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How Do Nurses Advocate for Their Patients?

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traumaRUs has 27 years experience as a MSN, APRN and specializes in Nephrology, Cardiology, ER, ICU.

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Advocating for Our Patients

Nurses advocate for their patients every shift. How do you learn to advocate? Did you learn in school, on the job or ???

How Do Nurses Advocate for Their Patients?

Advocating for our patients is what we do. However, how do we learn to do this effectively amid the barriers? Alene Nitzky, PhD, RN, OCN states it simply, "Many nurses think of advocacy as the most important role we play in patient care. We need to remember that to best serve patients, we must have our own house in order. That house includes the other healthcare professionals with whom we and our patients interact, as well as the organizations providing those services and the policies and legislation that influence them."

So, communication is the first step - how do we effectively communicate our concerns to members of the healthcare team? Here are some tips:

  • Decide on a goal. Do you know what you want before you start the conversation? If not, do you have all the facts necessary to assist with decision-making?
  • Start your conversation with patient-centered language; "in the patient's best interest, I think we should ........." Or, "Mrs Smith and I were talking earlier today and she said she would not want a feeding tube."
  • Learn your facility's policies on communication. How are you to contact another care team member? A phone call, paging system or something else? 

SBAR is another tool to facilitate communication:

 S = Situation (a concise statement of the problem)

 B = Background (pertinent and brief information related to the situation)

 A = Assessment (analysis and considerations of options — what you found/think)

 R = Recommendation (action requested/recommended — what you want)

You try to communicate but.... 

What if the other care team member disagrees with you or just doesn't respond in an appropriate manner? Again, reference your policy manual. Also, be aware of cultural differences. Our healthcare team is very diverse; we come from all parts of the world and while we work in the US, we all have deeply ingrained thoughts and cultural norms that might differ from others on the team. Consider this when communicating. Try repeating your request in a different manner, use different words. Be precise as to what you want for the outcome. 

"For example, in some cultures, individuals refrain from being assertive or challenging opinions openly. As a result, it is very difficult for nurses from such cultures to speak up if they see something wrong. In cultures such as these, nurses may communicate their concern in very indirect ways. Culture barriers can also hinder nonverbal communication. For example, some cultures ascribe specific meaning to eye contact, certain facial expressions, touch, tone of voice, and nods of the head."

Above all, mutual respect is the key to successful communication. 

So, what happens if you can't resolve an issue?

Several nurses recently have suffered dire consequences when they have advocated for their patients. Julie Stephens was a 20 year employee of a hospital and she was fired when she reported unsafe conditions at her facility. And nurse Julie Griffin was fired when she refused to accept a third ICU patient as she felt this wasn't safe care due to not having enough monitors to monitor all patients. 

Some tips when advocating at work:

  • Utilize solid communication skills and be clear in your expectations
  • Document your interactions whether they be with another member of the healthcare team or management
  • Know your chain of command
  • Utilize your legislature and national organizations too 

Advocating for our patients is always our first priority. However, it's equally important that we advocate in a way that produces results. 

What tips do you use to advocate for your patients?

 

References:

From Our Readers, Practical Approaches to Patient Advocacy Barriers

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I learned to advocate in school . I have always been a “by the book person” per the jurisprudence book btw. 

Im a firm believer in  Id rather be job hunting rather than be in court thinking “ man if I could go back .” 

I have saved many , many , many lives due to pt advocation and In exchange I have had to resign due to Bad hospital practices that I could not look at doctors and superiors the same way. 

2 of those incidents saved two homeless peoples lives . Homeless people have rights two . One incident transformed a persons life tramatically. Sometimes surgical procedures are not safe to perform just because a doctor needs to make his house payment . Sometimes it only takes a one word to save a life . “NO “ Even refusing giving an unsafe dose of medication , discharge a really sick pt. Notifying a charge nurse that a doctor cant even detect the pt had a stroke . Not wanting to take a pt w/103 temp to surgery. It starts with you .

I do it becuase I care . 

Plus the docs see my life on instagram they know Im not hurting If I never work again 

 

 

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mmc51264 has 7 years experience as a ADN, BSN, MSN, RN and specializes in orthopedic; Informatics, diabetes.

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I have 2 kids that are T1 diabetics and had to learn how to advocate for them before I was a nurse. I use similar techniques to advocate for patients. Many times it is a matter of communication. Sometimes nurses have more time to get to know things about their patients that providers do; what I call "soft" facts. 

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Jackie specializes in RN BSN experienced in many areas of care.

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Advocating for patients is a crucial part of a nurse’s job.  Some important things to remember are to holistically respect every patient's dignity, treat all patients equal, commit primarily to the patient and remember to protect their rights.   

I have found that you have to be brave and speak up for your patient to make sure that their entire care team is informed of the patients’ needs or preferences. As the patient’s direct care nurse, you have the unique opportunity to learn and interact with the patient.  

Another important patient advocate step is to ensure that family and other associates do not interfere with the rights of the patient.  Sometimes this includes providing the patient with information about resources that can help them socially or financially.

One of the most important part of being a patient advocate is to keep the patient informed, make sure that the patient understands and is educated about their health care and to teach them about how to advocate for themselves because you will not be there all of the time.  By teaching a patient to advocate for themselves it gives them the tools to take power of their own health (Skilled Communications in Shared Decision Making, 2019).  

For example, I had a patient that was older and did not hear well.  I advocated for her by rounding with doctors to ensure that I could explain things to her and ask questions for her.  I have found it useful to talk to patient’s prior to rounding and have them or myself write down any questions that they may have.  This helps to ensure that their questions are answered, especially when doctors round quickly.

To ensure that this patient was continually advocated for, I included her family with her care plan so that they also knew her wishes, even if they did not agree.  This is important because to be a good patient advocate your have to make sure that everyone is supporting the patient’s care plan. 

Finally, one last excellent tool that I have found to be a patient advocate is the care plan meeting.  This allows the patient to meet with family and all of the member of their care team.  Generally, at my facility this will include doctors, nurses, pharmacy and supportive care personnel such as, physical therapy, speech therapy, case worker and social worker. 

References

Skilled Communications in Shared Decision Making. (2019). Retrieved from NPAF: https://www.npaf.org/patients-and-caregivers/skilled-communications/

 

 

 

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Walti is a LPN, LVN, RN, EMT-I and specializes in ICU/ER mostley ER 25 years.

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Advocacy was impressed on me many years ago. Another impressive experience I had was a 96 year retired public health nurse I had as my patient. I started our initial conversation by saying," I understand you used to be a nurse". She put me in my place when she replied, "I still am". That struck and stuck. I still am. When a doctor retires he retains his title, likewise for nurse. We takes it to the grave unless the board takes it form us.

I recently got a call that one of my former coworkers was in the hospital. He had been recently discharged from a major facility and started having rectal bleeding. Next day the doc was going to discharge him. I had just helped him to the BR where he filled the commode with BRB, we didn't flush. He was feeling faint while OOB. Head down for a minute and assisted back to bed. Doc comes in and tells him it's time to go home. I pointed to the commode and said he's still bleeding. Doc dismissed the concern by saying he has Colitis. I asked what's his Hgb and he said 8.4. I looked at his and said don't you think he needs blood  and he asked me where I would transfuse him?  I replied 9. He said well the standards have changed and now we don't transfuse until 7.

He then ordered orthostatic vitals signs. He sat back down just shy of standing the full minute but the charge nurse charted them as completed. He was dyspnic and tachypnic with his RR up to 40. Doc came back in and said okay you're are going home. I said NO. He is too sick to go home. (His BP was mid 80s over low 50s which gives a marginal MAP in the low 60s.) Doc insisted he was going and I looked at him and said he is a retired RN and feels he is too sick to go home. I'm a retired RN and I concur. Between the two of us we have been in this business longer than you have been breathing. He's too sick, now treat your patient not the numbers.

Shortly afterwards the charge nurse told me I had insulted "Doctor." I responded by saying I trusted the nurses completely but didn't have much faith in that hospitalist.  He stayed overnight because we appealed the discharge. The next day he received two units of blood and stayed another day to get three more units. The day after he was flown to a higher level of care where he received a total of 17 more units and two colon surgeries. He is currently home and being cared for by home health and getting better everyday.

I have to say I was disappointed in the charge nurse as she too should have advocated and chose not to. I will add that a few years prior as the hospital was trying to downsize in anticipation of going critical access a number of senior nurses were let go, I was one of them. I did mention that to the charge nurse, and told her they can only fire me once so now I can say anything I want to without fear of retribution. Community activism prevented critical access.

AS a reminder to that charge nurse 1/3 of your duty is to treat your patients, 1/3 is to teach your patients and the last 1/3 is to advocate for them.

Your first responsibility as a nurse is your patient. your second responsibility is to your license and your last responsibility is to your employer.

Just my 2 cents.

 

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