Advocating is about speaking up when a problem goes unnoticed. Nurses are responsible for the trust patients put in them.
Know Your Patient’s Needs
The first step in successfully advocating for your patient revolves around knowing your patient’s wants and needs. If you are advocating for advanced life support and the patient does not wish to be resuscitated, you are not advocating for your patient. You need to know what the patient needs in that moment, from the resources available to you.
This can sometimes be as clear-cut as needing pain medication for a patient who is clearly uncomfortable. At other times it may be more complex. For example, a patient may not want to be resuscitated, but is facing resistance from their family.
Knowing your patient’s needs means knowing both the medical background, and your patient. This means that you will have to get to know them to understand what is unique about them and what they would want you to do for them.
Sometimes it is easy enough to ask if they need help with a problem, if they want you to call the doctor, or talk to their family. Other times the information is more subtle, and you need to determine what is in your patient’s best interests. It’s important not to confuse what you want with what your patient wants. If you advocate, you should do it for their wishes, not yours or the family’s.
Determining When to Advocate
It may be difficult to know when to advocate for your patient or when to speak up. You should speak up if the patient is unable or unwilling to speak for themselves. In most situations, the advocating is with the doctor.
If you feel that the doctor is being unsafe or not considering the patient’s needs, then this is a time when you need to be the advocate. The patient is unable to argue with the doctor on their own behalf because they don’t have the medical knowledge to enable it. When you advocate for medical issues, you are doing so because your patient doesn’t know medicine like you do.
Sometimes you have to advocate for your patient to someone other than the doctor. You may need to take their case to the social worker and press for intervention. You may need to get a more experienced nurse to help you perform a skill you are uncomfortable with. These are all times when you are the advocate, benefiting your patient and improving their condition.
Some nurses find themselves advocating for their patients against the patient’s family. In cases of neglect or abuse, this is expected but the situation doesn’t have to be this dramatic to warrant advocating. You can advocate just for the patient’s safety, comfort, and mental wellbeing by talking to the family in question.
Assertive v Aggressive
We’ve covered what to advocate for and when to advocate, but the question remains about how to advocate. This is where you must learn to be assertive. ‘Assertive’ means that you stand your ground, make your needs known, and are willing to broach a subject that may be uncomfortable. Assertiveness is not the same as aggression, although the two are often mistaken for each other. Aggression is bullying, raising your voice, and insisting that you are right without listening to the other side of the story.
Advocating is really about negotiation. You want to negotiate with the doctor or the family to get what you need for the patient in a peaceable way. This isn’t to say that assertive advocating isn’t emotionally charged. In fact, when you confront someone with the patient’s needs, you may meet resistance, even if it is with another medical professional. You still need to keep the mindset of negotiating, keeping your cool and thinking about the patient’s needs first and foremost.
The ‘how’ of advocating can sometimes feel like bomb-defusing, and learning to be assertive can be difficult for even the most confident nurse. Still, it is your responsibility to speak up for your patient, bring up the uncomfortable, and ultimately get your patient what they need from doctors and family members alike.
Lynda is a registered nurse with three years experience on a busy surgical floor in a city hospital. She graduated with an Associates degree in Nursing from Mercyhurst College Northeast in 2007 and lives in Erie, Pennsylvania in the United States. In her work, she took care of patients post operatively from open heart surgery, immediately post-operatively from gastric bypass, gastric banding surgery and post abdominal surgery. She also dealt with patient populations that experienced active chest pain, congestive heart failure, end stage renal disease, uncontrolled diabetes and a variety of other chronic, mental and surgical conditions. Her Website.