Advocating for a Better Healthcare System


This is the third in a 3-part series about nurses as advocates within healthcare.

Nurses can play important roles as advocates within the greater world of healthcare, which includes physicians, allied health professionals, and decisionmakers. We can work together to advocate for systems that are ideal for all of us to serve patients, and work with each other, effectively and with compassion.

Here’s a scenario: A patient diagnosed with breast cancer is told about her treatment recommendations—mastectomy, chemotherapy, and radiation—and referred to the surgeon on a day that the breast care nurse is on vacation. The surgeon tells her she can have reconstruction immediately with expanders placed during mastectomy surgery, necessitating fewer procedures.

Normally, the nurse would have educated the patient on a range of reconstruction options and tell the patient there is no need to rush into reconstruction immediately. The patient in this situation feels overwhelmed and rushed, feeling that surgery must be completed and a decision made imminently, causing her a great deal of distress.

While the patient may feel confident in the treatment recommendations, she has missed out on important information for decision-making. If the oncologist and surgeon don’t value the nurse’s role enough to ensure that the nurse is able to participate in the consultation, the patient could be making an important decision without all the relevant information.

There is a hierarchy within the world of healthcare and nurses are not at the top. That does not mean we can’t be the first to build bridges. No one is going to help bring us equity or respect in the system if we don’t ask for it. It’s up to us to climb up the ladder to talk with these groups as colleagues. If we don’t want to be underlings, we need to start talking to other professionals at their level instead of backing off in deference and fear. Expect respectful, timely, reciprocal communication.

In the scenario above, the breast care nurse must communicate the importance of his or her role to everyone, including staffing decisionmakers—which ultimately benefits the oncologist—the surgeon, the healthcare system, and the patient. How could the physicians address the problem of the nurse’s absence? Perhaps additional staff are needed to fill the gaps for vacation time. Another breast care nurse could be hired, the process could be modified to ensure that the patient never misses the education piece before seeing the surgeon, and attention to the patient’s needs would be preserved in the process.

Nurses can commit to forming working partnerships with other healthcare leaders, even policymakers and legislators, by finding the things we have in common with them—improvements that we can pursue for mutual benefit. When others know that we understand their pain, they will be more likely to trust us and reciprocate the effort. When we advocate not just for our own position, but for the entire system, we will make progress.

Start by finding influential leaders who are personable, treat you with respect, and follow through on what they say. They need to engage in conversation as well as effort. “Busy” is no excuse for dismissing a colleague’s concerns. Everyone is busy. Everyone needs to be willing to share the workload, in mutual commitment to the greater good.

If finding common ground is an issue, make sure everyone understands what everyone else needs, what is not being met by the status quo, and what the consequences are for the patients. No one can escape responsibility for sharing the workload.

Instead of shying away from tough conversations and building bridges, nurses need to take an active role because we do not practice in healthcare alone. Every decision made is going to affect us and our patients. We cannot act by ourselves, but no one is going to do it for us. Nurses need to step outside of our traditional worlds. We can take control of our profession.

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