An advocate is someone who champions the cause of another. Advocacy in nursing has existed for many years. Nurses represent patients to defend their rights and ensure they receive quality care. They will conciliate when there are issues and follow the correct procedures to solve them. Advocacy preserves human dignity, provides freedom from suffering, and promotes patient equality in nursing. It also means ensuring patients make their own health decisions. Nurses are in a prime position to provide innovative interventions, recognize vulnerability and defend quality care.
Elmhurst University’s online master’s entry program in nursing is for those with bachelor’s degrees in other subjects who want to enter nursing. This accelerated course prepares students to provide direct patient care and have the skills of a clinical nurse leader.
The advocacy of a bedside nurse
Fursan Sahawneh is an ICU nurse at Methodist Charlton in Dallas, America. He spends 12–13 hours a day with two patients, meaning he can spend up to six hours with each one. There are few areas of healthcare where so much time can be spent with patients. This gives him plenty of time to understand his patients’ needs socially, physiologically, emotionally and economically.
The knowledge he gains makes him feel responsible for advocating and speaking up for his patients. This could involve speaking out to providers for a patient without health insurance and requesting they be given a more affordable medication or speaking to social workers about a patient who needs resources to help them buy their home medications. It could also mean asking for a diabetic education consultation for a patient who lacks knowledge about managing their disease.
As a bedside nurse, Sahawneh believes he has a lot of responsibility. He should facilitate a good outcome for the patient because he spends the most time with them and therefore knows the most about them. Many colleagues in the healthcare team rely on his recommendations and patient assessments to determine the treatment they will provide. He believes that he must not neglect to be an advocate as it is probably his most important role and affects his patients’ wellbeing and outcomes. As a bedside nurse, he feels he is in an ideal position to be an advocate for his patients. He recommends that nurses speak up to the healthcare team, the social workers and the doctors, because this will benefit patients the most.
Teaching nurse advocacy
Katie Chargualaf is an assistant professor at the University of South Carolina Aiken School of Nursing. She tutors nursing students, and when she teaches them about being an advocate for patients, she asks that they see things through the eyes of a patient. When she taught about patients who have experienced trauma and the barriers that stop them from leaving the hospital sooner, Chargualaf described how one of her students cared for a patient like this during a clinical rotation. Chargualaf sat down with the student and told her to put herself in this patient’s shoes. She said to her that the young man had experienced a trauma and life was not going the way he expected. She asked the student how that would make her feel, and she replied that it would make her angry and frustrated.
Chargualaf asked her to consider what nurses could do to move past the barrier of frustration and apathy and show him what he can do to move toward getting out of the hospital. By the end of that day, the student had the patient out of bed, walking and smiling. Chargualaf told the student that she had made this happen.
S teaches her students that nurses are in a unique position to be strong patient advocates. They have a lot of knowledge and many skills that can benefit people. They spend the most time with patients, which helps build strong relationships. Nurses can use their healthcare knowledge to stand up for social, public health and political issues. Nurses are educators, and by educating people, they are advocating their rights.
Chargualaf believes that there are personal rewards to being a strong patient advocate, such as when patients do things the nurse has worked with them to do. Nurses can take the time to listen to patients and help them use their voice and express their wishes. Building these relationships can lead to better outcomes. Helping patients improve can mean they do things they cannot do when they are ill. This could be going on holiday, attending a wedding, or simply achieving everyday things that were impossible before.
Chargualaf recommends nurses think about the rewards of advocating for patients and not consider it a task. She says, “Don’t let it be daunting. You can, as a single nurse, create the change you want to see”.
Underserved populations have restricted or non-existent contact with healthcare or are vulnerable in other ways. These can be people from ethnic minorities who do not speak English, the socioeconomically disadvantaged, the educationally disenfranchised, prisoners, individuals with disabilities, seniors and refugees. There may be barriers preventing underserved populations from accessing basic healthcare and getting health coverage.
One reason for not being able to access healthcare is poverty, especially for African American and Hispanic populations. There are also many people living in rural areas below the poverty line. There can also be cultural reasons people do not access healthcare, such as not speaking English, and there are many rural and urban communities that do not have enough healthcare professionals to meet the needs of the population. Nurses may see patients that have low literacy, live in poverty, and inhabit run down areas with high crime rates. Nurses must accept patients as they are and focus on their health so they can build relationships, making the patients more likely to take clinical advice and make changes to improve their health.
Vulnerable people do not always have the resources to take care of their health and nurses must be non-judgemental when caring for patients like this. By listening carefully, nurses can understand the barriers being faced by the patient. Nurses must not make assumptions when patients do not take their advice as there could be financial, social, cultural or physical reasons for this. The patient-centered approach means the patient agreeing to their treatment.
Nurse advocates can raise awareness, inspire change and protect the health of underserved populations. Nurses are knowledgeable about preventive care and treatment and can educate people in their area. People with serious conditions, the LGBTQ+ community and prisoners might struggle to find healthcare providers who deliver the required healthcare. Nurses can be advocates for patients by liaising with Medicaid and insurance companies. They can join advocacy committees for underserved populations in schools, hospitals and communities.
The underserved populations experience rising diabetes diagnoses, higher death rates, high infant mortality rates, cancer and heart disease. Nurses have patients from diverse cultures and must develop cultural awareness to provide an equitable and effective service. Doing this can mean stronger relationships, overcoming barriers and patients receiving the necessary care.
The right interventions can address disadvantages, poor health and untimely disease and death. With the right policies there can be better access to healthcare and healthier communities. Nurses can advocate policies that generate health equity and address the social influences on health. They can be effective advocates because of their understanding and experience of healthcare. Nurses can join professional nursing associations, speak on behalf of their patients and influence policy.
The role of the nurse advocate
The Nursing Code of Ethics proclaims that nurses must protect human rights and mitigate health inequality. This means advocating people’s access to healthcare. Nurses must abide by ethical standards and act without bias or prejudice when working with patients. Nurse advocates work with patients, doctors and healthcare organizations. For example, a doctor might have prescribed a new medication or made a diagnosis. The nurse can look over the treatment plan with the patient and make sure they understand their treatment and answer any questions they or their family might have. Medical terminology can be difficult for many people to understand, and nurses can explain clearly.
Patient advocacy consists of almost everything nurses do for their patients. Understanding how advocacy relates to nursing duties is essential to patient care. Nurses keep their patients safe, including asking doctors for clarification when their instructions are unclear. Nurses also advocate when handing over at the end of the shift to ensure new staff understand the patients’ care. Patients can feel vulnerable in clinical settings. When they are ill, they trust the health professionals looking after them.
Nurse advocacy demonstrates that nurses care about patients and will represent them to improve their care. Nurses are the allies of patients when dealing with the healthcare system. If a patient disagrees with their treatment plan, the nurse can explain this to the doctor. The healthcare system is complex, and health information is only sometimes obtainable which can make it difficult for patients to make informed decisions. Nurses can assist patients in making decisions about their health and finances.
Nurses can be advocates for patients by ensuring their concerns and viewpoints are heard, and can represent patients to doctors and other healthcare professionals. They will do this even if they disagree with the patient’s choices. Patients are entitled to make decisions about their own healthcare. Some may want a second opinion, and others want their family involved in decision making. Other patients might not want any treatment. If patients can make decisions, they have the right to refuse treatment.
Low health literacy is a significant problem concerning patients understanding of health information and making suitable health decisions. Some factors that hinder understanding are hearing and vision issues, language and cultural differences, reading level of written information being too high, and undiagnosed cognitive impairment. High-risk groups for low health literacy are older people, refugees, immigrants, ethnic minorities and those living in poverty. Nurses are well-positioned to educate their patients, conveying medical information in a straightforward and easy-to-understand way.
Patients with low health literacy may not understand their diagnosis or treatment plan, and this makes decision making difficult. This can affect patient outcomes and mean that patients are more likely to be readmitted and make mistakes with medication. Nurses can be advocates for their patients by recognizing low health literacy and the barriers to communication and using best practices for cultural and linguistic connection.
Nurses usually spend the most time with patients, so they are in a good position to address health literacy, and they can carry out assessments and attach these to the patient’s electronic health records. Other staff will therefore be informed of a patient’s low health literacy, and they can adapt their service to the patient’s needs. Nursing staff can improve communication and ensure medical literature is easy to read and understand.
Nurses can advocate more widely by learning more about current health and patient care concerns. They have daily experience of the influence of politics and policy. As the largest staff group in healthcare, they are in a prime position to see the impact of health policy. Nurses can relate personal experiences of how policy affects patient care. They can be active with nursing organizations and participate in the local and national discourse on the future of healthcare. Nurses who are advocates for patients can get involved with professional nursing organizations, volunteer to be on the board and find ways to influence policymakers. Nurses can use their voices to impact patient care in the time ahead.
Traditionally, nurses have advocated their patients’ autonomy, rights and safety, and educated them about their conditions and treatment. They are well placed to advocate because of their role in clinical settings and their relationships with healthcare colleagues. Nurse advocacy works for all patients but is critical for underserved populations and those with low health literacy. Nurses are advocates for patients directly and campaign for better policies and regulations. They are central to the protection of patient’s rights and the provision of high-quality care.