Nursing accountability involves being responsible and answerable to someone
outside of ourselves for what we do. Nurses are not only accountable to
their clients, they are also answerable to their client’s families, their communities,
and society at large. This discussion demonstrates how accountability
aligns nicely with the ethic of care because they each embrace caring action;
responsibility for others; universal connectedness; and the protection of vulnerable
people. The assertion is made that nursing accountability is
grounded in the following four moral principles: fidelity, respect for dignity,
respect for worth and respect for self-determination of clients. The specific
way that each of these constructs are played out in the clinical setting is
clearly articulated. A crucial order of priorities in nursing accountability is
proposed and the argument is made that a client’s welfare supersedes all
other responsibilities. Nurses are also responsible to the profession of nursing.
The expectation is that nurses strive to maintain competency to practice,
and that their practice will be guided by the Canadian Nurses Association
(CNA) Code of Ethics and practice standards as dictated by their specific
regulatory body. If an institution’s policies violates nursing values and
ethical responsibilities as laid out in the CNA Code of Ethics, the delivery of
safe, competent, compassionate and ethical care comes first. Explicit strategies
are suggested for nurses to follow when they encounter an ethical conflict
with institutional policy. The case study at the end of the chapter reveals
how a nurse becomes morally distressed when she is asked to withhold
crucial information from her clients that will potentially result in serious
harm.
Keywords: Synergism, Dignity, Disease, Illness, Self-determination, Worth
