The accountable nurse practitioner
In this essay I intend to examine the issues surrounding nurses' accountability in relation to the scenario discussed, and to Adult nursing. From the group sessions and further reading I have broaden my understanding of what being an accountable practitioner involves. Nurses are highly responsible for their own actions and care they provide. Consequently they are professionally accountable to the Nursing and Midwifery Council, (NMC) as well as their employer, public, patient, families and to themselves. Nurses have to justify why specific care was given in a particular way, (Royal College of Nursing, 2008). And they are required to use their professional knowledge, judgement and skills to make decisions continually throughout their practice, to allow them to exercise best practice (NMC, 2008). Professional, ethical and legal issues are all incorporated into being an accountable practitioner and nurses must take these issues into account throughout their practice. However before exploring accountability further an understanding of the term must be addressed. Tingle, 1995 states it is a contested topic as the concept of accountability is indefinable and arguable. On the other hand Bergman, 1981, defines it as being able to be ‘counted on', however states it is a complex notion as there are varying ways a practitioner can be held accountable dependant on who they are accountable to at the time of the incident. In terms of health care McSherry and Pearce, 2002 explain that accountability relates to continual changing practice and the practitioner has a responsibility to ensure their practice is effective with an evidence base.
During nurse training students accept responsibility for their actions whilst on practice placement however it is the delegated professional who is held accountable for those interventions provided. This difference occurs because to be held accountable you need to have the extensive knowledge base of why interventions are carried out and this is what we as students are continually learning throughout our training. This is the role of the delegated professional to ensure that we are competent in the interventions we are providing to patients and they exercise the correct supervision to ensure this it is a safe learning environment. It is argued that a certain level of authority is required to be accountable as this allows the practitioner to act with a reasonable level of autonomy, (Burnard & Chapman, 1999). Student nurses are not fully autonomous as all decisions have to be agreed by the allocated mentor. Not until we become a registered nurse will we be able to make that transit to hold individual accountability. However, this individual accountability does not come without its stresses. As outlined by Gerrish, K, (2000) in her study which describes that very transition from student to newly qualified as shocking, because of the sudden shift to full accountability.
The element of accountability I will be focusing on in this assignment is standards of care. I have chosen standards of care, as this is one element that the accountable practitioner module intends to teach nursing students about. (University of Nottingham 2009) Black and Chitty (2007) tells me that standards of care guide and inform us on what it is a competent nurse would do in a similar situation. The Nursing and midwifery Council code of professional conduct (2008) dictates how one must maintain consistent high standards of care at all times, also informs us that one must do this by keeping knowledge and skills current with recent research. Basing actions on critiqued up-to date evidence, underpinning one's practice. However also highlights the importance of practicing under the boundary of one's own competency. The Department of Health (2008) expects from nurses a high standard of care and impose a strong view that these high standards will generate clinical effectiveness, and promote both patient safety and personal safety within the National Health Service (NHS).
The group sessions that I attended as part of this module examined the subject of accountability. The group session was based around the discussion of a particular scenario in relation to accountability. Our session studied the story of Emma a newborn receiving positive pleasure ventilation treatment. On one particular occasion nursing staff incorrectly attached her nebuliser to the ventilator consequential causing the over-inflation of the patient's lungs, as a result the patient sadly died. This scenario lends itself to analysing standards of care.
Legally nurses have a duty to act vigilantly when treating their clients, nurses are expected to achieve at least the minimum standard of care consistently. If a nurse fails this they will be judged as negligent (McHale and Tingle 2007). When analysing the scenario within our sessions, it was discussed that the nurse providing care was negligent, if so they would have been held accountable. Chitty and black (2005) inform the reader that negligence is ‘the failure to act as a reasonable careful practitioner would, in particular circumstances'. To assess how particular practitioner would act in a certain situation in relation to another is more complex and hard to resolve. The law simplifies this judgement using a tool called the bolam test. Simplified this dictates that a practitioner cannot be deemed negligent if the actions taken conform with that of another rational competent health care professional. (samanta 2004). The scenario can be related to adult nursing as well as the other specialities. One example of this is not maintaining sterile conditions in a procedure requiring so. Nurses are trained in sterile procedures and to desert this would be negligent (National Institute of Clinical Excellence, 2009).
As students we taught to follow clinical guidelines, and this continues through our professional career. Clinical guidelines for procedures should also be considered when judging whether a nurse has achieved the required standard of care (McHale and Tingle 2007). Throughout my nursing training so far the National Institute of Clinical Excellence, in future to be referred to as “NICE”, guidelines have been always been in the fore font of my mind when carrying out clinical procedures. Within the group sessions these guidelines were brought to my attention again. NICE provides guidance on how to perform Procedures and provide care to an excellent standard (NICE 2009). Contra to this form of assessment, McHale and Tingle (2007), reiterate the importance that NICE guidelines are just so, they are to provide guidance, and that guidance may not be relevant to each scenario a nurse in their career encounters. In my opinion professional judgement, knowledge and experiences cannot be sidelined by a simple set of guidelines; we are professionals and as professionals, are accountable to the patient, and if a nurse thinks the best course of action is contrary to the guidelines the professional should be able to call on their own knowledge and expertise so as to do best for their patient. On placement I experienced this when a client was receiving treatment for a grade 2 pressure ulcer on their sacrum. The guidelines for grade 2 pressure ulcer care state that the use of a hydrocolloid is most suitable for this stage of ulcer; However this patient was doubly incontinent and bedbound with Parkinson's disease. The use of a hydrocolloid was counterproductive as the faeces caused the dressing to become detached equalling a lack of protection to the wound. My mentor through experience and knowledge deemed simple foam Mepilex to most suit the client's situation, providing a boarder and pressure relief to the site. The dressing withstood faecal incontinence and therefore promoted wound granulation. A situation in 2007 supports my opinion and experience; the Institute of Clinical Excellence demonstrated an acceptance that some of the guidelines were not practical as a number of health care professionals challenged the guided amount of dementia medication provided to Alzheimer's patients. Professional experience prevailed over a simple guideline (Armstrong 2007). I believe a balance of one's own knowledge with the aid of NICE guidelines promote the best quality of care; however Samanta (2007) predicts that NICE will become more prominent in the legal system in the years to come, as the governing bodies try to fashion national equality of treatment in the NHS. NICE guidelines will become more regularly used within my chosen branch.
In the scenario, the court of law could prosecute the nurse who physically failed to attached the apparatus precisely as negligent. An expert witness may be used to appeal this ruling and make judgement on the standard of care they experienced (Dempski 2000). The expert witness must remain impartial and autonomous from the accused, only providing evidence from the field they specialise in (Mewburn, 2005).