From the staff development bookshelf: Accountability and intolerance of non-performers

Staff Development Weekly: Insight on Evidence-Based Practice in Education, August 30, 2012

Nurse managers often see pockets of non-performance among their staff members, and many times it seems easy to forgive, accept, or overlook these instances since those nurses do many others things well. But nurse managers need to examine their level of tolerance, as tolerating a lack of accountability sends a powerful message to your other staff members who are being accountable.

“She is a very good nurse, but she doesn’t document well. She especially has trouble with discharge. But she tries. No one is perfect.”

This is unacceptable. As nurse managers, we must hold all nurses to the same level of accountability. We can do this by training nurses in the process or procedure or whatever it is that we want them to do, and then ask them to commit to being accountable for a specific practice.

Nurse managers cannot accept non-performance. In the example concerning documentation, the nurse manager must engage the nurse in conversation and make a request: Will you commit to our documentation policy?

Then listen for the answer: “Yes” means the nurse commits. “Yes, and . . .” means the nurse commits and requests assistance. “No” means the nurse chooses not to commit. “Yes, but . . .” means the nurse says “yes” but negates it with qualifiers.

In the case of “yes, but . . .” the conversation must continue until the ambiguity is resolved.

Book excerpt adapted from Accountability in Nursing: Six Strategies to Build and Maintain a Culture of Commitment by Eileen Dohmann, RN, BSN, MBA, NEA-BC.

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