Bedside nursing not only involves delivering care like taking vital signs, running IV-lines and administering medications, it also involves becoming a patient advocate – speaking up for the unique needs and safety of your patients.
However, while patient advocacy has been embraced by many organizations and healthcare teams, it’s often limited in practice.
There are a number of barriers and challenges frontline healthcare professionals face when it comes to speaking up and breaking the silence.
Yet, there are important tools and information many frontline healthcare professionals can use to navigate hospital administration and gain support for the unique needs of each of their patients.
Read on to learn how frontline healthcare professionals can advocate for their patients to receive more compassionate, safe and patient-centred care.
Listening at the bedside
Beyond a hospital chart, every patient has a story, and as unique as our fingerprints are, so is the medical history and the needs of every patient.
In addition to specialized healthcare expertise, one of the greatest factors in delivering patient-centred care is listening.
Listening not only to what is happening with patients, but also what matters to them, is critical to co-creating a care plan, achieving positive outcomes and delivering compassionate care.
Frontline nurses are in one of the best positions to listen to and understand the unique needs of each patient.
As a frontline nurse, you know when your patient is “off,” you know when your patient is truly in pain, and you can see if your patient requires a unique approach to care.
But how do frontline nurses lead the charge in asking for additional or unique patient supports in a busy, resource-limited organization?
Barriers to being heard
Ideally, a hospital that heals is one that listens.
Over the years, strides have been made to support the role that actively listening to patients has in the provision of care.
Yet, when it comes to translating the knowledge from the bedside to the boardroom, many healthcare professionals struggle with being heard.
A number of factors commonly found across healthcare settings can cause the breakdown of communication from the frontline to leadership.
Some of these factors include:
- A culture of silence deeply rooted in healthcare culture
- A siloed approach to healthcare delivery
- A nursing shortage and time constraints
- A complex chain of committees and protocols
- A lack of communication tools and resources
Powerlessness to advocate comes with significant intangible costs including:
- Poor morale
- Fractured teamwork
- Increased complications
- Negative patient outcomes, including death
However, with the right information, empowerment and communication tools, more frontline healthcare professionals can navigate patient advocacy with confidence, obtaining the support, resources and response from leadership they need to improve the provision of care.
Advancing patient advocacy
Often, the impetus for a nurse to begin the path for patient advocacy is a close nurse-patient relationship.
Effective advocacy starts with frontline nurses recognizing the unique needs of a patient.
These needs may range from patients needing more knowledge about their condition, to switching medications due to side-effects, or applying a more gentle vascular access dressing.
Many times advocating on behalf of a patient may be a conversation with a physician or charge nurse, but other times, it may require presenting new solutions or asking for resources from hospital administration.
Navigating infection prevention committees and quality improvement councils may be new to many nurses and healthcare professionals, but there are some concrete steps you can take to advance patient care initiatives and acquire approval for new technology or resources.
Here are six tips frontline nurses and healthcare professionals can use to advocate on behalf of their patients:
- Focus on your cause - don’t be afraid to speak up, and know you are doing so for a good reason.
- Find your forum - understand the unique committee structure at your hospital and who you can speak with regarding quality improvement.
- Support your case - use evidence based research, patient stories and patient-centered care initiatives to provide context and research to your cause.
- Find a champion - if possible, team up with another colleague, specialist or member of the leadership team to advance your cause.
- Harness effective communication techniques - use resources and tips from established communication experts to present your case with impact.
- Follow-up - oftentimes demanding schedules and conflicting priorities block decisions or delay outcomes. Don’t be discouraged, and follow-up to keep momentum.
Patient advocacy in action
Below is an example of how one frontline nurse at a top pediatric hospital in the US changed the vascular access dressings used in the PICU.
- Problem identification: A PICU nurse performing a dressing change on a patient’s central line observed red and irritated underlying skin that caused the patient to itch and pull at the dressing. The nurse realized how often they were apologizing before a dressing change had to happen, and frustrated for their patients began to look into different solutions.
- Solution found: The nurse learns of a gentle silicone dressing used by a colleague that other patients with sensitive skin are tolerating well.
- Advocacy: The nurse begins to engage with their clinical nurse specialist. They discuss the potential of doing a clinical project on the new dressing and the clinical nurse specialist agrees to become a champion for this new solution.
- Collaboration: Together the clinical nurse specialist and nurse engage the product manufacturer for more information and invite them to present the new dressing to the hospital’s value analysis committee.
- Persistence: The presentation is a success and together they present at the CLABSI committee as well. They initiate the process to get an evaluation started to officially try the product on their unit. They follow up on their request and receive approval. Patients begin experiencing fewer MARSIs, other units in the hospital take notice and begin to advocate for the same dressing for their patients.
Don’t be afraid to speak up
Regardless of who we are, what position title we hold and how experienced we are, it can be intimidating to speak up, especially when it may mean a change to protocol, asking for more resources or providing exceptional care, outside of standard practice.
It’s important to remember that your voice matters and the positive intent behind your advocacy is critical to making a difference in the lives of vulnerable patients.
Speaking up and advocating on behalf of your patients doesn’t just make a difference in their lives, it helps to shape the healthcare system as a whole, making sure that the needs of your patients are met today and into the future.
American Association for Physician Leadership - The Importance of making time to really listen to your patients
Harvard Business Review - Making time to really listen to your patients
Mayo Clinic - The power of listening - mindful communication in healthcare
Nursing Times - Active listening encourages patients to share their perspective
The American Association of Critical Care Nurses - Silence kills
Harvard Business Review - Breaking down healthcare silos
U.S. News - The state of the nation’s nursing shortage
Nursing Open - Barriers to practicing patient advocacy in healthcare settings
Crucial Conversations - The standard in effective communication