Tired medical worker, wearing protective medical gear, leaning chin into their hands
HealthMarch 18, 2021

Nursing advocacy beyond the bedside

By: Dr. Daniel Eaton
What is the most important job of the nurse? This is a question I consistently ask my students and other nurses I work with.

One of the most common responses I hear from my students, and a quick search of many nursing surveys, consistently shows that nurses believe that advocacy is one of the most important components of our jobs. Regardless of our setting, nurses have the ability to engage in advocacy every day. Nurses are trained how to advocate for our patients, but what about advocating for ourselves? What about advocating for our profession?

State of the nursing profession

Nursing is the largest sector of the healthcare workforce. We are a trusted profession that generally enjoys overwhelming public support and admiration. I recently reviewed a couple of different surveys related to satisfaction with nursing. 83% of nurses reported being satisfied with choosing nursing as a career. Certainly, I wish this number were closer to 100%, but I would say that this is a fair number considering we know how difficult nursing can be. We have all heard, “It takes a special person to be a nurse.” I would say that not everyone can be a nurse, but it takes a special person to be a good nurse. As I worked my way through the survey, I found some other interesting figures.

  • 73% say they are happy with the care they provide
  • 66% say they would encourage others to be a nurse
  • 60% said they are not satisfied with their jobs

It appears that nurses are not quite as happy with their current job as they are with their careers. Why do we see an apparent disconnect between career satisfaction and satisfaction of the job? Why is it that 34% of nurses wouldn’t encourage others to enter the profession of nursing?

  • 50% either disagreed or were unsure if they could trust their leaders
  • 55% worry that nursing jobs are impacting their health

To me, these are some of the most concerning statistics. Why is there a distrust of leadership? Why are nurses worrying that their health is being impacted by their job? These are not concerns nurses should have! If nurses feel they can’t trust their leadership and if they are worried about their own health wouldn’t this have a negative impact on patient care?

  • 54% of nurses with five years of experience or less reported they were looking for new jobs

We all know that there is a shortage of nurses and it is a rather competitive job market in most communities. Nursing turnover remains a major concern and its impact varies by market. The national average turnover rate is around 17%. There are numerous articles about nurses leaving the bedside. I have had many students tell me, “Being a bedside nurse isn’t my destination but rather just a steppingstone for me to move on to something else.” We all know the importance of advanced practice nurses and the valuable role they play in healthcare delivery. There is also a shortage of nursing faculty and a need for more nursing research. One of the things I love the most about nursing is all the options and areas for practice that exist. However, we must do something to stop the hemorrhage of nurses from the bedside. Bedside nursing is the bread and butter of our field. The fact is, if we don’t stop this shift away from the bedside, patient care may suffer. It will also chip away at the bedrock of our profession and harm the discipline of nursing. How can we change the perception that many seem to have that bedside nursing isn’t a desirable career?

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.

Dr. Daniel Eaton
Expert Insights Contributor for Wolters Kluwer, Nursing Education
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