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https://www.ncbi.nlm.nih.gov/books/NBK232398/.
https://www.ihi.org/improvement-areas/triple-aim-p…
For this assignment, you will synthesize the information from the readings and find a movement in which nurses did or currently are leading the charge in advocating. Be sure to include:
The issue of justice
The people the movement is advocating for (movement does not have to be from the sources given, but movements that nurses currently are involved in or were successful. credible information please).
Why you believe this is an important issue (i.e. look at health outcomes)
Which one of the Triple Aim aspects this movement is helping to achieve
Has this movement been successful or not (how do you know)
Cite at least 2 credible sources. Please use APA format.
(Please note that there are four(4) sources. two (2) attachments plus the two links above).
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Advocating for Nurses and Nursing
Karen Tomajan, MS, RN, NEA-BC
Abstract
Every nurse has the opportunity to make a positive impact on the profession through day-to-day advocacy
for nurses and the nursing profession. In this article the author defines advocacy; describes advocacy
skills every nurse can employ to advocate for a safe and healthy work environment; and explains how
nurses can advocate for nursing as part of their daily activity whether they are point-of-care nurses, nurse
managers, or nurse educators. The advocacy practices discussed are applicable whether advocating on one’s
own behalf, for colleagues at the unit level, or for issues at the organizational or system level.
Citation: Tomajan, K., (January 31, 2012) “Advocating for Nurses and Nursing” OJIN: The Online Journal of
Issues in Nursing Vol. 17, No. 1, Manuscript 4.
DOI: 10.3912/OJIN.Vol17No01Man04
Key words: advancing the profession, advocacy, advocate, change management collaboration,
communication, decision making, healthy work environments, nurse educators, nurse leaders, shared
governance, staff involvement, influence, problem solving
…changes can challenge resource allocation decisions and adversely affect the work environment [and] can also
create opportunities for nurses and the nursing profession.
These are challenging times in which to be employed in healthcare. Unprecedented changes in the
healthcare system are impacting care in all practice settings. These changes include financial pressures,
uncertainty of the direction of healthcare reform, mandates from regulatory agencies to improve quality and
patient safety, advancing technology, looming workforce shortages, and changes in the patient population.
These changes can challenge resource allocation decisions and adversely affect the work environment.
However, these forces can also create opportunities for nurses and the nursing profession. These
opportunities include a greater voice for nursing in healthcare policy, expanded employment opportunities,
and an enhanced image for nurses and the profession (Benner, Stephen, Leonard, & Day, 2010; Institute of
Medicine, 2011; Page, 2005).
In order to successfully capitalize on these emerging opportunities, it is important for nurses to work
together, across employment settings and roles, to advocate on behalf of colleagues and the profession.
Nurses comprise the largest professional group within healthcare and have been recognized by the public as
the most trusted profession (Gallup, 2010; Jones, 2010). Despite nursing’s strengths inherent in its size,
diversity, and unique relationship with the public, the full potential for influence by the nursing profession
has yet to be realized (Buresh, Gordon, & Benner, 2006).
Although nurses in the United States anticipate future benefits resulting from healthcare system reform, the
stress of today’s workplace falls squarely on the shoulders of nurses at the point of care. To reap these
future benefits, nurses need to advocate for the profession’s desired future. It is important that all nurses
engage in, and become involved in developing processes in their respective work settings to advocate for
realistic changes that meet the needs of both patients and staff.
Other articles on advocacy in this topic have addressed the role of the nurse in patient advocacy and the
advocacy role of the professional association. The purpose of this article is to explore strategies that enable
nurses to successfully advocate for themselves and the nursing profession. Whether working within one’s
own employment setting to advocate for a safer work environment, or at the state level to achieve
prescriptive authority for advanced practice nurses, the process and skills required for successful advocacy
are the same.
Advocacy Defined
Advocacy often requires working through formal, decision-making bodies to achieve a desired outcome.
Advocacy
is defined by the Merriam-Webster Collegiate Dictionary (2009a) as the act or process of supporting a cause
or proposal. An advocate is defined as one that pleads, defends, or supports a cause or interest of another.
Much of the literature on advocacy comes from non-profit and special interest groups that prepare potential
advocates to influence public policy. Strategies promoted by these groups are also applicable for nurses and
the nursing profession. Amidei (2010) has described advocacy as “seeing a need and finding a way to
address it” (p. 4). Sharma (1997) defined advocacy as “action aimed at changing the policies, positions or
programs of any type of institution” (p. 4). Family Care International (2008) promoted advocacy as “the
process of building support for an issue or cause and influencing others to take action” (p. 3); while the
Worldwide Palliative Care Alliance (2005) identified advocacy as “a process that can lead to change through
influence” and a “way of directing decision-makers towards a solution” (p. 4). These definitions all suggest
that the role of an advocate is to work on behalf of self and/or others to raise awareness of a concern and to
promote solutions to the issue. Advocacy often requires working through formal, decision-making bodies to
achieve a desired outcome. This process could include the ‘chain of command’ within a healthcare
organization, a commission, a state legislature, or other groups at the healthcare system’s policy level.
While most nurses readily embrace the mandate of the professional nurses’ advocacy role as it applies to
patients, the expectation for advocacy on behalf of colleagues, the profession, or even oneself may not be
so clear or consistently noted. The professional responsibilities of the nurse to work with colleagues to
promote safe practice environments are described in the American Nurses Association’s (ANA) foundational
documents, including the Nursing Scope and Standards of Practice (2010) and the Code of Ethics for Nurses
with Interpretative Statements (Code of Ethics) (2001). The ANA Scope and Standards of Practice identifies
advocacy for safe, effective practice environments as a responsibility of the professional nurse (ANA,
2010).The Code of Ethics describes the responsibility of the nurse to work through appropriate channels to
address concerns about the healthcare environment. In addition, the Code of Ethics identifies a range of
advocacy skills and activities that nurses are expected to demonstrate. These activities promote the
profession and form the basis of the advocacy role for the professional nurse. The skills include service to
the profession through teaching, mentoring, peer review, involvement in professional associations,
community service, and knowledge development/dissemination (ANA, 2001). These activities and skills form
the basis of advocacy role of the professional nurse.
Advocacy Skills
The ability to successfully support a cause or interest on one’s own behalf or that of another requires a set
of skills that include problem solving, communication, influence, and collaboration. Each of these skills will
be discussed below.
Problem Solving
…it is important to take the time to develop a compelling request and to identify the appropriate time and
individual to whom to make the request.
Advocacy is focused on addressing problems or issues in need of
a solution. The steps in the advocacy process are first to identify the issue(s) to be addressed and develop
goals and a strategy to address the issue(s). Once the strategy is identified, a plan of action is developed to
organize advocacy efforts and establish a time line for completing each activity that supports the strategy.
Most advocacy initiatives involve approaching decision makers with requests for action to address the
identified issue. Before approaching decision makers, however, it is important to take the time to develop a
compelling request and to identify the appropriate time and individual to whom to make the
request. Patience and a sense of timing are necessary in order to achieve a successful outcome. Few
victories are achieved on the first attempt. Most advocacy initiatives are accomplished through collaboration,
negotiation, and compromise; they may require a series of actions over time in-order-to achieve a desired
outcome.
Communication
It can be helpful to put a ‘human face’ on the issue by using ‘word pictures’ to make the communication more
compelling. Successful advocacy requires effective communication skills.
Most advocacy initiatives involve
bringing individuals and groups together to address an issue or concern. Advocates need to communicate
clearly and concisely and to structure the message to fit both the situation and the intended audience.
Advocates must be comfortable with verbal, written, and electronic formats. Communication regarding the
issue should be factual and consistent. While it is important to be prepared to discuss the specific facts and
data associated with the issue, it is equally important to discuss the impact of the situation on those
involved. It can be helpful to put a ‘human face’ on the issue by using ‘word pictures’ (words that create a
picture in another’s mind) to make the communication more compelling (Amidei, 2010).
One way to help to formulate a consistent communication message is to prepare a ‘Sixty- Second Speech.’
This is a brief, practiced speech used to introduce the issue and proposed solution. Distributing a one-page
fact sheet or brochure is an excellent way to close the speech, and ensure that the listener is walking away
with the key points (Amidei, 2010). The following Box describes the content to include in a Sixty-Second
Speech.
Box. Items to include in a sixty-second speech
Sixty-Second Speech to Advocate for Nursing
Share your name, where you work or live, and the name of the department or agency you are representing
Describe the issue you are addressing
Put a human face on your request, paint a word picture, and/or tell a story
Describe what you would like the person/group to do
Distribute a fact sheet describing your request and including your contact information.
Influence
Influence is built on competence, credibility, and trustworthiness.
To facilitate change or solve an issue, the advocate must be able to influence others to action. Influence is
the ability to alter or sway an individual’s or group’s thoughts, beliefs, or actions; it is essential to the
advocacy process (Merriman-Webster, 2009b). Influence is built on competence, credibility, and
trustworthiness. Keeping the best interests of those involved in the situation builds trust and credibility. An
effective advocate influences decision makers by building a case for the desired change, backing the case
with facts and data, and putting a human face on the issue using a compelling visual image. Persuasion is a
stronger form of influence that makes use of an appeal or argument to make one’s point. While effective in
small increments, persuasion can elicit defensiveness in others, thus undermining the overall success of an
initiative.
Collaboration
Collaboration is working with other individuals or groups to achieve a common goal. It differs from cooperation
which involves groups working together to achieve their own individual goals.
In addition to demonstrating the
skills described above, the advocate must also establish positive, collaborative relationships with others to
garner the support necessary to address the issue. Collaboration is working with other individuals or groups
to achieve a common goal. It differs from cooperation which involves groups working together to achieve
their own individual goals. In collaboration, the individuals or groups involved develop common goals, along
with common strategies and activities that will achieve that goal (Denise, n. d.). Collaboration is built on
trust, mutual respect, and credibility. The end result of groups collaborating to achieve a common goal can
be greater than that which each group could accomplish independently. Successful collaboration requires
careful communication with the groups involved in the process, seeking input when appropriate, and
providing ongoing reports related to progress on achieving the goal.
It is necessary, during the advocacy process, to work with those people (the stakeholders) who are affected
by the issue. In addition, the advocate may collaborate with others in the organization interested in solving
the issue. These individuals often have expertise that would be beneficial to the effort. Developing a
collaborative relationship with professionals in support departments, such as infection prevention, employee
health, or human resources, will be invaluable when addressing issues that involve these departments.
Likewise seeking out support staff in other venues, such as a legislative aid or the assistant to a
commissioner, can be equally helpful.
In summary, advocacy is a complex process that requires skillful use of problem solving, communication,
influence, and collaboration to achieve a solution to an issue. Often, advocacy is an incremental process of
achieving change through a series of efforts that may take months or years to accomplish.
Point of Care Nurses as Advocates for Nurses and Nursing
Never before has the voice of the nurse at the bedside been so critical…The impact of registered nurses on patient
outcomes is increasingly evident…
It is essential that point-of-care nurses develop and use advocacy skills
to address workplace concerns, promote positive work environments, and advocate for the profession. Never
before has the voice of the nurse at the bedside been so critical to patients, colleagues, and healthcare
facilities. An increasing number of facilities have, or are developing shared governance structures to ensure
that nurses at the point of care have a voice in decisions related to patient care and the work environment.
The impact of registered nurses on patient outcomes is increasingly evident; and nursing input into
organizational decision making related to safety and quality initiatives is invaluable. Nurses are increasingly
positioned to advocate more effectively than ever before not only for patients, but also for themselves and
the nursing profession.
Opportunities for Point-of-Care Advocating
While the time an employee invests in completing a survey may be only a few minutes, the outcome can be very
significant for improving working conditions for all staff.
Membership on committees, councils, and quality
improvement teams provides opportunities to advocate. When serving on a committee, council, or team, it
is important to represent the needs of both colleagues and patients. Sometimes this means considering the
impact of an issue or proposed solution on nurses and staff in other departments as well as one’s own
workgroup. The best way to work through the needs of multiple groups is to consider what ultimately is best
for the patient, client, or population served.
Engagement in organization-wide activities provides opportunities to advocate for colleagues and for the
profession. Many organizations conduct periodic, employee satisfaction or opinion surveys that are used to
develop plans to promote staff engagement. While the time an employee invests in completing a survey
may be only a few minutes, the outcome can be very significant for improving working conditions for all
staff. Often a comment or recommendation will focus the attention of decision makers on a specific issue or
possible solution. Being as specific as possible about the issue or potential solution will help organizational
leaders to more appropriately address the concern. Nurses can also use employee forums or town hall
meetings to raise awareness of their concerns. When making use of these opportunities, it is important to
use good advocacy skills, which include communicating with credibility and promoting a sense of trust.
Identifying an issue, proposing a solution, and/or offering to be involved are very effective ways to serve as
an advocate.
Modeling positive professional behaviors and helping those new to the profession to acquire these behaviors is a
form of advocacy.
Nurses have an opportunity for advocacy when involved in teaching nursing students
and new nurses at the bedside. Students and new nurses are excited about the profession they have
chosen. They see practicing nurses as role models and mentors. Modeling positive professional behaviors
and helping those new to the profession to acquire these behaviors is a form of advocacy. Providing
guidance during a difficult learning situation, such as the first time a novice performs a procedure, can
advocate for both the patient and the novice.
Nurses can help to portray a more accurate picture of nursing by talking specifically about what they do, describing
the complexity of their work, and explaining the types of clinical judgments they make.
Nurses also have opportunities to advocate for the profession by describing the strengths of the profession
whenever they are asked about their work. Although nursing is consistently rated as the most honest and
ethical profession, the role of the nurse is not well understood by the public (Buresh et al., 2006). Another
opportunity to advocate for the profession is by promoting public understanding of the nursing role. Many
individuals do not comprehend that nurse have an independent practice responsibility beyond following the
doctor’s orders. There is an important need to educate the public that a nurse’s role is to assess, plan, and
intervene to address healthcare issues. Nurses can help to portray a more accurate picture of nursing by
talking specifically about what they do, describing the complexity of their work, and explaining the types of
clinical judgments they make. Developing a sixty-second speech to describe the nurse’s role and share the
consequences of nurses not being available to attend to patient concerns or complications prepare a nurse
to respond effectively to any advocacy opportunity that might arise during working or non-working hours
(Buresh, 2006).
Examples of Point-of-Care Advocacy
In one hospital a committee was established to address patient ‘throughput’ in the acute care setting, so as
to expedite patient transfer from the emergency department to the nursing unit. The committee was
comprised of nurses from the emergency department, intensive care, and medical surgical units, in addition
to managers and admitting staff. The team was charged with developing a process to limit extensive waiting
in the emergency department. One important area of discussion among the nurses was mitigating the
disruption caused by patient transfers during shift change. Following a lengthy, heated discussion about the
issue, the impasse was solved when the group agreed to focus on what was best way to get the patient to
the most appropriate venue for care. Once this was established, the rest of the plan fell into place, and a
strategy for minimizing the impact on inpatient areas was developed, thus improving the working conditions
of staff nurses as well as addressing the needs of the patient.
Opportunities for advocacy occur at many levels: some occur in the work setting and others may occur in the
grocery store.
In another agency nurses were concerned about the increasing incidence of back injuries among the nursing
staff. The staff approached the hospital risk manager who organized a task force to develop a program to
reduce back injuries. Nurses, nursing assistants, physical therapists, and transporters were all involved in
developing the program and testing products. They reviewed the lift and transfer devices available to
facilitate safe patient handling and ensure staff safety. In addition, they assisted with training on the use of
the equipment, which over time included ceiling-mounted lifts and transfer devices. The committee
members also served as champions for eliminating manual patient lifting. As a result, the incidence of staff
injuries decreased significantly.
In summary, every nurse can play a role in advocating for nurses and the profession. It is through day-today collective action that nurses work together to advocate for improvements in the work environment and
for the advancement of the profession. Opportunities for advocacy occur at many levels: some occur in the
work setting and others may occur in the grocery store. The key is to promote the profession with every
advocacy opportunity that arises.
Manager/Administrator Role in Advocacy
Leaders advocate for patients, nurses, and the profession in a number of ways. This advocacy can include
actions both to ensure appropriate resource allocation and to promote positive work environments.
Advocacy for Appropriate Resources
Today’s work environment is increasingly stressful, and competition for resources is keen. Nursing leaders
can advocate for staff by actively involving staff in decisions that directly affect the practice environment.
Advocacy is enhanced when scheduling and staffing are a collaborative process that involves staffing
committees and self-scheduling approaches. Staff involvement can help to ensure balanced schedules and
flexible staffing approaches that meet the needs of both patients and staff. In addition, proactive planning to
formulate solutions to unpredicted staff shortages can facilitate patient and staff safety in unforeseen
situations
Staff involvement in the budgeting process promotes an understanding of the challenges operating in today’s
healthcare environment.
Leaders also fulfill the advocacy role by protecting nursing resources during
times of budget scrutiny, work process redesign, or work flow change. Staff involvement in the budgeting
process promotes an understanding of the challenges operating in today’s healthcare environment. Staff can
be included in a number of ways, for example by providing input on and prioritization of equipment and
supply purchases. Increased staff knowledge of the costs associated with procedures also promotes effective
usage and cost containment. When staff are involved in organizational initiatives, they are more likely to
advocate for, and foster adoption. Collaboration between nursing managers/administrators and staff nurses
is essential for maintaining adequate resources.
Staff input on purchasing decisions for supplies and equipment is now the norm in many healthcare
agencies. Nurses sitting on purchasing committees serve as advocates by testing products and providing
input on behalf of colleagues. Nurses involved in product decisions ensure that selection is based on patient
and nurse safety, usability, and value, rather than being based on cost alone. In one agency a nurse
attended a national conference and talked with a vendor about an IV catheter that appeared to be less likely
to cause needle sticks. She brought samples and brochures home with her and took the information to her
nurse manager and the unit’s representative on the new product committee. The committee contacted the
vendor and worked with the staff to evaluate the IV catheter, which was eventually adopted by the
institution. This nurse advocated on behalf of colleagues by working within the organizational structure to
promote staff safety.
Advocacy for a Healthy Work Environment
When leaders support open communication, collaboration, and conflict resolution skills, staff are able to advocate
more effectively for themselves and for colleagues.
Managers play a pivotal role in developing the advocacy
capabilities of staff. When leaders support open communication, collaboration, and conflict resolution skills,
staff are able to advocate more effectively for themselves and for colleagues. In contrast conflict undermines
effective teamwork and jeopardizes patient safety. Much has been written about the negative consequences
of nurse incivility (Bartholomew, 2006; Longo, 2010). Fostering the development of conflict resolution skills
and addressing unprofessional behavior, including incivility, promotes an environment in which advocacy can
flourish.
Leaders promote advocacy when they enable staff to autonomously address concerns. They foster staff
ownership of issues when they refer a concern to staff councils and form task forces, involving other
departments as appropriate. In such situations the role of the leader becomes primarily a coach who
provides guidance, helps staff navigate within the organization, and removes barriers to the process.
Leaders promote advocacy when they enable staff to autonomously address concerns.
One hospital recruitment
and retention committee, comprised of staff from a variety of nursing units, plus recruiters, staff
development educators, and human resource professionals, met regularly to plan and evaluate recruitment
and retention programs. The committee had already implemented a comprehensive nurse retention program
that included recognition for national certification, incentives for nurse preceptors, and strategies to improve
communication between nurses and physicians. One staff nurse on the committee felt that recruitment and
retention could also be improved by providing an on-campus RN-to-BSN program. Prior to approaching the
committee with this idea, he talked with nurses from across the organization to determine the level of
interest and the program features that would accommodate working nurses. When he presented the idea to
the recruitment and retention committee, he was able to identify the potential number of nurses interested
in the program and volunteered to serve on a planning committee.
The nursing education director then sent a call for proposals to all baccalaureate nursing programs in the
community, and the most appropriate program was identified by a selection committee comprised of bedside
nurses. The faculty assigned to this program worked closely with these students to accommodate scheduling
issues and to construct meaningful class assignments to facilitate learning. Through this program the
hospital achieved a significant increase in the proportion of baccalaureate-prepared staff. In addition, many
of the staff graduating from this program moved in to leadership positions within the facility which
benefitted the facility as well as the staff. Advocacy was demonstrated as the university faculty provided
convenient and meaningful learning experiences.
…it is important to help nurses at all levels of the organization understand the current reality of the healthcare
system and engage them in designing a preferred future state.
In this time of change, it is important to help
nurses at all levels of the organization understand the current reality of the healthcare system and engage
them in designing a preferred future state. Quality improvement activities and process redesigns often
create anxiety and disrupt the patient care environment. New construction, implementation of new
technology, and redesign to improve work flow are opportunities both for disruption and for nursing
leadership to involve staff in creating the future of their healthcare setting. Changing the dynamic from
panic and dread to challenge and opportunity can have a profound effect on staff buy in and morale.
Advocacy during times of change includes using positive language when communicating about controversial
issues, listening carefully to staff concerns, and acting to address these concerns. In today’s healthcare
environment, change is a given. Leaders set the tone regarding reactions to change; they can make the
difference between stress and success during the implementation process (Kotter, 1996; 2008). Managers
and administrators can show their commitment to advocating for nurses and nursing by the manner in which
they facilitate change.
Nurse Educator’s Role in Advocacy
…faculty in academic settings and nurse educators in professional development roles serve as the culture carriers
for the profession. These educators are pivotal in the formation and continued development of nurses’ professional
identity as advocates, an identity that transcends their entire career.
One trend in healthcare over the past
twenty years has been the active involvement of the nursing staff in decision making. This involvement
increases the need for staff with more fully developed leadership skills and the ability to advocate
effectively. No one plays a more critical role in developing the capacity and capability for professional
advocacy than do nursing educators who model advocacy behaviors for students in both education and
practice settings. Nurses in staff development roles contribute to this process of role formation by providing
ongoing mentoring to nurses in practice. In many ways faculty in academic settings and nurse educators in
professional development roles serve as the culture carriers for the profession. These educators are pivotal
in the formation and continued development of nurses’ professional identity as advocates, an identity that
transcends their entire career (Benner et al., 2010).
It is expected that the future will bring expanded nursing roles, enhanced opportunities for collegiality, and a
greater voice for nurses at the organization and system level. It is essential that we prepare nurses now
with the advocacy skills they will need to bring about this new world of healthcare. In 2006, the American
Nurses Association invited academic nursing programs to serve as pilot sites to test a curriculum for safe
patient handling. One component of this curriculum included the teaching of advocacy skills to prepare the
students to use advocacy in overcoming barriers to the use of equipment that enhances the safety and
quality of care.
Another example of teaching advocacy skills occurred in a hospital in which the Nursing Shared Governance
Council was tasked with addressing the nurse-to-nurse incivility prevalent in some areas of the facility.
Council members worked with staff educators to develop an educational program to address this issue. The
council members developed case scenarios and role play activities and served as facilitators for classes
designed to help nursing staff respond to situations of incivility. This teaching project heightened awareness
of incivility and introduced new communication skills that promoted healthier ways of interacting within the
nursing division. In addition, staff became more comfortable confronting difficult situations. Through this
process, the council members learned to advocate effectively for a healthier work environment.
Educators involved in forming the professional identity of nursing students and shaping the capabilities of
the nursing workforce are pivotal to advancing the profession. Healthcare is changing. Achieving the best
possible future requires that nurses be prepared to advocate for nursing and for their professional roles.
Summary
Every nurse in every setting has the opportunity to make a positive impact on the profession through advocating
daily for nurses and the nursing profession.
It is an exciting time to be a nurse. Healthcare is changing and
the role and practice of the professional nurse is changing along with it. Advocacy skills are becoming
increasingly important in this ever-changing world. Opportunities abound for point-of-care nurses to
advocate both for nurses and for the profession. Point-of-care nurses have an opportunity to build on their
public image of being the most trusted profession by communicating and advocating for a more accurate
view of their contributions to healthcare and society. Managers and administrators work daily, advocating to
obtain adequate resources for their nursing staff and to promote positive work environments. Nurse
educators play a critical role in preparing nurses to strengthen the profession through advocacy. Every nurse
in every setting has the opportunity to make a positive impact on the profession through advocating daily
for nurses and the nursing profession.
Author
Karen Tomajan, MS, RN, NEA-BC
E-mail: [email protected]
Ms. Tomajan is Director of the Nursing Practice/Magnet Program at John Muir Health, an American Nurses
Credentialing Center Magnet Recognition Program®-designated facility in Concord, California. Her nursing
career includes a variety of roles that have focused on advocacy for patients and nurses, including staff
nurse, nurse manager, patient advocate, and nurse educator roles, along with leadership roles in nursing
education and quality management. She has published in the areas of nursing staff development, the image
of nursing, and safe work environments. She lectures on lean thinking, team training, patient safety, nurse
retention, and healthy/safe work environments.
