Nursing Advocacy: Standing Up for Patients and the Profession


By Megan M. Krischke, contributor

When it comes to patient care, nurses consistently play the role of advocate as they support each patient’s emotional well-being, contribute to the healing process and speak on their patients’ behalf. Nurses can also put their advocacy skills to work in advocating for each other and for the nursing profession as a whole.

“As nursing advocates we start with the foundation that we are servants to others and stewards of our profession,” said Ellen Noel, MN, RN-BC, clinical nurse specialist at Virginia Mason Medical Center (VMMC) in Seattle. “As an advocate we choose to lead from that servant position, making sure peoples’ needs are being met through wise and thoughtful interactions.”

VMMC is creating a model of care based on the caring theory developed by Kristen Swanson, RN, Ph.D., FAAN, which provides a clear outline for advocating for patients and co-workers. Swanson’s five steps of caring are: knowing, being with, doing for, enabling and maintaining belief.

“With the caring model, you start with the assumption that the person you are working with has valuable skills, that they are trying hard, that they want to improve and learn and that they have the best intentions,” explained Noel. “When you start with that attitude you give that person the best chance of taking control of their circumstances and reaching success.”

“While we are just at the beginning of working out the logistics of implementing the caring model, we are already seeing an increase in awareness, empathy and understanding with others on the team,” remarked Alison Pyle, MN, MPH, RN, clinical director of the hospital’s nephrology/urology/neurology unit that is taking part in the pilot project.

While a lot is written about the bullying that can go on within the nursing profession, Christine Szweda RN, BSN, MS, NE-BC, director of nursing education for competency and assessment at The Cleveland Clinic, believes nurses can instead provide each other with a powerful support network.

“When it comes to supporting each other, it is great when nurses not only encourage a peer who is considering furthering his or her education, but when co-workers are also willing to be flexible with schedule changes that accommodate another nurse’s schooling needs,” she said.

“Early in my career I decided I wasn’t going to talk about people in terms of their nursing education, because it was only divisive,” reflected Connie Curran, Ed.D., RN, FAAN, editor emeritus, Nursing Economic$. “I have also made a commitment that when I find myself in a position of privilege, to respond by trying to get another nurse there as well. I was serving on a hospital board and realized I was the only nurse on the board. It turns out that nurses only make up 2 percent of hospital board members, but they are the ones who are there evenings and nights and know how the hospital works.”

In response to this commitment, Curran started the company Best On Board, which is an educational program to help nurses get the education and certification they need to serve on boards. As board members, nurses have the influence and the know-how to create good environments for patients and caregivers.

There are a number of ways that nurses can be involved in advocating for the nursing profession. Sometimes it is as simple as being the best nurse you can be and speaking with pride about the work you and other nurses do; it can also mean being involved in research, politics or with one’s professional organization. Most often, working to improve the profession also benefits patient care.

“It is increasingly common for even young nurses to have opportunities to be involved in research that contributes to the body of knowledge of nursing science,” commented Szweda. “But even if you aren’t personally involved in research, you can be quick to share and implement best practices and support the research that has been done.”

“Along those lines, be quick to embrace technology,” she continued. “I read a lot about nurses resisting the electronic medical record, but the richness of data that can be kept there will not only contribute to the body of knowledge, but having a consistent and integrated patient health record drives patient safety and better care.”

Noel believes that a key component of nursing advocacy is to hold tight to procedures and competencies that ensure patients are safe, while also including staff nurses in determining how these evidence-based practices will be implemented. Through this approach VMMC has made significant improvements in the areas of preventing pressure wounds, patient falls and medication errors.

“Participating in your professional society is a powerful way to advocate for the nursing profession and for patients,” remarked Charlotte L. Guglielmi, RN, BSN, MA, CNOR, perioperative nurse specialist at Beth Israel Deaconess Medical Center and immediate past president of the Association of periOperative Nurses (AORN).

“At AORN we offer our ORNurseLink, which brings nurses together using social media to share knowledge, learning and experiences. We also provide a unified voice about the role of the nurse, as the nation works to develop a new health care model.”

By joining your professional organization, you can be part of important movements like AORN’s National Time Out Day, which serves as a reminder to surgical teams to take a “time out” for each patient to prevent wrong-site, wrong-procedure and wrong-person surgeries.

“With 40,000 members across the country championing this cause, we have the opportunity to impact surgeries in every hospital,” remarked Guglielmi.

Ultimately the goal of all nurse advocacy efforts is better care for the patient.

“When the patient is the top priority, everyone has the same vision and mission and it elevates our profession to a higher level,” concluded Noel.

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