Journal
INTERNATIONAL JOURNAL OF NURSING STUDIES
Volume 50, Issue 10, Pages 1407-1415Publisher
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.ijnurstu.2012.12.022
Keywords
Accountability; Nursing practice; Professionalism; Professional regulation; Work environment
Categories
Funding
- NIH National Research Service Award Individual Fellowship
- University Nursing Scholarship Award
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Background: Patient safety and professional self-regulation systems both rely on professional colleagues to hold each other accountable for quality of care. Objectives: To understand how staff nurses manage variations in practices within the group, and negotiate the rules-in-use for quality of care, collegiality, and accountability. Design/methods: Ethnographic case study; participant-observation, semi-structured interviews, policy analysis. Setting: In-patient unit in an urban US teaching hospital. Results: Explicit acknowledgment of conflicts and practice variations was perceived as risky to group cohesion. The dependence of staff on mutual assistance, and the absence of a system of group practice, led to the practice of mutual deference, a strategy of reciprocal tolerance and non-interference that gave wide discretion to each nurse's decisions about care. Conclusions: Efforts to improve professional accountability will need to address material constraints and the organization of nursing work, as well as communication and leadership skills. (C) 2013 Elsevier Ltd. All rights reserved.
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