Accountability is a key concern for nurses and midwives in the NHS today. Professional accountability—being responsible for your actions and for the outcomes of these actions—is part of the framework of clinical governance, which aims to provide good quality, cost-effective, evidence-based care. The second edition of Accountability in Nursing and Midwifery addresses current issues and key concerns in accountability, focusing on accountability in the four main branches of nursing (adult, child, learning disabilities and mental health), as well as in midwifery, community nursing, and nursing management. In an increasingly litigious society, the ethical and legal implications of accountability are growing and it is important that nurses understand the implications for everyday practice.

Table of Contents:
Contributors xi Preface xiii 1 Introduction 1 Roger Watson and Stephen Tilley Historical perspective 1 An accountant looks at nursing 1 Accountability and clinical governance 2 Accountability and the law 2 A policy perspective 3 An NHS trust perspective 3 A manager speaks 4 Caring for children 4 Learning disabilities 5 Midwifery 5 Community nursing 6 Mental health nursing 7 Research 8 Conclusion 8 2 The Development of Nursing as an Accountable Profession 9 Susan McGann Introduction 9 Historical perspective 9 The British Nurses’ Association 10 Mrs Bedford Fenwick 10 Professional registration 12 Matrons’ Council of Great Britain and Ireland 12 Political perspective 14 Early registration bill 15 The war 16 Registration Act 1919 18 Conclusions 19 3 Accountability and Clinical Governance in Nursing: a Critical Overview of the Topic 21 Kerry Jacobs Introduction 21 Accountability 26 Accountability and reform 30 Clinical governance 32 Conclusion 36 4 Accountability and Clinical Governance 38 Roger Watson Introduction 38 Clinical governance 39 Why do we have clinical governance? 39 Poor care 42 Short cuts 43 Trust 44 Conclusion 45 5 The Legal Accountability of the Nurse 47 John Tingle Introduction 47 The concept of accountability and the new NHS 47 Accountability is not irrelevant 48 Labels can obscure meanings 48 Ideas behind the label 48 This chapter 48 Legal accountability 49 Interests, rights and duties: the role of the law 49 The Ms B. case 49 Dispute resolution, compensation and punishment 50 Establishing nursing negligence 50 Vicarious liability 51 The aim of the law: compensation 51 Clinical negligence law today: all change? 51 Regulation, deterrence and education: the role of the law 52 Evidence-based healthcare and the courts 54 The scandals of recent years 54 The law affects all aspects of nursing 55 The various forms of accountability 55 Accountable to whom? 56 Accountability and sanctions 57 The allocation and management of healthcare resources: the nurse’s role 58 A conflict of accountability 58 The role of the law: legal accountability 59 Cases of resource and negligence 59 Conclusion 63 6 Accountability and Clinical Governance: a Policy Perspective 64 Tracey Heath Introduction 64 Background: the NHS pre-1997 64 The Labour Government’s challenge 66 Practising within an era of increasing accountability 68 Towards a modern and dependable NHS: the Labour Government’s response 68 Accountability and clinical governance 70 Organisational accountability 70 Reflections on the broader policy context 74 Conclusion 76 7 Accountability in NHS Trusts 77 Stephen Knight and Tony Hostick Introduction 77 Clinical governance 77 Responsibilities of trusts 78 Professional self-regulation 82 A systematic approach to decision making 84 Implications for practice 84 Conclusion 86 8 Accountability and Clinical Governance in Nursing: a Manager’s Perspective 87 Linda Pollock Introduction 87 Background context 87 Clinical governance as a concept 88 The meaning of clinical governance 88 Our interpretation of clinical governance 89 Has clinical governance made a difference? 91 Clinical governance and its impact at board level 91 Clinical governance structures as a vehicle for change 92 Clinical governance and people governance 93 Clinical governance and its impact on nursing 95 Clinical governance and cultural change 96 Sharing good practice 97 Evidence-based practice – the reality 98 9 Working with Children: Accountability and Paediatric Nursing 99 Gosia Brykczyñska Introduction 99 Definition of paediatric nursing 100 Ability 101 Obligations 103 Involving parents 104 Autonomy of children 106 Authority 107 Free will and choice 108 Power and political action 109 Responsibility 111 Responsibilities for treatment 111 Consequences of responsibility 113 Responsibility of parents and children 114 Conclusion 116 10 Accountability and Clinical Governance in Learning Disability Nursing 117 Bob Gates, Mick Wolverson and Jane Wray Introduction 117 Clinical governance in learning disability nursing and guidelines for practice 118 Consent 120 Interdisciplinary working 120 Evidence-based practice 121 Advocacy 121 Autonomy 121 Relationships 122 Confidentiality 122 Risk assessment and management 122 The challenges of effectively implementing clinical governance in services for people with learning disabilities 123 Fragmented partnership working 125 User and carer involvement 125 The spectrum of need 126 Quality of life 126 Solutions to the barriers associated with implementing clinical governance in learning disability services 127 Conclusion 131 11 Where does the Buck Stop? Accountability in Midwifery 132 Rosemary Mander Introduction 132 What is meant by accountability? 133 To whom is the midwife accountable? 134 Institutional accountability 135 Accountability to the woman 136 Personal accountability 136 Professional accountability 137 Hierarchy of accountability 138 Accountability and autonomy 139 What are the prerequisites for accountable midwifery practice? 140 What are the implications of the midwife being accountable? 141 Conclusion 141 12 Accountability in Community Nursing 143 Sarah Baggaley with Alison Bryans Introduction 143 Organisational and policy issues affecting the accountability of community nursing 143 Current issues in community nursing 145 Resource allocation and skill mix 145 Delegation and skill mix 145 Legal and professional issues in community nursing 147 Clinical governance 148 Clinical effectiveness and evidence-based practice 149 Role developments 150 Nurse prescribing 152 Primary healthcare and public health nursing 153 Conclusion 156 13 Clinical Governance, Accountability and Mental Health Nursing: an Emergent Story 157 Stephen Tilley Introduction 157 Review of themes from Tilley (1995) 158 The centrality of the topic 158 Accounts 160 Accounting 161 Accountability 162 Accountability and clinical governance 164 The role of the mental health nurse in clinical governance 167 14 Accountability in Nursing Research 170 Alison Tierney and Roger Watson Introduction 170 Research as a responsibility of an accountable profession 170 Accountability in nursing research 171 Nurse researchers as nurses 172 The importance of accountability in research 172 To whom are nurse researchers accountable? 173 Accountability to the sponsor 174 Accountability to research ethics committees 176 Accountability to research participants 178 Accountability to research ‘gatekeepers’ 182 Accountability to (and of) the profession 185 Accountability to the wider public 186 Tensions of multiple accountability 187 Conclusion 189 Appendix Code of Professional Conduct 190 (Reproduced with permission of the Nursing and Midwifery Council) References 198 Index 216