"Weaponized Advocacy"

[Brent Duff]

Throughout my nursing career, I've noticed a phenomenon I call "weaponized advocacy".

Weaponized advocacy happens when someone uses the noble idea of patient advocacy as a mask for self-promotion, sabotage, or shaming colleagues. Instead of improving patient care, it erodes trust, poisons teamwork, and creates a toxic environment.

Imagine a nurse, Becky, caring for a patient who is complaining of pain. At that moment, pain medication is contraindicated because the patient's vital signs are unstable. Giving it could cause serious harm. Becky is appropriately focused on stabilizing the patient first so that the medication can later be given safely.

Then another nurse, Janet, enters the room after seeing the call light. When the patient mentions their pain, Janet tells them they are entitled to pain medication and suggests that Becky is acting inappropriately by "allowing" them to suffer. To the patient, it now appears that Becky is neglecting their needs, while Janet positions herself as the hero.

In reality, Becky is protecting her patient's safety. Janet, missing key information and motivated by self-interest, undermines her colleague to elevate herself. This kind of behavior damages reputations, erodes patient trust, and undermines teamwork. The result is a fractured care environment where the nurse doing the right thing looks like the antagonist, while the one acting with selfish motives appears to be the advocate.

Weaponized advocacy is not about protecting patients—it is about advancing oneself by tearing others down. It thrives on undermining colleagues in front of patients and families, creating the illusion of superior advocacy while actually destabilizing care. Healthcare is a team effort. Yes, true neglect must be called out and corrected. But this is something different. This is advocacy with dark motives, dressed up to look virtuous, while in reality it sabotages both caregivers and patients.

If you have been in healthcare long enough, you will likely witness weaponized advocacy. And when you do, you'll recognize that it has nothing to do with patient safety and everything to do with someone trying to stand taller by standing on someone else.

Note: I have a great team of coworkers in my unit. So don't try to read into this. We have a great team that is free of this toxic behavior. 
I was just thinking about this and felt the need to talk about it, because I've seen it happen to outstanding nurses and have experienced it myself no matter what hospital.

Has this ever happened to you? 

[Tweety, BSN, RN]

It would seem like some communication would be in order,  It really should be a simple explanation to the nurses that doesn't have the full picture and an adult would understand this.  I've told a nurse that a patient has been calling for pain medication a couple of times, without judgement and offered to help, and have been told the BP is too low and understood the situation and went back to minding my own business.

Too bad not everyone can be an adult about it.

[FolksBtrippin, BSN, RN]

While I agree that sometimes a nurse might advocate for something that is inappropriate and I also think that hero complexes are common in our field, I don't think you're getting it right when you claim that the motivation is usually dark or thriving on putting others down.

Usually it's just misguided passion. Better to meet it with your confident rationale rather than see it as a personal attack or a destruction of teamwork. 

 

[Brent Duff]

FolksBtrippin said:

While I agree that sometimes a nurse might advocate for something that is inappropriate and I also think that hero complexes are common in our field, I don't think you're getting it right when you claim that the motivation is usually dark or thriving on putting others down.

Usually it's just misguided passion. Better to meet it with your confident rationale rather than see it as a personal attack or a destruction of teamwork. 

 

I hear what you're saying, and I agree that many times advocacy missteps come from good intentions. Misguided passion is common in nursing, and often it's just a matter of someone not having the full context. Healthcare is full of amazing, selfless people, but it's also full of human beings with egos, ambitions, and flaws. 

Most of the time it's not malicious — but sometimes it is. Sometimes advocacy gets twisted into a tool for self-promotion or to undermine a colleague. That's the behavior I'm calling out as weaponized advocacy. I'm not saying it is the norm as you suggest that I am. I am saying however that other does exist. Weaponized advocacy doesn't come from altruism, it comes from ego. And if you've been in healthcare long enough, you'll see both. If not you're lucky. I'm calling out a specific toxic behavior. These people do exist, to say it's always misguided passion is an optimistic way to view it. I can appreciate that, but we cannot act like people with malicious intent don't exist. 

[FolksBtrippin, BSN, RN]

How do you know when it's weaponized advocacy as opposed to misguided passion or hero complex? And how do you respond depending on which problem you think it is? Do you respond differently to the nurse's behavior based on what you perceive her motivation to be? 

[Brent Duff]

This isn't just about me. This is also other nurses in the cross fire. Some call it out. Some ignore it. Some talk to their manager. I have let it slide I have spoken with them. It moves out to perception to confirmation when you give your rationale when they down play it and try to override a legitimate rationale. 

Do you think "weaponized advocacy" doesn't exist?

 

[FolksBtrippin, BSN, RN]

Brent Duff said:

This isn't just about me. This is also other nurses in the cross fire. Some call it out. Some ignore it. Some talk to their manager. I have let it slide I have spoken with them. It moves out to perception to confirmation when you give your rationale when they down play it and try to override a legitimate rationale. 

Do you think "weaponized advocacy" doesn't exist?

 

I'm not saying it doesn't exist. I'm challenging how you can know what the motivation is.  How do you know that they don't just disagree with you when they downplay your rationale? When you say they override, are you talking about your superiors?

People are pretty complex and we all have egos. 

You can't really call a person out for their motivation, because only they really know what that is.  You can call out a behavior, and you can do that regardless of what is causing the behavior. For example, if you are the nurse taking care of the patient and some other nurse thinks you should give a pain med when you have decided not to, they should not make a scene in front of the patient. It doesn't matter whether they're right or wrong, whether they are doing it to humiliate you or doing it to help the patient, they should bring it up with you privately, and if they still take issue with your decision-making after talking it out with you, take it to a supervisor. If a supervisor has an issue they should also bring it up privately and not make a scene in front of the patient. That's a behavior to call out. Whether it is malicious, misguided, or advocacy is irrelevant. 

[offlabel]

Why does being a passive aggressive, manipulative toxic *** need a contrived, meaningless label like weapon whatever? If there are bad players on a team, it should be apparent enough to the leadership and the rest of the team. I think a more appropriate label would be 'incompetent leadership'.

[Sharon Gauthier]

I can tell you that 20 years ago when I started the first patient advocacy practice (which I've paid dearly for) no one understood what that meant, I couldn't find the term anywhere related to patients.  They were afraid of me and had me in mohagany conference rooms often having me explain what I was doing there. Now fast forward everyone from car dealers to phone companies have an advocate and the hospitals think that they have advocates but......no one is boots on the ground. What I see are nurses who graduate who do not have any critical thinking skills and no ability to connect a symptom to papthophysiology and the hospitals taking away the role that are the only people who spend the most time with patients. It's scary and terrifying to me for the future of nurses and the actual appropriate care of patients. When I would have to tell a nurse to send a urine for someone who is suddenly confused or falling often that's an exact example of a huge knowledge deficit.  I actually had to tell an ER nurse that my client needed to have an EKG because his potassium was off the charts.....I have no idea where these nurses are graduating from but I taught at a university and it was not like that before we started to push nurses out through "fast trac" programs

[TomBooley]

I've experienced underhanded attempted sabotage in nursing education. What has happened to nurses' integrity?

[DallasRN]

To me, the most egregious aspect of the scenario presented is the absolute lack of professionalism demonstrated by "Janet".  Unless the situation is life-threatening, it is inappropriate to confront another nurse in the manner described.  This could wait for a hallway discussion and clarification of the situation. We can all learn from each other no matter how long we've been nurses (almost 44 years for me and still learning) so I'm all for sharing thoughts/ideas.  But you don't get to embarrass me in front of a patient/patient family/other staff/physicians.  My first step would be a discussion with my manager.  

Frankly, IMO, these types of situations are exactly the things that keep nurses from being recognized as a truly professional group.

[TomBooley]

Managers often protect the bully.