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January 18, 2021

Practice Expectation Spotlight

Practice Expectation Spotlight: Accountability

Accountability is at the centre of registered nursing practice

As Registered Nurses we are always accountable for our practice even when there are challenges in our work or personal lives. Being accountable means acknowledging our professional, legal and ethical obligations and being capable to explain why we did or did not meet those obligations. It includes:

  • understanding that we answer for the consequences of our actions;
  • answering for our inaction and;
  • taking responsibility and actions to address errors.

Consider the case scenario below and reflect on actions that Drew can take to demonstrate accountability for his practice within the challenges he is facing.

Drew Thompson RN has been having difficulty sleeping at night since the pandemic started last year. At the beginning of the pandemic, Drew’s spouse lost their job and, by default, took on the role of home schooling their two children during the school closure. Although the kids are now back in school, Drew’s spouse is still looking for a job and their plans to purchase a home with a granny suite for their mother- in- law have been placed on hold. Drew is worried about what will happen if their mother- in law’s health declines and they are unable to provide support.

Usually, Drew attends the gym three times per week to help manage anxiety but since the gym has been closed Drew has not been exercising. Winter is setting in; the family’s holiday plans have changed and Drew is feeling increasingly emotionally depleted and tired. During Drew’s last shift, Drew‘s colleague identified that Drew had miscalculated a medication during a routine check prior to administration. Although Drew initially felt irritated and defensive, Drew recognizes that the miscalculation could have had devastating consequences for the client and decides to take time to reflect on his current practice to determine what steps he can take to ensure he is providing safe, competent and ethical care.

Case Scenario Analysis

In order to demonstrate accountability, Drew must take responsibility for his miscalculation and take steps to ensure he is fit to practice. When taking responsibility for his miscalculation, Drew can demonstrate
accountability by:

  • responding immediately to stop and minimize harm arising from the event;
  • demonstrating honesty, integrity and respect to the client by informing the client of the near miss and providing education to reduce future risk;
  • protecting clients through identifying the root cause of his miscalculation and communicating with other health professionals to stop or minimize harm arising from similar future events;
  • adhering to employer policy regarding reporting requirements.

When reflecting on his practice to ensure he is fit to practice, Drew can consider actions that can help him maintain his cognitive, physical, psychological and emotional health. This includes seeking help if needed.


Click on the links below for example resources related to maintaining cognitive, physical and psychological and emotional health:

Near Misses: “An event with the potential for harm that did not result in harm because it did not reach the patient due to timely intervention or good fortune.”(CRNM, 2019, Entry-Level Competencies (ELCs) for the Practice of Registered Nurses)