Accountability – A long word with a complex meaning
As a nurse (whether currently looking after patients or not), I am accountable for my actions and omissions. I am expected to do no harm as it were and not to practice from outside the remit within which I am competent. As a manager I am expected not to put other people into a situation where they cannot perform adequately. Only this week, I heard a colleague who is a nurse and manager telling someone how they were beginning to worry about their code of conduct because they were expecting an ever decreasing number of health visitors to manage a service. If something goes wrong in these instances it might not just be the practitioner who finds themselves before the Nursing and Midwifery Council but the manager too.
You can find the NMC here, as a member of the public you can check the qualifications of a nurse if you know their name, and you can look at the rules and regulations under which nurses must work(code of conduct, though there are others). To appear on the register you must complete a 3 year course (at least as some are longer), and some nurses have lots of qualifications which are recordable so they will have studied for much longer.
The code of conduct says things like this:
As a registered nurse, midwife or specialist community public health nurse you are personally accountable for your practice. In caring for your patients and clients, you must:
- respect the patient or client as an individual
- obtain consent before you give any treatment or care
- protect confidential information
- cooperate with other members of the team
- maintain your professional knowledge and competence
- be trustworthy
- act to identify and minimise the risks to patients and clients.
Some selected extracts:
1.3 You are personally accountable for your practice, this means that you are answerable for your omissions, regardless of advice or direction from another professional
This means that if you decide to treat a patient, you take responsibility for the care you give, even if a doctor or indeed manager for example has asked you to do the task. Therefore if you don’t feel able to perform the task you should not do it.
6.1 You must keep your knowledge and skills up to date throughout your working life, in particular you should take part regularly in learning activities that develop your competence and performance.
If you were going to be seeing patients out of hours, who might have a minor illness or injury, you might do a course, this course might comprise 5 taught days. But this would not make you competent, so you would be expected to be supervised by someone who was competent in their practice in this particular area until you were competent. People often do the minor illness course supervised by a GP, and it is the responsibility of that GP to say that the nurse is then competent.
6.2 To practice competently, you must possess the knowledge, skills and abilities required for lawful, safe and effective practice without direct supervision. You must acknowledge the limits of your professional competence and only undertake practice and accept responsibilities for those activities in which you are competent
In my opinion this is why working in a team is most important, especially where nurses are beginning to push the boundaries of practice. For example, as a specialist nurse, I learned how to inject joints. I undertook an academic / practical course, and a period of supervised practice. I was then competent to perform this task, but it didn’t mean that I didn’t consult with the expert (rheumatologist) over many of the injections I gave, even though he didn’t need to watch me actually give the injection.
6.3 If an aspect of practice is beyond your level of competence or outside your area of registration, you must obtain help and supervision from a competent practitioner until you and your employer consider that you have acquired the requisite knowledge and skill
So as an adult nurse, I don’t really have the knowledge and skills to treat children. If I were running a clinic and a child were brought along then I would need to be careful that I was practising within the scope of my practice. I would know that a BP of 170/120 was not normally associated with a urine infection in a 9 year old, especially if their urine were very dark (see Dr Crippen)
There is more, much more within the ‘code’ and I often wonder how many nurses refer to their copy (or for that matter have one), because with some of the practice I have been hearing about recently that doesn’t appear to be the case.
I wonder what we British nurses can do about this?
this morning, British people are responsible for one third of the total debt in Europe! Apparently we are obsessed with our credit cards, and save very little money, preferring instead to spend it. A spend culture is in one way good for the economy, and also gives people that ‘feel good feeling’. But how good does it feel to know that it is only the banks getting rich? How good does it feel to know that the money you now owe on your credit cards (and the loans you took out to consolidate your card debt) is more than your first house cost you? How good does it feel to know that it is going to take you as long as a mortgage to pay back?
That is pretty much how I felt yesterday, wound up to such an extent that during the early evening I slightly let rip. My hubby works really hard and I would never pretend otherwise. He works pretty long hours and has a journey of an hour each way (on a good day). But he doesn’t work on Sunday and lying on the sofa from breakfast till dinner will not help you feel refreshed in my opinion and it certainly doesn’t get much done around the house. He is good at agreeing with me that he can and should help out more, but he is short on ideas about how to get himself motivated to do it.
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