The Nurse as Patient Advocate

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Nurses are natural protectors of their patients, many of whom come into contact with the healthcare system during the most vulnerable, confusing and fearful times of their lives. In a world where the patient’s voice can get lost in the noise, nurses empower patients to ask questions and demand answers. In certain circumstances, nurses also serve as the voice of their patients and speak on their behalf.

Nurses have firsthand, inside knowledge of the medical system, which most patients and their families lack. Patients trust their nurse to be an ally and someone who advocates for their best interest, even if the patient isn’t entirely sure what that is. Because of the extensive training and experience nurses have, they can campaign for what’s best for a patient. This advocacy extends beyond individual patients to advocating for the profession as a whole, improving the circumstances for the future nursing workforce.

What Is Nurse Advocacy?

Of the many definitions of an advocate in Merriam-Webster’s dictionary, the one almost every nurse can relate to is “one who pleads the cause of another.” Pleading the case of a patient naturally comes with nursing.

If a patient’s language abilities, level of education or cultural differences make that individual vulnerable to misunderstanding their disease or plan of care, that patient needs an advocate. Nurses act at the bedside daily as advocates, helping to translate both literally and figuratively for patients learning a new medical language or who may not fully understand the situation in which they find themselves.

For example, when a patient in severe pain feels the doctor doesn’t understand how much pain they’re experiencing, their nurse can step in to advocate on their behalf. Nurses advocate for patients by using terminology and citing evidence similar to how lawyers may build their cases in court. It’s harder for a physician to dismiss a well-laid-out argument by a fellow healthcare professional versus a patient who may only know they’re uncomfortable and hurting. Another example would be a nurse case manager advocating for a patient and their family when finding appropriate community-based care after discharge.

The Growing Advocacy Field

Nurses’ advocacy on behalf of patients’ well-being stretches back to Lillian Wald’s Henry Street Settlement and its rich history of public health-minded nurses advocating for the well-being of entire communities at the population health level.

The National Association of Healthcare Advocacy provides support, education and mentorship for professional healthcare advocates. It aims to empower, educate and collaborate to improve patient care.

Postings on nursing job boards advertise official positions for RN Patient Advocates, and entrepreneurial nurses have launched small businesses offering private advocacy services. Unfortunately, patients usually pay for these services out of pocket and they’re only accessible to those with the means to pay for them. However, advocacy groups offer their services without charge, like cancer patients who’ve completed treatment and choose to assist newly diagnosed patients in navigating their initial treatment.

What Skills Do Nurse Advocates Have?

Nurse advocacy hinges on several skills that are key to the success of nursing care. Nurses learn some of these skills during nursing education, but they enhance and strengthen their advocacy skills throughout their careers.

• Communication: A nurse’s ability to communicate with patients and their loved ones couldn’t be more critical in patient advocacy. Listening to patients’ needs and translating complex medical information into layman’s terms is a vital nursing skill. Honesty, tactfulness and emotional and relational intelligence all play a role in nurse-patient communication. Another vital component is cultural competence, which is acknowledging personal differences and providing care to an individual that’s in line with and respectful of their personal cultural practices or beliefs.
• Collaboration: Patients must feel a nurse is trustworthy, that they’re working in collaboration with them and that their needs and opinions matter. Nurses must team up with patients and other healthcare team members to pursue the best possible patient outcomes.
• Critical thinking: Nurses are natural problem-solvers, and their powers of critical thinking assist them in finding solutions and helping patients actively participate in their care. Critical thinking may mean taking on a problem that has previously not been addressed or revisiting an issue with a fresh set of eyes to come up with a better solution that’s more acceptable to the patient.
• Creativity: Every patient is unique, and patients’ needs don’t always respond to cookie-cutter solutions. Along with critical thinking, a sense of creativity may help nurses better approach the advocacy process. Using a creative mind may help nurses find appropriate interventions to enhance patient care, increase collaboration and foster trust.

Nurse Advocacy in Action

Protecting patients from both present and anticipated injuries is a significant aspect of what nurses do through patient education and advocacy, both of which lead to optimal outcomes and increased patient satisfaction. Besides protecting patients, other aspects central to patient advocacy include:

• Being the patients’ voice
• Providing quality care
• Fostering interpersonal relationships with patients and their family members
• Respecting patients’ wishes
• Recognizing patients’ individuality
• Strengthening patients’ self-determination

Nurse advocacy roles in practice are often similar to case management positions or care utilization jobs, depending on the employer type. While professionals in these advocate positions often work from home, they involve extensive patient interaction over the phone. Tasks include answering questions, responding to chat messages, interacting with a patient’s care team and reviewing the patient’s history and health information. Nurse advocacy occurs in hospitals, home health, school-based clinics, private practice, dialysis and hospice.

Advocacy Beyond the Bedside

Nurses can act as advocates beyond the bedside by advocating for policy change on a broader scale. The same principles apply, only expanded to a larger audience. Nurses are uniquely positioned to see the issues facing our healthcare system today and, as such, can make a case for change.

An example of nurse advocacy on a federal level would be the American Nurses Association’s (ANA) push to prevent workplace violence for nurses. As a direct result of nurse advocacy, the recently passed bipartisan Workplace Violence Prevention for Health Care and Social Service Workers (H.R. 1195) bill took a significant step toward making the workplace safer for all nurses and other healthcare workers.

Another area where nurse advocacy works beyond the bedside would be the call for proper personal protective equipment (PPE) as nurses continue to be the front-line workers in the COVID-19 pandemic. The ANA advocates for the return of single-use PPE, ensuring that every nurse has access to the PPE needed to complete their jobs safely. As the pandemic continues, safe staffing concerns and mental health for nurses also move to the forefront of issues related to COVID-19.

Now more than ever, nurses also advocate for themselves in addition to supporting their patients. With resources being stretched thin in hospitals across the nation, nurses can no longer rely on their employers to “do the right thing” for their staff. Nurses can collaborate with their managers and healthcare administration to ensure that their basic needs are being met daily, such as breaks away from the bedside, proper equipment, PPE and safe staffing. Beyond that, advocating for mental health and wellness services and retention incentives to keep experienced nurses at the bedside are examples of ways nurses may advocate for better working environments.

The Nurse Advocate’s Role Is Versatile

Nurse advocacy is a set of skills, a way of being and a potential nursing career path. With quality of care being a focus for many hospitals, health systems, regulatory agencies and insurers, nurses are well positioned to fulfill the role of an advocate in any setting. The role of nurse advocate is crucial in reducing the chance of errors and harm to patients and ensuring better patient outcomes each day. There’s no one better than a nurse to understand, support and advocate for a patient in need.