Holding nurses accountable can be challenging. When you hold someone accountable, as the manager above tried to do, you are giving the staff member uncomfortable feedback about their behavior. You are, in effect, holding up a mirror to show them that what they said, did, or didn’t do isn’t acceptable. Sometimes staff shut down, and sometimes they fight back. Feedback can feel very unwelcome, especially if you don’t have a culture of feedback on the team. Sometimes staff has not had good role modeling in effective teamwork. The concept of “having someone’s back” may seem foreign if you are highly individualistic in your work.

So how can leaders help foster professional accountability in nursing around teamwork or any other challenge? The following are five essential strategies:

1. Be clear about professional role responsibilities and organizational goals

I had a wise mentor who once told me that when you are experiencing a leadership problem – go back to the basics as a starting point. I believe this to be true about professional accountability. Don’t assume that all professional nurses clearly understand their role or what is expected of them. You might be surprised if you ask questions at a staff meeting about the role of an RN to see what answers emerge, but more critically, what does not as part of role accountability. Your staff may not see teamwork as something they should be held accountable for.

2. Provide direction about how work should be accomplished

Being clear in leadership expectations can be one of the most difficult challenges. You may think you have been very clear about your expectations – only to learn that they were misunderstood. Nurses need to know from their leaders how the work should be accomplished, and saying it once is not enough. As much as possible, develop care delivery models that promote accountability. Patients want continuity in their care. Nurses should be assigned to the same patients or work with the same team when possible.

3. Develop clear standards and metrics against which professional performance is measured

Nurse leaders must seek staff commitment and set standards for role expectations. It is often said that what is measured is what is done, so be clear about how role expectations will be measured. These expectations should include work not only performance but also interpersonal skills. At this point, most health systems don’t make teamwork part of the nurse’s evaluation, but it should be.

4. Hold professionals accountable for their behavior

I believe that the biggest issue with professional accountability is that nurses are often not held accountable for their decisions and actions by their leaders. In the best possible world, professional staff would come to work and meet their performance expectations with little leadership intervention. Unfortunately, we are not living in that world, and nurse leaders do need to spend time coaching their staff. Early intervention with performance issues is critical, as is providing follow-up support.

5. Build a culture of accountability 

Building a culture of professional accountability is crucial in promoting personal responsibility among staff. The staff knows when “good enough” is an organization’s culture. I have served as an expert witness for my state board of nursing in Florida. A disturbing fact that emerges when staff is brought up for disciplinary actions for failing to meet expected standards of care is their behavior is that unprofessional behavior has often been tolerated for an extended period by an employer. There needs to be team accountability for commitments and personal relationships.

Promoting professional accountability is much like parenting – it is not a one-and-done activity, but the small things you do as a leader daily to provide feedback that compounds over time.

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