Developing Advocacy Skills

[DaFreak71]

I am a first semester nursing student. We are taught in our classes that if something is being done that isn't right, we have to advocate for our patients. I am overwhelmingly in support of this! I believe this is one of the aspects of nursing that I will have a passion for. But I look around my class (after looking deep within myself) and I have some concerns that I would like some feedback on.

I notice that in class (and in my 35 years of life experience) that many people are not assertive. For example, it is rare for a student in my class to ask for further clarification when they are dealing with a particularly intimidating instructor. They prefer to remain silent and then get clarification from equally clueless classmates. In life, it seems like a lot of people are more comfortable going with the status quo than to risk bucking the system because it could be awkward or put them in the spotlight. I've come to realize that being assertive is not a skill that is naturally within most people, it must be developed.

I was lucky enough to have had actual assertiveness training. Due to a personal problem I was having years ago, I learned methods of communication that could help me in these types of situations. Most people, however, do not get this type of training.

How can the average student learn to be a patient advocate without having developed the skill to be assertive? In my nursing program, there aren't any classes devoted to this, aside from a generalized communication class which mostly focuses on how to communicate with patients. How can we adequately prepare ourselves for the times when we have to speak up knowing full well we will draw the ire of the doctors or fellow nurses?

We come from diverse backgrounds and life experiences. I had the misfortune to be raised in a family that was aggressive and assertiveness would never have been tolerated.

Do you think that schools should offer assertiveness training?

How can the average person learn these skills?

In my opinion, this is an area of nursing education that is neglected. What are your opinions about this?

Adri

[DaFreak71]

LOL, bumping my own thread :roll

[clee1]

I'll bump your thread too.

This is a problem I don't have.

I have never cared a whit what others think of me, and I'll fight a wrong to the highest authority. I am well known for failing to hold my tongue; I'll not suffer fools in silence.

Too many people think their shizzle doesn't stink, and it does my heart a world of good to see them knocked off their high horse.

[lpnstudentin2010, LPN]

nothing much of substance to say but good for you for wanting to advocate

[ceecel.dee, MSN, RN]

Patient advocacy is about making sure that the patient is getting the kind of care that the PATIENT HERSELF thinks is right for her...not just about what the NURSE thinks is the right care for the patient. It is more than assertiveness.

I do agree that assertiveness is needed in nursing too.

[pagandeva2000, LPN]

I see this all the time. I have almost gotten into power struggles with professors that have not given me the clarity I need, and I hated this, because the rest of the class would just freaking sit there while I would speak up, and then, I would get private calls or emails later where they would tell me that they agreed with all that I was saying. Then, if issues came up again, someone would nudge me.

Eventually I told my classmates that I would only advocate for the patients. They are grown, able bodied, and can do for themselves, and I would be of better use speaking for those that can't help themselves.

[EricJRN, MSN, RN]

I think it's a big (although common) misconception that nursing school will teach you all of the skills needed to become a skilled and successful nurse. Most nurses tell me that nursing school was only the tip of the iceberg as far as their learning curve and that they learned far more about nursing in their first few months/years on the job.

It's very likely that once your classmates do begin experiencing the ire of doctors or fellow nurses (in clinicals or on their first job), they'll decide they don't like being beaten up, and they'll likely develop some assertiveness as a survival measure.

[llg, PhD, RN]

I think it's a big (although common) misconception that nursing school will teach you all of the skills needed to become a skilled and successful nurse. Most nurses tell me that nursing school was only the tip of the iceberg as far as their learning curve and that they learned far more about nursing in their first few months/years on the job.

It's very likely that once your classmates do begin experiencing the ire of doctors or fellow nurses (in clinicals or on their first job), they'll decide they don't like being beaten up, and they'll likely develop some assertiveness as a survival measure.

I agree. If nursing schools tried to include EVERYTHING you needed to be a successful nurse, programs would be at least twice as long as they are now. Sometimes, people have to take responsibility for themselves and learn a few things on their own.

I think that it is also true that people don't always act the same as students as they do after graduation. Years ago, I had an instructor who thought I was "too polite" to the hospital staff and "not assertive enough." In my actual career, that has not been the case -- though I do try to treat everyone with courtesy and respect. My friends and I have laughed over that instructor's wrong opinion of me many times.

Finally, while I agree that too many students hurt themselves by relying too much on each other for clarification when they should be speaking with their faculty ... some students (and nurses) who think they are being appropriately assertive are actually hurting themselves by being too harsh and clumsy in their political dealings. Questioning, challenging, negotiating, advocating, etc. are all very advanced interpersonal skills that take time and experience to learn. While some people think, "Oh no, I don't want to play politics," the art of successful advocacy usually involves tact, diplomacy, and consideration for the other person's point-of-view. Some of the assertive students and nurses need to learn to tone it down a bit and work WITH their collegues (faculty and supervisors) instead of fighting them all the time.

Good idea for a thread ...

llg

[pagandeva2000, LPN]

This is the issue I had, I would not listen to a student, per se, unless they were someone that was reliable (that critical thinking thingy). I'd get clarity from the instructors, and that is actually where I could have wound up in trouble. Many instructors had ego problems, and hated to be proven wrong. I learned that a bit late in the game, but I had to turn to diplomacy and tact, but it had to be said, because we're being tested on the things that they're instructing us to do.

Yes, this IS a nice thread!

[grinnurse, RN]

Gosh.........great thread. I have never been really assertive except with my kiddos. I never really had a problem getting clarification on things while in NS but did try to remain a "flower on the wall" all the while letting the "show offs" do their thing. My assertiveness has really grown in the last nearly 9 months. You have to stand up for yourself and your patients or you are not doing your job that you agreed to do when you were licensed. I find it more difficult for me to stand up to the more experienced nurses b/c I am so new and don't have the confidence in my critical thinking or skills, but that is slowly but surely improving. Has anyone ever seen any place that offers CEs for assertiveness training? Thanks for the thread.

[pagandeva2000, LPN]

You, see, you started a wonderful, thought provoking thread. It allows each of us to make an honest assessment of ourselves and how our actions affect other people. The response is so positive! Thanks for that!

[pagandeva2000, LPN]

I chose to be somewhat of the fly on the wall, myself. There are always those ones that want to stand out before the professors by leading them to think that they know more than they do. I think it is better to simply admit what you don't know. I'd rather do that then open my mouth or let my actions prove that and possibly hurt someone. A patient should not be harmed because of someone's ego.