AORN Congress will be held in Philadelphia this year, and the theme, "Freedom to be," certainly is appropriate in a city integral to our country's history. For me, the theme and venue conjure the image of our founding fathers taking responsibility and accountability for moving the country in a new direction. The environment was ripe for change and the activists had the support from fellow citizens to take the risk. They also had barriers from the current government and surely had naysayers among their fellow citizens who were satisfied with the status quo or afraid of taking the risk to change it. The rebels had the courage of their convictions and answered the call to action to pursue a dream.
How can perioperative nurses relate this theme to their practice and what does it mean to be responsible and accountable for their practice? To me, the concept of "Freedom to be" invokes a vision of perioperative nurses being responsible and accountable for their practice, both collectively and individually.
Often the terms responsibility and accountability are used interchangeably, but the two terms have different meanings. Responsibility describes the authority to act independently. Nurses are individually responsible for providing patient care that's in accordance with the institution's policies and procedures, the standards of care, and within the scope of practice as defined by the state board of nursing.
Accountability implies a commitment to others and an ownership of one's individual practice. We're accountable to the institution, management, and patient for the care we deliver. We take responsibility and accountability for our individual nursing practice and the outcomes whether we perform the tasks ourselves or through delegation.
Managers are accountable for the care given in their department. A leader's responsibility is to hold staff accountable for their practice and to provide an environment in which nurses can be accountable. An environment in which nurses are free to speak up, encouraged to use critical thinking skills, and are encouraged to admit mistakes without fear of punitive action supports nurse accountability.
These principles are illustrated in the following example:
Recently, a colleague called me for help with the automated sponge counter. The nurse said she'd forgotten to scan in some sponges during the case, ultimately making closing counts irreconcilable. The nurse knew she was responsible for following the policies and procedures of the institution. She was accountable to the patient and leadership in reporting the event immediately and taking the steps to rectify the situation. As a leader, I'm responsible for creating an environment that supports nursing accountability, that is, providing an environment in which the nurse can feel free to report events without the fear of punitive action.
With responsibility and accountability come an inherent risk. Collectively, taking responsibility and accountability for our practice involves patient advocacy and may involve moving nursing practice in a new direction. Recognizing the need for change in practice and challenging the status quo takes the courage of our convictions. Too often some are satisfied with receiving an "A" for their effort. Effort indicates only an attempt and not the commitment needed to improve practice. When perioperative nurses accept the responsibility and accountability for providing optimal patient outcomes, we are using the gift of our forefathers: the freedom to change things for the better.
Elizabeth M. Thompson, MSN, RN, CNOR
Editor-in-Chief Nursing Education Specialist Mayo Clinic, Rochester, Minn. [email protected]