Government Impact, Innovation and Accountability


The American Nurses Association (ANA) defines accountability as being answerable to oneself and others. The nursing code of ethics requires that nurses abide by the principles of fidelity and respect for the dignity of patients. Accountability not only improves the quality of healthcare services provided to the patient but also creates value for money spent or invested in healthcare services. It also promotes the application of evidence-based practice and thus considers the variability of individuals while administering treatment.  Accountability care organizations guide both nurses and nursing students on being accountable for their actions and prepare them on how to handle challenges in the healthcare industry.   

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Roles of nursing students in accountability in healthcare

Serving as role models

Nursing students have a responsibility for role modeling the behavior they want and holding themselves accountable. Students can help achieve accountability by engaging in collaborative professional education. They can also assist in administrative support through attending healthcare meetings, facilitating discussions on health-related topics in society, partnering with the community in healthcare-related activities, and building bridges between antagonistic professions.

Communicating expectations

Nursing students ought to research and understand what is expected of them in both school and society (Vaismoradi, Salsali, & Marck, 2011). Having a clear picture of what is being asked of them within a set period helps students to plan their work toward their targets. Students who fail to achieve their goals should hold themselves accountable, and it is only by seeking the necessary information on how to define success that students can know whether they succeeded or failed.

Enhancing teamwork

Many organizations believe in team spirit and thus encourage individuals to work in groups to achieve their goals efficiently. Nursing students should also work in collaboration with other nursing schools or professions in promoting healthcare within their settings. By building a cohesive and supportive team, it would be much easier to share responsibilities and achieving targets, thus resulting in improved healthcare provision. 

Inspire joy

Humans love to feel good, and patients deserve some moment of happiness out of the ailment. One responsibility of healthcare practitioners involves giving hope to patients. Nursing students should, therefore, participate in activities that inspire joy to the community and patients and the community in general. Moreover, they should appreciate other individuals who participate in activities that promote healthcare and even patients, for example, in rehabilitation therapy, who collaborate to improve their health.

Other ways of showing accountability

Furthermore, nursing students can show accountability by committing to doing their best in practice, learning best practices and advocating for both patients’ and nurses’ rights, and taking responsibility for their mistakes and learning from constructive feedback.  Students should also support their teammates actively and remind them to honor their commitments.

Accountability Care Organization

An Accountability care organization (ACO) refers to a group of healthcare practitioners, hospitals and other stakeholders in the health care industry who combine efforts voluntarily to provide high-quality, coordinated care to particular Medicare patients under their supervision (Bao, Casalino,  & Pincus, 2013). The benefits of ACOs include ensuring that patients, especially those suffering from chronic illnesses, can get quality care in time. ACOs also help prevent unnecessary duplication of healthcare services and help to avoid medical errors. Companies that implement accountable care apply population health management and accountable care administration skills. Population health management abilities help in creating delivery networks capable of servicing a population of patients appropriately and clinically defining communities that deserve the attention of ACOs. The proficiency also helps in systematically improving the quality of healthcare while reducing wastes within the delivery system.    

Challenges facing healthcare workers

Workload and quality of care

Recent research in various hospitals indicates a significant mismatch between expected tasks and duties and the number of healthcare nurses. The provider shortage has hit many hospitals, forcing the management to avail only a small number of nurses to attend morning and night shifts (Al-Otaibi, El-Saed, & Balkhy, 2010). Healthcare workers experience challenges in coping with huge numbers of patients. Even though employers argue that they have limited control over the availability of allied healthcare people, a small investment on new employees would result in an improved patient-provider ratio and would lead to worker satisfaction for many healthcare workers. Working with Satisfied workers results in less turnover and fewer resources spent on finding searching and acclimating new people.

Working environment and general working conditions

The availability of infrastructure and supplies affects the care for patients and affects the motivation, performance and even well-being.  In the rural areas, issues of poor planning during the construction of hospitals and the availability of inadequate resources for maintenance results in the availability of scarce resources, for example, water sources, for use in healthcare facilities. Some healthcare workers also have to travel long distances to go to work. Poor roads also affect the arrival of supplies in time, and thus, healthcare workers are sometimes left with no equipment or medication to serve patients. Weak organizational structures are also impacting negatively on the provision of health care services. Many healthcare nurses complain of working in hospitals where the management does not organize labor fairly and efficiently.

Clinical knowledge, referrals, and hierarchy

Healthcare workers have to make decisions that affect the lives of patients. While hospital nurses seek guidance from doctors, health center nurses are often isolated and thus have to make decisions on their own without consulting even though a nurse may have limited clinical experience. The standard requirement for most hospitals is that health center nurses should refer patients, who present complicated cases, to district or major hospitals for advanced care. However, some situations, require immediate action, and despite being critical, healthcare workers get tempted to act, especially in rural areas. Some of the reasons that force healthcare workers into such situations include geographical differences and referrals seeming cumbersome.  Other challenges

More common challenges include lack of mentoring, poor personal relationships with employers, lack of opportunities to advance careers, unsatisfactory and delayed remuneration, limited or lack of access to technology, inadequate training, and limited time with patients due to the availability of many patients and few staffs.

Ways in which the role of the healthcare workers is changing as a result of these challenges The many challenges faced by healthcare workers impacts negatively on their efficacy and cause staffing and work-related injuries and stress. Recent research indicates that hospitals and nursing homes have become hazardous working stations as the workers are exposed to several risks, most of which lead to injuries and illnesses (Williams-Piehota et al., 2011). Overworking healthcare workers has caused back injuries to many practitioners in the industry. Exposure to needlestick injuries may also result in nursing personnel contracting diseases like hepatitis B and C or even HIV. Consequently, healthcare workers are getting discouraged from staying in the profession, and thus, they keep switching professions. Those that remain are either too overworked to deliver effectively or are not competent.


 Accountability is an integral aspect of the nursing profession. Patients trust healthcare workers to do the right thing, and thus, all nursing staff has a shared responsibility to ensure patients receive the best service. Nursing students also have a responsibility to learn and understand what is expected of them as they enter the profession. Students also need to learn of the various challenges they should expect in the field and research on ways in which they will cope.


Al-Otaibi, B. M., El-Saed, A., & Balkhy, H. H. (2010). Influenza vaccination among healthcare workers at a tertiary care hospital in Saudi Arabia: Facing challenges. Annals of thoracic medicine, 5(2), 120.

Bao, Y., Casalino, L. P., & Pincus, H. A. (2013). Behavioral health and health care reform models: patient-centered medical home, health home, an accountable care organization. The journal of behavioral health services & research, 40(1), 121-132.

Vaismoradi, M., Salsali, M., & Marck, P. (2011). Patient safety: nursing students’ perspectives and the role of nursing education to provide safe care. International Nursing Review, 58(4), 434-442.Williams-Piehota, P. A., Sirois, F. M., Bann, C. M., Isenberg, K. B., & Walsh, E. G. (2011). Agents of change: how do complementary and alternative medicine providers play a role in health behavior change. Altern Ther Health Med, 17(1), 22-30

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