The Silent Nurse and the Death of Nursing Advocacy.
Posted by realityrounds on July 13, 2009
According to Websters Dictionary to “Advocate” means…….……. Yeah, right. For those who know me in person, or have read even one post on this blog, ya know I would never give a speech or start a post with those words. Lame. I promise never to use Wikipedia as a reference also.
I am going to try and cut through some bullshit and pretty talk and tell you what it means for a nurse to advocate for a patient in REALITY. The reality of American health care, hospitalizations, work load, professionalism, liability, diversity, and life outside the blogosphere. I can spit out what the American Nurses Association believes is advocating for patients according to our Code of Ethics. This is a long document that spells out what is means to practice ethically and to advocate for a patient. According to the ANA, we as a profession must “promote, advocate for, and strive to protect the health, safety and rights of the patient.”
This means the rights of every patient. We do not have the luxury of choosing our patients. They come in all shapes, sizes, languages, backgrounds, religions, economies, philosophies, etc. Nurses must respect all their choices without judgment. On any given week, or day, or shift, we may encounter patients who are homeless, drug addicted, don’t read blogs (gasp!), are sexually abused, physically abused, don’t speak English, are disabled, can’t communicate, are neonates, infants, teenagers, adults, elderly. We may encounter patients who are well read, educated, independent, feminists, conservative, liberal, racists, atheists, and devout. They may be scared, angry, shy, embarrassed, controlling or confident.
We are strangers to them. But when they enter the hospital and enter our lives, as nurses, we must become their voice. Talk to your patients! Ugh. It is such common sense, yet I see it over and over again from health care providers. Breeze in and out of the room. Ask only what will get your admission form filled out. Avoid all eye contact, because that may illicit more questions. Leave in silence. And by the way, I think I will start tasering any nurse I hear say “I don’t know, ask you doctor.”
Silence from a nurse is the ultimate betrayal of patient confidence and it kills patient advocacy. I believe nurses are the connection to what is real, and safe, and comforting to the patient in a very scary and intimidating world of the hospital. We may not like what our patients have to say, we may not even like our patients, but that’s tough shit. Nurses need to start thinking outside of their comfort zones and outside of the box. Let the drug addicted mom hold her baby. Let the dying man bring his dog to the hospital for one last goodbye. Let the mother deliver outside of a hospital bed. Let the teen with cancer wear her own clothes. Let the immigrant family have more than 4 visitors at a time.
Advocating for a patient means to speak up, and to shut up and listen. It means to fight for the patient, when no one else will. It’s not easy. Most fights are not.
It seems others around the nursing blogs are talking about advocacy also. Check these sites out for some interesting reads:
RR
Wanderer said
Listening is the hardest thing to do, especially when driven by the demands of TJC, management, 3+ other patients, etc., but you’re so right: we need to listen. We can’t be advocates if we don’t know what it is our patients need/want.
That’s why I love working nights. I can spend a little extra time if I need to with my patient to do exactly what you’re saying. It’s not always the case, but more often than not, it is.
realityrounds said
I worked nights for seven years and could not agree with you more. Thanks for reading!
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takingheart said
I am guilty of using wikipedia when I defined “culture of poverty” a while back. Thanks for the “lame” tip… lol… won’t do that again…
I agree with you whole heartedly on this post. In the past year I have been involved with a “situation” (try and read my HIPAA-fied code talk) where I had to stand up, literally… and defend my patient. It was the single most terrifying moment in my career… the doc’s career was on the line, she was my friend, she is a mother. A lot of emotions pulling me in different directions.
But… what’s right is right. What’s fair is fair. What’s just is just. I messed up in that “situation” because I didn’t defend that patient initially… but, I wouldn’t let that opportunity pass me by again. I’m a better nurse advocate for it. I question doctors orders and use my chain of command. I sleep at night knowing I did the right thing. I feel sorry for the other person involved who is no longer practicing. I am sad… but with no regrets. My patient is alive. And, her voice was heard.
realityrounds said
Good for you! Sometimes I hate HIPAA, OK all the time I hate HIPAA. I want to hear the whole story
That’s why I love when patients comment. They do not have to filter themselves.
pinky said
Well you know I agree with you. I sleep like a baby at night because I always do what I feel is right. Probably because I was raised by a big mouth woman who was raised by a big mouth woman. It may be in my genetic code?
Anyhow when nobody is talking, now everyone in the room looks at me as if to say, “so are you going to say something?” I don’t disappoint them. But it has gotten me bounced to the nurse manager’s office a fair amount. And I think other nurses and Docs should speak up too. I am sick of being the one who has to point at the elephant in the room and say, “Hey guys what are we gonna do about the Elephant?”
Jill said
“I am sick of being the one who has to point at the elephant in the room and say, “Hey guys what are we gonna do about the Elephant?”
Best quote I’ve read in a long time. Nice one, Pinky!
M'Lynn said
I’ve been a big mouth, elephant recognizer for a long time. It doesn’t make me popular, but it keeps me from going insane. Others do need to speak up. Complacency accomplishes nothing.
The issue over at Uncompromised Airways really upsets me. The nurses tried, and still nothing happened. I really don’t get why end of life care is so screwed up. It’s 2009, and we’re still letting people die in pain?
realityrounds said
That story about refusing the baby pain meds is rage inducing. It makes not sense. It does happen, but not if I am working.
M'Lynn said
I can’t imagine a parent out there, when given that diagnosis, who would have a problem with being told, “We’re going to make your child as comfortable as possible.” The outcome was not going to be any different. What is the fear in the meds might hasten death, at that point? The parents suing? Would that even be discussed at an M&M?
Refusing the pain meds is criminal in my mind.
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RehabRN said
My favorite on pain meds we had recently: refuse pain meds as ordered to a patient with a drug history. Yes, that’s smart, let him get riled enough that he’ll hurt himself or someone else because, despite his history, he’s got an injury that causes pain.
I’m a newer nurse who doesn’t know squat. This from the same nurse who covered a patient with a 102+ (and climbing–to 105) temp in blankets, because he had chills.
Sean said
‘Shut up and listen’ can be the hardest part of ’speaking for’ our patients. We have such strong passion for advocating, that we can become blinded by our own ambition.
In the end, the patient is what matters the most. The patient and their overall health and safety.
We have to remind ourselves daily to treat the patient and not just the disease.
Good stuff. Nice post.
realityrounds said
Thanks Sean!
Great comment. It really can be hard to advocate in the right way for our patients.
DreamingTree said
Great post! I’m ready to hang it up in our break room at work. It’s frustrating when some blindly and silently go through the motions. Or worse yet, complain loudly that something is WRONG, but never to those who can actually bring about change. Grow a set & go to the source — get it done.