This essay will explore the concept of accountability in healthcare and social care setting. Firstly, A definition of the accountability will be provided followed by an overview of the law, ethical theories and frameworks that help nursing practice in decision making these include principles of consent and autonomy and confidentiality. Secondly, it will demonstrate an awareness of the potential healthcare dilemmas and how the influence of the law, ethics and professionalism. thirdly, the essay will move on to identify and demonstrate an understanding of the professional and legal responsibilities of the registered nurse.
There are many definitions on accountability. According to The Royal College of Nursing (2018), it defines accountability as being responsible for own actions and making sure that you have the skills and competencies required for the task for the safety of the patients. While, Kennedy et al (2014), defined accountability as the practices, actions and processes used to display responsibility and justify actions. According to Department of Health (2012), as healthcare professions if failed to be accountable for own conduct this will result into lawsuits or disciplinary actions by regulatory bodies i.e. Nursing and Midwifery Council. Griffiths and Tenghan, (2014), explains that All health care practitioners including nurses and doctors are accountable to themselves, the patient, society, profession and employers. Paraphrase
Accountability to oneself entails acceptance of responsibility and consequences for one’s practice and conduct (Fitzpatrick and Bronstein, 2006). This means that one must take responsibility for their conduct, be a reflective practitioner, update your skills and competencies and most look after your wellbeing (ibid). Health care workers are answerable to the law and regulatory bodies for harm caused to patients or service users due to their inadequate standard of practice (Castledine and Close, 2009).
Kopp (2001) explains that a person’s accountability to the employer are stipulated in the written employment contract and job description. The Contracts of Employment Act 1963 makes it mandatory for any employer to have a signed contract of employment and any breaches to the contract such as negligent behaviour can lead to the employer taking disciplinary actions such as suspension or termination of the contract (Deakin and Morris, 2005). A signed contract of employment means that the health care worker has agreed to the expectations of the job description and the required duty of care (Savage and Moore, 2004). Any breach to the contract could also lead to criminal or civil charged in the courts taken up by the patients if they feel that there was negligence in the way their care was provided or omitted.
When a civil case arises against a health care worker, they can be covered by their employer through vicarious liability if there is enough evidence to show that they acted in accordance to the stipulated contract, job description and approved competencies. Should the courts agree on any financial compensation to be paid to the patient, the liability is borne by the employer. Consequently, the Nursing and Midwifery Council (NMC, 2009) emphasizes that to protect oneself from lawsuits, workers must adhere to taking on duties as agreed in their contract of employment to which they have the right skills and qualifications. Pearce (2006) argues that careful consideration should be taken before accepting delegated duties and only accept duties that they have verified skills and competencies. Adding to this, the NMC (2008) stress that the delegating officer must also be satisfied that the worker has the required competencies by conducting appropriate checks before delegating any duties to them. It is also a requirement that the delegating office must be available to offer supervision and support to the staff member undertaking delegated duties to minimise potential harm or errors (ibid). Upon accepting to undertake a delegated role, the worker accepts full responsibility of the role and become legally answerable to their actions, omissions and associated consequences even in the courts (Hughes, 2002). Another reason for only accepting delegation when you have the required competency is the protection offered by the Bolam Principle. The Bolam test was founded in 1957 and states that claims against negligence can be dismissed by the courts if there is proof that the health care worker acted in a similar way that any other health worker would have done in the given situation (Hendrick, 2004). Hence performing duties and accepting duties within the agreed competencies offers protection to both the delegator and delegate (ibid).
Health care workers are accountable to society in issues of public interest where general society agree that such behaviours are wrong such as murder, causing grievous bodily harm or theft to mention a few (UNISON, 2011). These public interests are protected by legislation passed by Acts of Parliament (ibid). Any breaches against the public interest are dealt with in the criminal courts and criminal proceedings are entered against the individual (Op.cit).
Accountability to the profession is enshrined in the requirements and regulation of the codes of conduct of the regulatory bodies such as Skills for Care and Skills for Health (2013) for health care assistants and NMC for Nurses. Breaches to these professional codes can lead to actions such as dismissal, withdrawal of licence to practice or suspension.
All accountability processes have clear lines of responsibilities as well as consequences for failure to act appropriately (Mulryan, 2009). In health care practice, following ethical principles such as respecting autonomy, obtaining consent and respecting and upholding the confidentiality of a patient or service user offers protection against any civil or criminal proceedings against workers (ibid). Timely and clear record keeping also helps to offer protection by providing a clear audit trail of work undertaken (Wood, 2003).
Consent is another area where Health care workers can display accountability through obtaining consent before offering any care or treatment interventions to a client or service user. Consent is the notion that permission must be granted by a patient or service user before any care or intervention can be given (NHS Choices, 2017). Under the UK law, there must be presumption that everyone is able to consent to care or treatment (Mental Capacity Act, 2005). Therefore, providing personal care without obtaining prior consent can be interpreted as battery and the patient has the right to seek civil redress in the court of law. The Department of Health (2009) emphasises on the importance of all health care professionals to get consent from patients or service users to avoid civil or criminal proceedings. Even in cases where it has been established that the patient has no capacity to consent and an incapacity certificate was issued, consent must be obtained from an authorised decision maker (British Medical Association, 2009).
Health care professionals are also accountable for upholding the duty of confidence for their patients or service users (Blightman, Griffiths and Danbury, 2013). Confidentiality in health care is the legal duty to protect patient’s personal information without sharing it to any third party without the explicit consent of the patients (ibid). The duty of confidence is protected in law by the Data Protection Act 1998 that restricts the sharing of private individual data and allows sharing with other professionals only when there is explicit consent (Boyd, 2003). Even where explicit consent is obtained, this Act restricts the usage of personal information only for the purpose for which it was collected for. Confidentiality principles in health care work are also reinforced by the Human Rights Act 1998, Caldicott Principles 1998 and the nursing and social work professional codes of practice. Article 8 of the Human Rights Act 1998 requires the respect to private life and that any decision to share private information should be justified and limited to a specific purpose. In health care work, confidentiality of patients is also protected by the Caldicott Principles which has strict controls on usage of patient’s identifiable or confidential information (Crook, 2003). Under these principles, only minimal use of patient’s information is authorised when there is sufficient justification and any breaches attract penalties from the professional governing bodies (ibid). Confidentiality clauses are also featured in the NMC Code of Professional Conduct 2002, NHS Code of Practice 2003 and Skills for Care ; Skills for Health 2013. These professional codes emphasise on explicit consent before sharing information and restricting usage only to the purpose for which the consent was given.
Record keeping is a good instrument for accountability in health and social care practice (Dimond, 2008). Good, accurate and timely record keeping is vital to ensure the safety and positive outcomes for patients as well as for resolving legal and professional incidents (NMC, 2008). Patient records or case notes are legal documents which can be used in court in cases of any lawsuits (Gasper, 2011). Absence of documentation of care or intervention is interpreted by courts as absence of the care or intervention taking place (ibid).
The NMC (2009) issued guidance for good record keeping which include legible, factual, accurate and signed entries of care or intervention provided. They argue that patient records of care, treatment interventions and observations are a provide a vital communication tool among multidisciplinary teams or between different healthcare practitioners. As such they aid smooth continuation of care, handover between staff, provide a clear trajectory of patient condition and changes and help to avoid duplication of intervention and treatment overdose (Owen, 2005).