Patient Advocacy
As nurses, we have long accepted that part of our professional role is to act as a patient advocate. Considering the fact, we are the only professionals who are with patients 24 hours a day, 7 days a week, we obviously are well-suited for this role. In addition, our knowledge and skills in patient education allow us to effectively "translate" information about medical diagnoses, procedures and medications into language patients can understand and use.
Nurses are well-informed and well-educated, and we are passionate about the well-being of our patients. All of these factors drive us to advocate for our patients. But for many nurses, their concept of advocacy ends at the bedside of an individual patient - and that's too bad. Those same skills that serve us well as patient advocates at an individual level also can be used at the community or public health level. When nurses can go to that level, real change can occur.
As a patient advocate, you have an individual responsibility, but you may have more clout if you approach an issue as a group. Being effective, however, requires more than just passion and knowledge. Specific strategies and organizational and communication skills will enhance your effectiveness and opportunities for success. This article reviews the role of the nurse as an advocate beyond the bedside, and provides suggestions for techniques you can put to work in your expanded role of patient and health advocate.
Why Be an Advocate?
Advocacy, whether at an individual or broad level, involves one person or group speaking on behalf of a patient or cause. Why do nurses get involved in advocacy activities? In general, people become advocates because they believe in an issue and see a need for change - whether it be for a family, school, community or state. Health advocacy involves issues relating to public health, such as smoking, domestic violence or air pollution. By being advocates, nurses can effect change that, in the long run, will make it easier for people to be healthy.
When nurses take on public health advocacy roles, it benefits the profession, too. Many people do not understand and appreciate the vast knowledge and skills nurses possess. By taking a leadership role in a visible way - as part of a public health campaign, for example - nurses do more than "talk the talk." Nurses are held in high esteem and trusted by the public. In an advocacy role, nurses areseen asactive and constructive, which in turn can help improve nursing's image. Given the ongoing nursing shortage, every action that shines a positive light on our profession is beneficial.1
Barriers to Advocacy
Many people shy away from advocacy activities because they believe participation requires a great deal of time and energy. While that may be true in some cases, it is easy to start small. If your time is limited, you still can be involved. Advocacy can be something as quick as sending an e-mail to a legislator. When written effectively, a two-sentence e-mail can make an impact and the time investment is minimal.
Another common barrier is believing it is impossible to make a difference. To counter that, remember this quote from Margaret Mead: "Never believe that a few caring people can't change the world. For, indeed, that's all who ever have."
Another fear - and this one is realistic - is employment-related repercussions. You need to carefully draw the line between what you can do as a private citizen and what you can and cannot do as an employee of an agency.
As a citizen, you have the right to vote, lobby and campaign, whether it be for an individual running for office or a policy or law you hope to see passed. However, keep in mind you run the risk of displeasing an employer if you publicly advocate for a position not congruent with your employer's interests.
To minimize risks, make it clear you are advocating for your opinion. Do not use your official title from your job when you are advocating for yourself; that is unethical and foolish.5 Do not use work resources to advocate. Instead, make phone calls from home and use a personal e-mail account and computer to send messages.
To share contact information with others, create a set of personal business cards. While you may opt to have them professionally printed, you also can make a perfectly acceptable set with a computer, printer and package of pre-perforated business card stock. If campaigning for a candidate or issue, check with your employer to see if they have any policies against wearing campaign buttons while on the job. If so, leave them at home.
Depending on the group with which you are affiliated, there may be more stringent rules you should follow. For example, government employees are prohibited from engaging in advocacy activities during work time and using government equipment and materials, including all government-owned communication channels. Likewise, federal law has restrictions on lobbying initiatives by nonprofit organizations; nonprofits also are banned from electioneering activities.
Keep in mind many professional associations, such as the Oncology Nursing Society and the Hospice and Palliative Nurses Association, are nonprofit organizations. If you are a member of such a group, whether at the local or national level, you need to be very clear about your advocacy efforts as an individual versus a member of a professional association.
Only use an association's logo or letterhead when acting in an authorized role as a representative of the association. There have been cases where an individual's actions on behalf of a nonprofit crossed the line on lobbying and, as a result, jeopardized the nonprofit status of the organization. Make sure to keep the executive director informed about your activities, both verbally and by providing copies of letters, e-mails and all other relevant documents.
Along the same lines, many nurses wonder if they should use "RN" after their name, for example, in a letter to the editor of a newspaper. My take is that it is your credential - you have earned it - so it is yours to include or not. Personally, I include RN when writing about health and nursing issues; I leave it off for other topics.
Taking the Steps to Advocacy
As noted earlier, being an advocate does not always require large investments of time and energy. At the most basic level, being an informed citizen and voting in elections are advocacy activities. However, for this discussion, we are taking a broader view. With that in mind, how do you get started?
In general, most advocacy efforts begin with an issue. The issue usually presents itself to you, rather than you searching for it.
Advocacy Actions
Advocacy strategies have been described as indirect and direct. Indirect activities are methods that influence the public and media perceptions about issues. They include letters to the editor, guest editorials and petitions. Direct activities speak directly to the people making the policy decisions. In addition to letters, direct activities include calls, visits, legislative testimony and protests. Successful advocacy campaigns usually include a mix of both.
No matter what the approach, there are a few rules that apply to every situation. First, keep your message clear, simple and concise. Whether delivering your message in the form of a letter, an editorial, a fact sheet or testimony, focus on the issue and address a single point. Most letters to the editor have length limits (usually 250 words); if you are presenting testimony, your time likely will be limited to 2 minutes. If you have several points to make, use the power of the group: have one person write a letter on point A, a second person on point B and so on.
Second, be clear about your audience. A direct message written to legislators or corporate executives will be different from an indirect message targeted to the mass media. While you certainly can reuse and revise a variety of letters and fact sheets, make sure each one is targeted specifically for your audience.
Third, identify the best way to communicate and then use the proper channels. Is e-mail or a phone call best? Verbal communication is immediate, and you have the opportunity to answer questions and clarify your message, but there is no written record. For a written message, find out the preferred way to send it: e-mail, fax or traditional mail.
Fourth, be accurate. Do your research so facts and statistics are correct. You do not need a mountain of data, but the data you do present needs to be iron-clad in its accuracy. The corollary to this is to never make up an answer. "I don't know" is an acceptable answer. "Let me find out and I'll get back to you" is even better.8
Last, but certainly not least, don't forget your manners. Be polite. Introduce yourself by name. When meeting with people, thank them for their time and attention. Remember your paths may cross again, so work to build relationships, even when the issue is adversarial. Remember the expression, "you catch more flies with honey than with vinegar."
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