NRS 430 Outline the concept of professional accountability as it pertains to nursing

Professional accountability is not only holding oneself accountable in the nursing profession, but also holding others accountable professionally. Maintaining professional accountability is staying honest, trustworthy, operating within the nurse’s scope of practice, maintaining patient confidentiality, and upholding the code of “doing no harm” (Green, 2018). I have been practicing at bedside for the past two years and I have encountered a few situations where I had to hold myself professionally accountable, as well as other fellow nurses.

An instance that comes to my mind most recently is, after receiving report from a less experienced nurse who is notorious for cutting corners and leaving work left behind for the second nurse to do, had given me spotty report and neglected to inform me that the patient was on a continuous Heparin drip. As this patient’s labs were scheduled to be drawn at 6am, the patient was a difficult stick and the labs were attempted but not collected. Heparin drips require Q6 blood draws and careful monitoring to ensure the patient stays within the therapeutic range, and the Heparin levels do not become critically high. The nurse giving me report quickly raced through giving me report and grabbed his bag and ran out of the building, without going to bedside with me to evaluate a patient with an oncoming nurse.

I entered the patient’s room directly after the report and found that the Heparin bag was indeed completely empty, and the patient’s labs had not been collected in over 8 hours. I attempted to collect the lab myself to avoid any longer a delay in adjusting Heparin drip and I was unsuccessful myself. I currently work on an organ transplant floor, and I have between 5-6 transplant patients with 20-30 medications per patient, that are all due by 9am and passing these medications is very time sensitive and consuming.

I brought this situation to the attention of my charge nurse, who accelerated it to my nurse manager. At this time the Heparin draw was 10 hours past due and had to be drawn by the nurse manager to avoid any further delay in the process. The doctors had to be contacted regarding the situation as well as the pharmacist who stressed the importance of these critical labs being drawn on time. I had to document the situation in depth to protect my license and I also had to write a patient safety report about the nurse who had given me report and failed to complete his list of tasks to keep the patient safe.

I wouldn’t ever want to get my coworkers in trouble, but this situation could have become dangerous if I didn’t catch the error made by the other nurse, so I had to protect myself and the patient by doing a thorough documentation.

Situations such as these often arise in the nursing profession where a nurse has to hold their fellow nurses professionally accountable when it pertains to patient safety. I was told in nursing school over and over to protect your license because it was so hard to obtain that degree in the first place. Some situations occur in the nursing field that can become uncomfortable for a nurse to hold another nurse or interdisciplinary team member accountable but looking back on the oath taken to “do no harm,” we as the patient primary care giver and advocate, must make those difficult decisions to keep our patients safe.

References

Green, S. (2018). Advancing professional standards. (2nd ed.) Dynamics in Nursing: Art and Science of Professional Practice. Grand Canyon University.

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I have used every good and bad experience I’ve had over the past 2 years of working as a beside nurse, as a learning experience. I see the good and bad situations as lessons, and I use those lessons to guide my daily patient care. I recently had to politely ask a nurse giving me report to slow down, because she was going so fast that I couldn’t even write down everything she was saying, and I wanted to catch everything she was saying. Sometimes those situations can feel awkward because I don’t want to seem rude, but it requires assertiveness to ask them to slow down or correct something that wasn’t done when it should have been done. Going forward, with nurses that give partial report to me, I will review the chart myself before receiving report from the previous nurse. Reviewing the patient’s chart will prepare me for what to expect from the patient, as well as prepare me to ask the nurse to clarify something I didn’t understand, or something they may have missed saying during report.

There have been instances with nurses who have left patients lying in bed soiled, and the lesson I learned from that is, I actually go into the room with the nurse giving me report and quickly assess the patient and any drips they may have running. As nurses, I do feel we are leaders in the hospital setting, because we have to delegate care to others. As a leader guiding and training new nurses, I would personally share my experiences as a bedside nurse. When I became a new nurse, I was eager to learn as much as possible about nursing, and I would listen to advice from the more seasoned nurses, and I greatly valued their abundance of knowledge and experience. I remember thinking I was envious of their years of experience, and I can’t wait to be in that position one day, and be able to onboard new graduate nurses, and take them under my wing and lead them and guide them. New nurses are the future of our healthcare system, and after the terrible bullying I experienced as a new graduate nurse in the ICU, I would never want another new nurse to have that experience, that is why training new nurses is something I am very passionate about.

Accountability is defined as the acceptance of responsibility for honest and ethical conduct. (Faubion,2023). A lack of accountability in nursing practice can have significant, far-reaching consequences. Nurses should strive to demonstrate accountability in all aspects of practice. Professional accountability as simply being answerable to oneself and actions. Nurses have a formal obligation of accountability placed on them by their Nurse Regulatory Board and must be willing to accept professional responsibility for the care they provide to patients. Working within the Scope of Practice is one of the best ways to demonstrate accountability in nursing practice even when faced challenging and demanding situations. For example, monitoring patient vital signs and recognizing abnormalities, administering and monitoring medications. Last week, I received hand off on a patient receiving intravenous antibiotics who developed a rash on his back and the doctor was convinced that it was not medication related despite my many attempts to convince him that it is was indeed an allergic reaction and possibly Steven Johnson’s disease. After a dismissal from the doctor, I went to my supervisor to express my concerns about this case and wound care was consulted. Patient merely got worse and soon after he was transferred to the burn unit for Steven’s Johnsons disease. There are several characteristics associated with accountability, including dependability, confidentiality, acting as a patient advocate, and ensuring best practices are followed.

Reference

Faubion, D. (2023). 10 Ways to Demonstrate Accountability in Nursing Practice. 10 Ways to Demonstrate Accountability in Nursing Practice (nursingprocess.org)

As nurses must always practice with integrity and professional accountability (Faubion, 2023). Although we all think that we practice this way there can be times that even the most respectful nurse can fall short and loose their sense of responsibility to the profession and to their patient. I had a mentor who always showed great leadership skills, was trustworthy, respected and kind. She always seemed to advocate for her patients and worked within her scope of practice and I would rarely see her encounter situations she could not handle. Except for one incident where she went against the code professional accountability of doing no harm. She was the top provider for the medical spa I work for which means she had a high patient retention rate and top sales. She was sought after from local patients and patients within the entertainment industry. Sometimes patients who work in front of the camera can be more demanding and this was the case this particular incident. The patient came in with a dilemma. She needed to be in front of the camera in a matter of weeks and just found out she was pregnant. She insisted of receiving a neuromodulator treatment to soften fine lines so she appears “presentable” in front of the camera. After a hour of back and forth conversation and persuasion form the patient the nurse decided to go against what we have been taught and that is that you never inject and neuromodulator or fillers to a patient who is or suspected to be pregnant. She violated a code of conduct that could have potentially put the patient and her fetus in danger. In the moment I was extremely disappointed in her for not holding her ground and going against her morals and acted without integrity to herself and the practice. She should have not let the pressure of working with a high profile patient or let the patient control the situation. She should have shown more professional accountability.

Faubion, D. (2023). 10 Ways to Demonstrate Accountability in Nursing Practice. 10 Ways to Demonstrate Accountability in Nursing Practice (nursingprocess.org)

Upon starting my shift, I overheard a patient complaining and yelling. When I went to the patient, the patient told me that his nurse never came to him since he arrived. He also mentioned he’s been waiting for at least four hours for his due pain medication. When I assessed him, I noticed swelling in his knee and he seemed to be in a lot of pain. I apologized to the patient and told him that I will check his chart and help him. When I stepped away, I realized that the nurse hadn’t seen the patient in a little over four hours. I checked the chart for orders and administered the patients pain medication. I apologized to the patient for the inconvenience and reassured him that if he needed anything to use the call bell and I’ll come and help. I came back 30 minutes later to assess if the pain medication helped. He was very relieved and thanked me. After making sure that the patient was dealt with, I spoke to the nurse that was assigned to the patient. The nurse stated that she had a terminal break and never came back because she started to feel sick. I told the nurse that the patient was seen by me and is now comfortable and relieved of pain. I believe that this was professional accountability because I could have called the nurse back to take care of her patient, but I didn’t. I decided to take responsibility and care for the patient’s needs.

NRS 430 Outline the concept of professional accountability as it pertains to nursing