Registered Nurses (RN) have a complex role in advocating for patients. The definition of advocacy varies according to who is providing the definition and the health care setting in which she acts. Many ethical, professional and personal issues are involved that require appropriate education, experience and judgment.
According to John Banja, Ph.D., in a paper he presented to the Southern Council on Collegiate Education for Nursing in 1991, nurse educators are not always sure what or how to teach nurses in training to advocate for their patients. Nurse training includes advocacy issues, but the guidance offered in teaching programs is not uniform, and the guidance provided can never cover every contingency.
Sometimes, nurses in training get the advice to learn by example--to watch someone else and do what she does. However, it’s not always true that another nurse is doing the right thing. Situations arise that can lead a nurse to make mistakes and set a poor example.
Advocacy ranges from activities on behalf of patients, such as hand washing and proper identification before treatments, to arguing that an early discharge will harm her patient's recovery.
If a nurse observes a practice or procedure she believes to be wrong, advocating for her patient demands she speak out even if that practice was carried out by her superior. This is not always easy and may have a cost for the nurse.
Different nursing settings may lead to special complications. A patient in an outpatient surgery facility may present different issues than a person in a nursing home. Advocacy for a patient in an addiction treatment center may be quite distinct from a home-care patient needing medication supervision.
A nurses learns about patient rights during her training. She needs to accept her patient’s rights in order to be an effective advocate. She must believe in the patient's right to participate in decision-making about treatment. She must accept his right to be told the truth about his condition. She must agree even if she has a different belief.
Without an understanding of what her patient indicates he wants, advocacy may become a hollow exercise. A nurse must know if a patient has prepared an advance directive and listen if he explains his desires about his care. If her patient refuses treatment, she must accept that and help to ensure that her patient’s wishes are respected by the entire treatment team.
Some barriers to patient advocacy by nurses result from patients who are unwilling or unable to express their preferences. Patients may be afraid to say what they want because they believe it will alienate their physician. Families and patients may disagree about a whole range of choices. On occasion, an RN may find other professionals are indifferent or opposed to her patient’s wishes. Nurses may find that they strongly disagree with what a patient wants. For these reasons and many others, advocating for patients is a complex activity.
While it is not always easy or without complications, members of the nursing profession should always seek to reduce the disagreements which arise between patients and the systems that treat their illnesses and conditions.