Holding Nurses Accountable for Mistakes

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

What do you do when an experienced nurse will not take responsibility for her mistakes? This is a performance management issue that a nurse manager recently discussed in a leadership development program. The manager had tried many approaches over a five-year time-frame to help this nurse gain insight into her behavior but none seemed to work. The manager felt the nurse’s emotional self-awareness was low and she identifies herself as a perfectionist. We know that while a little perfectionism can be a good thing, too much can be a double-edged sword. Perfectionists who lack self-awareness often derail themselves. Their excessive worry about failure accompanied by low self-esteem can lead to an inability to assume full responsibility for their actions.

This manager is in a tough spot. She can’t force this nurse to take responsibility for their actions. What she can do is to look at her own approach in working with this nurse. The commonly held construct of responsibility is built like a who-done-it mystery built on a cause and effect model. We look for who contributed to the problem and who did not accept accountability in the situation. Not surprisingly, some staff react to any insinuation where it looks like they are being blamed. Daphne Scott, a leadership expert, recommends that leaders change this approach to a paradigm that involves many levels of participation. This approach is more solutions-focused than problem focused.

As an example if an order was missed on a patient under a nurse’s care who pushes back on taking responsibility, a solutions-centered approach would focus on the fact that medication was given late. The goal is to prevent this from happening in the future. Some good coaching questions include:

What needs to happen now?
What solutions can we generate to allow everyone involved to be successful in the future?
How can this be avoided in the future?
What can we learn from this?

This manager will need to be firm and courageous, and wiling to tolerate some conflict with the nurse. People who don’t take responsibility often play the blame game. If the manager notices the nurse is starting to point the finger of blame, she needs to stop her immediately. The focus needs to move away from assigning blame, and, instead, direct it to what needs to be done to fix the problem and move forward. There is solid research evidence that solutions-focused performance management coaching works better than problem-oriented performance management coaching.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave

Read to Lead

Scott, D. (July 7th, 2016 Forbes Blog) How to get your employees to take responsibility.