Accountability Among Baccalaureate Nursing Students: Definitions, Perceptions, and Engagement Practices of Accountability

To ensure optimal patient care an especially high level of accountability is required when new graduate nurses enter the workforce. In a study for the Carnegie Foundation, Benner et al. (2010) identified that nurses starting their first jobs were not prepared for clinical practice with the appropriate level of skills and knowledge. Results of this study and pressure from health care organizations challenge nursing educators to better prepare nursing students. In order to increase student preparedness, schools of nursing compel faculty to change teaching pedagogy, curriculum, assessment methods and instruments, and advisement practices (Benner et al., 2010). As accountability in higher education remains a theme in the forefront of public and governmental discussion, the responsibility of positive student outcomes remains the focus and responsibility of nurse educators. Understanding student perceptions of accountability will provide nurse educators insight when implementing curriculum changes.

 Even with defined standards for nursing practice, the definition for nursing accountability remains ambiguous and confusing, creating challenges for nurse educators to prepare nurses who demonstrate and understand the concept of accountability (Krautscheid, 2014). The ambiguity and confusion surrounding accountability also creates challenges for students themselves to understand what being accountable requires and means. Failure to develop and implement a cohesive understanding of accountability results in a lack of connectedness, intercommunication, and consistency in application of teaching and performance between faculty and students (McGregor, 2007). Students may lack an understanding of the importance of demonstrating accountability, or how to be active participants in their educational success to learn or achieve accountability (Hassel & Lourey, 2005; Nelson, 2007). Little is known about student perceptions or understanding of accountability and their role in achieving it (Hassel & Lourey, 2005; Krautscheid, 2014).

The purpose of this qualitative study was to explore, describe, and define perceptions of accountability as described by sophomore and senior nursing students in two baccalaureate nursing programs. The research questions aimed to: 1) Define what it means to be accountable as a student in general and a nursing student in particular 2) Describe the importance of accountability to the profession of nursing 3) Describe the circumstances and conditions that demand accountability 4) Engage in actions that promote self-accountability. After obtaining IRB approval, the researcher explained the study to the sophomore and senior nursing students who agreed to participate in the research. Eighteen participants were interviewed.

Six questions were asked during interviews conducted to investigate perceptions of accountability. Content analysis was used to discern the essence of the narratives from which nine themes emerged. The nine themes identified are: Difficulty defining accountability and the interchangeable use of the terms; accountability and responsibility; emerging knowledge; focus on work of nursing; student attention to tasks and outcomes; motivation/self-discipline; student stress and sources of stress; conditions for accountability and responsibility, and faculty actions; promoting self-accountability & accountability to others.

Study findings suggested that this group of students understood the importance of accountability but were unable to verbalize a definition, often confusing accountability with responsibility. Students perceived that faculty played a role in their academic success; and, students promoted accountability in faculty and in peers who were less successful academically.

Increased excellence in nursing education and accountability of nursing students will benefit the profession of nursing and the public by preparing nurses to be accountable for their practice when entering the workforce, to provide quality patient care, and to meet the expectations of healthcare reform for achieving the desired health outcomes.