Provision 4. The nurse has authority, accountability, and responsibility for nursing practice, makes decisions, and takes action consistent with the obligation to provide optimal care.
4.1 Acceptance of accountability and responsibility – Individual registered nurses bear primary
responsibility for the nursing care that their patients receive and are individually accountable for their own
practice. Nursing practice includes direct care activities, acts of delegation, and other responsibilities such as
teaching, research, and administration. In each instance, the nurse retains accountability and responsibility for the
quality of practice and for conformity with standards of care.
Nurses are faced with decisions in the context of the increased complexity and changing patterns in the delivery
of health care. As the scope of nursing practice changes, the nurse must exercise judgment in accepting
responsibilities, seeking consultation, and assigning activities to others who carry out nursing care. For example,
some advanced practice nurses have the authority to issue prescription and treatment orders to be carried out by
other nurses. These acts are not acts of delegation. Both the advanced practice nurse issuing the order and the
nurse accepting the order are responsible for the judgments made and accountable for the actions taken
4.2 Accountability for nursing judgment and action – Accountability means to be answerable to
oneself and others for one’s own actions. In order to be accountable, nurses act under a code of ethical conduct
that is grounded in the moral principles of fidelity and respect for the dignity, worth, and self-determination of
patients. Nurses are accountable for judgments made and actions taken in the course of nursing practice,
irrespective of health care organizations’ policies or providers’ directives.
4.3 Responsibility for nursing judgment and action – Responsibility refers to the specific accountability
or liability associated with the performance of duties of a particular role. Nurses accept or reject specific role
demands based upon their education, knowledge, competence, and extent of experience. Nurses in
administration, education, and research also have obligations to the recipients of nursing care. Although nurses in
administration, education, and research have relationships with patients that are less direct, in assuming the
responsibilities of a particular role, they share responsibility for the care provided by those whom they supervise
and instruct. The nurse must not engage in practices prohibited by law or delegate activities to others that are
prohibited by the practice acts of other health care providers.
Individual nurses are responsible for assessing their own competence. When the needs of the patient are beyond
the qualifications and competencies of the nurse, consultation and collaboration must be sought from qualified
nurses, other health professionals, or other appropriate sources. Educational resources should be sought by
nurses and provided by institutions to maintain and advance the competence of nurses. Nurse educators act in
collaboration with their students to assess the learning needs of the student, the effectiveness of the teaching
program, the identification and utilization of appropriate resources, and the support needed for the learning
process.
4.4 Delegation of nursing activities – Since the nurse is accountable for the quality of nursing care given
to patients, nurses are accountable for the assignment of nursing responsibilities to other nurses and the
delegation of nursing care activities to other health care workers. While delegation and assignment are used here
in a generic moral sense, it is understood that individual states may have a particular legal definition of these
terms.The nurse must make reasonable efforts to assess individual competence when assigning selected components
of nursing care to other health care workers. This assessment involves evaluating the knowledge, skills, and
experience of the individual to whom the care is assigned, the complexity of the assigned tasks, and the health
status of the patient. The nurse is also responsible for monitoring the activities of these individuals and evaluating
the quality of the care provided. Nurses may not delegate responsibilities such as assessment and evaluation;
they may delegate tasks. The nurse must not knowingly assign or delegate to any member of the nursing team a
task for which that person is not prepared or qualified. Employer policies or directives do not relieve the nurse of
responsibility for making judgments about the delegation and assignment of nursing care tasks.
Nurses functioning in management or administrative roles have a particular responsibility to provide an
environment that supports and facilitates appropriate assignment and delegation. This includes providing
appropriate orientation to staff, assisting less experienced nurses in developing necessary skills and
competencies, and establishing policies and procedures that protect both the patient and nurse from the
inappropriate assignment or delegation of nursing responsibilities, activities, or tasks.
Nurses functioning in educator or preceptor roles may have less direct relationships with patients. However,
through assignment of nursing care activities to learners they share responsibility and accountability for the care
provided. It is imperative that the knowledge and skills of the learner be sufficient to provide the assigned nursing
care and that appropriate supervision be provided to protect both the patient and the learner
https://www.princetonhcs.org/-/media/princeton/documentrepository/documentrepository/nurses/code-of-ethics.pdf
Answer these questions based on the above provision 4.
1.What ethical theories or principles is this provision designed to uphold?
2.What virtues does this provision exemplify?
3.Look into the future fifteen years. Based on expected advances in health care, what revisions would you expect would be needed in this provision?
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