1. Accountability in Nursing for Safe Patient-Centered Care
Melissa Lynn, MSN, RN, CMSRN
Florida Gulf Coast University, School of Nursing
PURPOSE
DISCUSSION
Holding nurses accountable for patient errors does not decrease nurses’ self-esteem, job satisfaction, or quality of care.
Encouraging nursing leaders to hold nurses accountable for their patient care practice increases morale, teamwork, patient satisfaction, and patient safety.
Factors Contributing to Nursing Errors
Four studies of nurses, which included over 750 total participants, found some similar themes and associated factors that contribute to nursing errors.
Staffing/Workload
Nurses are overwhelmed, fatigued.
Nurses are in a hurry to complete tasks and are often distracted.
Accountability
Policies are not followed.
Expectations and consequences are unclear.
Teamwork and Communication
Patient safety and preventable errors decrease as teamwork and communication increases.
INTRODUCTION
More than 1,000 hospitalized patients die each day due to preventable hospital errors.6
Up to 440,000 hospitalized patients die annually from hospital-acquired infections, injuries, and avoidable errors.6
Approximately1.5 million hospitalized patients suffer injuries annually.9
Prevention has not focused on nurses’ professional accountability for providing safe, quality patient care.
“Accountability at its finest communicates organizational values, establishes boundaries for acceptable behaviors, explicates excellence, and creates psychological safety within a just culture that ultimately safeguards patients.”
Elizabeth Duthie, RN, PhD, 2015
“If you are building a culture where honest expectations are communicated and peer accountability is the norm, then the group will address poor performance and attitudes.”
Henry Cloud
RESULTS
Perceptions
A survey of 202 nurses revealed 94% agree that medication errors should be reported, yet only 87% felt that managers should keep track of nurses’ errors. Even fewer, 77%, felt that clients and/or families had a right to know about errors. 4
A cross-sectional survey of 393 hospital-based RNs revealed 4 themes contributing to nursing errors:
Loss of focus
Unhealthy work environment
Interpersonal deficits
Being overwhelmed.
A survey of 393 hospital-based RNs revealed that feeling overwhelmed and overworked were the most important factors contributing to nursing errors. Critical thinking was also listed as a top contributing factor, but the nurses felt it was not one of the most modifiable factors.9
A comparison between nursing units found that higher-performing units reported more teamwork, communication, accountability, trust, and leadership. The higher-performing units had less turnover, increased retention rates, and greater staff satisfaction.5
Nurse Leader Actions
Nurse leaders must first hold themselves accountable for actions and outcomes when creating a culture of accountability.1
Nurse leaders need to examine the context and intent of the nurses’ actions or inactions.3
Enforcing consequences based solely upon the outcome destroys trust in the leadership.7
Increased team engagement leads to increased individual and team accountability.
Engaged nurse leaders are willing to mentor and teach, resulting in higher-performing teams.5
METHODOLOGY
CONCLUSIONS
Literature Review
Key Words
Errors
Error Prevention
Accountability
Patient Safety
Error Reporting
Cumulative Index to Nursing and Allied Health Literature (CINAHL)
Ovid Nursing & Health Professions Premier Collection
Eight Articles Utilized
Two Descriptive quantitative and qualitative studies
One Cross-sectional qualitative study
One Grounded exploratory study
One Organizational position statement
Two Scholarly articles
One Expert Opinion
Utilizing evidence-based principles to keep staff nurses accountable for their practice increases patient safety and quality of patient care.
Setting clear expectations of nurses with well-defined consequences for not following standards of care creates a culture of accountability.
Involving beside nurses in establishing and setting expectations builds commitment and effectiveness.
Holding nurses accountable to one another, nurse leaders, and patients increases teamwork, job satisfaction, patient safety, and patient satisfaction.
Building teamwork promotes individual accountability.
REFERENCES
Available upon request.