1. Running head: ACCOUNTABILITY VS. RESPONSIBILITY 1
Accountability vs. Responsibility in Nursing
Shannon Hart
Christian Leadership in Healthcare Organizations
NUR480A
Professor Yuliya Malishkin
June 12, 2016

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Abstract
Nurses face new challenges everyday which require critical thinking skills and the ability to act
fast. With this fast pace, nurses run the risk of turning their job into a laundry list of tasks, losing
sight of their purpose as a nurse. This risk is the reason nurses and nurse leaders must ensure that
an environment of accountability over responsibility is encouraged, to promote optimal care for
patients. Understanding the difference between accountability and responsibility, will help me
provide quality care through ownership of my nursing practice. Learning from past work
experiences and lack of leadership will also help mold my nursing practice and future as a nurse
leader.

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Accountability Vs. Responsibility in Nursing
Throughout time, nurses have been the backbone of the healthcare system, being the eyes
and ears of the doctors, using their critical thinking skills to help better care for their patient.
With the advancements of healthcare, nurses must be able to work independently, coordinating
with other healthcare members, and still provide the best care possible. Due to the independent
nature of nursing, nurses must think in terms of accountability, and not just responsibility, for the
care of their patients. So how can nurses and leaders work to create an atmosphere of
accountability vs. responsibility to help better care for their patients? This paper will discuss the
differences, and how patient care can be improved when nurses adopt the values of
accountability in their own practice.
Accountability vs. Responsibility
Accountability and responsibility may seem very similar, but the differences between
them make large impacts on the practice of nursing. According to authors Malloch and Porter-
O’Grady (2016), responsibility is focused on the work process, how well a task was performed,
as well as defining the individual based on the value of the job performed. Under the
responsibility framework, jobs are defined as a list of tasks that need to be completed (p. 494-
495). “Accountability is the key to increasing trust, reducing fear, and improving morale and
performance, and should be the basis for establishing a culture of trust, support, and dedication to
excellence. Establishing this culture is everyone’s responsibility” (Battie, Steelman, 2014, p.
15). Accountability differs from responsibility by demanding a sense of ownership of the task at
hand. Ownership requires the individual to fully apply their own skills, grow and learn to
enhance their own skills, help develop others, evaluate their own effectiveness of contribution,
and a commitment to lifelong learning (Malloch, Porter-O’Grady, 2016, p. 497).

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At the root of all work there is a motivation and desire, either good or bad to accomplish
certain goals. “Accountability is a personal choice to rise above one’s circumstances and
demonstrate the ownership necessary for achieving desired results” (Lowe, 2013, p. 247). It
should be the goal of every nurse to be motivated to work for the good of their patient, and
through the creation of an environment of accountability, nurses can strive to provide the best
care possible. If an environment of responsibility prevails over accountability, individuals may
feel motivated to work through fear, because they are focused on the completion of a task, and
not on the outcome. This must be avoided at all costs in the nursing profession, as this hurts both
the nurse and their patients. “It is important to acknowledge that accountability will only
strengthen the health care system when it is cultivated within the framework of a just culture
model” (Moller, 2013, p. 506). Nurse leaders would benefit from taking a leadership course that
encourages accountability, because it will help them take ownership of their nursing practice,
which then will inspire and encourage other nurses to do the same, as imitation is the sincerest
form of flattery.
Accountability in my Nursing Practice
As a nurse, I plan to embrace the values of accountability over responsibility, by
committing myself fully to the care of my patient, taking ownership of my mistakes and learning
from them, working to improve my practice throughout the life of my nursing career, as well as
working as part of a team. I also want to help eliminate the old nurse adage that “nurses eat their
young.” I find it odd that some nurses are great at providing patient care, but treat their fellow
nurses with such lack of respect. As a nurse, I want to be accountable for my patient care, and
for the care of my fellow nurses. “Positive relationships and effective communication between
care providers are essential for quality patient care and professional satisfaction. Communication

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between providers is a cornerstone of an effective and efficient health care enterprise” (Muzio,
2013, p. 7).
As a nurse, I will be viewed by my patients as a leader within their healthcare experience.
To be a leader for others, you must first be able to lead yourself. Self-leadership is a skill that
successful nurses embrace, and a successful nurse is a motivated nurse. “Being motivated to
perform at your very best on a daily basis was viewed as a valuable part of self-motivation
necessary for self-leadership (Jooste, Cairns, 2014, p. 535). Self-leadership helps a nurse
organize and prioritize their day, helping them provide optimal care for their patients. “Self-
leadership is a process that requires an individual to control personal actions, to be self-aware
and to utilize personal strength, which are necessary for performing tasks effectively (Cairns,
Jooste, 2014, p. 532).
Why I Chose Accountability vs. Responsibility
I chose this subject, because I am currently in a work environment that emphasizes
responsibility over accountability. I work at a chiropractic office as a massage therapist. My
coworkers are amazing, and I am blessed to know each of them. But as stressful as my job can
be, I would never want to take the position at the front or back office. They are required to
complete goals that are unreasonable and are punished when they are not met. The daily task list
is incredibly long, and is often not finished by the end of the day. Often times they are pulled
away from a task to complete another, and then reprimanded when the first task is not finished.
The office is based on principles of Scientology, where “brainwashing” techniques are used by
the owners, on both the employees and the clients in order to achieve their desired results.
The principles of Scientology do not encourage an environment of trust, compassion, or
accountability. It is also impossible to come forward with any complaints or suggestions for

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improvement, as our boss feels they have always done things right, and do not need to change
anything. If an environment of accountability were to be established within the office,
employees may feel they are an asset to the office and make an effort to do their job without fear
of reprimand. “Accountability should not be viewed as a way to blame someone for making a
mistake, and it should not result in fear” (Battie, Steelman, p. 15). Because of the unreasonable
expectations and the sense of fear and blame, my boss has lost respect from the entire office.
“People long to follow a leader who is a person of integrity, authenticity, and compassion. That
person will have the loyal following and trust of his people” (Leman, Pentak, 2004, p. 49). This
is exactly what my coworkers and myself long for in leader; one of integrity, authenticity, and
compassion.
I am counting down the days until I can finally say I have accomplished my dream of
becoming a nurse, and can leave the negative work environment I am in, to a hopefully more
positive one. I have learned more from this class than I ever imagined I would, and am so
excited to one day be able to apply the principles of being a servant leader to my fellow nurses. I
only wish I had learned these principles sooner, as I feel they are universal principles everyone
can and should apply in their own life.
As a nurse, there are many things I can do to help better care for my patients, but I feel
that holding myself accountable in all aspects of my nursing practice will help me become a
better nurse. It is may be easier to treat my nursing practice as a task list of things that need to be
accomplished, and I am sure I will have days I feel this way. But I know that through personal
ownership and accountability, I will learn from my mistakes, grow from my experiences, and
have a sense of satisfaction knowing that I have worked hard to be the nurse God has called me
to be. Colossians 3:23 says, “Whatever you do, work heartily, as for the Lord and not for men.

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References
Battie, R., & Steelman, V. (2014). Accountability in Nursing Practice: Why is it important
for Patient Safety? AORN: Journal of Perioperative Nursing, 28(4), 14-16.
Cairns, L., & Jooste, K. (2014). Comparing nurse managers and nurse' perceptions of nurses'
self-leadership during capacity building. Journal of Nursing Management, 22, 532-539.
doi:10.1111/jonm.12235
Leman, K., & Pentak, B. (2004). The Way of the Shepherd: Seven Secrets to Managing
Productive People. Grand Rapids, MI: Zondervan.
Lowe, N. K. (2013). Leadership, Accountability, and Safety in Healthcare. Journal of Obstetric,
Gynecologic & Neonatal Nursing, 247.
Moller, J. L. (2013). Leadership, Accountability, and Patient Safety. Journal of Obstetric,
Gynecologic & Neonatal Nursing, 506-507.
Muzio, L. (2013). RN Responsibility and Accountability for Client Care. SRNA
Newsbulletin, 6-8.
Porter-O'Grady, T., & Malloch, K. (2016). Leadership in Nursing Practice (2nd ed.).
Burlington, MA: Jones and Bartlett Learning.