Accountability, Responsibility, Liability
Quite frequently a nurse will ask, "Is it true that, as Charge Nurse, I'm responsible for the care given on the unit on my shift?" In a similar vein the question arises, "Am I responsible for the care given by the LPN?" A nurse who finds her/himself in a difficult position when ordered to carry out a questionable action may ask "What is my liability if I do this even though the other person has said she will take responsibility?"
Sound familiar? Are these questions you have asked yourself? Have you faced situations which caused you to question your liability? If you have, don't worry, you're not alone. These questions are all tied to the issue of accountability in nursing. It is important that you, as the individual nurse, recognize this concept and the effect it can have on your nursing practice. In an increasingly litigious society, nurses are becoming more aware of their accountability; of their responsibility; of their liability.
Numerous studies have been done and various articles have been written concerning the complex but important concept of nursing accountability.1 One author has defined nursing accountability as "that special phenomena related to nursing practice which nurses are entrusted with, answerable for, take the credit and blame for, and can be judged within legal and moral boundaries". 2 Black's Law Dictionary holds accountability to be the "state of being responsible or answerable". Within the legal context an accountable nurse is held to be responsible for, answerable for and liable for her/his own actions.
Society has certain expectations of the nurse. Legislation has been enacted in each province/territory relating to the regulation of the nursing profession. This legislation may define who may be called "nurse" within that province, 3 who may be registered 4 or who may be licensed 5 to practice nursing, as well as other matters pertaining to self-regulation. This indicates to the public that a certain body of knowledge and minimum standards must be met before a nurse is a recognized member of that profession. You, as the nursing professional, are relied upon as having this specific body of knowledge with its attendant skills. You must meet those requirements; if you fail to meet them you face the ensuing consequences which can range from criminal or civil liability to employment and/or professional disciplinary measures.
Among the identified areas of specific nursing accountability are the nurses' accountability to the client; to the employer; to the profession and to the union 6. In each of these areas you must ascertain where your accountability arises and how it affects your nursing practice.
Accountability to the Client
The foremost accountability of the nurse is to the client. You hold yourself out to the client as someone having the special knowledge, training and skills associated with nursing. Because of this, your client looks to you and relies on that knowledge, placing her care in your hands. Once this reliance has been established you have a duty to your client to provide the standard of care of a reasonable, prudent, average nurse with similar training in similar circumstances. If you breach this standard you could injure your patient and incur liability. You are accountable to know the limits of your competency and to work within those limitations. If you undertake to perform an action which you are not competent to perform, you must answer for the consequences; no one else can answer for you. If you are not directly involved in the negligent action and did not contribute to it, you could not be held responsible for it.
Accountability to the Employer
As an employee you have the responsibility to work within the scope of employment as defined by the employer. You are responsible to know your terms of employment, and to work within those terms. You should be aware that you cannot be expected by your employer to perform any act which is illegal; nor can you be expected to perform any act which is unsafe or reasonably believed to be unsafe. Refusal should not result in disciplinary action7 by the employer. You are responsible to know what policies and procedures are in place governing your scope of employment, to work within them and to keep current with any changes to them. Your employer is considered to be liable for your negligent actions under the doctrine of vicarious liability, if you are working within your scope of employment; if you do not work within that scope you may void the employer's responsibility towards you leaving you to bear the liability costs of your action. You alone are accountable to your employer for your actions in the workplace.
Accountability to the Profession
As a nurse you are accountable to meet the standards of your profession. In some provinces/territories these standards may be contained in the nursing Act itself or in Regulations accompanying that Act. These are the recognized standards of the nursing profession in that province/territory to which you are held. You should not be required to perform any nursing service which is outside that scope of practice. If you do not work within the scope of practice of your licensing/registering body you may face disciplinary consequences. It is your responsibility to maintain and keep current with your standards of practice. If you have questions concerning your scope of practice contact your licensing / registering body. Remember, in determining the standards of practice to which you will be held in a court of law, the judge will probably look to your licensing / registering body to determine what is the provincial/territorial standard.
Accountability to the Union
As a union member you have the responsibility to partake in union activities -to vote, to participate. You should be fully aware of union decisions and policies affecting you as a member of a collective bargaining unit. You should also know your responsibilities towards your union. Workplace problems may be addressed according to your collective agreement; you are responsible to know the terms of your collective agreement and to abide by them.
As a nurse, you face the threat of liability on a daily basis. This can be somewhat daunting. However, if you practice your profession as would the reasonable, average, prudent nurse accountable for your actions, you should have little to fear.
- Snowdon, A.W. & Rajacich, D. The Challenge of Accountability in Nursing. Nursing Forum (1993) Vol. 35 No. 2, 5-11 at p. 5.
- Castledine, G. Accountability in Delivering Care. Nursing Standard (1991) Vol. 5 No. 25, 28-30 at p. 29.
- The Registered Nurses Act, 1988. S.S. 1988-89 C.R.-12.2 S23 (1)
- Nursing Profession Act. S.A. 1983 C.N.-14.5
- Ibid, note 3 at s 17 (2).
- Castledine, G. Ibid, note 2 at p. 30. Philpott, M. Legal Liability and the Nursing Process. (1985) W.B. Saunders, Toronto at pp. 12-18.
- Mount Sinai Hospital and the Ontario Nurses Association (1978) 17 L.A.C. (2d) 242 at p. 258.?
Bocchino, C.A. A New Accountability in Health Care: Providers, Insurers, and Patients. Nursing Economic. (1993) Vol. 11 No. 1, pp. 44, 51.
Castledine, G. Accountability in delivering care. Nursing Standard. (1991) Vol. 5, No. 25, 28-30.
Crossley, T. Too Scared to Care. Nursing Standard. (1993) Vol. 7 No. 10, 48-49.
Devine, J. Accountability. Nursing Times. (1990) Vol. 86 No. 21, 30-31.
McSweeney, P. Accountability in Nursing Practice. Nursing Standard. (1990) Vol. 4 No. 18, 30-31.
Morris, J.J. Canadian Nurses and the Law. (1991). Butterworths, Canada.
Philpott, M. Legal Liability and the Nursing Process. (1985) W.B. Saunders, Toronto.
Richard, J.E. & Stern, P.N. How Primary Nurses Operationalize Accountability. The Canadian Journal of Nursing Research. (1991) Vol. 23 No. 3, 49-66.
Pyne, R. Accountability in principle and in practice. British Journal of Nursing. (1992) Vol. 1 No. 6, 301-305.
Pyne, R. Accountability. (1991) Nursing Times. Vol. 87 No. 3, 25-26.
Tingle, J. Negligence: the new accountability. Nursing Standard. (1991) Vol. 5 No. 29, 18-19.
Snowdon, A.W., & Rajacich, D. (1993). The Challenge of Accountability in Nursing. Nursing Forum. (1993) Vol. 28 No. 1, 5-11.
Woude, D.V. Professional Practice: Standards, Code and Accountability. South Dakota Nurse. (1993) June Vol. 35 No. 2, 6-8.
Note: This article has been reprinted with permission from The Canadian Nurse, April 1994.
All articles appearing in this section are for information purposes only and should not be construed as legal advice. Readers should consult legal counsel for specific advice.