Advocacy is a must-have skill in any clinical environment, from critical care to private practice. But what does it really look like to advocate for your patients, and how can you learn to center your care around your patients’ autonomy?

In this guide, we’re breaking down patient advocacy in nursing: the promotion of patient safety, quality care, and patients’ voices.¹

We’ll discuss this definition in more detail, describe how nurses can advocate for patients, explore how to overcome common challenges, and offer strategies for advocating effectively. If you’re looking to hone patient advocacy nursing skills, this is the primer you need to get started.

What is Patient Advocacy in Nursing?

First, what is patient advocacy? In a 2018 study, researchers interviewed RNs to build a working definition: “Promoting patient safety and quality care which includes the following: protecting patients, being patients’ voice, provision of quality care and interpersonal relationship as well as educating patients.”²

If you completed a nursing degree program, elements of this definition likely informed your curriculum—especially “provision of quality care” and “educating patients.”

However, some parts of this expansive definition are not as straightforward. Let’s break these down:

• Protecting patients – Nurses must establish ways to protect patients from health risks as much as possible: infections and side effects of treatments, for example. But nurses must also protect patients from other potential risks in the clinical environment: systemic biases in healthcare, consent violations, administrative roadblocks, and more.
• Being a patient’s voice – Serving as a trustworthy voice for the patient is at the core of patient advocacy. While this might be described as a “soft skill” in the realm of nursing competencies (compared to “hard skills” like starting IVs or managing medications), voicing patients’ wishes to the clinical team is just as critical.
• Building interpersonal relationships – Regardless of the level of nursing, every seasoned nurse knows that patient trust both eases the treatment process and improves overall patient outcomes.³ To build that trust, nurses must foster an interpersonal relationship with a patient.

All of these elements of patient advocacy form core parts of nursing ethics and clinical practice.

The Nurse’s Role in Patient Advocacy

With the above definition in mind, how can nurses act as advocates for their patients? Let’s break down what patient advocacy looks like in context.

Representing Patient Interests

When nurses build treatment plans with their care teams, they can advocate for their patients by faithfully representing their interests. Let’s explore a hypothetical:

• Lou (RN) asks Jo (patient) if she has a birthing plan or preferences related to her stay in labor and delivery. 
• Jo says that she’d like to avoid an epidural and prefers not to have an IV so she can walk around.
• Lou makes sure to note these wishes in Jo’s chart, share them with Jo’s physician team and mention them when giving a report at shift change.

While this might sound simple, it might be more difficult for Lou, the RN, to be an advocate for Jo’s wishes when the physician team recommends a surgical procedure. Advocacy can be challenging when patient wishes conflict with healthcare provider recommendations, but good advocates will also do their best to facilitate open dialogue between patients and the care team to find a resolution.

Ensuring Informed Consent

In the hypothetical above, Jo’s medical wishes are clear: Jo does not consent to any medication during delivery.

And if the need for either arises, Lou must act with regard to Jo’s wishes. But Lou can help ensure that Lou is making an informed decision via two possible methods:

1. Engaging the entire care team – If Jo’s physician team decides that a surgical procedure is the best route, Lou can facilitate a conversation with Jo and all of the providers involved in her case. By giving the experts a chance to educate Jo on epidurals, Lou can ensure that the patient has all of the information she needs to make a factually informed decision.
2. Offering one-on-one education – To help Jo decide whether or not to consent to an epidural, Lou can present the risks and rewards in a one-on-one conversation. By answering questions and outlining the risks and benefits, Lou can ensure that Jo has the full picture of a possible treatment before she consents (or doesn’t).

Navigating Healthcare Policies

Informed consent is just one healthcare policy that nurses must navigate when treating patients. Others include:

• Privacy regulations
• Infectious disease management protocols
• Patient hygiene requirements

Policies are designed to benefit both patients and providers—they keep both parties safe and promote positive patient and community health outcomes. Since these policies protect patients, nurses must implement them with fidelity and help patients understand them. They can do the latter by:

• Explaining relevant policies to patients and their families
• Describing the negative consequences of breaking policies
• Breaking down how each policy benefits the patient

But to follow these policies, nurses must know what they are. Staying on top of changing regulations is a must for today’s nursing staff, and investing in continuing education for nurses is just one way to stay up-to-date on changing health policies.

Challenges in Patient Advocacy 

We’ve touched on a few potential challenges inherent in patient advocacy—conflicts between providers’ recommendations and patient consent, for instance. But what other roadblocks should nurses expect as they advocate for the best possible care for their patients?

Navigating Healthcare Systems

When nurses take every possible step to ensure that their patients’ voices are heard, they’ll likely have to contend with red tape—healthcare system nuances that present roadblocks for patients and providers.

Nurses can thoroughly be a patient advocate in complex healthcare settings by:

• Understanding their network’s structure and policies – Nurses must understand how their hospital system or nursing practice works to be able to support patients’ success within it.
• Documenting their efforts – Communicating in writing and documenting attempts to navigate bureaucratic roadblocks can help nurses maintain accountability (discussed further below).
• Working as a team – When the entire patient care team—from nursing assistants to physicians and everyone in between—has a clear picture of a patient’s wishes, the team can work in harmony to advocate for the patient at multiple organizational levels.

Dealing with Ethical Dilemmas

Healthcare education programs widely focus on approaching potential ethical issues in clinical practice. When they embrace a patient advocacy mindset, nurses will likely encounter challenges like:⁴

• Informed consent – As noted above, nurses are likely to encounter consent-related issues often during their nursing career. Nurses may have to face consent disagreements between patients and their families, patients, and providers, and other parties. Consent issues are best approached with a commitment to patient advocacy—after educating patients; nurses should do everything they can to center their patients’ decisions and consent.
• Disclosure – Some patients’ families ask nurses not to disclose the full scope of their health details to a patient. While families are often trying to protect the patient, nursing ethics demand that patients be completely informed of their diagnoses and health issues. Refusing to disclose these details undermines a patient’s right to informed consent.
• Peers’ advocacy issues – During your time as a nurse, you may encounter a fellow nurse who doesn’t value patient advocacy as much as you do. While you may want to avoid conflict, it’s your responsibility to speak up anytime you witness an ethical breach.

Overcoming Communication Barriers

Communication is the backbone of patient advocacy. To prioritize a patient’s voice, you, as a healthcare professional, have to be able to communicate with them. Nurses may encounter the following barriers:

• Language fluency – If a patient doesn’t speak the same language as you, exhaust all of your possible options: your hospital’s or practice’s interpretation services, tech tools, or even informal interpretation from a family member or peer.
• Language disabilities – When treating patients with speaking, hearing, or comprehension difficulties, they sometimes must work harder to educate patients and get informed consent. Using multiple modes of communication, liaising with family members (when appropriate), and leveraging interpreter services may all be required in these scenarios.

When in doubt about your communication resources, turn to your hospital’s or practice’s nursing leadership. They can provide procedures, expectations, and support when you’re not sure how to communicate effectively with a patient.

Strategies for Effective Patient Advocacy 

With all of the above in mind, let’s explore some practical tips for nurses looking to embrace a patient advocacy approach to care:

• Stay informed – Investing in continuing education and professional development opportunities can help you stay on the cutting edge of healthcare policies and research-based approaches to patient advocacy in nursing.
• Improve communication skills – Soft skills like communication are just as critical in nursing as hard skills—take time to learn new techniques, get advice from more experienced clinicians, and intentionally use the approaches you’ve learned when interfacing with patients.
• Prioritize patient relationships – To center your patients’ wishes and build trust, make a concerted effort to build a strong relationship with patients. Showing an interest in your patients’ wishes will show them that you truly care about their treatment outcomes.

Training for Future Nurses

Looking for a nursing curriculum that centers patient advocacy skills alongside practical excellence? You’ll find your match in a top-quality nursing program from Alliant International University.

Our health programs are designed to prepare the next generation of nurses and nursing leaders. Led by experienced clinical and academic experts and supported by cutting-edge technologies, Alliant International University’s nursing curricula set future nurses up for success.

Learn more about our approach to nursing education and apply now.

Sources: 

1. Nsiah, C., et. al. “Registered Nurses’ description of patient advocacy in the clinical setting.” Nursing Open Access Journal. July 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650676/. Accessed March 24, 2024.
2. Nsiah, C., et. al. “Registered Nurses’ description of patient advocacy in the clinical setting.” Nursing Open Access Journal. July 2019. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6650676/. Accessed March 24, 2024.
3. Johanna Birkhäuer, J., et. al. “Trust in the health care professional and health outcome: A meta-analysis.” PLoS One Journal. February 7, 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5295692/. Accessed March 24, 2024.
4. Wood, Debra. “4 Common Nursing Ethics Dilemmas.” AMN Healthcare. November 16, 2023. https://www.amnhealthcare.com/blog/nursing/contract/4-common-nursing-ethics-dilemmas/. Accessed March 24, 2024.

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