Accountability in Nursing and Midwifery Second edition Edited by Stephen Tilley BA, RMN, PhD Senior Lecturer, Nursing Studies University of Edinburgh Edinburgh and Roger Watson BSc PhD RGN CBiol FIBiol ILTM FRSA Professor of Nursing School of Nursing, Social Work and Applied Health Studies University of Hull Hull Blackwell Science Accountability in Nursing and Midwifery Accountability in Nursing and Midwifery Second edition Edited by Stephen Tilley BA, RMN, PhD Senior Lecturer, Nursing Studies University of Edinburgh Edinburgh and Roger Watson BSc PhD RGN CBiol FIBiol ILTM FRSA Professor of Nursing School of Nursing, Social Work and Applied Health Studies University of Hull Hull Blackwell Science © 1995 Chapman & Hall © 2004 by Blackwell Science Ltd a Blackwell Publishing company Editorial offices: Blackwell Science Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK Tel: +44 (0) 1865 776868 Blackwell Publishing Inc., 350 Main Street, Malden, MA 02148-5020, USA Tel: +1 781 388 8250 Blackwell Science Asia Pty, 550 Swanston Street, Carlton, Victoria 3053, Australia Tel: +61 (0)3 8359 1011 The right of the Author to be identified as the Author of this Work has been asserted in accordance with the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the prior permission of the publisher. First edition published by Chapman & Hall 1995 Second edition published by Blackwell Science Ltd 2004 Library of Congress Cataloging-in-Publication Data Accountability in nursing and midwifery / edited by Stephen Tilley and Roger Watson. — 2nd ed. p. ; cm. Rev. ed. of: Accountability in nursing practice / edited by Roger Watson. London : Chapman & Hall, 1995. Includes bibliographical references and index. ISBN 0-632-06469-2 (pbk. : alk. paper) 1. Nursing—Standards—Great Britain. 2. Midwifery—Standards—Great Britain. 3. Responsibility. 4. Clinical competence. [DNLM: 1. Midwifery—standards. 2. Nursing—standards. 3. Nursing Care—standards. 4. Quality Assurance, Health Care. WY 16 A172 2004] I. Tilley, Stephen. II. Watson, Roger, 1955– III. Accountability in nursing practice. RT85.5.A25 2004 610.73′06′9—dc22 2003020922 ISBN 0-632-06469-2 A catalogue record for this title is available from the British Library Set in 10.5/12.5pt Sabon by Graphicraft Limited, Hong Kong Printed and bound in Great Britain using acid-free paper by TJ International Ltd, Padstow, Cornwall The publisher’s policy is to use permanent paper from mills that operate a sustainable forestry policy, and which has been manufactured from pulp processed using acid-free and elementary chlorine-free practices. Furthermore, the publisher ensures that the text paper and cover board used have met acceptable environmental accreditation standards. For further information on Blackwell Publishing, visit our website: www.blackwellpublishing.com The opinions expressed in this book are those of the editors and authors concerned. These views are not necessarily those held by Blackwell Publishing. Contents 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 vi Contents 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 Contents vii 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 viii Contents 9 Working with Children: Accountability and Paediatric Nursing 99 Gosia Brykczyñska 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 [...]... nurses continued in the years leading up to World War I At an international level, the ICN held meetings and congresses in Berlin in 1904, in Paris in 1907, in London in 1909 and in Cologne in 1912 For nurses campaigning for professional status and registration against prejudice and apathy in their own countries, the international meetings were of the greatest value: ‘It is an inspiration and source... United Kingdom Central Council for Nursing, Midwifery and Health Visiting, included somewhere in the spectrum xiv Preface The advent of clinical governance has, on the one hand, brought accountability into clearer focus and, on the other hand, changed the nature of accountability in nursing Clinical governance provides a framework, essentially lacking in previous years, within which nurses and other... instead endorses the value of a ‘discourse of individual accountability in nursing Accountability and clinical governance Clinical governance has been a relatively recent addition to the guidelines for working with patients in the NHS The second editor examines the relationship between accountability in nursing and midwifery and clinical governance If accountability is still the hallmark of a profession,... affecting the accountability of community nursing Current issues in community nursing Resource allocation and skill mix Delegation and skill mix Legal and professional issues in community nursing Clinical governance Clinical effectiveness and evidence-based practice Role developments Nurse prescribing Primary healthcare and public health nursing Conclusion 13 Clinical Governance, Accountability and Mental... of accountability in nursing and midwifery which did not include clinical governance would be incomplete In order to address this, therefore, the present volume includes contributions from practice which examine the issue of clinical governance from a number of perspectives and also chapters in which the link between accountability and clinical governance is examined Two of the major issues of the introduction... clinical governance in learning disability nursing Midwifery Rosemary Mander distinguishes nursing from midwifery and reckons that midwifery could learn a great deal from the nursing literature about accountability because it is not covered to any great extent in the midwifery literature Perhaps this is because midwives take a certain degree of autonomy, 6 Introduction and therefore accountability, for... conclude in the same way: community nursing is challenging and satisfying and issues of accountability remain at the heart of practice Mental health nursing Stephen Tilley reflects upon the in uence that clinical governance may have had upon accountability in mental heath nursing The major change, since 1995, is that the introduction of clinical governance has put evidence-based practice at the heart of clinical... as nursing, which at one point in its history was striving to be considered accountable and therefore a profession, was only 2 Introduction seeing one side of the accountability coin In fact, such a struggle for accountability may have been naive to the extent that accountability is imposed rather than self-claimed, and nursing, and other healthcare professions, including medicine, have now imposed accountability. .. registration died in 1919 – perhaps this was significant The historical and political perspective on the development of professional nursing offered by McGann, taking us up to 1919 and establishing the historical basis for claims of accountability linked to professional registration, continues to inform the ongoing debate about accountability in nursing An accountant looks at nursing Kerry Jacobs brings a welcome... aware of the constraints of accountability in research This is a task which must be addressed by those providing undergraduate and postgraduate research courses for nursing and midwifery students Conclusion Accountability remains a key topic and clinical governance has become a key topic for the professions of nursing and midwifery The editors, apart from their own chapters, now hand over to the other . Hull Hull Blackwell Science Accountability in Nursing and Midwifery Accountability in Nursing and Midwifery Second edition Edited by Stephen Tilley BA,. guidelines for working with patients in the NHS. The second editor examines the rela- tionship between accountability in nursing and midwifery and clinical gov- ernance.