Patient Advocacy: How It Should Guide Care

The Primary Role of Nurses

Posted by Shanna S. RN, BSN on December 11, 2013

My grandmother has been the subject of two of the last articles I have written, as her recent health situation raised major concerns for me, as a nurse. After some difficulty in obtaining access to the care and services she needed, she was diagnosed with cholecystitis.

For treatment, she was given three options: travel four hours North, into a different state to have her gall bladder removed at a well-respected urban facility; travel five hours South, to have the procedure performed in a small suburban facility near her family; or have the surgery performed an hour from home, in a rural facility lacking basic tools of the trade, including ultrasound.

Ultimately, she chose to have surgery five hours from home, near her family. The anticipated quality of care, coupled with the presence of family nearby guided her choice. The fact that she would have three intelligent adults at her side, from intake to discharge, was the most compelling factor.

In today's healthcare system, having someone that can advocate for the needs, preferences and concerns of patients is of utmost importance.

My grandmother needed that. She needed someone to back her up when she asked for the pain medication that would not make her sick. She needed someone who knew her to be there when she went under, and when she woke from anesthesia. She needed someone to remind staff of her low sodium diet needs, her physical therapy requirements and limitations, her complicated follow-up visit coordination, her co-morbid conditions and her current medication regimen.

She needed someone who could understand, communicate, and encourage her healthcare providers to incorporate her independent nature into her hospitalization and recovery. What she needed was simply to have someone that was on her side while she was a patient. Someone that understood her as a person, and who could advocate for her best interest. She needed a patient advocate.

As nurses, we are tasked with several roles within the diverse and complex health care system. We are first hand care providers, teachers, counselors, resource managers, mediators, investigators, and spokespersons. But there is one role that should dictate how we perform all of the other tasks given to us: the role of patient advocate.

Patient advocacy should guide every other role we fill as nurses.

The care we give, the education we provide to patients and families, the way we manage our time, the research we perform, and the causes we promote are all rooted in the fact that we are, first and foremost, advocates for our patients. This is evidenced by the first three provisions of the American Nurses Association's Code of Ethics for Nurses.

  • Provision 1. The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes or the nature of health problems.

  • Provision 2. The nurse's primary commitment is to the patient, whether an individual, family, group, or community.

  • Provision 3. The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.

Excerpted from ANA Code of Ethics

Attending to our role as patient advocates is, quite possibly, the most important responsibility we have as nurses.

When we are holding our patients' best interest at the core of what we are doing, we have the capacity to make sound decisions in every other aspect of what we do. From documentation to facility wide quality improvement, we should be guided by patient benefit. From task delegation to national policy formation, we should first consider what is best for our patients.

It is easy to get caught up in budgets and schedules and bureaucracy, oh my! The complexities of healthcare are widespread, difficult to digest, and can become overwhelming in an instant. As an educated nurse, who has been in many different settings, has seen many different scenes play out, and who is dedicated to the profession of nursing, I maintain that there is a way to simplify toward success.

It is as simple as remembering that, first and foremost, as nurses, we are patient advocates.

When we guide our professional efforts based upon what is best for our patients, we are upholding the duties of our profession. Everything else falls in line. We educate ourselves so that we can provide better care to our patients. We document thoroughly to share accurate and relevant information with other members of the healthcare team. We use supplies, staff and resources wisely, because we know that affordable healthcare is important to sustainability. We do these things with our patients in mind, because we are patient advocates.

Being a patient advocate need not be a formal title, though it certainly can be. Being a patient advocate simply starts with listening to what your patients have to say. It includes asking patients what they need, and what they believe is important for their health.

I have often told nursing students and new nurses, when they ask for advice, that there is one very important thing I would encourage:

Treat your patients like you would treat your own grandmother. Give them the care that you would want your own grandmother to receive. Listen to them. Be kind. Consider how you would want your loved ones treated in the same situation. Provide your patients with the nursing care that you would want provided to your own family members. I do believe it is really that simple. Simply advocate for your patients, as if they were your own loved ones.

Shanna Shafer RN, BSN is driven by the impact nursing, and nursing education, can have on the health of our patients, families, communities, and nation. She has almost ten years of nursing experience in a variety of settings, and currently serves as the Managing Editor at