Account

ability &
Assertiv
eness as
essential

Accountability & assertiveness as essential traits for developing

autonomy, professional organization & collective bargaining
Introduction:-
Nurses recognise and appreciate the important role of newer trends plays
a revolution in nursing care. We also recognise that it can be adequately
designed and implemented. Under the newer trends in Nursing Autonomy
and independent nursing practice is one of the is most important thing.
Autonomy means preserving the freedom of the client and nurse.
Accountability and assertiveness are the essential trails for developing
autonomy.

Autonomy:-
Autonomy is derived from a Greek word; Autos means Self and Nomo’s
means Laws.
Autonomy means that individual is able to act for themselves to the level
of their capacity. It is the right of individuals, governing their actions
according to their own purpose and reason.
Accountability:-
It is the liability of satisfactory completion of work.
Accountability is the process that mandates that individuals are
answerable for their actions and have obligation to act.
Accountability involves admitting mistakes rather than blaming others and
evaluating the outcomes of one’s own action.
If a person has to perform job assignment effectively according to their
own qualification and experience or convention there should be
delegation of authority and responsibility needed, which in turn helps to
get accountability.
Accountability is a concept that has been present in Nursing for a very
long time, although the use of the word itself is relatively recent. In the
simplest sense, accountability is synonymous with responsibility.
The concept of accountability have two major attributes:
1.Answerability
2. Responsibility
Elements of Accountability: -
Where an expectation of accountability exists three elements must be
present:
1)Clarity, 2) Commitment, 3) Consequences.
Clarity: It means expectation and goals are clear and specific. Clarity also
means explaining why. If staff members know the reasons behind the
expectation, they are more likely to commit themselves to meeting it.
Commitment: You have to ask for a commitment to get it. Simply giving
an order is not enough. The accountable employee must listen,
understand, agree and commit to achieving the objective.
Consequences: Consequences are the after effect of negligence to
commitments. A person should bear the consequences of being
unaccountable.

Accountability in Nursing :-
Accountability is at the heart of nursing, weaving its way through nursing
practice in all settings and at all levels. It’s an emerging force throughout
an organization.
Nursing personnel are accountable for:
1. Providing safe and therapeutic environment for the patients.
2. Delivering component and personalized care.
3. Maintaining adequate supplies of material and equipment for smooth
functioning of the ward or unit.
4. Maintain accurate and up to date record and reports.
5. Maintaining good interpersonal relationship.
6. Protecting client’s legal right and privacy.
7. Working within ethical and legal boundaries.
8. Keeping pace with changing health needs and developing technologies.
9. Delivering care as per standards lay down by profession, statutory
body and institution.
10. Delegating responsibility appropriately.
11. Contributing to development of the profession.

Accountability as the essential trait of Autonomy: -

Accountability is the state of being responsible and answerable for those
behaviours and their outcomes that are included in one’s professional
role, as it is reflected in the periodic written reporting of those behaviour
and outcomes.
In contrast to accountability, autonomy refers to independent functioning,
the ability and recognized right to perform one’s total professional
function based on one’s own knowledge and judgement. Obviously, this
concept is related to accountability, as one who function autonomously
must be accountable for her behaviour.
 Another associated term, authority can be defined as being in a position
to make decisions and to influence others to act in a manner determined
by those decisions. Again this term is certainly related to accountability,
as a person in authority is accountable for the decisions she makes and
for the actions of herself and others who act on the basis on her decisions.
Further, authority is related to autonomy because one is authority often
acts autonomously in performing all or part of her roles.
These relationships are further developed in the nursing literature. For
example, Responsibility, authority autonomy and accountability are in
inextricably related. Responsibility and authority are necessary conditions
for both autonomy and accountability It is illogical inappropriate for an
organisation to hold a department or an individual accountable for those
activities over which the department or individual has no authority.
Autonomy within the area in which nursing service has responsibility is
also a necessary condition for accountability. Accountability is an exercise
in futility and an experiment in failure unless it is linked to nursing
services autonomy. The process of fulfilling nursing‘s formal obligation to
disclose requires that nursing service have the formal and legitimate
power to carry out relevant action without the opportunity to make
binding decision, accountability is a hollow concept.
Bergman (1981) sees this relationship somewhat differently by
considering responsibility and authority (along with ability) as
preconditions leading to accountability. As she states “The basic
precondition to have the ability to decide and act on a specific issue.” One
must be given or take the responsibility to carry out the action. Next one
needs the authority i.e., formal backing, legal right to carry the
responsibility. Then with the preconditions one can be accountable for the
action one takes.
The International council of Nurse means accountability is an inherent part
of the image of the professional nurse. In-fact, it is part of image of any
professional person. Accountability is a necessary attribute to all those
who wish to execute authority and act autonomously and this
characterises nursing today.
A checklist for Accountability: -
In attempting to prepare herself to act in a accountable manner in the
profession which can relates with the development of autonomy also and
to evaluate her actions, the nurse may use the following question as
guide.
** Am I fulfilling my professional role in accordance with the requirement
of the profession.
** Are other nurses in my setting doing the same.
** If I or others are not performing satisfactorily, am I taking steps to
remedy that situation.
** Am I participant in professional meeting, organisation, seminars,
conferences, and so forth, so that I may express my views on nursing to
those in nursing.
** Am I working within the profession so improve practice, education and
research.
** Am I complying with the ethical code of the profession.

Assertiveness: -
Assertiveness is a tool for expressing ourselves confidently and a way of
saying yes or no in an appropriate way.
It can be defined as the quality of being confident in stating one’s opinion
or needs.
Assertiveness offer many benefits:
1. Creating health and meaningful relationship.
2. There is less friction and conflict.
3. There is increase self-respect as well as respect from others.
4. Our self esteem is enhanced and we always feel in control.
5. Our productivity at work and home increased.
6. Less stress at work and overall sense of wellbeing.

Aim of assertiveness: -
1. To find the best possible solution for all people.
2. It increases the chances of our needs being met.
3. It allows us to remain in control.
4. Brings greater self-confidence.
5. Lets us have greater confidence in others.
6. Assertive people have more friends.
7. Reduces stress.

Assertiveness Model: -
A-S-E-R-T Model
A - Ask for god’s help: -Pray to god to guide you through scripture and his
spirit.
S - State the problem: -Think over and state the facts of the problem.
E – Express yourself: -State your feelings. Do not judge.
R - Request change and feedback: -Specify one behaviour change. Then
listen to the other person’s thoughts and opinion.
T – Talk it out: -Paraphrase ideas. Discuss the consequences,
considerations and options.

Assertiveness as the essential traits of autonomy: -

Assertiveness is to talk or communicating clearly with the staff, allowing
them to be autonomous and supporting group cohesion. It can increase
the job satisfaction by seeking out and valuing contribution from staff, we
can promote a climate in which information is share, decision are
supported and coordination of work helps to decrease work stress as well
as retain staff. Clear and open communication is the pillar of assertiveness
which is a critical skill for leaders to model and support. If Nurse leaders
cannot confront verbally abusive physician or clients how will staff
member learn? Although all nurse receives some education in
communication skills, only psychiatric field nurses tends to master this
aspect of their work, and even they may not be Zero in on assertive skills
thus they develop autonomy side by side. Even Nurse leaders who believe
that they possess good communication skills could benefit from attending
assertiveness work shop. BY demonstrating their willingness to learn new
skills such leaders are more likely to convenience staff member. It is an
essential of Professional status. This indicates that the existence of
personality traits typically associated with men’s assertiveness hence it is
a essential traits of the developing autonomy. Also, social comparison
may be an important variable in assertiveness and submissive behaviour
and shows a strong relationship to neuroticism and introversion.
Submission behaviour is not just the minor opposite of assertive
behaviour.

How to be assertive in planned meetings: -

** Set up an appointment well in advance whenever possible and
prime the other person. For the purpose of an upcoming interview or
meeting, speak to the person or send a memo or email stating the
objective for the meeting and any request (like that the appointment not
to be interrupted). A written reminder is preferable because it stands as a
permanent record of the purpose of the meeting.
** Role play upcoming anxiety provoking situation with a friend or
colleague anticipate intimidating or unclear comment and practice
responding to them before the actual meeting or interview.
** Write down important points or statement or an index card and
bring it with you for the meeting. If necessary, read them aloud to the
other person, saying something like “I have written this down because it’s
very important and i don’t want to forget anything.” Reading your point
aloud is preferable to stumbling or forgetting to say on the topic.
** when the meeting begins, structure the discussion environment for
clear and open communication. Move chair to face one another (without
desk in between) use eye contact and stick to the topic.
** Restate the purpose of the meeting. For example, say “I am here to
clarify .... or I want to talk with you about.... or I would like us to work
together to solve the problem of....”
** Avoid getting side tracked by irrelevant issue. Keep the discussion
on the identified issue with such comment as “ I would like to finish
discussion .....”.
** Concentrate on the words the other person says, this is especially
important if the other person’s tone of voice, facial expression, or nervous
movement intimidate you.
** Use relaxation exercise and deep breathing technique to remain
calm. Write a reminder like, “Breath in your abdomen” or “picture Peace
and Serenity” on your index card.
** Determine what motivates the other person and use that
information to support your argument or purpose. If the other person is
motivated by budgetary concerns, use that to support your argument. For
example, say “Not only will this program help employee to be more
effective but it will also save money because participants will have
learned to be more efficient in their communication and every day work.”
** Keep time limitation in mind. Move the meeting along if necessary,
make such comment as “we have 10 minutes left and i would like to come
to an agreement on .... or if i don’t hear from you about this by Thursday, i
will call you.”

ASSERTIVENESS RELATED TO NURSING PROFESSION:

Assertiveness is essential to nursing profession in many ways. Nursing
profession is the respectful profession which demands and shows respect
for others. Assertive ways of communicating and putting one’s own
concerns, ideas in front of others which help to the clients care as well as
for nursing profession itself. Assertive nurse defends client in every
aspect. It enhances honesty and dedication in nursing profession.
Assertiveness is a broad term associated with the individual from
hierarchical development of life. It adds to the quality of life by adding
meaning and support to one’s behaviour. It is not only being confident
about one’s words but also about one’s actions, doing and behaviour
exhibited in every situation of life.
It is learned behaviour or mode of communicating feelings, ideas in a
confident way without being aggressive on others. It depicts the confident
behaviour in an individual within under estimating the others. Being
assertive is beneficial to everyone. It can be defined simply, to convey
one’s own point of view which affirms the right of the individual without
violating the rights of the other person.

ASSERTIVENESS IS AN IMPORTANT TRAITS FOR PROFESSIONAL

DEVELOPMENT:
Assertiveness and Nursing are very closely related to each other. Nursing
practise cannot be declared good if a nurse is not assertive. The
assertiveness can be visualized in nursing care given by the nurse. Nurse
has to be assertive enough in order to preserve rights of nurse as well as
for clients who is seeking the nursing care.
Assertiveness by a nurse shows a behaviour that is based on certain
principles like: -
1. Equality
2. Respect
3. Responsibility
4. Accountability.
Being assertive, nurse is not being selfish rather it promotes the rights of
the client, fairness and equality of description and most important
efficiency and effectiveness of nursing practice is being attained. Nursing
is a collaborative effort and teamwork with other nurses and that can be
achieved ironically by assertiveness.
Nurse play different roles in health care setting:
A. Individual to group member.
B. Advocate to lawyer.
C. Collaborator to team builder.
D. Leader to manager.
To perform all these roles effectively nurse has to be assertive.
The main aim of nursing care is to develop the effective nurse client
relationship, in order to achieve the client’s progress and nurse-client
relationship, assertiveness is necessary. Assertive nurse is always
confident, listens to others, always is clear to other, not confused with any
issue and more over nurse is always assertive while hand-overring charge
or duties to other health professionals.
Assertiveness in nursing is the important footstep in the ladder of
professional organizational progress. Assertiveness is a healthy behaviour
and valuable component in nursing profession which are beneficial to
nurse, client, other workers and community in large. Being assertive will
also increase the visibility in nursing.

COLLECTIVE BURGAINING: -
An individual is free to bargain for himself and safe guard his own interest.
Collective bargaining consists of two words: -

Collective: Implies group action through representative.

Bargaining: Suggest negotiation.
The phrase therefore implies collective negotiations of a contract between
management representatives on one side and those of the worker on the
other side.
Definition: - Collective Bargaining is the process of discussion and
negotiation between two parties.
According Tudwig Teller, Collective Bargaining is an
agreement between a single employer or an association of employers on
one hand and a labour union on the other which regulates the terms and
conditions of employment.
Prerequisites of Collective Bargaining: -
1.Existence of a truly representative and strong trade union.
2. Existence of a progressive management.
3.Abscence of any external pressure either on the employer or on the
worker.
4. Existence of a measure of party’s strength or bargaining power.
5.Delegation of authority to an officer involved in negotiation.
6.Acceptance of a fact-finding approach by the management as well as
union.

Characteristics of Collective Bargaining: - The main characteristics of

Collective Bargaining are as follows,
1. It is a group action as opposed to individual’s action and is initiated
through the representatives of worker.
2. It is flexible and mobile.
3. It has fluidity or ample scope for compromise for a mutual give and
take before the final agreement is reached.
4. It is a two parties process. Both the parties are involved in it.
 5. It is not a take it or leave it policy.
6. It is a continuous process which provides a mechanism for
continuing an organized relationship between management and
trade unions.
7. It is a dynamic process not static because it is a relatively new
concept and is growing expanding and changing.
8. It is scientific factual and systematic.
9. It is an industrial democracy at work.

Principal of Collective bargaining: -

1. Collective bargaining should be made as an education as well as

bargaining process.
2. Collective bargaining should offer to trade union leaders an opportunity
to present to the management the wants desires grievance and
attitude of its employees.
3. The management and trade union must look upon Collective
bargaining as a means of findings best possible solutions.
4. Both parties to a dispute should command the respect of each other
and should have enough bargaining power.
5. There may be mutual confidence and good faith and a desire to make
collective bargaining.
6. There should be honest able and responsible leadership.
7. The two parties should entirely observe and abide by the entire
national and state laws which are appreciable to collective bargaining.

Collective Bargaining at three level: -

1.National level
2.Sector or Industry level
3.Company or Enterprise level

 Economy wide bargaining is a bipartite or tripartite form of

negotiation between union confederation, central employer
association and government agencies.
 Sectoral bargaining which aims at the standardization of the terms
of employment in one industry includes a range of bargaining
patterns.
 The third bargaining level involver the company and or
establishment.

Guide to Collective Bargaining: -

 1.Electing the agent
2.The elements of a contract
Process of Collective Bargaining: -
The collective bargaining process comprises of five steps:
Prepare:- This phase involves composition of negotiation team. The
negotiation team should consist of representatives of both the parties.
Discuss:- In this phase both parties decide the rules that will guide in
negotiation.
Propose:- This phase involves the initial opening of the statement and
the possible option that exist to resolve them.
Bargain:- This stage comprises the time and support for the drafting of
agreement take place.
Settlement:- This stage consisting of effective joint implementation of
the agreement through shares vision, strategic planning and negotiated
change.

Nurses participation in Collective Bargaining: -

Collective bargaining for nurses usually occurs in states where
there is significant trade union activity. present few nurses are involve in
collective bargaining. All nurses need to involved and understand the
benefits of union.

Conclusion: -
Autonomy, assertiveness and accountability are very much interrelated to
each other. The meaning of these three trio terms must be clarified to all
nursing personal. Accountability continues to retain its original meaning of
responsibility but has an added dimension that of answerability.
Answerability makes one confident in stating his opinions which is
assertiveness. These two terms are leading to autonomy development in a
profession as a holistic approach. Being assertive from student period will
increase truthfulness, confidence which are important during working as
staff.
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