Ethical, legal and professional accountability in emergency nursing practice: An ethnographic observational study. (September 2019)

• Record Type: Journal Article
• Authors: Rubio-Navarro, Alfonso; Garcia-Capilla, Diego Jose; Torralba-Madrid, María Jose; Rutty, Jane
• Is Part Of: International emergency nursing. Volume 46(2019)
• Publication Date: 2019-09
• Subjects: Accountability -- Clinical ethics -- Decision-making -- Emergency nursing -- Legal -- Motivation -- Nurse-patient relationship -- Professional ethics -- Work conditions; Emergency nursing -- Periodicals; 616.025
• DOI: 10.1016/j.ienj.2019.05.003
• Languages: English
• ISSNs: 1755-599X

Abstract

Highlights: Routine nursing practice in the observed ED followed a similar pattern with the same steps every day. Junior nurses were pushed to take senior roles for which they were not prepared for. The subjective perception of the nurse's role was linked with their influence on others. The clinical workload rise facilitated the proliferation of defensive practice. The distribution of human resources was affected by the lead nurse's subjective priorities. Abstract: Introduction: Accountability in nursing practice is a concept that influences quality care, decision-making, safety standards and staff values. Therefore, understanding accountability and how it affects nursing practice could improve patient care and nurses' working conditions. Aim: The aim of this study was to find factors that influenced ethical, legal and professional accountability in emergency nursing practice. Methods: A qualitative ethnographic approach using participant observation through convenience sampling was employed as the data collection method, while ethnographic content analysis was used for data analysis. Results: The factors linked to nursing accountability found were classified into four main themes: daily dynamics, work environment evolution, customs and routines and bioethics principles' application. Discussion: The long-term effect of chronic high workload and crowding, which affects nursing accountability, could promote burnout in a junior ED workforce. Changes in the nurses' working conditions need to be implemented to limit the workload to which an ED nurse is subjected to. Conclusion: ED nurses have to manage their accountability in difficult situations regularly, which followed patterns of four main themes across the majority of situations. Nonetheless, all those factors were influenced by nursing workload, an ever-present factor that was always considered by ED nurses during decision-making.