Chapter 6 Patient Subordinate and Professional Advocacy Copyright

Advocacy • Advocacy involves helping others to grow and selfactualize • Nurses must advocate for themselves, clients, subordinates, and their profession • Advocates must inform others of their rights and make sure they have enough information to make informed decisions • Advocacy is defined as protecting and defending what one believes in for both self and others Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Values Central to Advocacy 1. Each individual has a right to autonomy in deciding what course of action is most appropriate to meet his or health-care goals 2. Each individual has a right to hold personal values and to use those values in making health-care decisions 3. All individuals should have access to the information they need to make informed decisions and choices 4. The nurse must act on behalf of patients who are unable to advocate for themselves 5. Empowerment of patients and subordinates to make decisions and take action on their own is the essence of advocacy Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

How Nurses Can Act as Advocates • Helping others make informed decisions • Acting as intermediaries in the environment • Directly intervening on behalf of others • Advocating for social justice Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Tell whether the following statement is True or False: One way nurses can act as advocates is by directly intervening on behalf of others. A. True B. False Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer: Rationale: Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Controlling Patient Choices versus Assisting Patient Choices It is important for the patient advocate to be able to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom) Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Advocating for Patients as Managers • Creating a work environment that recognizes patients’ needs and goals as paramount • Creating a work culture in which patients are respected, well informed, and empowered • Advocating for patients with regard to distribution of resources and the use of technology • Taking risks particularly when advocating for a client may be in direct conflict with a provider or institutional goal Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Areas Requiring Nurse–Patient Advocacy • End-of-life decisions; aging populations • Technological advances • Health-care reimbursement • Access to health care • Provider–patient conflicts • Withholding of information • Insurance authorization Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Areas Requiring Nurse–Patient Advocacy—(cont. ) • Medical errors • Patient information disclosure • Patient grievance and appeals process • Culture and ethnic diversity and sensitivity • Respect for patient dignity • Inadequate consents; complex social problems • Incompetent health-care providers Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Patient Rights • 1998 Patient’s Bill of Rights: – Helps patients feel comfortable in the system – Stresses strong patient–provider relationship – Stresses key role patients play in staying healthy • 2010 Affordable care act: – Gives patients protection in dealing with insurance companies Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Subordinate Advocacy • Nurse administrators should advocate for other health-care providers (including subordinates) as well as patients, especially when this is related to health and safety • Workplace advocacy occurs when the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Internal versus External Whistle-Blowing • Internal whistle-blowing occurs within an organization, reporting up the chain of command • External whistle-blowing involves reporting outside the organization, such as to the media or an elected official Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Whistle-Blowing Concern • While much of the public wants wrongdoing or corruption to be reported, such behavior is often looked upon with distrust, and whistle-blowers are often considered disloyal and experience negative repercussions for their actions Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Tell whether the following statement is True or False: Reporting an offense to one’s boss is an example of external whistle-blowing A. True B. False Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Leader-Managers Leader-managers also must be advocates for the nursing profession When nurses find a discrepancy between their perceived role and society’s expectations, they have a responsibility to advocate for the profession Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Profession of Nursing • Entry into a profession involves a personal and public promise to serve others with the special expertise that a profession can provide and that society legitimately expects it to provide • If nursing is to advance as a profession, practitioners and leader-managers must broaden their sociopolitical knowledge base to understand better the bureaucracies in which they live • Nurses who participate in professional organizations are integral in determining whether voluntary or legal controls represent what nursing is and should be Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question What are some ways nurses can advance the nursing profession? (Select all that apply) A. Learn about sociopolitical issues B. Participate in professional organizations C. Participate in bureaucracy Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Making Concerns Known Nurses must exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Writing a Letter to a Legislator • Write a personal letter. Be formal, but polite. The letter should be one page • Address the legislator by title • Establish your credibility early in the letter as both a constituent and as a health-care expert • Refer to a specific bill by number • State your position on the issue. Offer your assistance as a resource person for additional information • Sign the letter, including your name and contact information. Be persistent and write repeatedly to legislators who are undecided on an issue Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Which should one not do when writing a letter to a legislator? A. Be persistent B. Write a personal letter C. Address the legislator by his or her title D. Make the letter at least two pages long Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Media Exposure • Many nurses avoid media exposure because they believe they lack the expertise or because they lack self -confidence • However, nurses should take every opportunity to appear in newspapers and on radio and television Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Tips for Interacting with the Media • 1. Respect and meet the reporter’s deadlines • 2. Assume, until proven otherwise, that the reporter will be fair and accurate in his/her reporting • 3. Have key facts and figures ready for the interview • 4. Limit your key points to two or three and frame them as bullet points • 5. Avoid technical or academic jargon Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Tips for Interacting with the Media—(cont. ) • 6. Speak confidently but do not be afraid to say when you do not have the expertise to answer a question or when a question is better directed to someone else • 7. Avoid being pulled into inflammatory arguments or blame setting and repeat key points if you are pulled off into tangents • 8. Provide the reporter with contact information for follow-up and needed clarifications Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Tell whether the following statement is True or False: Nurses should avoid media

Tips for Interacting with the Media— (cont. ) • Be prepared • Stick to three or four key points • Provide the media with clear, concise information • Stay on track by sticking to predetermined points • Do not be afraid to say that you do not have enough information or expertise to answer a question Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins