Nursing advocacy beyond the bedside

Nurses advocating for nurses

Now, I have asked a lot of questions. We all probably have some thoughts on the issues and the questions that were posed, but who has the answer? The answer is simple. Nurses have the answer! As nurses, we must listen to each other’s struggles and to the struggles of our profession and advocate for change. We must advocate for and with each other. Believe it or not, nurses have been around for over two millennia, although over time the capacity of the nurse has changed considerably. Nursing is a profession that continues to evolve at a rapid pace. When we look back at the history of nursing, many figures stick out, but perhaps none as much as Florence Nightingale. Nightingale not only advocated for her patients, but for the profession of nursing. Nightingale knew that advancing the profession of nursing was important for improving healthcare for all. This continues to be true today. As nurses, we do a great job of advocating for our patients. Nurses are generally a selfless breed and we tend to put the needs of others, like our patients, above our own needs. Despite being so familiar with advocacy and practicing it often, the concept of nursing advocacy may be a little different or foreign to some.

What does nursing advocacy look like?

Advocacy, by definition, means public support for or recommendations for a particular cause or policy. Advocacy may mean taking steps to create change. The practice of advocacy involves an individual or group organizing themselves to take steps to tackle an issue. There are also different types of advocacy:

Self-advocacy

Self-advocacy is literally speaking up for yourself. This can be done related to common problems we see in nursing. Nurses often times spend so much time taking care of others that we neglect the needs of ourselves. Nurses can advocate for themselves and each other by doing simple things. I used to think I was a hero because I didn’t take a lunch. I would scarf down a granola bar or protein shake and wash it down with some coffee between patients. I did this because I was always busy. I felt as though I couldn’t take a lunch. Not taking a lunch left me feeling obviously hungry, but I was also feeling drained and burnt out. Nurses need and deserve a minimum of a half-hour lunch break and two 10 minute breaks for an 8-hour shift. We need to advocate for ourselves and make sure we are taking breaks. Step off the unit, go outside and get some fresh air. I started doing this and, although it was a little thing, it made a big difference. I would make sure my patients were safe and I would have another nurse cover for me. I would make sure I would do the same for them. Just this simple step allowed nurses needed time to clear their heads. This helped create a safer environment.

Individual advocacy

Individual advocacy isn’t just one person. Often times it is a group of individuals coming together to advocate over a specific issue or issues. Often times it is best for the individual or group to concentrate their efforts on one issue at a time. Nurses must come together and work to influence structures, powers, and support systems that are in place so we can provide safe and effective care for our patients. After all, isn’t the safety and effectiveness of our care a top priority? There are some common issues that nurses tend to agree on and should be available to come together to advocate for. Examples include:

Reasonable, safe, and fair working conditions

Included in this area would be things like safe staffing, proper training and orientation programs, technical support, and mental health support. Mental health support is especially important after traumatic events. In general, we need to do a better job of promoting the mental health of our nurses by offering emotional support, decompression, and time for stress management. The last is key. As a nurse with a specialty focus in mental health care, I know what I can do to help me manage my stress. It is another thing to find the time to do this on a busy 12-hour shift.

Adequate pay and compensation

Wage and benefits are just one part of what can be considered a safe work environment. Research has shown that hospitals with better work environments have a better nurse and patient outcomes. Wage is one important component of good nurse outcomes. The definition of adequate pay is one that varies by market. However, the ability of the nurse to advocate for adequate pay and compensation should be something that nurses are able to advocate and be involved with, regardless of location.

Inclusion and representation on healthcare committees and boards

Healthcare boards make decisions that impact our work and workplace. Think of the number of nurses that are employed compared to other professions in most healthcare organizations. Like I discussed earlier, nurses are a major component of the workforce and in many cases, represent the highest number of those employed by the facility. The staff on the boards should be proportionate. Unfortunately, in many cases, we find few nurses that serve on boards. Rather there seems to be a dominance of physicians and other employment sectors such as business or even pharmacy. This is something that needs to change. There also needs to be opportunities for bedside nurses to serve on boards at every level. Also, the involvement of nurses on committees should extend beyond those directly related to healthcare. Nurses make the ideal members to have on a variety of community boards and committees and it is time that nurses step up and fill this need. Nurses offer a unique perspective that is valuable to our community!

Responsible healthcare policy and policy development

It is important that nurses are offered the opportunity to participate in policy development and provide feedback on existing policies that directly impact us. This can include advocating for responsible attitudes and policies towards absences. It can also include policies related to lateral violence. Policy development, implementation, and enforcement impact the daily lives of the nurse and it is important that we advocate and become involved in the process.

Systems advocacy

Systems advocacy is about changing policies, laws, or rules that impact how we function and perform our job. This type of advocacy is typically engaged with local, state, or national agencies or government. This type of advocacy can impact the scope and standards of practice of nurses. Systems advocacy is important to engage in especially related to advanced practice issues. The nurse may also engage in systems advocacy when advocating for laws. Such as laws that set minimum patient staffing or impact mandatory overtime. We are seeing unprecedented changes in healthcare systems. These changes are impacting nurses and the care we deliver in every practice setting. Examples of the changes we are seeing include mandates from regulatory agencies, financial pressures, uncertainty in the direction of healthcare reform, as well as changes in the workforce and patient populations. These dramatic changes can present an opportunity for nurses and the nursing profession at large. Currently, there is a tremendous opportunity for a greater voice coming from nursing in terms of policy development at the local, state, and national levels. This has been brought into dramatic focus as a result of the recent pandemic. This is a tremendous opportunity for nurses to capitalize on these upcoming opportunities and become more involved in advocacy. To do this successfully, we must do this together. It is important for nurses to work across employment sectors and roles.

Lessons learned from nursing advocacy

As a nurse advocate, one of the most important lessons I have learned is that there are strengths in numbers. In addition to the team approach, planning is necessary. We have to plan and commit to finding resources that will be needed. People, money, and time common resources that are needed. Time and people are often more valuable resources than money.

Advocates are everywhere. In government, we have another name for advocates. Lobbyists. Nurses may occasionally need to look to lobbyists, professional organizations, or unions to help us engage in advocacy. Policymaking is a complex process. Sometimes it is unnecessarily complex, but when we are engaged in advocating for issues that have a larger scope it may be helpful to have professional support. Someone who understands the complex nature of policymaking, knows the culture related to the advocacy work, and is a professional in utilizing current political strategies may be helpful. Just like we work with our patients on setting goals, we must do the same with advocacy.

We need to make our goals smart (Specific, measurable, attainable, realistic, and time-specific). Sometimes we need to be flexible and change our short-term goals in response to changes in circumstances while keeping focused on the long-term vision. Advocacy is a long-term commitment. Patience and persistence are necessary to keep at it, even when it seems like little is happening. Just when you think you have reached the end, there are often other goals that you want or need to accomplish. Also, while working towards the ultimate goal, there is often other needs or goals that come up. Additionally, you must have a strategy to maintain the goals that were accomplished. As you are playing the long-term game, it is important to focus on victories won along the way. Together, we can work towards positive change in our profession, communities, and beyond the bedside.