Healthcare Policy Advocacy Research Paper

Health Policy & Advocacy Committee The HP&A Committee of NAAN/NANNI (hereafter referred to collectively as NANN) acts to promote NANN as the professional voice that shapes neonatal nursing through excellence in practice, research, education and professional development.NURS 4105 – Advocacy Through Healthcare Policy Research Paper On behalf of NANN, the Committee pursues and promotes NANN’s legislative agenda by monitoring and responding to legislation, governmental regulations, and administrative actions that affect neonatal nurses, neonatal nurse practitioners, and the patients and families they serve. The Committee also encourages and assists NANN members to become involved in grassroots legislative activities in pursuit of common goals. NANN is not large enough to have, like some organizations, our own legislative representative or lobbyist. Even so, there is much we can do at the grassroots level, and to increase our effectiveness, NANN and NANNP are joined in these activities. Turning Outrage into Action Every day, people have experiences that are frustrating, unbelievable, or so outrageous that they think, “How can this be? There ought to be a law!” Nurses often experience this frustration in their day-to-day practice- fighting with managed care, facing inadequate Medicare reimbursement, and struggling with inadequate staffing or unsafe working conditions. Also every day, federal and state legislators are making decisions that affect neonatal nursing and our patients, often with very little knowledge or understanding of the issues and with little or no input from nurses. We can’t afford to let this happen. We must contribute our authority, leadership, and unique knowledge of neonatal nursing to the legislative process, or suffer the consequences.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Health policy advocacy means channeling this sense of outrage about inadequately conceived laws, policies, and regulations or about the absence of a law when the need for one is clear. Advocates let policymakers know what they, as citizens and constituents, believe elected officials should do. Health policy advocacy can be easy, and it can make a difference in the outcome of our nation’s policy decisions. It doesn’t require any new skills, it just involves applying skills you already have, such as communication and building relationships, in a new context. Advocacy is a Right and a Responsibility Polls have found that Americans’ knowledge of television shows such as The Simpsons and American Idol far surpasses their familiarity with the First Amendment of the U.S. Constitution. The First Amendment guarantees freedom of speech, the press, religion, the right to peacefully assemble, and the right to petition the government for a redress of grievances. So if you are thinking, who am I to lobby Congress? I am just a nurse! The U.S. Constitution grants us the right to tell our elected officials our concerns and to take action to address them. Policymakers work for the citizens. Your tax dollars pay their salaries, their health insurance, retirement benefits, and travel. As their “employer,” you have every right to hold them accountable for their actions, tell them what you want them to do, and give feedback on how you think they are doing at their jobs.NURS 4105 – Advocacy Through Healthcare Policy Research Paper The ultimate job review you can give your public officials is by voting – either returning them to office or ending their service. The United States has a participatory democracy and representative government. Becoming involved is not only a right, but also a responsibility. And finally, Congress needs the expertise of nurses. Nurses have first-hand direct bedside experience and understanding of how decisions in Washington affect constituents. Nurses understand the “big picture,” relating to health issues. Nurses are trusted, tenacious, and reliable.

Advocacy and health policy have important implications for what we do every day. Unless we communicate with lawmakers about key issues, laws and regulations will be created and enacted without the benefit of our expertise and unique perspectives. Nurse are a powerful and well-respected constituency; our active involvement in health policy issues helps policymakers take action on key issues, such as the nursing shortage. Engaging nurses in health policy advocacy is essential to ensuring that nursing and NANN’s priorities are received and addressed by policymakers. We can and must become involved in health policy advocacy. The following sections of this Health Policy & Advocacy Toolkit provide the tools needed to become effective health policy advocates at the national, state, and local level.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

What is a Healthcare Policy Advocate?

One of the newest professions to emerge in the burgeoning healthcare system is that of a Healthcare Policy Advocate. This person speaks for patients who are at their most vulnerable state in an environment of increasing healthcare costs and privacy concerns that sometimes block access to resources. What does this profession entail and who are the people that work in the advocate position?

Why Advocates are Needed

The average household in the United States spends roughly $15,000 on healthcare each year, according to an article in a New York Times blog. That includes insurance premiums, Medicare taxes, Medicaid expenses and other costs in addition to out-of-pocket charges. The U.S. also spends a sixth of its annual gross product on providing healthcare. The health industry is big business. According to an article found in the Journal of Medical Ethics, the medical profession has, at its core, the goal of promoting a patient’s best interests, but, in reality, that must be tempered with an eye to the good of the community. In other words, what is good NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Who are Advocates?

Some advocates work for healthcare facilities, some are employed by insurance companies, some work for “advocacy agencies” and some work as private practitioners. Obviously, the best advocate would be the patient, but advocacy is needed at a point when the patient is most vulnerable. Family or friends are also sometimes advocates. With all of these people, though, there may be a conflict of interests. Even family members sometimes struggle with how the wishes of the patient will impact their lives.

What Do Advocates Do?

There are two kinds of advocates: those who advocate for a class, and those who advocate for the individual. Nurses advocate for patients by attempting to change the system. Other advocates work on a more personal level, in face-to-face contact with their clients. Some of their duties are:NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Helping with insurance claims
Informing patients of all treatment options
Negotiate bills. This is especially true of an advocate who works for an insurance company or a healthcare facility.
Support the patient emotionally
Support patient decisions and make sure these are expressed to the healthcare providers.
Educate the patient about his illness and possible treatments.

The role of the advocate is not well-defined, because the position is so new and there are advocates from so many entities. The focus of the advocacy will depend upon who employs the advocate. In addition, there is a debate over whether the advocate should push for all patient requests or act in a parental capacity to advocate for what is actually in the patient’s best interests.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Policy & Advocacy

With experience across a range of policy areas and issues, combined with our strong record working side-by-side with business, government, and community-based organizations, PHI and its programs are effective, influential advocates for public health in local, state and federal policy.

Building on this success, PHI is now working to strengthen its role in U.S.-based policy that has implications for health domestically and worldwide. With strategic policy platforms, PHI addresses policy in areas such as obesity prevention, climate change and health reform. In addition, PHI tracks federal and state legislation, regulations and budgeting processes across a wide range of issues that impact the public’s health, and advances policy solutions that address the social determinants of health.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

PHI continues to produce forward-thinking research to support the public health perspective as it relates to many of the most complex policy challenges facing the nation today, including: agriculture and nutrition, transportation planning, climate change, economic development, obesity prevention, healthy communities, telehealth and health information technology, and alcohol, tobacco and substance use.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Policy advocacy is defined as active, covert, or inadvertent support of a particular policy or class of policies.^[1] Whether it is proper for scientists and other technical experts to act as advocates for their personal policy preferences is contentious. In the scientific community, much of the controversy around policy advocacy involves precisely defining the proper role of science and scientists in the political process.^[2] Some scientists choose to act as policy advocates, while others regard such a dichotomous role as inappropriate.^[3]

Providing technical and scientific information to inform policy deliberations in an objective and relevant way is recognized as a difficult problem in many scientific and technical professions.^[4] The challenge and conflicts have been studied for those working as stock analysts in brokerage firms,^[5] for medical experts testifying in malpractice trials,^[6] for funding officers at international development agencies,^[7] and for intelligence analysts within governmental national security agencies.^[8] The job of providing accurate, relevant, and policy neutral information is especially challenging if highly controversial policy issues (such as climate change) that have a significant scientific component.^[9] The use of normative science by scientists is a common method used to subtly advocate for preferred policy choices.^{[10]NURS 4105 – Advocacy Through Healthcare Policy Research Paper}

The most basic meaning of advocacy is to represent, promote, or defend some person(s), interest, or opinion. Such a broad idea encompasses many types of activities such as rights’ representation¹ and social marketing², but the focus of this manual is on the approaches adopted by organizations and coalitions in trying to change or preserve specific government programs, that is, approaches focused on influencing decisions of public policy. In order to distinguish this from other types of advocacy activities, it is often referred to as “policy advocacy.” This is also the term we use throughout the guide to make this distinction clear.

There are many definitions of policy advocacy available from multiple authors and perspectives³. At their core are a number of ideas that continually come up, characterizing policy advocacy as follows:

a strategy to affect policy change or action — an advocacy effort or campaign is a structured and sequenced plan of action with the purpose to start, direct, or prevent a specific policy change.NURS 4105 – Advocacy Through Healthcare Policy Research Paper
a primary audience of decision makers — the ultimate target of any advocacy effort is to influence those who hold decision-making power. In some cases, advocates can speak directly to these people in their advocacy efforts; in other cases, they need to put pressure on these people by addressing secondary audiences (for example, their advisors, the media, the public).
a deliberate process of persuasive communication — in all activities and communication tools, advocates are trying to get the target audiences to understand, be convinced, and take ownership of the ideas presented. Ultimately, they should feel the urgency to take action based on the arguments presented.
a process that normally requires the building of momentum and support behind the proposed policy idea or recommendation. Trying to make a change in public policy is usually a relatively slow process as changing attitudes and positions requires ongoing engagement, discussion, argument, and negotiation.NURS 4105 – Advocacy Through Healthcare Policy Research Paper
conducted by groups of organized citizens—normally advocacy efforts are carried out by organizations, associations, or coalitions represent the interests or positions of certain populations, but an individual may, of course, spearhead the effort.

However, taking these basic elements outlined above a little further and emphasizing the specific challenge that we develop in this chapter, our definition is as follows:

Policy advocacy is the process of negotiating and mediating a dialogue through which influential networks, opinion leaders, and ultimately, decision makers take ownership of your ideas, evidence, and proposals, and subsequently act upon them.

In our definition, we place a great emphasis on the idea of the transfer of ownership of core ideas and thinking. In essence, this implies preparing decision makers and opinion leaders for the next policy window or even pushing them to open one in order to take action. If advocates do their job well, decision makers will take the ideas that have been put forward and make changes to the current policy approach in line with that thinking.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Health advocacy encompasses direct service to the individual or family as well as activities that promote health and access to health care in communities and the larger public. Advocates support and promote the rights of the patient in the health care arena, help build capacity to improve community health and enhance health policy initiatives focused on available, safe and quality care. Health advocates are best suited to address the challenge of patient-centered care in our complex healthcare system. The Institute of Medicine (IOM) defines patient-centered care as: Health care that establishes a partnership among practitioners, patients, and their families (when appropriate) to ensure that decisions respect patients’ wants, needs, and preferences and that patients have the education and support they need to make decisions and participate in their own care.^[1] Patient-centered care is also one of the overreaching goals of health advocacy, in addition to safer medical systems, and greater patient involvement in healthcare delivery and design.^[2]

Patient representatives, ombudsmen, educators, care managers, patient navigators and health advisers are health advocates who work in direct patient care environments, including hospitals, community health centers, long term care facilities, patient services programs of non-profit organizations or in private, independent practice. They collaborate with other health care providers to mediate conflict and facilitate positive change, and as educators and health information specialists, advocates work to empower others.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

In the policy arenas health advocates work for positive change in the health care system, improved access to quality care, protection and enhancement of patient’s rights from positions in government agencies, disease-specific voluntary associations, grassroots and national health policy organizations and the media.

There may be a distinction between patient advocates, who work specifically with or on behalf of individual patients and families, or in disease-specific voluntary associations, and health advocates, whose work is more focused on communities, policies or the system as a whole. Often, however, the terms “patient advocate” and “health advocate” are used interchangeably NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Rapidly growing areas of health advocacy include advocates in clinical research settings, particularly those focused on protecting the human subjects of medical research, advocates in the many disease-specific associations, particularly those centered on genetic disorders or widespread chronic conditions, and advocates who serve clients in private practice, alone or in larger companies.

With member hospitals, the Children’s Hospital Association works with policymakers—both in Congress and in the administration (White House and federal agencies)—to ensure children’s unique health care needs are considered and that every child has access to high quality, cost effective health care services tailored to meet their needs. We are the nation’s leading voice advocating on behalf of children’s hospitals and the millions of children they serve. NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Through its advocacy efforts, the association:

Works with member hospitals and Congress to craft, reform and promote health care legislation to benefit children, especially those with complex medical conditions
Educates federal policymakers, both during legislative drafting and policy implementation about key issues that impact children’s health and children’s hospitals
Analyzes and synthesizes federal legislation and regulations for their impact on children’s health care, and organizes input from a network of more than 220 children’s hospitals
Assist children’s hospitals in understanding how federal policy may impact children’s health care in their communities
Mobilizes a grassroots network of thousands of parents, health care providers and others concerned about children’s health to influence Congressional action
Provides tools to advance children’s hospitals’ advocacy efforts at national, state and local levels
Collaborates with other organizations concerned with children’s health to advance shared policy goals and amplify our reach on Capitol Hill, within the White House and key federal agencies, and in traditional and social media

Health advocacy

Advocacy is one strategy to raise levels of familiarity with an issue and promote health and access to quality health care and public health services at the individual and community levels. When trying to gain political commitment, policy support, social acceptance and systems support for a particular public health goal or program-me, a combination of individual and social actions may be used to try to affect change. This is one way of understanding Health Advocacy.

The adoption of a health advocacy model can focus on an educational dimension when it identifies emerging public health issues that require action. It encompasses gathering information on existing practice related to public health, related legislation monitoring and providing feedback on how specific regulations impact local groups and communities. It may also help guiding health policy reforms.

Often, health advocacy is carried out using mass and multi-media, direct political lobbying and community mobilization. It may materialize within an institution or through public health associations, patients’ organizations, private sector and NGOs. All health professionals have a major responsibility to act as advocates for public health at all levels in society.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

The National Association of Healthcare Advocacy is the professional healthcare advocacy organization; we are dedicated to the improvement of patient outcomes through continuing education, promotion of national standards of practice, and active pursuit of policy changes, leading to a high standard of person-centered healthcare.

We promote rigorous standards for the practice of advocacy including ethical considerations and codes of conduct when providing medical decision-making support.

We educate consumers and healthcare professionals on research and current trends in patient-centered navigation, advocacy and decision-making support.

We partner with individual advocates and other grassroots organizations to collaborate on patient-centered reforms that maximize use of the healthcare system, protect consumer choice and improve access to high quality, affordable care.

Health Policy and Advocacy Group

The purpose of the Health Policy and Advocacy Group is to identify public policy issues and concerns affecting surgeons and our patients; prioritize these issues and concerns, identify those on which the American College of Surgeons (ACS) should focus its attention and resources, and recommend these priorities to the Board of Regents; develop action plans for addressing these issues, including recommending positions and initiatives the College should adopt; expand and monitor mechanisms by which the ACS makes surgeons, our patients, and the public aware of our health policies and agendas; and develop and maintain mechanisms by which legislative and regulatory issues can be addressed in a timely and effective manner.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Nursing Advocacy: Standing Up for Patients and the Profession

When it comes to patient care, nurses consistently play the role of advocate as they support each patient’s emotional well-being, contribute to the healing process and speak on their patients’ behalf. Nurses can also put their advocacy skills to work in advocating for each other and for the nursing profession as a whole.

“As nursing advocates we start with the foundation that we are servants to others and stewards of our profession,” said Ellen Noel, MN, RN-BC, clinical nurse specialist at Virginia Mason Medical Center (VMMC) in Seattle. “As an advocate we choose to lead from that servant position, making sure peoples’ needs are being met through wise and thoughtful interactions.”

VMMC is creating a model of care based on the caring theory developed by Kristen Swanson, RN, Ph.D., FAAN, which provides a clear outline for advocating for patients and co-workers. Swanson’s five steps of caring are: knowing, being with, doing for, enabling and maintaining belief.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

“With the caring model, you start with the assumption that the person you are working with has valuable skills, that they are trying hard, that they want to improve and learn and that they have the best intentions,” explained Noel. “When you start with that attitude you give that person the best chance of taking control of their circumstances and reaching success.”

“While we are just at the beginning of working out the logistics of implementing the caring model, we are already seeing an increase in awareness, empathy and understanding with others on the team,” remarked Alison Pyle, MN, MPH, RN, clinical director of the hospital’s nephrology/urology/neurology unit that is taking part in the pilot project.

While a lot is written about the bullying that can go on within the nursing profession, Christine Szweda RN, BSN, MS, NE-BC, director of nursing education for competency and assessment at The Cleveland Clinic, believes nurses can instead provide each other with a powerful support network.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

“When it comes to supporting each other, it is great when nurses not only encourage a peer who is considering furthering his or her education, but when co-workers are also willing to be flexible with schedule changes that accommodate another nurse’s schooling needs,” she said.

“Early in my career I decided I wasn’t going to talk about people in terms of their nursing education, because it was only divisive,” reflected Connie Curran, Ed.D., RN, FAAN, editor emeritus, Nursing Economic$. “I have also made a commitment that when I find myself in a position of privilege, to respond by trying to get another nurse there as well. I was serving on a hospital board and realized I was the only nurse on the board. It turns out that nurses only make up 2 percent of hospital board members, but they are the ones who are there evenings and nights and know how the hospital works.”

In response to this commitment, Curran started the company Best On Board, which is an educational program to help nurses get the education and certification they need to serve on boards. As board members, nurses have the influence and the know-how to create good environments for patients and caregivers.

There are a number of ways that nurses can be involved in advocating for the nursing profession. Sometimes it is as simple as being the best nurse you can be and speaking with pride about the work you and other nurses do; it can also mean being involved in research, politics or with one’s professional organization. Most often, working to improve the profession also benefits patient care.

“It is increasingly common for even young nurses to have opportunities to be involved in research that contributes to the body of knowledge of nursing science,” commented Szweda. “But even if you aren’t personally involved in research, you can be quick to share and implement best practices and support the research that has been done.”NURS 4105 – Advocacy Through Healthcare Policy Research Paper

“Along those lines, be quick to embrace technology,” she continued. “I read a lot about nurses resisting the electronic medical record, but the richness of data that can be kept there will not only contribute to the body of knowledge, but having a consistent and integrated patient health record drives patient safety and better care.”

Noel believes that a key component of nursing advocacy is to hold tight to procedures and competencies that ensure patients are safe, while also including staff nurses in determining how these evidence-based practices will be implemented. Through this approach VMMC has made significant improvements in the areas of preventing pressure wounds, patient falls and medication errors.

“Participating in your professional society is a powerful way to advocate for the nursing profession and for patients,” remarked Charlotte L. Guglielmi, RN, BSN, MA, CNOR, preoperative nurse specialist at Beth Israel Deaconess Medical Center and immediate past president of the Association of preoperative Nurses (AORN).

Ways Nurses Can Advocate for Patients

Many nurses think of advocacy as the most important role we play in patient care. We need to remember that to best serve patients, we must have our own house in order. That house includes the other healthcare professionals with whom we and our patients interact, as well as the organizations providing those services and the policies and legislation that influence them.
How can oncology nurses advocate for patients every day? Here are some examples.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Ensure Safety. Ensure that the patient is safe when being treated in a healthcare facility, and when they are discharged by communicating with case managers or social workers about the patient’s need for home health or assistance after discharge, so that it is arranged before they go home.
Give Patients a Voice. Give patients a voice when they are vulnerable by staying in the room with them while the doctor explains their diagnosis and treatment options to help them ask questions, get answers, and translate information from medical jargon.
Educate. Educate patients on how to manage their current or chronic condition to improve the quality of their everyday life is an important way nurses can make a difference. Patients undergoing chemotherapy can benefit from the nurse teaching them how to take their anti-nausea medication in a way that will be most effective for them and will allow them to feel better between treatments.
Protect Patients’ Rights. Protect patients’ rights by knowing their wishes¾this might include communicating those to a difficult family member who might disagree with the patient’s choices and could upset the patient.
Double Check for Errors. Everyone makes mistakes. Nurses can catch, stop, and fix errors, and flag conflicting orders, information, or oversights by physicians or others caring for the patient. Read the orders and previous documentation carefully, double check with other nurses and the pharmacist, and call the doctor if something is unclear before administering chemotherapy.NURS 4105 – Advocacy Through Healthcare Policy Research Paper
Connect Patients to Resources. Help patients find resources inside or outside the hospital to support their well-being. Be aware of resources in the community that you can share with the patient such as financial assistance, transportation, patient or caregiver support networks, or helping them meet other needs.

While we function as advocates for patients, many of the tasks we do become automatic and we can forget they are really about advocacy. When we are short-staffed or tired, our ability to advocate becomes compromised.

Advocacy for patients doesn’t happen in a vacuum. Every patient’s care is affected by the environment in which their care is provided, and the individuals providing that care. This means nurses need to have the time to be able to do these things and to become aware of patient needs, communicate, and follow through.

The nurse needs to come to work not exhausted or burned out. A safe patient load is necessary, as well as support and backup from other staff in the facility. Administrators must understand our role as advocates for patients, so they can provide adequate staffing levels and an environment that allows us to fully care for our patients. When the administration does not understand, it is part of our advocacy duty to inform them. NURS 4105 – Advocacy Through Healthcare Policy Research Paper

In my next post I will explore how nurses also play important roles as advocates for their own profession, and within the greater healthcare space where we exist, intertwined with physicians and other healthcare professionals who ultimately serve patients.

Effective nurse advocacy

Advocacy means using one’s position to support, protect, or speak out for the rights and interests of another. Nurses have long claimed patient advocacy as fundamental to their practice. The American Nurses Association’s Code of Ethics for Nurses and Scope and Standards of Nursing Practice clearly identify nurses’ ethical and professional responsibility for protecting the safety and rights of their patients. State nursing practice acts may establish a legal duty for patient advocacy as well.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Why must nurses advocate?

Patient safety depends on nurse advocacy. Over 10 years ago, the Institute of Medicine (IOM) shocked the nation when it reported in To Err is Human: Building a Safer Health System that an amazing 100,000 deaths each year were attributable to medical errors. In 2004, the IOM report Keeping Patients Safe: Transforming the Work Environment of Nurses highlighted the critical role of nurses in safety efforts and challenged organizations to design work environments in which nurses can provide safe care.

Nurses are at the “sharp end” of errors in health care. Because of their proximity and continuity with patients, nurses are often the last opportunity to prevent an error—to spot a mislabeled I.V. bag before it’s infused, to recognize that a patient’s allergy band doesn’t match the medication administration record, to identify slight changes in a patient’s condition that could signal a significant complication.

Keeping Patients Safe urged the establishment of “cultures of safety” within healthcare organizations to achieve safe practice environments. An organization committed to a culture of safety makes safety an explicit priority and responsibility shared by every individual at every level of the organization. Everyone is expected to participate in identifying and resolving safety issues.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Nurse advocacy challenges

Direct-care nurses are poised especially well to identify and speak up about conditions that may result in near misses or actual adverse events. Cultures of safety promote and encourage staff to raise issues, yet most workplace cultures are imperfect and nurses may face challenges in their advocacy efforts. For example:

Nurses may lack communication skills to clearly articulate their concerns in such a manner that others are able to respond. A nurse who complains that “staffing is always unsafe” leaves a supervisor in a poor position to respond. However, by specifically describing the nature of the concern—for example, “I’m concerned that our planned staffing didn’t account for an ICU patient being transferred in and two additional patients being admitted from the ED. How can we adjust to accommodate these changes?”—the problem and potential solutions become clearer.

Nurses may be uncertain about how to address an issue. Reporting structures may vary depending on the issue: a physician who fails to respond adequately to a patient issue at 2:00 A.M.; chronically late medication delivery from the pharmacy; a medical device that repeatedly fails during patient use. The chain of command through departments (risk management, corporate compliance, medical staff) or individuals (direct supervisors, the chief nursing officer) may not be well established. Further, nurses, especially those in direct-care roles, may not be adept at negotiating the inherent power gradients in healthcare organizations.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Nurses may fear retaliation and lack knowledge about established processes and protections for patient advocacy activities. Raising a concern disrupts the status quo and challenges the organization to confront problems. If identifying concerns or opportunities for improvement is viewed as complaining, those raising concerns may be labeled “troublemakers.”

One of the most egregious examples of retaliation for patient advocacy activities occurred recently in Winkler County, Texas, when two nurses, Vickilyn Galle and Anne Mitchell, were criminally indicted by the county attorney for reporting a physician to the Texas Medical Board because of patient-safety concerns. One week before trial, charges against Galle were dropped. A jury found Mitchell not guilty. Subsequently, the Texas Medical Board took action against the physician for witness intimidation as well as practice violations. Further, the Texas Attorney General’s office indicted the hospital administrator, Winkler County sheriff, county prosecutor, and physician for retaliation and other charges. (See www.texasnurses.org for more information.)

Nurses may have limited opportunities to advocate proactively in organizations lacking shared decision-making processes. Decision-making opportunities concerning patient care include performance-improvement activities, staffing committees, and product evaluation teams. This is a missed opportunity for improving safety.

The nurse’s duty to patient safety is well established and is reflected in the nurse’s role of patient advocate. The value of patient advocacy in supporting an organizational culture of safety isn’t always appreciated, yet the knowledge and response to nursing concerns about patient safety can make a powerful contribution to patient outcomes.NURS 4105 – Advocacy Through Healthcare Policy Research Paper

Speak to be heard

Nurses in all roles and at all levels of the organization have a duty to patient safety, although each may have different circles of influence. To be effective in advocacy efforts, nurses first need to understand the laws and regulations governing their practice. For example, the Texas Nursing Practice Act (NPA) has specific provisions to protect nurses who raise concerns about patient safety. It’s illegal to retaliate against a nurse who reports a licensed healthcare practitioner, agency, or facility to a licensing board (such as the Texas Department of Aging and Disability Services, which licenses nursing homes), to an accrediting agency (such as The Joint Commission), or internally (within the facility) because he or she believes they have exposed a patient to a substantial risk of harm. Another provision in the Texas NPA protects nurses who report staffing concerns to nurse staffing committees, who are then responsible for evaluating and responding to the concern. A unique provision in Texas, called Safe Harbor, provides an avenue for resolving situations in which a nurse believes an assignment or directive may violate his or her duty to the patient. (See Safe Harbor.) Nurses who understand their state practice acts are best able to use established processes to advocate effectively for their patients while protecting themselves from retaliation and from violations against their license. NURS 4105 – Advocacy Through Healthcare Policy Research Paper