Professional accountability applies to both the student and the professional nurse. Accountability applies to everyone involved in health care.

Accountability is a legal obligation; in health care it is also an ethical and moral responsibility. Within the realm of professional accountability, there are many factors.

Assuming responsibility for one’s own nursing practice is the most important. The American Nursing Association (ANA) states in its code that the nurse will assume accountability for nursing judgment and actions. What is the expectation of the student vs. the expectation of the professional nurse when delivering treatment to a patient?

A professional nurse has the responsibility to practice within his/her scope of care, calling upon his/her knowledge and skills to make decisions in the best interest of the patient. The student has the same responsibility to the patient. There are different levels of students. The scope of practice for the student depends on the level of education. It is the obligation of the student to understand the guidelines.

The level of responsibility and accountability not only depends on educational levels but professional levels as well. The Charge Nurse has more responsibility then the staff nurse, the RN has more responsibility then the LPN, and therefore their levels of professional judgment and practice are different. Their levels of professional accountability are not different.

According to A. Pearson, professional nursing is based on altruism, integrity, accountability and social justice (Apr2005). Judgments and practice that are based with those ethical values will always be in the best interest of the patient, no matter what the educational or professional level.

The definition of altruism is that individuals have the ethical obligation to serve others without self-interest. The nurse or student who comes from an altruistic place will make decisions that are in the best interest of the patient. A patient advocate.

Case Study:

A physician has told a patient who has been newly diagnosed with pancreatic cancer that the cancer has metastasized and there is not a cure. The physician is a general practitioner. The patient and the family are devastated. Does the nurse tell the family to accept the General Practitioner"s diagnosis or does the nurse tell the patient and family to insist on an Oncology consult? The nurse has the obligation to act in the best interest of the patient. This nurse specializes in Oncology, so using the knowledge that she has; she makes a judgment and tells the family to insist on getting an Oncologist on board.

The nurse tells the family and patient, the Oncologist may not offer a better outcome but he may have options for a better quality of life. The nurse has used her integrity. She has not given false hope but she also has not destroyed all hope.

The Oncologist suggests chemotherapy. He has explains to the patient, it is not a cure but may extend her life. He is going to start her on Gemzar and explains to the patient the side effects are very minimal. The patient has agreed to the treatment. The medicine is ordered.

It is the change of shift, the nurse coming on has never initiated chemotherapy. Does she give it? If she does she will have to be accountable for her actions. She uses her judgment and seeks out the Charge Nurse(CN), who is chemotherapy certified, to hang the medicine. If the nurse had hung the medicine, she would have been practicing outside her scope. Her action to involve the charge nurse was the most responsible decision for the patient.

Nine months later, the patient comes back into the hospital. The chemotherapy is no longer working. The patient is in terrible pain. She is very thin and can no longer eat.

The physician wants to put in a feeding tube.

The family tells the nurse, they are not ready to lose their mother yet. They have talked her into consenting for a feeding tube placement.

After the family leaves, the patient tells the nurse, she is tired and always in pain. She wants to die peacefully. The patient says her family will not listen to her when she speaks of dying. The patient is frustrated because she wants to spend the last moments at peace with her family.

Does the nurse discuss Hospice with the patient?

She knows the physician is not a big supporter of hospice and the family is not ready. The obligation is to the patient. The nurse tells the patient about Hospice. The patient tells the nurse to please get the order so she can speak to them. She does and Hospice helps them all get to the point where they can say good-bye. The patient can now dye with dignity. The nurse called upon her knowledge and experience to do what was in the best interest of the patient. Ethically and legally she made the right decisions.

Now let’s put a twist on it, what if the patient was a pediatric patient.

Scenario remains the same, the child is tired and the family is not ready to let go.

Where does the moral and ethical responsibility lie, with the patient, the family or to both?

It now becomes more difficult. The nurse can only act responsibly if she has the expertise to care for a pediatric patient. If she does not have the experience and knowledge, her obligation now becomes finding someone who does. The nurse who may run into such a situation is a Nursing Supervisor. He/she may not have pediatric experience but his/her responsibility is to seek out someone who does. Part of nursing judgment is to know your resources.

With all the regulatory agencies involved in health care today, the nurse needs to very careful about the decisions he/she makes. If the nurse had gone directly to the child and discussed Hospice without the parents being present, the parents could have notified the state.

If you return to the adult oncology patient and that patient asked not to have the family involved but the nurse ignored the patient’s wishes, it would be a Health Portability and Accountability Act (HIPPA) violation. Today HIPPA can stand in the way of how quickly we treat our patients and how we treat them. Nurses are at the fore front of solving the problems which can occur due to the Health Portability and Accountability Act.

The Joint Commission has many standards, from patient safety issues to nursing competencies. Nurses are responsible for knowing the Patient Safety Goals and the Core Measures, which are forever changing.

The Patient Bill of Rights affects the way we care for patients. Patients today know their “rights” and we give them the phone number of the state if they think these rights have been violated. This is just one of the ways in which the future will impact nurse’s ethical and legal responsibilities.

The nursing shortage will also impact the future of health care. So many nurses today are “Baby Boomers” and will be retiring within the next few years. There are not that many new nurses have to replace them.

As time goes forward, there will be a developing role of non-licensed individuals to play a bigger part in actual patient care. This will put even more legal and ethical responsibility on the RN. He or she will be responsible for overseeing more patients and skilled support staff, e.g. LPN and CNA. The position of RN will be as Leader in the Health Care Industry.

In the future, continuing education will play a big part in the development of the professional RN. Many facilities have clinical ladders in place for their registered nurses and offer incentives for the nurse to further their education. The future of the professional nurse is uncertain at this time but the possibilities are incredible.