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 Brykczynska
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
