Nursing Assignment: Accountability of Registered Nurses in Practice

This assignment examines the critical topic of Registered Nurse (RN) accountability in healthcare, arguing that RNs should be held responsible for their own practice. The paper defines key terms such as RN, accountability, delegation, and enrolled nurse (EN), setting the foundation for its argument. It explores the responsibilities of RNs based on the Nursing and Midwifery Board of Australia (NMBA) standards, highlighting their legal and professional obligations, including the need for professional indemnity insurance. The assignment details the importance of autonomy in practice, and emphasizes the accountabilities of RNs in delegation, supervision, and documentation. It also discusses the various standards and codes of conduct that govern RN practice in Australia, including the Code of Professional Conduct, Code of Ethics, and Competency Standards. The assignment concludes by reinforcing the necessity of RN accountability within the framework of healthcare regulations, emphasizing the consequences of negligence and incompetence.

Running head: NURSING ASSIGNMENT
1
Nursing Assignment
Student’s Name
University Affiliation

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Should registered nurses be held accountable for their own practice?
Introduction
Registered Nurses (RNs) are fundamental in the delivery of care in a wide variety of
settings. RNs deliver and coordinate patient care, patient education, provide advice and
emotional support. This assignment aims to shows that registered nurses should be held
accountable for their own practice. The paper will first define the key terms that will be used
throughout to support this argument. Then the assignment will go on to discuss the
accountabilities of RNs nurses based on the nursing standards for practice, authority regulations
and the standards established by the Nursing and Midwifery Board of Australia (NMBA).
An RN is an individual, who has attained the required or prescribed education, exhibits
proficiency to practice, and is registered under the Health Practitioner Regulation Nation Laws as
a registered nurse in Australia. RNs undertake tertiary level degrees (Jacob, Sellick, & McKenna,
2012).
Accountability means that nurses are liable or answerable to the patients in their care,
nursing regulatory authorities, their employer and the general public (Battié & Steelman, 2014).
For RNs, accountability cannot be delegated.
Delegation is the professional relationship that prevails when a registered nurse delegates
activities of their nursing practice to another health care professional such as student, nurse,
enrolled nurse (EN) or a person who is in another discipline other than nursing. Delegation aims
to meet client’s needs and enable access to readily available care delivered by the right person
(ANMF, 2015).

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Enrolled nurse (EN) is an individual who delivers nursing care with the direct or
indirect supervision of an RN. This person has attained the required education level and exhibits
proficiency to practice under the Health Practitioner Regulation Nation Laws as an enrolled
nurse in Australia. EN is trained at vocational education level (Jacob, Sellick, & McKenna,
2012).
Documentation is written or electronically generated information that elucidated the
condition of a patient or the type of care or service delivered to that patient. The client
information is gotten through the nursing process (NMBA, 2015).
Should registered nurses be held accountable for their own practice?
As regulated health care providers, RNs should be accountable for their own practice. In
Australia, RNs are left to practice “unsupervised” and do not deliver care for or on behalf of any
other healthcare professionals (Australian Nursing Federation, 2011). This aspect differentiates
RNs from other nurse practitioners who are often supervised when delivering care. An RN
should directly or indirectly supervise enrolled nurses when they work in general practice.
Indirect supervision occurs when the RNs can be easily contacted but are not involved in direct
supervision of the ENs as they perform their duties (Daly, Speedy, & Jackson, 2009). The RNs
might be away from the care setting, but should be available for constant, direct communication
with the ENs. The absence of proximity needs solid processes to be instituted for the direction,
support and supervision of the activities of ENs. While ENs are responsible for their own action
in practice, the RNs are accountable for their decisions made in practice. In a general practice
setting, nurses offer multidisciplinary care. They collaborate with other health professionals to

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offer care with a focus on a positive outcome for all patients (Australian Nursing Federation,
2011).
Accountability and responsibility are fundamental for RNs, but they are different aspects.
Responsibility is the obligation to conduct tasks and roles applying sound professional judgment
and being liable for all the decisions made in practice. (Kraak, Swinburn, & Lawrence, 2014)
RNs have greater responsibility due to the scope of their practice.
Based on the standards of practice outlined by the Nursing and Midwifery Board of
Australia (NMBA), RNs are accountable professionally and legally for their own practice.
Besides, RNs are accountable to their clients, the public and their regulatory body as well as
supervisory authority. In legal accountability, RNs are liable for making sure they have suitable
professional indemnity insurance (PII) (NMBA, 2017). Patients expect RNs to hold PII, which
would help to address any risk in case there is corroborate the claim of professional negligence.
RNs achieve accountability by having autonomy to practice. Autonomy is having the capacity to
make decisions within the profession. It also entails having the right as well as the responsibility
to perform according to the standards of nursing practice. RNs practice autonomy since they the
ability to use critical skills in practice. Also, they have the knowledge and motivation to practice
based on the institutional, legislative and personal factors.
For effective accountability, RNs need continuous critical thinking and evaluation in the
context of thoughtful sustenance and creation of constructive relationships. As such, RNs should
continue to advance professionally and sustain their capacity for professional practice. RNs are
liable to deliver safe and coordinate quality nursing practice. Their practice entails
comprehensive analysis, designing of a plan, implementation and appraisal of outcomes. In their

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practice, RNs are accountable for the delegation and supervision of nursing roles to enrolled
nurses (ENs) and other healthcare professionals (Lee, Goeman, Johnson, Thorn, Koch, & Elliott,
2015). Thus, the primary accountabilities are supervision and delegation. Other kinds of
accountability are referral and documentation of practice. An RN who delegates duties to another
health professional such as ENs is accountable to their decision to delegate. Also, the RN is
accountable for delegating the duties to the right person, monitoring the performance of the
duties and assessing the outcomes. The delegation decision is made should be made by the RN
and the person who will perform the delegated duties (ANMF, 2015). In the process of
delegation, the RN should access the risks and capabilities. Competency evaluation and teaching
might precede the delegation.
The accountability of nurses to delegation is different from allocation or assignment of
duties, which entails requesting another health care professional to care for a certain patient on
the presumption that the needed activities for consumer care are usually within that individual’s
roles and scope of practice. RNs should understand that most of the similar elements concerning
competence analysis and supervision that are pertinent to delegation also require being regarded
in relation to assignment or allocation. The accountability for delegation for RNs is broad and
requires observing various responsibilities. To sustain the required standards of care when
delegating roles, RNs should embrace responsibility in various contexts. The first liability is
teaching the person who will conduct the delegated role (Berman, et al., 2014). However, the
role of teaching might be performed by another competent healthcare professional. Competence
evaluation is a fundamental aspect of the accountability for delegation among the RNs. They
should also offer assistance and support as well as clinically-focused supervision. These
liabilities are aimed towards ensuring that the person to whom the delegation is being made

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recognises and understands their role and is ready to accept the delegation. After the delegated
roles have been completed the RNs should evaluate the outcomes and reflect on practice.
Another form of accountability for RNs occurs during referral. Often primary health care
responsibilities are transferred to another more qualified health professional or health service
provider. The RN is accountable for their decision to refer a patient to another health service
provider. As a result, the RN might be required to continue offering professional help and
services collaboratively in the process of referral (Australian College of Nursing, 2015).
RNs have professional accountability for documentation. According to the professional
standards, RNs should document timely and right reports of assessment, decisions about a
patient’s condition, treatment and outcomes. Documentation is fundamental for RNs because it
serves three main purposes; facilitates communication, enhances safe and right nursing care and
meet legal and professional standards. Through documentation, RNs communicate to other
health care professionals their nursing assessments, diagnosis and the treatment plan for a certain
client (McKenzie & Porter, 2007). When an RN documents the care they deliver, other health
care professionals can review the documentation and make their own contributions to safe and
right care. The documentation further offers medical data for workload management and
research. Documentation shows that a nurse has applied nursing skills and knowledge as outlined
by NMBA. Hence, documentation acts an evidence of legal proceedings and practice (Stevens &
Pickering, 2010). RNs are accountable to their employer. When seeking employment, the nurses
are given a set of guidelines and principles that should govern their practice. They should adhere
to these guidelines in all their practice. In case they breach the guidelines or exhibit negligence,
the RNs would be accountable to their employer.

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RNs exhibit these accountabilities by following the nursing standards of practice. The
standards of practices are classified into four domains including professional practice, critical
thinking and appraisal, provision and coordination of care. Professional practice relates to
ethical, legal and professional liabilities which require expression of a competence knowledge
base, accountability for practice and practising according to legislation impacting nursing and
health care. The professional practice also requires protection of personal and group rights. It can
be thought as the observation of human rights and human dignity. There are several tenets of the
professional practice which guide the practice of RNs. The nurses should observe the legislation
governing their practice and fulfil the duty of care (ANMAC, 2013).
Critical thinking and analysis is another theme that causes RNs to be accountable in their
practice. RNs should conduct self-evaluation, be accountable for their professional development
and exhibit the value of research and evidence for practice (Ross, Barr, & Stevens, 2013). They
should practice within an evidence-based framework. RNs are accountable for identifying the
relevant research on enhancing individual or group health outcomes. In doing so, they should
utilise the best available evidence, nursing knowledge and respect for values of their clients. The
demonstration of analytical abilities in assessing health information and research evidence is
required in offering care (Nurisng and Midwifery Board of Australia (NMBA), 2017) Each nurse
should be involved in nursing research and participate in ongoing professional development.
The third domain is the provision and coordination of care. Under this standard of
practice, RNs coordinates, organise and provides nursing care that includes the analysis of
personal or groups, designing and implementation and appraisal of care (Ehrlich, Kendall, &
John, 2013). The last domain that guides nursing practice in Australia is collaborative and
therapeutic practice. In this theme, the nurses establish, sustain and conclude professional

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relations with individuals or groups. Additionally, this theme emphasises on the competencies
that RNs should exhibit when offering care. The nurses should also understand the contributions
of Interdisciplinary health care team (Edmonds, Cashin, & Heartfield, 2016).
The RNs in Australia are governed by multiple professional standards in their practice.
Firstly, they should be practised according to the Code of Professional Conduct for Nurses in
Australia. Secondly, nurses should adhere to the Code of Ethics for Nurses in Australia. This
standard is pertinent to all nurses in different levels in Australia. The purpose of the Code of
Ethics is to determine the fundamental ethical standards and values that guide nursing profession.
Also, it offers nurses a reference point from which to deliver professional care (Zahedi, et al.,
2013). Thirdly, there is ICN Code of Ethics for Nurses which decide professional standards in
Australia. Fourthly, professional nursing is governed by the NMBA Competency Standards for
Registered Nurses. Finally, professional nursing is governed by the NMBA National Framework
for the Development of Decision-Making Tools. There are, however, other standards that have
been endorsed and published by the NMBA. RNs in Australia are required to exhibit the
understanding and application of these nursing standards in practice. Based on the Health
Practitioner Regulation National Law Act 2010, a nurse can be punished for incompetence or
negligence, which is a failure to exhibit accountability (Attorney-General's Department, 2014).
Besides, failure to comply with the provisions of this Act can be viewed as lack of
accountability.
Conclusion
This assignment has argued that RNs should be held accountable for their own practice
since they do not offer care on behalf of any other healthcare professional. The RNs should be

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accountable to the patients, the public, their employer, and regulatory authorities. Specifically,
the RNs are accountable for delegation of certain aspects of their nursing practice, referral of
patients, and documentation. Also, they are liable for ongoing professional development, critical
thinking and analysis and promotion of patient-centred practice. The RNs are accountable for
their own practice because they are governed by nursing standards for practice. Conclusively,
RNs should demonstrate competence in nursing practice because they are answerable for their
decisions.

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References
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Edmonds, L., Cashin, A., & Heartfield, M. (2016). Comparison of Australian specialty nurse
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Framework-for-assessing-national-competency-standards.aspx

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