The Royal College Of Nursing Accountability Essay


Put simply, ‘accountability’ is about taking responsibility for your actions, always ensuring you are competent to do the activity you’ve been asked to perform, and always putting patients’/clients’ interests first.

What it means in practice is that whatever you do in your work as a health care assistant, you should be able to justify it as a sensible course of action. This means that whatever you do:

  • you should know why you’re doing it
  • you should have been properly trained and assessed as being competent to do it
  • you should be doing it as part of an agreed plan of care for the patient/client.

Even though you’ll always be working under the supervision of a registered member of staff who’s accountable for the overall care given by the team, you’re still accountable for what you do as part of the team.

You’re accountable to your patients/clients, to whom you owe what is called a ‘duty of care’. In health care, there will be times when your actions could cause harm to a patient/client if not carried out in a careful and competent way. There are also times when your failure to do something that a health care assistant would normally be expected to do – what is called an ‘omission’ – could also cause a patient/client harm. Health care assistants are legally accountable to patients/clients for any errors they make, or any acts they fail to take, that cause them harm, and  patients/clients are entitled to pursue the case through the civil law. In very extreme cases, where a patient/client has died or suffered serious harm due to an error or omission, the case might be pursued through the criminal courts.

You’re also accountable to your employer, who must set out in your contract of employment the duties you’ll be expected to perform. You then become accountable to the employer for safely and effectively carrying out those duties, and failure to do so can result in disciplinary action. Your employer has accountability to you as well, however, and the RCN has suggested that employers must support you to carry out your duties safely and effectively by:

  • making your duties clear and ensuring you have the right training to carry them out safely and effectively
  • making the boundaries of your role very clear
  • providing agreed protocols to guide care delivery
  • ensuring you have adequate support and supervision in your role
  • offering you opportunities to develop in your role
  • making issues around delegation clear.

Accountability also means complying with the code of conduct for health care workers that applies to you in your country and  any codes your organisation has in place – ask your manager or supervisor to advise you on what codes apply to you, then study them to make sure you comply.

Consent and its influence on Nursing Practice

This assignment will discuss consent and how it influences nursing practice in my area of study, which is adult nursing. According to the Nursing and Midwifery Council Code of Conduct (NMC, 2008), states that healthcare professionals must presumed patients to have the mental capacity to accept or refuse treatment after being given information on their treatment. However there may be instances where healthcare professionals will treat patients without their consent, for example in an emergency situation where the patient is unconscious and lack of the mental capacity to make an informed choice. Treatment in this situation can be given in the patient's best interest. The assignment will define what meant by consent and highlight its importance to the nursing profession. Furthermore, it will draw comparisons and highlight the differences between the adult and mental health nursing fields. Issues of culture and diversity will be address.
Definition of consent
Consent can be defined as the process in which a healthcare professional gives his/her patient correct and truthful information about their treatment and allowing them to make an informed decision without any convincing or fraud (Dimond, 2009). Consent is respecting individual moral and legal rights by giving them independence and freedom to choose what they want (Thomson, 2010). The Royal College of Nursing(RCN) states that, it is essential to good practice that every patients have the right to access information about their condition and the information must be simple and easy to understand and also this information should be correct and honest (RCN, 2013). Department of Health (DH, 2001) defined consent as allowing a competent person to make a decision on their treatment without any pressure or guidance from health professionals, friends, and families, when they have received enough information to make such decision.
Important of consent in adult field
It is legal and ethical principle to seek valid consent before starting treatment or providing essential care for a patient. This will shows the patient's right respected and that is a good fundamental part of good practice (McHale, Tingle 2007).A healthcare professional who does not respect this principle may be liable both to legal action by the patients and principle action by their professional body. Their employer also be accountable for action of their staff (DOH, 2001)
Human Right Act in article 3 state 'prohibition of torture' it means no one shall be subjected to torture or to inhuman or degrading treatment or punishment Human Rights Act (HRA, 1998). In addition, in common law touching a patient without valid consent may create the civil or criminal offence of battery (common law). Any employee who is not follow the legal principle relating to consent to treatment will face criminal, civil, professional conduct and disciplinary action (Dimond, 2009).
In article 14 Human Rights Act state' prohibition of discriminations' health professional should not judge their patients on any ground such as sex ,race colour language religion, political or other opinion, national or social origin, association with a national minority, property ,birth or other status. Compliance with the Human Rights Act is largely reflected in existing good ethical practice, but all health practitioners should be aware of the Human Rights Act and ensure that they act with it (DOH, 2001).
Health professionals should explain the nature of treatment in details as long as it has been explained in aspect the nature of touching will not arise action in trespass (Griffith, Tengnah 2010). For example when a patients believed that she was having a routine post-natal vaccination. In fact she was given the long acting contraceptive Depo-Provera. If health professionals give false and misinformation to the patients consent will be invalid and responsibility in trespass will arise (Griffith, Tengnah 2010).

Influence of consent to the nursing
The NMC Code Conduct states nurses must advocate people's rights to be fully involved in decisions about their care. It is important to give adequate information to enable them to accept or refuse their treatment. Also the NMC code states 'You must respect and support people's rights to accept or decline treatment and care.' If a patient feels the information he/she received inadequate. He/she could lodge a complaint to the NMC or take legal action. The majority of legal action are based on the allegation of negligence because of this nurses must ensure share information with people in a way which they can understand and want to know about their health (NMC, 2010).

It is a fundamental aspect of patient management to seek consent before treatment. It is not only about applying procedures. It is also about information given to the patients to make valid and inform consent (Lake and Harvey 2008). Patients can give consent to treatment through various means, example, it can either be through verbal, written or implied. On the other hand, patients have the right to refuse or withdraw consent in the same way (RCN, 2011). In most cases Implied and verbal consent will be enough evidence but written consent should be obtained in the case of risky, complex and lengthy treatment (Dimond,2009).The discussions that occur between health professionals and the patient before they consent or refusing treatment should be recorded (NMC 2010). There are the duty to seek consent before any medical intervention under National Health Service (NHS) contract of employment, the NMC Code of professional Conduct and the duty under the law (Griffith and Tengnah, 2009).
According to the (NMC 2008) Code of Conduct nurses have three over riding professional responsibilities to ensure that patients understand their options to help them make an informed consent. They should put care of patients their first concern make sure seek consent before any medical intervention or care. As process showing consent is hard nurses should determine a crystal clear level of professional accountability. They should record correctly any discussions and decisions when obtained consent (RCN, 2011). For instance after the doctor has spoken with the patient, ask them open ended questions to ascertain their understanding. (What did the doctor tell you about the procedure?) If the nurse thinks there are unanswered questions or she/he thinks the patient has misconceptions about what they were told, it is the nurse responsibility to alert the doctor prior to them signing.
A competent patient should not treat without consent. It is clearly because protecting their autonomy and their bodily integrity. The law in the UK states all competent adults have the right to refuse medical intervention and care, even though they have nonsense and unacceptable reason for it and health professional must respect their decision (Jackson, 2010). If a patient admitted to hospital as conscious and the capacity to make the decision is lost the health professional only act the best interest to the patient (Brown, et al 2009).

Mental health and consent important

Every patient must be presuming to have the capacity unless this is evidence proof their lack capacity (jones, 2012). The Mental Health Act 2005 provides the legal framework for acting and making decision on behalf of individual who lack the mental capacity to make particular decision for themselves (Brown et al, 2009). Anyone who work with and/ or caring for an adult who may lack capacity to make a specific decision must comply with this Act when making decisions or Acting for that person. The same rules apply whether the decision is life changing events or everyday matters (Jones, 2012). The Mental Capacity Act 2005 section 5 state health professionals who provide care or treatment to the patient should take reasonable step to check patient's capacity. Make sure lack of capacity is relation to the matter and act best interest to the patient. Failure to comply with the act procedures bringing a criminal law prosecution against a nurse or other health professional (Dimond, 2009).failure to obtain consent to treatment may amount to the crime of battery or negligence a common law offence (jones2012).

Those people held under mental health legislation the principle of consent continue to apply for condition not related to the mental disorder. Nurses who are involved in the care or treatment of patients detained under the relevant mental health legislation, must ensure that they are aware of the circumstances and safeguards needed for providing treatment and care without consent (NMC, 2011)
The similarity between Adult and Child branch
In both Adult and Mental Health settings seeking consent is part of a respectful relationship, regardless of the patient's age, gender, culture, background and race. Therefore, consent may be withdrawn at any time, even after signing a consent form.. Another similarity is that when asking consent the healthcare professional has to identify whether the person is able to understand what is being said and the person's state of mind. This is where patients are competent and free from mental illness. Communication difficulties may arise if a patient's first language is not English, or with those who are deaf. In a case where a patient is deaf, the healthcare professional would have to communicate with them in sign language. Gaining consent is a way to promote the health of patients. In term of life and death the healthcare professional must act kindly and considerately for the child's health if they are unable to get in touch with child's parents. (Department of Health 2003)

Seeking consent is something that is important in the healthcare sector. It is important that all healthcare professionals realise the importance of following the procedure at all times as otherwise there can be legal implications. Respect on behalf of both patient and professional should lie at the heart of every decision taken. Clarity of explanation is important in order to allow the patient or someone acting on their behalf, to make an informed choice. Those involved in healthcare have a serious responsibility in ensuring that the information they offer patients is factually accurate and takes into account any differences in opinion, race, religion age or other factors. Consent increases patients' power to make an informed choice about their situation and treatment and puts safeguards in place for both the professionals and the patient involved which should lead to the best course of action.

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