Accountability in Nursing and Midwifery 2e
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More About This Title Accountability in Nursing and Midwifery 2e


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.


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.


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


‘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