Accountability in Nursing and Midwifery (eBook)

Stephen Tilley is a Senior Lecturer in Nursing Studies at the University of Edinburgh. Roger Watson is a Professor of Nursing in the School of Nursing, Social Work and Applied Health Studies at the University of Hull.

Contents 7
Contributors 13
Preface 15
1 Introduction 17
Historical perspective 17
An accountant looks at nursing 17
Accountability and clinical governance 18
Accountability and the law 18
A policy perspective 19
An NHS trust perspective 19
A manager speaks 20
Caring for children 20
Learning disabilities 21
Midwifery 21
Community nursing 22
Mental health nursing 23
Research 24
Conclusion 24
2 The Development of Nursing as an Accountable Profession 25
Introduction 25
Historical perspective 25
The British Nurses’ Association 26
Mrs Bedford Fenwick 26
Professional registration 28
Matrons’ Council of Great Britain and Ireland 28
Political perspective 30
Early registration bill 31
The war 32
Registration Act 1919 34
Conclusions 35
3 Accountability and Clinical Governance in Nursing: a Critical Overview of the Topic 37
Introduction 37
Accountability 42
Accountability and reform 46
Clinical governance 48
Conclusion 52
4 Accountability and Clinical Governance 54
Introduction 54
Clinical governance 55
Why do we have clinical governance? 55
Poor care 58
Short cuts 59
Trust 60
Conclusion 61
5 The Legal Accountability of the Nurse 63
Introduction 63
The concept of accountability and the new NHS 63
Accountability is not irrelevant 64
Labels can obscure meanings 64
Ideas behind the label 64
This chapter 64
Legal accountability 65
Interests, rights and duties: the role of the law 65
The Ms B. case 65
Dispute resolution, compensation and punishment 66
Establishing nursing negligence 66
Vicarious liability 67
The aim of the law: compensation 67
Clinical negligence law today: all change? 67
Regulation, deterrence and education: the role of the law 68
Evidence-based healthcare and the courts 70
The scandals of recent years 70
The law affects all aspects of nursing 71
The various forms of accountability 71
Accountable to whom? 72
Accountability and sanctions 73
The allocation and management of healthcare resources: the nurse’s role 74
A con.ict of accountability 74
The role of the law: legal accountability 75
Cases of resource and negligence 75
Conclusion 79
6 Accountability and Clinical Governance: a Policy Perspective 80
Introduction 80
Background: the NHS pre-1997 80
The Labour Government’s challenge 82
Practising within an era of increasing accountability 84
Towards a modern and dependable NHS: the Labour Government’s response 84
Accountability and clinical governance 86
Organisational accountability 86
Reflections on the broader policy context 90
Conclusion 92
7 Accountability in NHS Trusts 93
Introduction 93
Clinical governance 93
Responsibilities of trusts 94
Professional self-regulation 98
A systematic approach to decision making 100
Implications for practice 100
Conclusion 102
8 Accountability and Clinical Governance in Nursing: a Manager’s Perspective 103
Introduction 103
Background context 103
Clinical governance as a concept 104
The meaning of clinical governance 104
Our interpretation of clinical governance 105
Has clinical governance made a difference? 107
Clinical governance and its impact at board level 107
Clinical governance structures as a vehicle for change 108
Clinical governance and people governance 109
Clinical governance and its impact on nursing 111
Clinical governance and cultural change 112
Sharing good practice 113
Evidence-based practice – the reality 114
9 Working with Children: Accountability and Paediatric Nursing 115
Introduction 115
Definition of paediatric nursing 116
Ability 117
Obligations 119
Involving parents 120
Autonomy of children 122
Authority 123
Free will and choice 124
Power and political action 125
Responsibility 127
Responsibilities for treatment 127
Consequences of responsibility 129
Responsibility of parents and children 130
Conclusion 132
10 Accountability and Clinical Governance in Learning Disability Nursing 133
Introduction 133
Clinical governance in learning disability nursing and guidelines for practice 134
Consent 136
Interdisciplinary working 136
Evidence-based practice 137
Advocacy 137
Autonomy 137
Relationships 138
Confidentiality 138
Risk assessment and management 138
The challenges of effectively implementing clinical governance in services for people with learning disabilities 139
Fragmented partnership working 141
User and carer involvement 141
The spectrum of need 142
Quality of life 142
Solutions to the barriers associated with implementing clinical governance in learning disability services 143
Conclusion 147
11 Where does the Buck Stop? Accountability in Midwifery 148
Introduction 148
What is meant by accountability? 149
To whom is the midwife accountable? 150
Institutional accountability 151
Accountability to the woman 152
Personal accountability 152
Professional accountability 153
Hierarchy of accountability 154
Accountability and autonomy 155
What are the prerequisites for accountable midwifery practice? 156
What are the implications of the midwife being accountable? 157
Conclusion 157
12 Accountability in Community Nursing 159
Introduction 159
Organisational and policy issues affecting the accountability of community nursing 159
Current issues in community nursing 161
Resource allocation and skill mix 161
Delegation and skill mix 161
Legal and professional issues in community nursing 163
Clinical governance 164
Clinical effectiveness and evidence-based practice 165
Role developments 166
Nurse prescribing 168
Primary healthcare and public health nursing 169
Conclusion 172
13 Clinical Governance, Accountability and Mental Health Nursing: an Emergent Story 173
Introduction 173
Review of themes from Tilley (1995) 174
The centrality of the topic 174
Accounts 176
Accounting 177
Accountability 178
Accountability and clinical governance 180
The role of the mental health nurse in clinical governance 183
14 Accountability in Nursing Research 186
Introduction 186
Research as a responsibility of an accountable profession 186
Accountability in nursing research 187
Nurse researchers as nurses 188
The importance of accountability in research 188
To whom are nurse researchers accountable? 189
Accountability to the sponsor 190
Accountability to research ethics committees 192
Accountability to research participants 194
Accountability to research ‘gatekeepers’ 198
Accountability to (and of) the profession 201
Accountability to the wider public 202
Tensions of multiple accountability 203
Conclusion 205
Appendix Code of Professional Conduct (Reproduced with permission of the Nursing and Midwifery Council) 206
References 214
Index 232

'This interesting book would be an ideal reference source
particularly for students and post graduate/ registration nurses
undertaking professional studies in nursing.'

Journal of Neonatal Nursing

'This book is enjoyable and thought provoking and would be of
use to alI nurses, particularly those with an interest in clinical
governance or those who are wishing to expand their clinical
roles.'

Nursing Standard

''If you are looking for a book with opinions on
accountability, this book is for you... A great reference for the
library.'

Journal of Advanced Nursing

"This book has attempted successfully to address the whole
issue of accountability and clinical governance in a truly holistic
way... It is a book that is neither simple nor abstruse but
succeeds in placing all the threads together in order to clarify
the truth behing accountability and clinical governance."

Journal of Psychiatric and Mental Health Nursing