When it comes to patient advocacy, nursing professionals are the voice for those who are most vulnerable. We advocate for them when they can't speak for themselves and work to ensure that they receive the best possible care. This is especially important when caring for patients who suffer health disparities due to race, religion, age, gender, sexual orientation, and socioeconomic status. In this blog post, we’ll discuss how to be an effective patient advocate for those most at risk.
Patient advocacy—speaking up on behalf of another—is one of the nursing Code of Ethics’ provisions that the profession is based upon.
In the American Nurses Association’s (ANA’s) Code of Ethics for Nurses with Interpretive Statements (the Code), Provision 3 says, "The nurse promotes, advocates for, and protects the rights, health, and safety of the patient." Furthermore, Provision 8 of the Code states that "The nurse collaborates with other health professionals and the public to protect human rights, promote health diplomacy, and reduce health disparities."
This means that as patient advocates, we're obligated as nurses to promote and protect the welfare of our patients first and foremost, even when doing so may be difficult or unpopular. The Code provides a framework for patient advocacy, and all registered nurses are expected to uphold this Code.
As patient advocates, we may find ourselves speaking out against discrimination, fighting for patient access to care, protecting patients, or providing resources and support to patients and families during difficult times. Whatever the situation, our “primary commitment” is to our patients, “whether an individual, family, group, community, or population” (Provision 2 of the Code).
The National Commission to Address Racism in Nursing revealed the findings of a poll of over 5,600 nurses in January 2022. They found that racism in the nursing field is a significant problem, and "Nearly half of nurses agree there is 'a lot' of racism in nursing.”
To turn the tide on this scourge in the nursing profession, we need to advocate for more cultural diversity in nursing and healthcare that more accurately reflects the diverse racial and cultural backgrounds of the patients we serve. This means hiring nurses and other healthcare team members from various racial and ethnic backgrounds so our patients see and feel that diversity is embraced in our healthcare system.
Racial groups aren't the only patients who face discrimination and "fall through the cracks" in the health care system. Those suffering from mental health problems, children, the homeless, and people who have fallen victim to violence and human trafficking also need us to stand in the gap as nurse advocates for them.
The nursing profession is based on ethical principles that guide nurses in their work with patients. Among these principles is the commitment to provide care for all members of society, regardless of their race, socioeconomic status, or other characteristics. This means that as nurses, we have a responsibility to provide patient care for marginalized, underserved, and at-risk groups which include:
People of color face significant healthcare disparities, so advocating for the needs of this group is especially important. For example, in 2018, only “8.7 percent of African American adults received mental health services compared with 18.6 percent of non-Hispanic white adults.”
In our nursing practice, we can help reduce these inequities by speaking up for patients of color in a number of ways. To begin with, we need to provide culturally-competent care, ensure that our patients have access to culturally-competent care, that their medical needs and rights are met and protected, and that they’re not discriminated against when they seek health care.
We also need to provide emotional support and understanding and serve as a reassuring presence during what can be a stressful and degrading experience for these patients.
Nursing advocacy is an essential component of providing care for the LGBTQ+ community as well. This starts by ensuring that these patients feel welcome and comfortable seeking medical care.
As patient advocates, we also need to speak up for LGBTQ+ rights, both inside and outside the healthcare setting. One way nurses can advocate for the community LGBTQ+ is to promote culturally-sensitive patient care. This means that both the nurse and the healthcare facility are knowledgeable about and respectful of the patient's LGBTQ+ identity and use appropriate pronouns and language when speaking with them.
It also means having resources available to meet the specific needs of LGBTQ+ patients, such as transgender-inclusive policies and educational material.
Patient advocacy is an essential part of providing care to people who live in poverty too. Nurses must identify and address the social determinants of health that contribute to poverty, such as lack of access to healthcare, education, and housing. Then we need to identify ways to improve access to these resources for those with little money.
As nurses, we also need to be aware of these patients' unique challenges, such as food insecurity and limited transportation options. By being informed and engaged, nurses can be patient advocates for those who lack adequate financial resources to meet their needs.
Undocumented immigrants are another group of patients who face significant barriers related to health care. First, they might be afraid to seek medical treatment for fear of deportation, or they may not have insurance or the financial resources to pay for care. Because of this, many of these patients go without the medical care they need.
Nurses can play an important role in advocating for the health of undocumented immigrants by connecting these patients with community resources, such as free clinics or advocacy groups. We also need to educate these patients about navigating the healthcare system and provide them with information about programs that are available to help undocumented immigrants.
Patients with disabilities often need nurses to advocate for their needs as well. This may mean working to ensure patients in wheelchairs can access a community health clinic or that signs are posted in Braille and large lettering in hospitals and clinics for the visually impaired.
Regardless of the disability, nurses can help educate patients and their families about their rights and the services and resources available to them. Raising awareness about issues affecting people with disabilities, such as access to quality healthcare, housing, jobs, and transportation, are also ways nurses can help reduce the inequities these people experience.
As the first point of contact for health care, nurses often have direct contact with the homeless and can see firsthand the challenges they face. Besides providing these people with the essential health care they need, nurses can connect these patients to desperately needed resources such as food, housing, and other services.
Nurses also need to advocate for policy changes that would improve the lives of homeless people. For example, nurses can lobby for more funding for affordable housing or support programs that provide appropriate employment opportunities.
Nurses may also be the first point of contact for victims of violence and human trafficking. Because of this, they have the responsibility to connect victims with essential services, such as police, social work, legal assistance, housing, counseling, and victim assistance programs which are vital for their safety and well-being. Bystander intervention training can also help nurses learn how to identify potential trafficking situations and provide emotional support and assistance to these victims.
How can nurses advocate for mental health patients? If you don't routinely work with people who have mental health problems, this can feel overwhelming to deal with when you're trying to help patients and families struggling with these issues. However, for psychiatric and mental health nurses, advocating for these patients is something they do daily.
This may include:
In addition, nurses can advocate for changes in policy and practice that will improve the care of patients with mental health problems.
Health care can be a complex and overwhelming system for anyone to navigate, let alone the elderly. The population of people over the age of 65 continues to grow, and many older adults live alone and have no family or friends for support. Nurses often need to advocate for the needs of this group which may include:
Nurses can also help identify elder abuse and neglect and provide resources and support to victims. In addition, nurses can raise awareness of the importance of advance care planning so older adults can ensure their end-of-life wishes are known and carried out.
Addiction is a progressive, chronic disease that requires treatment and support. Nurses can help individuals understand this disease and make informed care choices by providing information about addiction and its treatment.
According to the Addiction Center, 21 million Americans have at least one addiction, but only 10% receive treatment. Nurses can help people with addiction by:
Children are one of the most vulnerable people we care for as nurses because they usually can't speak out for themselves. Here are some ways you can advocate for the children you care for:
By working closely with children and their families, nurses can help ensure that children receive the care and services they need to thrive.
As nurses, we’re often our dying patients' strongest advocates and are uniquely positioned to help them with their complex needs.
Depending on their needs, we can advocate for palliative care, pain control, euthanasia, and assisted suicide. As nurses, we can help families accept their loved one's wishes, even if they disagree with them. On the other hand, families may request treatments the patient doesn't want or that aren't in their best interest. As nurses, we must facilitate these difficult conversations and advocate for what's best for our patients.
We have a long way to go when it comes to erasing racism in the nursing field and advocating for the needs of people of color. However, there are many vulnerable groups we need to speak up for. When it comes to patient advocacy, nursing care for all vulnerable patients should be a priority.
The sooner we embrace diversity and inclusion in nursing and healthcare, the sooner our patients will see themselves reflected in those they seek care from. This applies to all patients we advocate for, including the homeless, poor, elderly, and those with mental health problems.
Written by: 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.
