Accountability in Nursing and Midwifery

Accountability and collaborative care: how interprofessional education promotes them

Nurses and midwives hold positions of responsibility and are, therefore, expected to be accountable for their practice. Responsibility and accountability are the cornerstones of professional nursing and midwifery practice, and are represented as a key principle in the Code of Professional Conduct and Ethics for Registered Nurses and Registered Midwives. Responsibility is explained as the obligation to perform duties, tasks or roles using sound professional judgement and being answerable for the decisions made in doing this.

A nurse or midwife who is considering expanding their scope of practice should realise that this will involve greater responsibility.


A nurse or a midwife should be able to give reasons for the decisions they make in their professional practice and should justify their decisions in the context of legislation, professional standards and guidelines, evidence-based practice and professional and ethical conduct. Nurses and midwives are accountable both legally and professionally for their practice, that is, for the decisions they make and the consequences of those decisions.

Nurses and midwives are accountable to the patient, the public, their regulatory body, their employer and any relevant supervisory authority.

NHS accountability

Legal accountability involves nurses and midwives being responsible for ensuring they have appropriate professional indemnity insurance, as patients have a right to expect them to hold this insurance in case there is a substantiated claim of professional negligence. March Nursing and Midwifery Board. National Board accountability and transparency. Values underlying our actions are vision,…. Date published 6 September Date published 10 August National Board strategic plan - Nursing and Midwifery Board. Values underlying our actions are vision, accountability , consistency and collaboration.

Date published 1 April A key aspect of our proposal is to establish clear accountability and responsibility for progressing desired reforms to address a current gap in governance which has….

Standards & Guidance

The research revealed 21 studies, mainly British and American. Five studies were referring to the contemporary situation in midwifery practice, seven of them were exploring how accountability obliges health professionals to work collaboratively with other professionals and nine of them were seeking how interprofessional education promotes collaborative care. Health professionals have to work in a collaborative manner not only with other professionals, but also with patients and their families, while interprofessional education plays a significant role in the formation of an effective team.

Accountability and collaborative care are two meanings indissolubly connected to each other and the main subject of discussion on professional practice. As the complexity of health and welfare services is growing, the medical knowledge is expanding and the specialization is increasing, the need for bringing together separate but interlinked professional skills has become urgent. Single providers or disciplines are no longer able to meet all the health care needs of an individual.

Therefore, health professionals are urged to work together in teams.

Accountability in Nursing and Midwifery, 2nd Edition

Recent studies showed that interprofessional team working in the health care field leads to more efficient use of staff, more effective service provision and a more satisfying work environment. On the other hand, inter-professional pitfalls have included time-consuming consultation, administrative and communication costs, differing leadership styles, language and values between professional groups, separate training backgrounds, inequalities in status and pay, conflicting professional and organizational boundaries and loyalties, lack of clarity about roles and negative mutual perceptions and latent prejudices [ 1 ].

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As a result, it is crucial for the well-functioning of a team the members to have explicit roles, to know to whom they are accountable and for what. Moreover, the need for interprofessional education among different health care professions is clearer than ever. In this paper, it will be discussed what accountability is for a health professional as an individual and as a team member, what collaboration and collaborative care means, how accountability obliges caregivers to work collaboratively with other professionals, a theoretical model that could be applied in collaborative health care and finally how interprofessional education promotes collaborative care.

For midwives, the concept of accountability becomes more specific as each midwife is accountable for her own practice in whatever environment she practices. The standard practice in the delivery of midwifery practice shall be that which is acceptable in the context of current knowledge and clinical developments.

In all circumstances the safety and welfare of the mother and her child must be of primary importance [ 4 ]. On the other hand, collaboration is an interprofessional process of communication and decision-making that enables the individual knowledge and skills of health professionals to synergistically influence the provided care.

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Social accountability and accreditation: Wiley Nursing Book Collection. Professional autonomy stems from the ability to use various kinds of knowledge in a critical manner, which offers safe, quality health care to patients. Among the team members, three types of collaboration can exist: Nurses and midwives are accountable both legally and professionally for their practice, that is, for the decisions they make and the consequences of those decisions.

It is a relation of interdependence built on respect and understanding of the unique and complementary perspectives each profession makes to achieved desired outcomes [ 5 , 6 ]. Collaborative care refers to initiatives or activities that aim to strengthen links between different providers working together in a partnership characterised by common goals, a recognition of and respect for individual strengths and differences, equitable and effective decision-making, a focus on the patient and clear and regular communication [ 6 , 7 ].

Accountability is an integral part of midwifery practice.

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Midwives must be competent to give the necessary supervision, care and advice to women during pregnancy, labour and the postpartum period, conduct deliveries on their own responsibility and take care of the new-born [ 4 , 8 , 9 ]. They are responsible for the mother and her child during the perinatal period, but in case of emergency or deviation from the normal, midwives are obliged to call a registered medical practitioner [ 9 , 10 ].


Accountability is a key concern for nurses and midwives in the NHS today. Professional accountability—being responsible for your actions and. The second edition of Accountability in Nursing and Midwifery addresses current issues and key concerns in accountability, focusing on accountability in the four.

Their professional code of practice obliges them to work collaboratively with doctors in pathological cases. They are, also, obliged to collaborate with other health professionals under ordinary circumstances in order to meet with the needs of the women and her family. However, even as members of a multidisciplinary team, midwives maintain their professional accountability. Moreover, if a midwife is delegating care to another professional, health care support staff, carer or relative, she must delegate effectively and is accountable for the appropriateness of the delegation.

The code requires that nurses and midwives must establish that anyone they delegate to be able to carry out their instructions, confirm that the outcome of any delegated task meets required standards and make sure that everyone they are responsible for is supervised and supported [ 8 ].

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Collaborative practice provides greater opportunities to educate and counsel patients with the goal of preventing disease, promoting wellness and increasing compliance with treatment regimes during illness [ 12 - 14 ]. However, midwives appear to be reluctant to co-operate and co-ordinate their activities with other health care professionals, especially with doctors.

The findings of studies in teamwork showed that midwives were not well integrated team members. This was not a situation they were dissatisfied with [ 6 , 15 ]. What seems to be the cause of this reluctance is the relationship between doctors and midwives; a relationship often described as highly charged, traditionally antagonistic and prone to conflict [ 6 , 15 , 16 ]. Midwives, contrary to other professions allied to medicine, are practitioners in their own right. The stature expects full professional accountability from the midwife within her sphere of practice [ 15 ].