What is nursing advocacy? And in which situations do we advocate for our patients?

Clovery · Mar 14, 2014

As a nurse you will advocate for your patients in a number of ways. One way, like you mentioned, is making sure they understand their plan of care and have all of their questions answered to their satisfaction. Some other examples off the top of my head: Maybe the doctor doesn't realize that whenever you turn the patient she grimaces in pain... you need to advocate for her to get pain medication. Maybe she can't stand tuna salad sandwiches, but you know she needs to eat to heal that sacral decub... you need to call the cafeteria and ask them to send her something else. Maybe the little old lady with a poor prognosis confides privately to you that she wishes she could just go to sleep - she doesn't want another surgery. You need to arrange a conversation with the patient, her family, and the doctor to talk about other options like comfort measures. Maybe transport staff arrives to pick up your bariatric patient with a stretcher designed for someone who is 150 lbs.... you need to say NO you're not trying to cram my patient into that, go get a bigger one. To me, patient advocacy is assessing your patient's needs and ensuring they are addressed. Another example from just the other day... I was discharging a young man back to the nursing home where he was a resident (he was a paraplegic) and he requested that we dress him in his regular clothes because he would be embarrassed to arrive in a hospital gown. The CNA flat out refused to assist with that and said it wouldn't kill him to wear the gown. I didn't have time to dress him but I made time because I was his nurse and his dignity was important to him and me.

RunBabyRN · Mar 14, 2014

There are so many ways you can advocate for your patient. We have a stable patient who was on Q4 vitals for whatever reason, and we advocated to get her to Q12 vitals. We also got a Q6 med changed to PRN, as half the time, her VS contraindicated the med, and she hasn't been showing any of the symptoms the med is meant to keep at bay, but it does have other side effects.

I have also advocated for better pain management for patients. I'm not a big fan of drugging people up, but I am also not a fan of suffering, and it is our responsibility to stand up for our patients in ways in which they may not be capable or even aware that things can be improved. I've advocated for doctors to discuss changes in code status on people who are clearly approaching end-of-life. There are always ways that crop up that you can advocate. This is why it's important to question orders and think critically. Why is this patient taking this cocktail of meds? One of my classmates found a med someone with Parkinson's was taking that was contraindicated for pts with Parkinson's. You can advocate for better education of discharge instructions, for print outs of side effects of every medication they're going home on, all kinds of things. It can be minor, like getting a cup that's easier for them to drink from, or something life-changing. Either way, it's patient advocacy.

nurseprnRN, BSN, RN · Mar 14, 2014

My favorite model of nursing is that we do for patients what they can't do for themselves, until they can. That kid would have dressed himself if he could. That lady would have spoken right up and said, "I don't want to have any more surgery," if she could, but she needed help to say it.

You can sneak a pet into see someone; one of the happiest patients I ever heard about was visited by his pet pigeon, who was totally imprinted on him and pining away when his human was in the hospital. Their reunion brought tears to his eyes and mine. Really.

You can see that someone's favorite pillow doesn't disappear into the laundry. You can refuse to discharge someone who does not have a safe place to go or a safe way to get there. You can, and must, decline to implement a part of the medical plan of care that you know will be harmful or that your patient has refused.

missmollie, ADN, BSN, RN · Mar 14, 2014

My very first clinical day, my patient found out he had a terminal disease. He also had an odd heart sound. My instructor wanted to bring all the students in to hear his heart, because we were new, and the extra heart sound would have been a good for them to hear.

I told her no. I don't regret that. I didn't think when I said it, because my patient would have been asked by my instructor if that was okay. I didn't even think when I told her no. Afterwords, I thought that maybe I had done something bad. My instructor later gave me positive feedback about that incident.

For me, patient advocacy is speaking for the patient when they can't speak for themselves. Keep nursing students out, keep that medication they are allergic to out, let the doctor know that they need x,y, and z, and letting the doctor yell at you because it's really not important in the long run.

Patient advocacy is acting as a mother. You take all the blame willingly for the benefit of your patient. You also let the patient make their own decisions, even though you know it's a poor decision. You do what you need to for them, and you act on their behalf, and you sometimes let them fail (if they are competent).