Creating a More Accountable Staff - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

I visited a clinical site recently where one of my graduate students was doing an administrative practicum. She had an incredibly good experience with a very dynamic nurse leader. She was however surprised at the lack of accountability she observed in many RN staff when challenges with performance measures were being discussed. This is a good organization with an important mission yet her perception was that many of the nursing staff did not care about the mission, vision or values. Attempts by their leadership to engage them and hold them accountable were not working. What my student observed in this clinical setting is not that unusual.

Ethicists have commented that there has been a change in the willingness of individuals to accept responsibility. for their behavior. The culture has instead become one of blame. Not surprisingly, the issue of professional accountability in nursing has become a concern in many healthcare environments. We talk about nursing professional accountability as though nurses share a common definition and understanding of what it means. Dr. Maria O’Rourke has spent a good part of her career working with nurses on role development and role socialization. She makes a strong case about the need for nurse leaders to take an active role and be intentional in helping staff to understand their professional role, responsibility and accountability for their actions.

So how can leaders help foster professional accountability in nursing? The following are five important strategies:

1. Be clear about professional role responsibilities and organizational goals

I had a wise mentor who once told me that when you are experiencing a leadership problem – go back to the basics as a starting point. I believe this to be true about professional accountability. Don’t assume that all professional nurses have a clear understanding of their role or what is expected of them. You might be surprised if you ask questions at a staff meeting about the role of an RN to see what answers emerge, but more important what does not as part of role accountability.

2. Provide direction about how work should be accomplished

Clarity in leadership can be one of the most difficult challenges. You may think you have been very clear about your expectations – only to learn that they were misunderstood. Nurses need to know from their leaders how the work should be accomplished and once is not enough.

3. Develop clear standards and metrics against which professional performance is measured

Nurse leaders need to seek commitment from staff and set standards for role expectations. It is often said that what is measured is what is done so be clear about how role expectations will be measured. These expectations should not only include work performance but also interpersonal skills. A contribution to unit performance measures needs to be part of performance standards.

4. Hold professionals accountable for their behavior

I believe that the single biggest issue with professional accountability is that nurses are often not held accountable for their decisions and actions by their leaders. In the best of all possible worlds, professional staff would come to work and meet their performance expectations with little leadership intervention. Unfortunately, we are not living in that world and nurse leaders do need to spend time coaching their staff. Early intervention with performance issues is key as is providing follow-up support.

5. Build a culture of accountability

Building a culture of professional accountability is key to promoting personal accountability among staff. Staff know when “good enough” is the culture of an organization. I have served as an expert witness for my state board of nursing in Florida. A disturbing fact that emerges when staff are brought up for disciplinary actions for failing to meet expected standards of care is their behavior is that unprofessional behavior has been tolerated often for a long period of time by an employer. There needs to be team accountability to commitments and personal relationships. Marcia Rachel has observed that accountability is at the heart of nursing. Patients trust us to do the right thing and this should be a shared accountability with nursing staff.

Read to Lead

Rachel, M.M. (2012). Accountability: A concept worth revisiting. American Nurse Today. 7(3). 36 – 40.