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.