The Standard, Winter 2012 - College of Nurses of Ontario

Featureprofessional designation (RN, RPN or NP) and what youare about to do gives the client the opportunity to consentto treatment, to clarify what is about to happen and whois going to do it,” says Angela McNabb, RN, OutreachConsultant for the mental health/corrections and complexcontinuing care/rehabilitation sectors.Nurses are accountable for identifying themselves andexplaining their role. Failing to do so at the beginning ofthe therapeutic nurse-client relationship is among the morecommon issues raised in complaints and reports to theCollege.Why is identification such an essential part ofaccountability? It speaks to your authority and to informedconsent. With so many categories of health care providers,clients can’t be expected to know who is who, addsBarbara Czerniawski, RN, Outreach Consultant for thepaediatrics and academic sectors. “You don’t want clientsmistakenly believing that a personal support worker or anunregulated care provider, for instance, is a nurse. You alsodon’t want anyone who isn’t a nurse to use the protectedtitle.”“The bigger picture is about maintaining publicconfidence,” elaborates Puckrin. “If a client understandsthat you’re a nurse, they can assume that you have theknowledge, skill and judgment to perform a controlled act.The second part is that if the College’s members alwaysidentify themselves, the public can feel confident that theyare receiving care from a regulated professional.”Advocate for the clientNo form of abuse is acceptable. Nurses are accountable foradvocating for clients even when they don’t provide themwith direct care. Nurses must also recognize the potentialfor client abuse, prevent abuse when possible and takeaction to stop it.What if you witness a fellow nurse aggressively shoutingat her client to stop ringing the call bell? The first step inintervening is to remove the nurse from the situation; askto speak privately, outside the room. You could offer theother nurse an opportunity for an explanation, but be sureto provide feedback: you overheard what was said and itdidn’t sound like an appropriate way to interact.What’s your next step? McNabb says you areaccountable for reporting abuse if you see evidence thatyour colleague will not modify their behaviour. ProfessionalStandards, Revised 2002 requires nurses to report to theappropriate authority “any health care team member orcolleague whose actions or behaviours toward clients areunsafe or unprofessional.” This includes verbal abuse.In a situation like this, it can be easy to diminish theAccountability vs.responsibilityWhat’s the difference between responsibilityand accountability? The terms are oftenused interchangeably. The dictionary definesresponsibility in part as being accountable, andaccountability in part as being responsible — nohelp there. Yet when it comes to being anurse, there is a distinction.Professional Standards says: “Each nurse isaccountable to the public and responsible forensuring that her/his practice and conductmeets legislative requirements and thestandards of the profession.“Nurses are responsible for their actions andthe consequences of those actions. They’re alsoaccountable for conducting themselves in waysthat promote respect for the profession.”Is it a matter of semantics? Not at all, saysKaren Puckrin, RN, Manager of Reports. It’sall part of being a regulated professional.Nurses, like everyone, have everyday jobresponsibilities. “But we have an accountabilitybeyond the job or employer,” Puckrin explains.It’s an accountability to the College, to thepublic and to supporting the public’s belief insafe nursing practice.Here’s one way of looking at it: at work, we’reall responsible for something; nurses are alsoaccountable to something.College of Nurses of Ontario the standard winter 201219