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Nurse Advocacy: Speaking Up for What You Need

Written by: Leona Werezak MN, BSN, RN

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As nurses, we’re used to advocating for our patients. But when it comes to nurse advocacy—advocating for what nurses need—we put ourselves dead last. It’s time to change that. It’s time to speak up for what you need as a nurse. Because if you don’t, no one else will.

What is advocacy?

When we talk about advocacy, what comes to mind? Being an advocate means engaging in activities to promote and protect the needs and rights of others. It’s working to ensure that all people have access to the resources and opportunities they need to live healthy and productive lives. By speaking out and speaking up, we can help to bring about positive change. 

What is nurse advocacy? 

Nurse advocacy is nurses working to improve conditions for themselves and fellow nurses. This includes advocating for better pay and working conditions, more training and educational opportunities, and improved patient care. 

Nurses often work together to advocate for these changes, using their professional knowledge and experience to make a case for why these improvements are needed. In recent years, nurse advocacy has taken on a new urgency in the face of the COVID-19 pandemic as nurses have been on the frontlines of the pandemic, caring for patients and risking their own health in the process. 

Nurses have also been vocal in calling for better safety protections, such as more personal protective equipment (PPE), increased staffing levels, and improved infection control measures. As the pandemic continues, nurse advocacy is essential to ensure nurses have the resources to provide safe care while remaining strong patient advocates.

The importance of nurse advocacy

As often the first point of contact for patients, nurses have a unique opportunity to advocate for their patients and ensure that they receive the best possible care. However, advocates don't just speak up for others – they also advocate for themselves. Nurses must be willing to stand up for their own needs and rights and call attention to the resources and support they need to do their jobs effectively.

Given the ongoing pandemic and nursing shortage, every nurse needs to be a nurse advocate and stand up for the needs of the nursing profession as a whole.

Dr. Daniel Eaton urges us, “…we must do something to stop the hemorrhage of nurses from the bedside. Bedside nursing is the bread and butter of our field. The fact is, if we don’t stop this shift away from the bedside, patient care may suffer. It will also chip away at the bedrock of our profession and harm the discipline of nursing. How can we change the perception that many seem to have that bedside nursing isn’t a desirable career?” 

What does nurse advocacy look like?

Self-advocacy

Self-advocacy is about taking action to improve our working conditions and professional environment as nurses. It's about being aware of the issues that impact us as nurses and taking steps to address those issues. When we advocate for ourselves, we not only make our own lives better, but we also set a powerful example for others that they can improve their lives as well.

Individual advocacy

Dr. Daniel Eaton explains:

Individual advocacy isn’t just one person. Often times it is a group of individuals coming together to advocate over a specific issue or issues….Nurses must come together and work to influence structures, powers, and support systems that are in place so we can provide safe and effective care for our patients.”

Advocacy skills for the nurse advocate

In Advocating for Nurses and Nursing, Karen Tomajan, MS, RN, NEA-BC, explains that four critical skills are needed to be an effective advocate in bringing about the changes you'd like to see in your nursing practice. These include:

1. Communication 

Most advocacy campaigns entail bringing together individuals and groups to address a problem. Therefore, nurse advocates must speak effectively and concisely while tailoring their message to the context and their audience. 

Nurse advocates must be able to communicate verbally, in writing, and electronically. Communication should be consistent and factual. Being able to present facts and statistical data is just as important as painting a picture of how individuals are being affected by the situation. Using ‘word pictures’ (words that help form a picture in another person’s mind) can help put a human face on the issue and make the communication more effective.

2. Collaboration

In collaboration, individuals or groups develop common goals, strategies, and activities to achieve their goals. During the nursing advocacy process, it's essential to work with all stakeholders affected by the issue. Collaboration also requires mutual respect and credibility. Groups that work together towards a common goal can often achieve more than they could individually. Finally, collaboration requires careful communication with all parties involved, soliciting input when necessary, and reporting on progress toward the goal. 

3. Influence

To facilitate change or solve an issue, the advocate must be able to influence others to action. Influence is the ability to alter or sway an individual’s or group’s thoughts, beliefs, or actions; it is essential to the advocacy process (Merriman-Webster, 2009b). Influence is built on competence, credibility, and trustworthiness.”

As nurse advocates, we need to make a compelling case for change with facts and data as an effective way to influence decision-makers. However, keeping the interests of all parties involved is essential for building both credibility and trust.

4. Problem-solving

Patient advocacy and nursing advocacy focus on solving problems or issues. Begin by identifying the key issues, then develop goals and a strategy to deal with them. After a strategy has been chosen, a plan of action is created to organize advocacy efforts and set deadlines for each activity. 

Most advocacy efforts involve approaching decision-makers and requesting action on a specific issue. Before addressing decision-makers, it's critical to craft a compelling request and identify the best time and person to approach. Patience and timing are required for success. Few victories are first attempts. 

Nurse advocates: Medical professionals who improve health care

Nurses are uniquely positioned to understand the needs of nurses, patients, and other medical professionals. As a result, they’re ideally suited to serve as advocates for improving the quality of the entire health care system. 

Nursing advocates must work to secure the resources and support they need to provide high-quality care in a work environment that can sustain health care workers over the long term. This requires advocating for:

  • Better work conditions 

  • Improved staffing and pay

  • Access to continuing education 

  • More respect for nurses demonstrated by making the changes necessary

By fighting for the needs of nurses, nursing advocates help improve the quality of healthcare for everyone.

Patient advocacy starts with nursing advocacy 

We're all familiar with the emergency directions airline passengers receive before flight takeoff: "Be sure to put on your own mask before assisting others." However, nurses are expected to put both their patients' and employers' needs before their own needs AND provide flawless, high-quality care. 

Common sense says this is impossible and is a recipe for disaster. Although it may seem counterintuitive (because most nurses are innate caregivers), nurses must demand that their needs for things like adequate staffing are met. Exhausted nurses don't have time to advocate for their patients when they're just trying to make sure no one dies needlessly on their shift because of short staffing.

How can nurses advocate for the nursing profession and their patients? 

There are several key issues that nurses should consider advocating for. Some of these include:

1. Appropriate compensation

Nursing salaries should reflect things such as supply and demand given the ongoing nursing shortage as well as inflation and differences related to the geographical cost of living. 

2. Safe and sustainable working conditions

This includes things such as:

  • Adequate orientation and training 

  • Appropriate staffing

  • At least one 30 min. meal break and two 15 min. coffee breaks during an 8-hour shift.

  • An adequate supply of fully functioning equipment and medical supplies

  • Mental health support, debriefing, and paid time off (if needed) after traumatic incidents

  • Sufficient time off work between shifts and sets of shifts

  • No shifts longer than 12 hrs.

  • No mandatory overtime 

  • Timely technical support

3. Acceptance of and adequate coverage for staff absences

Nurses should be treated professionally and trusted when they say they need time off due to illness, injury, or urgent family matters.

4. Protection and recourse for workplace violence from patients and families

Verbal and/or physical threats, abuse, or assault from patients or others in the workplace should not be tolerated under any circumstances. An appropriate plan should be established before providing care for mental health patients, those with cognitive impairment, and those who pose a safety threat to ensure the safety of staff and patients alike.

5. Protection from lateral workplace violence

All healthcare staff should feel safe and respected at work. In addition, nurses should have a neutral third party who will advocate on their behalf if they have concerns about bullying or lateral violence from fellow employees.

6. Nursing inclusion and representation on hospital boards and committees

Nursing representation on these healthcare boards and committees is essential if the needs of nurses and patients are to be heard and addressed.

7. Appropriate, professional representation of nurses in the media

Nurses are not the servants of doctors or patients. Nurses need to be portrayed in the media as the knowledgeable and independent healthcare professionals that they are. When appropriate, they should be interviewed by the media instead of or alongside physicians for a more balanced perspective of patient and healthcare issues.

8. Adequate personal protective equipment (PPE) and recourse if it’s lacking

Asking nurses to work without adequate PPE is like asking police officers or other high-risk workers to do their job without appropriate safety equipment. It's ridiculous and unethical. If adequate PPE isn't available, nurses shouldn't be asked to perform nursing work for obvious safety reasons. And if nurses identify a lack of PPE to do their job safely, they should be able to legally refuse to perform their work for safety reasons—and be supported by leadership for making this decision.

How do I advocate for myself as a nurse? 

Alene Nitzky, PhD, RN, OCN, explains there are different ways you can advocate for yourself as a nurse without compromising your job or feeling intimidated about speaking out alone.

1. Get involved in larger organizations

Look for nursing organizations that fit with the type of nursing work you do. 

For example, the American Association for Long Term Care Nursing (AALTCN) or the Association of Rehabilitation Nurses (ARN) represents the needs of nurses in these specialties. There is strength in numbers, and nursing groups welcome new members who are passionate and concerned about their work. In these groups, you will find other nurses who share your concerns. Most nursing organizations are actively advocating for nurses. Some provide nursing advocacy toolkits, including letter templates that are quick and easy for you to fill out and send to your Members of Congress.

2. Reach out to other nurses

There's nothing worse than feeling like you're struggling alone. If there aren't nurses you feel safe talking to where you work, look for nurses to connect with in other departments or private social media groups. 

Initially, venting is good, but resentment can start to build when you feel like that's all you can do. Look for like-minded nurses who are optimistic and interested in making changes to improve nursing along with you. Talk about how you can work together with other nurses and organizations to bring about the changes you'd like to see. And then trust your voices are making a difference.

It's time we as nurses speak up, loudly if need be, for what we need—and take action if our needs aren't met. It's not wrong, and it doesn't mean we don't care. It's called nurse advocacy. We advocate for our patients. Now it's time we advocate for our health and well-being, as millions of people who also happen to be nurses. 

We aren’t handmaidens.

We aren’t servants.

We are intelligent, well-educated professionals. We are Nurses. Not doormats. We require respect and safe, acceptable working conditions, or we will leave. End of story.

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About the author

Headshot of Leona Werezak MN, BSN, RN

Leona Werezak MN, BSN, RN

Leona Werezak MN, BSN, RN has worked as a nurse in a variety of positions at the bedside for 13 years and as a nurse manager. From there, she began teaching nursing in BSN programs for the next 20 years.