even in those circumstances where no harm will occur. This demonstrates integrity and honesty. This is what accountability means to me, doing the right thing even when no one is watching.  

How Does Accountability Play a Part in the Success of a Nurse? 

Taking accountability as a nurse aids in their success because being able to admit to mistakes and learn from them helps you grow in your nursing career. For instance, my example of the medication error taught me an important lesson about eliminating distractions during medication passes and allowed me to implement strategies for successful medication passes going forward.  

What about the Transfer of Accountability? 

Receiving shift reports is a routine occurrence for nurses on each shift. You probably don’t spend a lot of time thinking about it because it is so routine. When nurses receive a report from the outgoing nurse, this is a transfer of accountability from the outgoing nurse to the oncoming nurse. The oncoming nurse is now responsible for the outcomes of the patients during the shift.  

Accountability and Its Role in Leadership 

As a nurse in a leadership position, such as a nurse manager or a charge nurse, you are looked at as a role model for other nurses under you and other support staff. It is important to conduct yourself in a manner that demonstrates maturity, responsibility, and accountability.  

When other staff witnesses your ability to take ownership of your actions, it assists in setting the standards of conduct you expect from them as well. As a result, they will be encouraged to report their mistakes and take accountability too.  

The Bottom Line

In conclusion, accountability is one of the most important aspects of nursing. Nurses who hold themselves to high standards and practice accountability provide safe, high-quality care to patients and are dependable and trustworthy.  

An accountable nurse understands the impact their actions have on their patients and works to make the choices in the best interests of their patients to achieve positive health outcomes.  

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