Trust between nurses and their patients has long been recognized as an important aspect of health care. Patients’ positive evaluations of that relationship are directly reflected in their attitudes toward the nursing profession: In a 2020 Gallup poll, Americans said nurses were the most honest and ethical of 15 different occupational groups for the 19th year.
Patients have a good reason to trust their nurses. Nurses spend a significant amount of time with their patients, and fulfilling their obligation to advocate for them under the nursing code of ethics can significantly affect patient outcomes.
Nursing advocacy can take many forms and occur at various levels in health care, and nurses must understand their role in advocating for patients. This is especially true for nurses who want to advance in their careers or take on leadership roles. Nurses who complete online Master of Science in Nursing (MSN) to Doctor of Nursing Practice (DNP) programs may find themselves at the forefront of patient advocacy. They must keep this aspect of the profession in mind as they advance in their careers.
WHAT IS NURSING ADVOCACY?
Understanding what advocacy in nursing is, how it fits into the profession, why it’s important, and the potential consequences are critical components in nurses’ understanding of their responsibilities to their patients.
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THE NURSING ADVOCACY CONCEPT
Several overarching characteristics of nursing advocacy were identified in a 2019 study published in the journal Nursing Ethics. Following a review of 46 articles and two books on the subject published between 1850 and 2016, the study’s authors identified the following characteristics that define the concept of nursing advocacy:
Apprising entails duties such as informing patients about their diagnoses, prognoses, treatments, and discharge and discussing health care options with them.
ADVOCATE FOR SOCIAL JUSTICE IN HEALTH CARE
Promoting social justice in health care entails facilitating patients’ access to health resources, addressing inequalities in health care delivery, and identifying and confronting inappropriate rules or policies in a health care system.
Serving as a patient’s voice when necessary, acting as a liaison for patients with other health care professionals or patients’ families, and relaying patients’ cultural values and preferences to other health care professionals are all responsibilities associated with meditating.
Safeguarding entails performing tasks such as tracking errors in patient care and protecting patients if other healthcare professionals are incompetent or have committed misconduct.
Valuing emphasizes responsibilities such as facilitating patients’ ability to make free decisions, protecting patients’ privacy, and operating following patients’ preferences, beliefs, and culture.
THE INHERENT NATURE OF NURSING ADVOCACY
Patient advocacy comes naturally to nurses and nurse leaders. Because nurses spend so much time with their patients, they have a unique opportunity to develop trusting relationships and an open rapport.
The nursing code of ethics also establishes nurses’ fundamental obligation to advocate for their patients. The provisions of the American Nurses Association (ANA) Code of Ethics for Nurses, particularly, contain important requirements related to nursing advocacy. As an example:
Provision 2 states that nurses’ primary commitment is to their patients and requires nurses to allow patients to participate in the development of treatment plans that they deem acceptable.
Provision 3 requires nurses to protect and advocate for their patient’s safety, rights, and health.
Provision 4 requires nurses to provide optimal care and promote the health of their patients.
Provision 7 requires nurses to protect patients’ rights throughout the continuum of care and while patients participate in research projects.
Provision 8 requires nurses to collaborate with other healthcare professionals on human rights and health disparities.
Provision 9 requires nurses to incorporate social justice principles into health policies.
WHY IS NURSING ADVOCACY ESSENTIAL?
Nursing advocacy is important for a variety of reasons. According to the previously mentioned Nursing Ethics study, nursing advocacy can:
Enhance public health
Increase collaboration among medical professionals, patients, and their families.
Improve the standard of care
Enhance the protection of vulnerable patients
Improve patients’ feelings of empowerment
Improve patient access to healthcare services
Patient advocacy can also improve the morale of nurses. The study found that nurses can improve their self-concept, self-motivation, and job satisfaction by advocating for their patients. However, the study cautioned that healthcare organizations must support nurses’ advocacy efforts, or nurses may feel isolated.
WHAT ARE THE DIFFICULTIES IN NURSING ADVOCACY?
Certain obstacles can make it difficult for nurses to advocate for their patients. According to a 2020 study published in the journal Nursing Open, the primary barrier to patient advocacy is a general lack of cooperation among patients, healthcare professionals, and healthcare organizations. The study identified the following more specific barriers to nursing advocacy as components of that overall lack of cooperation:
The bureaucracy of healthcare organizations
Inadequacies in the working environment, such as a lack of doctor support or a scarcity of medical equipment
Inadequate communication and interpersonal skills among staff Absence of legal support from health care organizations
Inadequate support from patients’ families
Patients’ financial resources are limited.
Fear of negative outcomes from advocacy, such as being fired or transferred, among nurses
Nurses’ mistrust of patient advocacy
Nurses’ lack of knowledge about patient advocacy
Factors or barriers related to the patient, such as culture, limited literacy, or strongly held ideologies or religious beliefs
Nurses in leadership positions must be aware of the barriers to nursing advocacy to implement strategies to overcome them.
WHAT ARE EFFECTIVE NURSING ADVOCACY STRATEGIES?
Several effective nursing advocacy strategies are available at the patient and healthcare organization levels.
PATIENT-LEVEL NURSING ADVOCACY STRATEGIES
According to a 2018 article published in the journal Oncology Nursing News, nurses can use the following strategies to advocate for patients:
GIVE THE PATIENTS A SAY
Simply remaining in a patient’s room while a doctor discusses a diagnosis and treatment options can make the patient feel more at ease asking questions.
Nurses can give patients valuable advice on managing their health issues and improving their quality of life. Nurses, for example, can teach chemotherapy patients how to take anti-nausea medication most effectively.
PROTECT THE RIGHTS OF PATIENTS
Learning about patients’ wishes and communicating them to others can help to protect patients’ right to make health-care decisions.
CHECK FOR ERRORS
Advocating for patients requires taking the time to review and correct errors in their healthcare information. Nurses can identify errors, conflicting orders, or oversights in a patient’s care by conducting reviews.
LINK PATIENTS TO THE RESOURCES THEY REQUIRE
Nursing advocacy includes raising awareness of community resources such as transportation, financial assistance, and support networks and connecting patients with those resources.
STRATEGIES FOR NURSING ADVOCACY AT THE ORGANIZATIONAL LEVEL
Nurses who can influence policies and procedures or serve on committees where they work can promote organizational advocacy strategies. A 2021 article in ONS Voice, for example, suggests:
Setting up patient care conferences
Inquiring about ethics consultations
Being a member of an ethics committee
Collaboration with nurse mentors
According to a 2018 HealthLeaders article, holding patient care conferences — in which healthcare professionals from various disciplines confer on patients’ health care — is especially beneficial for patients with multiple morbidities. Holding these conferences can result in improved collaboration and coordination and better prioritization of patients’ health goals.
According to the American Medical Association (AMA), ethics consultations — in which parties such as patients, members of their health care teams, and ethics consultants confer to clarify ethical issues — can help patients make more informed decisions about their care. The AMA also notes that ethics committees can help facilitate patient care decision-making, improve organization-held ethics training, and assist organizations in developing ethics policies.
In 2020, a study on in-service nurse mentoring published in the journal Global Health Action noted the potential for using mentors in nursing to improve patient care. Nurse mentoring can be beneficial in helping nurses develop their skills to improve the quality of care, especially in rural areas where there may be fewer opportunities for professional development.
Nursing Advocacy in Action: Case Studies
Patient advocacy occurs in various contexts, with specific nursing advocacy examples available at both the patient and organizational levels.
EXAMPLES OF PATIENT-LEVEL NURSING ADVOCACY
Please look at the COVID-19 pandemic for some incredible examples of nurses advocating for their patients. A 2021 article in Issues in Science and Technology highlights several examples of nurses’ pandemic-related innovations, including the following:
Nurses relocated infusion pumps (which dispense fluids and medications) from patients’ bedsides to hallways. This allowed the nurses to tend to the pumps and replace the bags. Limiting close patient contact allowed nurses to assist more patients while lowering the risk of COVID-19 transmission.
Nurses were instrumental in turning hospitalized COVID-19 patients on their stomachs, improving their blood oxygen levels.
Nurses used their cellphones and iPads to allow COVID-19 patients in hospitals to communicate with loved ones who were not permitted to enter hospitals.
In North Dakota, a psychiatric-mental health nurse practitioner (PMHNP) was instrumental in quickly developing a program to assist a homeless shelter in assisting individuals experiencing alcohol withdrawal during quarantine.
Aside from the pandemic, examples of patient-centred nursing advocacy show nurses’ commitment to patient care. Healthlink Advocates Inc., a nurse advocate firm, provides the following examples:
Checking for errors assisted a nurse in determining that a patient’s blood thinner dosage was too high, resulting in the patient’s transfer to a facility to treat signs of internal bleeding.
A nurse advocate was able to help a patient avoid treatment errors by communicating with members of the patient’s healthcare team.
Guardian Nurses Healthcare Advocates Inc., a nurse advocate firm, provides the following examples:
A nurse advocate could fully inform the family of a hospitalized patient by interpreting medical terms.
A nurse advocate reduced the patient’s anxiety and allowed the patient to make informed treatment decisions by facilitating medical appointments and treatment for a rare form of cancer.
Premier Medical Staffing Services, a medical staffing firm, provides the following examples:
Nurses can teach patients how to advocate for themselves by assisting them in creating a list of concerns or questions to discuss with medical professionals.
Nurses can tactfully protect patients’ privacy rights by requesting their permission before discussing their care in public or regularly reminding other medical professionals about patients’ privacy rights.
Nursing Advocacy Examples at the Organizational Level
Nurses can develop organizational strategies for advocating on behalf of multiple patients. Nursing advocacy can be integrated into an organization’s operations, as demonstrated by the following examples:
NURSES ARE DESIGNATED AS CARE COORDINATORS
Cleveland Clinic Care Community reduced patient transmissions and ER visits by designating registered nurses (RNs) as care coordinators for high-risk patients. Following identifying high-risk patients using an algorithm based on claims information, demographics, and disease state, the organization assigns RNs to those patients to assist them in disease management.
The RNs also refer patients to community resources (such as social workers or exercise programs), ensure that routine health care (such as colonoscopies and eye exams) is provided, and encourage patients to participate in other health-related programs (such as smoking cessation or weight loss programs).
THE APPLICATION OF A GUIDED CARE MODEL
Assisting patients with multiple chronic diseases through a guided care model developed by Johns Hopkins University can help patients adhere to a care plan that addresses all of their health concerns. RNs assess patients’ needs and collaborate with primary care physicians to develop care plans in the guided care model. Nurses also teach patients and caregivers how to manage their illnesses. In addition to increasing the likelihood of positive outcomes, this model has reduced patients’ healthcare costs.
IMPLEMENTING A TRANSITIONAL CARE MODEL
A Vermont hospital improved patient care by implementing a transitional care model, which allows patients to be assisted after they move from one healthcare setting to another. Southwestern Vermont Medical Center significantly improved service continuity by assigning advanced practice nurses to patients transitioning to other healthcare settings. The nurses assist patients in better understanding their medications and physician instructions; they visit patients’ homes as needed and connect patients with social services such as housing or addiction treatment. Patients who participate in the program are not charged.
PATIENT ADVOCACY NURSING IS WHAT?
Nurses passionate about nursing advocacy may want to specialize in patient advocacy nursing. Although nurses are not required to follow a specific career path to work solely in patient advocacy nursing, they must be aware of the certifications available in the field. As an example:
The Oncology Nurse Navigator-Certified Generalist certification is offered by the Academy of Oncology Nurse & Patient Navigators (AONN Plus) (ONN-CG). Eligible RNs must pass an exam covering community outreach, coordination of care, patient advocacy, psychosocial support services, survivorship, and ethics.
The Patient Advocate Certification Board (PACB) offers Board Certified Patient Advocate certification (BCPA). Individuals from various backgrounds, including nursing, can obtain the certification. Certification candidates must meet eligibility requirements and pass an exam covering empowerment, autonomy, communication, interpersonal relationships, healthcare access, and ethics.
Nurses have also begun to establish their nursing advocacy firms. Patients and their families hire and pay nurse advocates to assist them with difficult health issues. Some of their services include:
Assisting when a patient makes medical decisions
Medical appointments, hospitalizations, and surgeries must all be coordinated.
Visiting hospital patients to ensure that their needs are met
Helping patients obtain medical equipment
Giving health and wellness advice and coaching to patients
Helping patients with insurance billing and other insurance issues
According to the Alliance of Professional Health Advocates (APHA), hourly rates for independent advocates range from $125 to $350, depending on the advocate’s credentials, location, and services.
As with any business venture, nurses who want to go it alone can benefit from researching the market for their services, developing a business plan, considering factors such as insurance, and pinpointing the specific services they intend to provide.
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Nurses play an important role in the healthcare system. As the first point of contact with patients, nurses are responsible for addressing their concerns about the effectiveness and safety of COVID-19 vaccines. They administer vaccines and ensure people receive the required doses as in accordance to the ministry of health guidelines. Manning et al. (2019) state that nurses can help institutions such as schools and offices develop vaccination guidelines to minimize virus spread. At the same time, they are well-positioned to identify social and cultural barriers that might hinder vaccine administration among certain populations.
Also known as telehealth, telemedicine has gained popularity in recent times. The COVID-19 pandemic has pushed healthcare systems to adopt digital ways of serving patients to minimize exposure to the virus. Nurses are at the center of telemedicine success as they sensitize patients about its benefits and risks. They educate patients on the benefits and limitations of telemedicine. They also offer assistance, such as installing the software on patient devices where necessary. Additionally, nurses use telemedicine technology to monitor patient progress remotely, a beneficial technique for patients with chronic illnesses.
Prescription drug pricing is a major concern for many patients. The rising cost of healthcare is a bottleneck for low-income earners, with some opting to forego treatment or drug purchases due to a lack of funds. Like in vaccine administration, nurses are also at the frontline when prescribing drugs. They play the critical role of educating patients about the available alternatives and associated costs (Coster et al., 2018). They help patients understand the scope of their insurance coverage and how they can lower the cost of treatment by recommending generic drugs or advising patients to seek help from medical assistance programs.
Coster, S., Watkins, M., & Norman, Ian. J. (2018). What is the impact of professional nursing on patients’ outcomes globally? An overview of research evidence. International Journal of Nursing Studies, 78, 76–83. https://doi.org/10.1016/j.ijnurstu.2017.10.009
Manning, M. L., Gerolamo, A. M., Marino, M. A., Hanson-Zalot, M. E., & Pogorzelska-Maziarz, M. (2021). COVID-19 vaccination readiness among nurse faculty and student nurses. Nursing Outlook. https://doi.org/10.1016/j.outlook.2021.01.019