Bridging the accountability gap

Accountability for patient care is a responsibility shared by nursing and hospital administration. Inherent in professional nursing is the responsibility for the achievement of patient outcomes, while administrators assume more indirect responsibilities related to managerial functions, strategic planning and legal obligations. Historically, the poor communication and conflict between these groups have been a barrier to achieving true institutional accountability for patient care. Collaboration rather than conflict can be promoted in health care institutions by making organizational changes that promote communication and clarify ambiguities in job responsibilities. Such changes include redefining the nurse's job to reflect its scope and purpose; integrating nursing into the hospital environment via regular forums for information exchange and participation in hospital committees; considering that the delegation of patient care is implicit in nursing practice and patient-care management; and strengthening the nursing work force by improving compensation and benefits packages for nurses.