What Is Nursing Advocacy?
Written by:
University of Tulsa
• Jul 23, 2024
As advocates, nurses ensure that patients’ voices are recognized in the complex health care system. Nursing advocates promote and protect patients’ rights, health, and well-being. They also champion policy change — advocating for laws and regulations that improve patient care and support the nursing profession more broadly.
While registered nurses (RNs) are often taught the importance of nursing advocacy, they may require additional training to become fully effective nurse advocates. Explore the practice of nursing advocacy and the relevant career paths, skills, and education to become a nurse advocate, plus trends and tips for nurses who want to improve their efficacy as nursing advocates.
Basics of Nursing Advocacy
Nursing advocacy encompasses a range of activities, from individual patient care to policy creation at the federal, state, and local levels. Advocacy involves promoting patients’ rights, wishes, and values; adhering to nursing ethics; and championing social justice in patient care at all life stages.
At its core, nursing advocacy is about safeguarding patients and can include many different kinds of activities. Advocacy activities include the following:
- Protecting Patients’ Rights: Nurses advocate for patients’ rights to informed consent, privacy, and autonomy in health care settings.
- Promoting Patient Safety: Nurse advocates identify and address potential risks in the health care environment to create safer settings for patient care. This can include advocating for improved nurse staffing and ordering adequate personal protective equipment (PPE) for professionals.
- Improving Health Care Access: Nurse advocates work to eliminate barriers to health care access so that patients receive proper care regardless of gender, age, race, socioeconomic status, or other factors.
- Communicating Clearly: Effective communication between patients, families, and health care providers is a cornerstone of nursing advocacy. A nurse advocate’s top priority is to do everything in their power to ensure that a patient’s wishes and needs are clearly understood and respected.
The nurse-patient relationship is central to nursing advocacy, with nurses engaging in activities such as teaching, informing, supporting, and standing up for patients as needed. Nursing advocacy also extends beyond individual patient care to health care resource allocation, service delivery, and policymaking. This highlights the importance of advocacy in spurring needed changes in the health care industry.
Importance of Nursing Advocacy in the Industry
Nursing advocacy is crucial for several reasons. First, advocacy is a moral obligation in nursing. The foundational Code of Ethics for Nurses with Interpretive Statements from the American Nurses Association (ANA) outlines nine provisions describing how nurses must provide consistent quality care according to professional ethical standards. It states that “the nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” Failing to advocate for a patient would be a violation of nursing professional ethics as well as grounds for termination and loss of professional licensure.
Second, nursing advocacy leads to better health outcomes and higher patient satisfaction. A 2023 study of nurse advocates published in the Open Journal of Nursing reported that “successful patient advocacy activities reported by the nurses include increased quality of nursing care for patients a positive change in the patient’s health condition, satisfaction, and fulfillment, as well as positive emotions such as feelings of joy, happiness, thankful, inner motivation to work, and smiles.” Nurse advocates serve as liaisons between patients, their families, and health care providers; this can assist in rapid and effective health care delivery.
Nurse advocates also educate patients, helping them understand care processes and treatment options; this facilitates speedier recoveries for informed patients compared to patients who were less informed and included in the care process. By advocating for patients, nurses empower individuals to take an active role in their own health care, fostering greater patient self-efficacy.
Finally, nursing advocacy is necessary to identify systemic issues and improve health care quality and safety, ultimately benefiting the broader population. The American Association of Colleges of Nursing (AACN) notes that the 4.7 million RNs make nursing the nation’s largest health care profession. This means that nurses can be a powerful voice in health care policymaking when they align on policy agendas and take collective action.
Examples of Nursing Advocacy
Nurse advocates can support patients in many ways. Below are some examples.
Clinical Advocacy
In clinical settings, nurses often advocate for patients by:
- Speaking up about patient concerns. Nurses are often the first to notice subtle changes in a patient’s condition; this can be critical. They ensure that these observations lead to timely medical interventions that may otherwise be missed. Nurses may notice changes in a patient’s condition that others may overlook, prompting timely interventions.
- Ensuring informed consent. A fundamental part of nursing is to educate patients about their treatment options. Nurses ensure that patients understand the potential benefits and risks, helping them make well-informed decisions regarding their health care.
- Coordinating care. Nurses are pivotal in advocating for coordinated care efforts. They facilitate smooth transitions between different phases of treatment and ensure effective communication among various health care providers. This coordination is essential to maintaining continuity and quality of care and significantly enhances patient outcomes.
Policy Advocacy
Beyond direct patient care, nurses extend their advocacy to influence health policy and broader systemic changes.
- Lobbying for legislative change. Nurses are active in lobbying efforts that seek to improve health care systems. They advocate for legislative reforms that can enhance health care access, quality, and affordability at the local, state, and national levels. Their unique insights and front-line experiences provide valuable perspectives in shaping health policy.
- Participating in professional organizations. By engaging with professional nursing organizations, nurses can significantly impact health care policies and standards of practice. These organizations provide platforms for nurses to voice collective concerns, propose solutions, and advocate for the professional interests and needs of the nursing community at large.
Through these advocacy efforts, nurses work to ensure that patient care is both effective and compassionate, and they contribute to the ongoing improvement of health care systems.
Challenges in Nursing Advocacy: Moral Dilemmas
Importantly, advocating for patients isn’t always simple, and sometimes nurse advocates encounter genuine moral dilemmas when faced with conflicting values. Moral dilemmas in nursing are situations in which two or more moral values conflict, leading to a situation in which even a best-case scenario involves a violation of one moral value or another.
In a 2021 review of ethical dilemmas and moral distress among primary care nurses published in the International Journal of Environmental Research and Public Health, researchers found that nursing advocates faced moral dilemmas often. “In many clinical contingencies,” researchers explained, “the principles of biomedical ethics (autonomy, beneficence, nonmaleficence, and justice) are conflicting.” While nurse ethicists debate the exact definitions of these terms, these ethical principles can be understood broadly to mean the following in a nursing context:
- Autonomy: This principle is about respecting a patient’s capacity to make choices about their body and care. Nurses have an ethical obligation to help patients understand their treatment options so that their choices are informed.
- Beneficence: Beneficence involves acting in the best interest of the patient. For nurses, this means providing care that’s intended to benefit the patient, including promoting good, preventing harm, and removing harm when possible. It encompasses the motivation to do good and provide the best possible care to patients.
- Nonmaleficence: This principle means “do no harm.” In nursing, nonmaleficence means avoiding the causation of harm or hurt. It involves not only refraining from harmful actions but also actively preventing situations in which harm may occur. This includes careful monitoring for side effects of treatments and interventions, as well as ensuring that negligence or incompetence doesn’t compromise patient care.
- Justice: In the nursing context, justice refers to fairness and equality in the distribution of health care resources, as well as respecting the rights of all patients. Nurses must ensure that each patient is treated fairly and that decision-making about such matters as resource allocation, care prioritization, and treatment access is made equitably and without discrimination.
Here are two examples of moral dilemmas (that is, a conflict between two obligations, principles, or values) that nurse advocates face when these ethical principles conflict.
First Dilemma — Treatment Refusal: A Conflict Between Autonomy and Beneficence
Imagine a patient diagnosed with a potentially life-threatening condition who refuses a treatment that their medical team highly recommends.
The conflict here arises between the principle of autonomy, which supports the patient’s right to make their health decisions, and the principle of beneficence, which compels the nurse advocate to act in the patient’s best interest by advocating for a treatment that could significantly improve or save the patient’s life.
Nurses must navigate these situations by respecting the patient’s wishes while also ensuring that the patient is fully informed about the consequences of refusing treatment. This may involve additional counseling and education, involving family members, if appropriate, and ensuring that all decisions are made with the patient’s informed consent.
The nurse advocate, respecting their patient’s autonomy, may still feel guilt, anger, or grief in the instance of a poor health outcome — even when the patient’s wishes were respected. In nursing ethics, moral residue refers to the distressing, unsatisfactory feelings that a nurse advocate may feel after acting on a moral dilemma. The advocate’s moral distress makes sense; they respected patient autonomy (upholding one nursing principle), but at the cost of beneficence (failing to act for the benefit of the patient).
While some professional ethicists argue that respecting patient autonomy can be a form of beneficence — an interpretation that would resolve the issue — many nurses experience this as a genuine dilemma.
Second Dilemma — Scarce Medical Resources: A Conflict Between Justice and Beneficence
Imagine a situation in which there are limited medical resources, such as a crisis in which there’s a shortage of critical care beds or life-saving medications. Nurse advocates face a dilemma between the principle of justice, which demands the fair and equitable distribution of these scarce resources, and the principle of beneficence, which focuses on doing the most good for each individual patient. This could involve making difficult decisions about who receives treatment based on criteria that aim to maximize benefits while being fair to all patients.
In an ideal world, nurses would always have the resources they need to provide optimal care to every patient. The reality is that nurses need to constantly navigate constraints such as limited time for care, scarce resources, disagreements with patients and their families, and organizational limitations. These factors can increase the likelihood that nurses will face moral dilemmas when advocating for patients.
Nurses must always exercise their best judgment when navigating complex dynamics between the patient, the patient’s family, and members of the patient’s care team. However, the point of these examples is to illustrate just how challenging this can be in practice.
These dilemmas highlight the complex ethical challenges that nurse advocates face, requiring a deep understanding of ethical principles, strong communication skills, and a compassionate approach to patient care.
Necessary Skills for Nursing Advocacy
Learning how to advocate for patients involves developing the right set of skills. Essential nursing advocacy skills include the following:
- Communication: Effective communication skills are essential for advocating on behalf of patients, ensuring that their needs and preferences are clearly articulated and understood.
- Critical Thinking: Advocates must be able to critically assess situations, identify potential issues, and develop strategies to address them.
- Empathy: Empathy allows nurses to understand and relate to patients’ experiences, fostering trust and effective advocacy.
- Negotiation: Advocates often need to negotiate with other health care providers, administrators, and policymakers to achieve the best outcomes for patients.
- Self-Care: Advocacy takes lots of mental and emotional resources. Nurse advocates must develop skills for maintaining mental health to avoid burnout and nurse turnover while advocating for others.
Nurse advocates may find a significant overlap of advocacy skills and leadership skills for nurses . Nurses who are interested in becoming more effective nurse advocates should learn more about different leadership styles in nursing and how to become nursing leaders.
Trends in Nursing Advocacy
Nurse advocates must monitor current nursing issues as well as the state of the nursing field.
Increasing Focus on Social Determinants of Health
Understanding that medical care isn’t the sole determinant of health outcomes, nurses are placing greater emphasis on the social determinants of health, such as housing stability, education level, and socioeconomic status.
By advocating for policies and practices that address these broader social factors, nurses aim to improve overall patient well-being and health equity. Initiatives may include community outreach, policy advocacy, and interdisciplinary collaboration to create interventions that mitigate these determinants.
Technology and Advocacy
The integration of advanced technologies in health care is significantly enhancing how nurses advocate for their patients. Telehealth services have expanded access to care, particularly in underserved areas, allowing patients to receive timely consultations without the need for travel.
Additionally, electronic health records (EHRs) have improved the continuity of care by providing health care professionals with immediate access to comprehensive patient data. Nurses leverage these technologies to ensure better patient monitoring, personalized care plans, and improved health outcomes.
Interpersonal Collaboration
Effective advocacy in nursing increasingly depends on the ability to collaborate across various disciplines. Nurses are actively engaging with physicians, social workers, pharmacists, and other health care providers to foster a holistic approach to patient care. This collaborative effort is crucial in developing comprehensive care plans that address all aspects of patient health.
By working together, health care professionals can ensure that patient advocacy is robust, coordinated, and effective, leading to better patient outcomes and higher levels of patient satisfaction.
Tips for Effective Nursing Advocacy
Implementing nursing advocacy requires practical strategies and continuous effort. Tips for effective advocacy include the following:
- Stay informed. Keeping up to date with the latest developments in health care, including policies, best practices, and technological advancements, is crucial for effective advocacy.
- Build relationships. Strong relationships with patients, families, and colleagues enhance the ability to advocate effectively and ensure that patients receive the best possible care. Many conflicts can be resolved or avoided by strengthening interpersonal relationships, fostering mutual respect, and practicing active listening.
- Persist. Advocacy often involves overcoming obstacles and challenges, sometimes without immediate positive results. Persistence and determination are key to achieving successful outcomes, especially in advocating for sweeping policy changes.
- Engage in continuing education. Continuing education opportunities can enhance advocacy skills and knowledge, empowering nurse professionals to become more effective advocates.
With the right foundation, nurse advocates can make a meaningful difference in their patients’ lives and the lives of other health care professionals.
Explore an Advanced Nursing Degree
Nursing advocacy is fundamental to providing high-quality patient care. By understanding its importance, developing the necessary skills, and staying informed about industry trends, nurses can effectively advocate for their patients, contributing to better health outcomes and a more equitable health care system. Whether through direct patient care, policy involvement, or education, nursing advocacy remains a cornerstone of compassionate, patient-centered care.
With the increasing demand for skilled health care professionals, the need for nurse advocates is growing faster than many other occupations. The University of Tulsa’s online RN to Bachelor of Science in Nursing (RN to BSN) program is designed for RNs looking to advance their careers and accelerate their journey toward nursing leadership. This program equips students with the knowledge and skills to effectively advocate for patients and better health care practices and policies.
Learn more about how TU’s online programs can help you accelerate your nursing career.
Recommended Reading:
The Role of a Community Health Nurse
How Global Health Nursing Supports Population Health
Sources:
American Association of Colleges of Nursing, Nursing Workforce Fact Sheet
American Nurse Journal, Elevating the Voice of Nurses Through Advocacy
American Nurses Association, View the Code of Ethics for Nurses
