Enacting and/or Retreating: A Theory of Registered Nurses' Practice of Accountability

Abstract

In the current context of health care, the registered nurses’ perception and enactment of accountability may be constrained by many factors out of their control. The purpose of this research was to examine how registered nurses perceive accountability and translate this to professional practice. A Grounded Theory approach was adopted to explore 11 registered nurses’ understanding and experiences enacting accountability in clinical practice. Data were obtained through semi structured interviews. The theory that emerged provides a detailed portrait of the process of enacting and/or retreating from accountability. The process encompasses 4 stages where the registered nurses: develop personal understanding, then gain professional knowledge, find their way in the complex healthcare system and concludes with becoming professionally confident. The development of the stages exposed a multitude of challenges faced by the registered nurses in fulfilling accountability expectations. Importantly, the registered nurses’ expended significant effort in finding a balance between their individual accountability and the collaborative accountability of the healthcare team and organization which contributed to retreating from accountability. The contextual factors of financial and human resources, institutional culture and healthcare system processes were found to contribute to the registered nurses enacting and/or retreating from accountability. The study findings illustrate the importance of ongoing reflective practice, mentorship and continuing education, all of which have implications for nursing educators and healthcare executives in preparing and supporting registered nurses’ in practice. Further research on the concepts of this theory of accountability is needed to obtain a greater understanding of how the concepts can be operationalized within the context of current healthcare systems.