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Some Fundamentals March 10, 2006

Posted by manthey in Creative Health Care Management, Leadership, Professional Practice.
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My friend and colleague, Mary Koloroutis, is working on a field guide to Relationship-Based Care. She has been looking over some of my old writings and asking me questions, trying to clarify some fundamental concepts. As we talked, I realized it is important to review those fundamentals every so often.

So, here is what I shared with Mary about Articulated Expectations and Authority:

Authority has to do with power: the power or right to take specific actions. This is the concept so hard for nurses to accept, and yet it is the foundational element of a profession, which has the defining characteristic of autonomy as the core of its meaning.

Autonomy — the right to make decisions based on an “identifiable body of knowledge acquired in a formal education program” — is one of the main characteristics that differentiates a profession from an occupation or a vocation. In order to have autonomy, one needs to exercise authority.

The three concepts — Responsibility, Authority and Accountability — are three aspects of a single process: decision making. Whether it is decentralized or centralized doesn’t really change the process. Whatever the allocation of responsibility, it is only right and just for the person who accepts that responsibility to have commensurate authority. Anything less than that is fundamentally unjust. I believe this is true throughout life. In relationships of all kinds — especially that of parents of adult children.

And as nurses we remain unclear about our true responsibility, in that we accept responsibility for many functions over which we do not and should not have any authority. And  we refuse to accept responsibility for that for which we are licensed. To me this is the essential conundrum that needs to be resolved at this point in time, for now and the future.

It is not surprising that we are here, given the history of women’s oppression in the greater society, but the challenge now is to grow out of “here.” I continue to believe that with the attention paid to autonomy in Magnet and the lack of reaction to it among our physician and administrative colleagues is proof positive that any failure to perform autonomously at the bedside is ours to own. My severe frustration is that everyone seems to agree with me, but no one has come forward to join me in making this growth step happen.

PS. Collaborative practice is not in opposition to autonomy — au contraire — true collaboration cannot exist without prior autonomy.

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