Accountability in Nursing

Healthcare organizations are continually challenged to be excellent and successful. It is a pressing concern for healthcare organizations and the need for effective organizing is imperative. (Ramanujam & Rousseau, 2006). The pressure is unrelenting to the leaders and staff to ensure safe and effective patient care. Achieving safe and effective care is not solely directed to clinical care but also to organizational culture. For this reason, most healthcare organizations are gearing towards examining their culture that promotes patient’s safety (Haydar, Cox, Stafford, Rodriguez, & Ballard, 2009).

The differences in culture within the organization originates from the unique healthcare environment that is interplayed by pressures resulting from increased productivity demands, cost containment requirements, embedded hierarchies, and fear of litigation. These pressures are complicated further by changes or differences in the authority, autonomy, empowerment, and roles or values of professionals on the healthcare team (Singer, Falwell, Gaba, Meterko, Hartmann, 2009). These existing pressures create challenges among healthcare professionals to communicate effectively and to build trust among team members. It is ironic how these pressures constantly affect the healthcare team when safety and quality of patient care is dependent on teamwork, accountability, communication, and collaborative work environment (Gerardi, 2005).

Building accountability in the workplace is a collaborative effort. It requires a clear definition of accountability that everyone can agree on and adherence to some basic principles of high performance management and team effort (Zeller & Fontanarosa, 2009). Effective leadership is the key to accountable employees. The nurse leader must know and communicate the strategic direction and core values of the organization to enable the employees understand where the organization is going and what it stands for. A nurse leader must also work with employees as an individual, providing direction and input as well as feedback. (Freeman, McWilliam, MacKinnon, DeLuca, & Rappolt, 2009).

In addition to effective leadership is employees’ engagement. According to Ellis and Sorensen (2007), an engaged employee is the one who knows what to do at work and wants to do the work, which means the employee has the right knowledge as well as the attitude and willingness to do the work. Engaged employees have high levels of energy and are enthusiastic about their work and fully immersed in their work (Ellis & Sorensen, 2007).

Employee engagement is a new model of social contract between companies and their people. It means actively involving its own people in decision-making and change management (Pech, 2009). Each employee needs to understand and believe in the mission statement of the organization and actively work towards its achievement. One should have the freedom to express and develop his ideas at work. Employees who are flexible, committed, and highly motivated have a strong sense of purpose about their work.

Healthcare organization should find ways to adapt their practice to suit different employees’ needs and keep them engage. Providing role clarity, job variety, shared challenges and strategies from time to time, encouraging two-way communication, promoting an open and caring environment, communicating openly and clearly about expectations from the employees, and celebrating individual, team and organizational successes on a sustained basis are strategies that would keep the employees engaged (Welbourne, 2007).

Now that everyone is engaged, it is the role of the nurse leader to monitor the progress of shaping an accountable culture. The nurse leader must evaluate strengths and weaknesses of each employee and its direct effect to the team, identify causes of performance below plan, and allow employees to formulate possible solutions to the identified causes of poor performance. It is also vital to communicate the nurse leader’s direct observation of the employees’ performance.

Accountability in nursing is a means of establishing that employees are aware of their responsibility to maintain safety. It must begin to the highest levels of the organization, and extend down to the teams and individuals. It is a means to secure that the team knows the shared responsibility of safety, both of the patient and one another.



References
Ellis, C. & Sorenson, A. (2007). Assessing employee engagement: The key to improving productivity. Perspectives, 15(1), 45-55.

Freeman, A., McWilliam, C., MacKinnon, J., DeLuca, S., & Rappolt, S. (2009). Health professionals' enactment of their accountability obligations: Doing the best they can. Social Science & Medicine, 69(7), 1063.

Gerardi, D. (2005). The culture of healthcare: How professional and organizational cultures impact conflict management. Georgia Law Review, 21(4), 857-890.

Haydar, Z., Cox, M., Stafford, P., Rodriguez, V., & Ballard, D. (2009). Accelerating best care at Baylor Dallas. Baylor University Medical Center Proceedings, 22(4), 311-315.

Pech, J. (2009). Delegating and devolving power: A case study of engaged employees. Journal of Business Strategy, 30(1), 27-32.

Ramanujam, R. & Rousseau, D. (2006). The challenges are organizational not just clinical. Journal of Organizational Behavior, 27, 811-827.

Schraeder, M., Tears, R., Jordan, M. (2005). Organizational culture in public sector organizations: Promoting change through training and leading by example. Leadership & Organization Development Journal, 26(6), 492-502.

Singer, S., Falwell, A., Gaba, D., Meterko, M., Rosen, A., & Hartmann, C. (2009). Identifying organizational cultures that promote patient safety. Health Care Management Review, 34(4), 300-311.

Welbourne, T. (2007). Employee engagement: Beyond the fad and into the executive suit. Executive Forum, Leader to Leader, 21(5) 45- 51.

Zeller, J. & Fontanarosa, P. (2009). Shared accountability, appropriateness, and quality of surgical care. JAMA: Journal of the American Medical Association, 302(14), 1590-1591.