"You are either out on the court, or sitting on the bench": understanding accountability from the perspectives of nurses and nursing managers.

Abstract

The aims of this study were: (1) to understand the implicit and explicit perceptions of accountability from the perspective of bedside nurses and their managers; (2) to identify the factors that facilitate accountability behaviours. Despite the importance attributed to accountability in nursing education and practice, empirical research lacks clarity regarding how nurses perceive accountability and decide whether or not to act accountably. Qualitative study. Data of a purposeful sample of 23 nurses were collected through in-depth semi-structured interviews during 2015. They were tape-recorded, transcribed verbatim and content analysed. Nurses agreed that accountability, more particularly responsibility, was crucial to nursing professionalism. However, they perceived the demands for transparency and answerability as unjustified. Bedside nurses held this view more than nursing managers. Still, accountability was not considered an integral organizational norm but the choice of each nurse and his or her assessment of risks or benefits of acting accountably. Nurses' individual accountability was insufficient to generate accountability behaviours. They tended to weigh up the unit's accountability level in gauging risks and benefits before acting accountably. Risks of accountability behaviour included isolation, resistance and bullying, while benefits included professionalism, empowerment and pride.