Accountability is one of the key concepts that fortifies the professional practice nursing. Accountability is said to be at the heart of nursing and on an overall scale, it helps in the improvement of nursing practice. The term has often been defined differently in different medical circles but in its most basic definition, accountability is simply a special phenomenon in nursing practice whereby nurses working in any caregiving setting take the credit for, are entrusted with, are blamed for and are also be judged within moral and ethical boundaries (Rowe, 2000 p. 550). This means that the nurse is answerable for any actions taken in any particular nursing situation. The nurse holds some liability in responding to various issues experienced in the course of nursing practice and understands that he or she will be held liable for these actions
Therefore, accountability should hold the basis of all the actions in every clinical setting. A nurse should not respond in a particular way or take actions that she knows she might not be accounted for favorably (Rowe, 2000 p. 551). Accountability leads to enhanced quality of care and improves overall health outcomes as it entails taking actions that are in the best interests of both the patient and the nurse. To explore more on this issue, this essay will Shalof T’s book “A nurse’s story: Life, death, and in-between in an intensive care unit” to identify examples where the concept of accountability has been exhibited. Using the identified examples, the aim of the essay will be to show that when accountability is applied as part of professional nursing practice, it leads to improved health outcomes and also enhances the process of delivering care.
In the book, “A nurse’s story: Life, death, and in-between in an intensive care unit, Shalof provides the reader with a vivid description of the everyday life of ICU nurses. Shalof, who is an experienced Canadian writer and a nurse describes vividly some of the issues and situations that nurses at the ICU go through and gives the reader an inside look at some of these situations. It is in some of these situations that the concept of accountability can be identified.
One of the examples where the concept of accountability is exhibited is where she is talking about a son who is unwilling to let his mother go even if the father is very aged and is experiencing multiple organ failure. The son is insistent that if need be, heroic measures be taken by the medical providers to cater for this mother (Shalof, 2004, chapter 3). This is in spite of the fact that these measures might just bring more suffering to the mother. Shalof exhibits great accountability on her part as she tries to explain to the son that at this point, medical interventions on his father would just bring him more suffering and it would be more advisable to let him go. Shalof is accountable because she knows that she will be judged on the actions she takes to ensure the well-being of the patient. In this case, ensuring the well-being of the patient means not allowing him to suffer anymore by stopping all medical interventions and letting him die peacefully. Therefore, this is one of the examples in Shalof’s book where the concept of accountability is vividly exhibited and described by Shalof herself in the course of her professional practice.
The other example where the aspect of accountability is vivid is where Shalof (2004, chapter 8) is talking about a woman who is so desperate to take a sperm from her boyfriend who is brain dead so that she can get his child. This, in fact, seem to be a very bizarre situation, and any nurse would be overwhelmed on how to act. This situation however reveals the huge relationship that exists between accountability and ethics.
Accountability goes hand in hand with ethics and part of being accountable in the course of nursing practice entails being ethical. In this situation, Shalof acts in both ways because she understands the implications that might be associated with this action or how she might be judged if she allows this unethical action to take place. She is liable for how she responds and therefore, guide by accountability, makes the woman understand the consequences that might accompany this act. This is a case of the nurse being accountable for the both deceased patient and her grief stricken girlfriend.
The other situation where the concept of accountability is depicted is where the nurse is faced with a very difficult task of relieving painful constipation by a cancer patient (Shalof, 2004, chapter 13). This is in itself a very difficult task and some nurses would obviously not even contemplate engaging in such an activity or helping the patient in this manner. However, this is something that affects the overall heath outcome of the patient and as the nurse assigned to the patient, Shalof is accountable for all actions meant to ensure that the patient gets better. Therefore, she takes full accountability in assisting the patient and facilitating his recovery process.
Ultimately, all the actions taken should be in the best interest of the patient. An accountable nurse will be favorably judged if the can she takes are in the best interests of the patient (Milton, 2008, p.303).
However, these actions might not resonate well with others, For example, in the case of the son who was unwilling to let the father go, the actions could have led to the development of a bad relationship between the nurse and the family member. In fact, the son referred to Shalof as the “angel of death” (Shalof, 2004, p. 92). However, since the actions are in the best interests of the patient, a positive relationship usually ensures between the nurse and the client, for example the mutual respect that emanated afterwards between Shalof and the cancer patient.
This learning will hugely influence my future development as a nurse. I have learnt that no matter the kind of situation that a nurse is going through; accountability should take precedence. I have learnt all the actions that a nurse takes should take into consideration that these actions will later be judged, and the nurse will be personally liable for them. Therefore, I plan to take these aspects into deep consideration even as I advance with my nursing career. Ultimately, I plan to ensure that all my actions are in the best interests of the patient.
In conclusion, it is clear to see that accountability is a fundamental concept in the professional practice of nursing. It refers to a special phenomenon in nursing practice whereby nurses working in any caregiving setting take the credit for, and entrusted with, are blamed for and are judged within moral and boundaries. Nurses are supposed to be accountable for every single action they take or in how they respond to various clinical situations that they encounter.
Shalof, T. (2004). A nurse’s story: Life, death, and in-between in an intensive care unit. Toronto, ON: McClelland and Stewart.
Rowe, J. A. (2000). Accountability: a fundamental component of nursing practice. British Journal of Nursing, 9(9), 549-552.
Milton, C. L. (2008). Accountability in Nursing Reflecting on Ethical Codes and Professional Standards of Nursing Practice from a Global Perspective. Nursing science quarterly, 21(4), 300-303.