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?

■ ‘the requirement that each nurse is

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

■ ‘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

■ Accountability to the public

■ Accountability to the employer
■ Accountability to the profession
■ Accountability to the patient
(Dimond, 1995)
Accountability to the public
■ Through taxation
• NHS is funded via public funds. Practitioners
are accountable for providing a service and
using resources appropriately
■ 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
■ 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
■ Vicarious liability
• employer held responsible for nurse’s actions
as long as appropriate policies etc. followed
Accountability to the profession
■ 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
■ 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’
■ 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’?
■ 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?

■ The person who delegates an activity to

another is responsible for ensuring that
the task has been undertaken safely.
» (Pennels, 1997)
Scenario
■ 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
■ 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.