Navigating the health care system can be especially challenging for some patients. Issues such as limited appointment availability and clinician shortages — particularly in rural areas — can make it difficult for patients to see their primary care providers or specialists. Additionally, patients may have inadequate access to transportation or suffer from chronic conditions that make travel difficult or dangerous.
Further, patients who have debilitating conditions may not fully understand their treatment plans, their options, or even their rights as a patient. This makes nursing advocacy a crucial element of the relationship between health care providers and patients. By leveraging their extensive industry knowledge and experience, nurses can help patients navigate the health care system and their individual treatment plans.
Advocacy in nursing can also occur at the policy and legal levels, which means that nurses have the potential to influence how health care facilities operate and how patient care is delivered.
Becoming an effective nurse advocate requires extensive experience and training. An advanced education, such as a Doctor of Nursing Practice (DNP) degree, can prepare nurses for their important role as patient advocates.
What Is a DNP, and How Do Graduates Use Their Degrees?
A Doctor of Nursing Practice degree is the highest level of nursing education students can attain. According to the American Association of Colleges of Nursing, the DNP is a practice-based alternative to a Ph.D. in nursing, which is research-based. DNP programs expand upon Master of Science in Nursing (MSN) programs to cover systems leadership, health care quality improvement, evidence-based practice, and other key concepts.
The goal of DNP programs is to create innovative nurse leaders who can translate their research into practical application and improve patient outcomes through policy and systemic improvements. Considering the advanced nature of the degree, a DNP is what universities, research facilities, and health care agencies tend to prefer when evaluating candidates for high-level leadership positions. Popular career paths for DNP graduates include:
- Working in education
- Conducting clinical research
- Working as a nurse practitioner
- Working as a chief nursing officer (CNO) or similar health care leadership role
- Focusing on nursing advocacy and policy
One of the key advantages of earning a DNP degree is that it often leads to several career options on both the administrative and clinical sides. For instance, many MSN to DNP programs allow students to select an area of focus as a clinician. Regis College offers multiple nurse practitioner concentrations for DNP students, including:
- Pediatric nurse practitioner
- Psychiatric mental health nurse practitioner
- Women’s health nurse practitioner
- Family nurse practitioner
- Adult gerontology – primary care nurse practitioner
- Adult gerontology – acute care nurse practitioner
Additionally, MSN to DNP students have concentration options in nurse leadership and nurse education. Nurse leadership focuses on organizational structures, regulatory issues, and the study of informatics, making it ideal for students who aspire to become directors, managers, or executives in health care. Nurse education, on the other hand, prepares DNP graduates to enter the world of academia to educate and train the next generation of nurses. Much of the coursework focuses on developing curricula, learning different teaching methods, and engaging in teaching simulations.
Although there is no specific nursing advocacy concentration in the Regis MSN to DNP program, students explore key concepts such as health care policy, ethical and legal issues, and the leadership and communication skills needed to become a successful advocate.
What Is Advocacy in Nursing?
Several different causes and policies receive varying levels of support in the health care community, which means that advocacy in nursing is broad in scope. Advocacy in health care can occur at the individual and family level, or on a macro level, such as when nurse advocates formally promote a new policy or law, or an amendment to an existing one.
Regardless of the exact type of advocacy a nurse engages in, the common thread of advocacy is nurses standing up to make their voices heard on behalf of their patients. Some of the best practices of nursing advocacy at the individual level include:
- Helping patients overcome financial and social challenges
- Communicating with patients and their families and listening to concerns
- Keeping health care teams informed about patients’ concerns and ideas
- Helping patients secure the necessary resources to ensure their well-being
- Checking for potential mistakes and oversights in patient care
- Being mindful of patients’ rights and dignity
- Keeping patients informed about their condition, treatment plan, and other pertinent information
- Prioritizing patient safety
- Educating patients on how they can advocate for themselves
Patient advocacy follows a process that ensures that the correct issue is addressed, that the patient benefits, and that the advocate conveys the correct messaging in the most effective way. The four stages that advocates undertake are as follows:
- Evaluate the patient’s needs, considering their level of situational awareness, personal values, and medical background.
- Identify the patient’s goals, including their preference regarding treatment options.
- Develop an advocacy plan to meet those goals; this step may benefit from working with other members of the health care team.
- Assess the plan’s success; the satisfaction of the patient, family, and health care team is the key performance indicator.
Examples of Advocacy in Nursing
A DNP equips nurses with the institutional knowledge and legal insight to properly advocate on behalf of their patients. However, the scope of everything a nurse can do may seem broad at first glance, which is why examining specific examples of advocacy in nursing is beneficial.
Clinical Nursing Advocacy at the Patient Level
One of the most common nursing advocacy examples occurs at the patient level during the diagnosis and treatment phase. This process can be overwhelming and confusing to patients, especially if they are suffering from a condition that affects their mental acuity or ability to fully comprehend their situation. Nurse advocates may do any of the following to help their patients:
- Work with patients and their families to identify and understand their treatment options so that they may make informed decisions
- Help patients find the doctors or specialists who are best equipped to handle their health care condition
- Coordinate with doctors and other medical professionals on treatment plans, keeping patients’ specific needs and health care goals in mind
- Serve as mediators between patients and their doctors, who may have overlooked certain patient needs or made inaccurate diagnoses
Financial Nursing Advocacy at the Patient Level
Insurance and billing can be confusing for patients, especially if they’re not familiar with how their insurance coverage works. Additionally, there may be instances where patients’ health care services are coded incorrectly, meaning they could be improperly billed.
Nurse advocates with a DNP are particularly helpful in this regard. Their understanding of and experience with health care billing and insurance makes them uniquely equipped to explain things to patients in a way that they’ll understand, including:
- Deductibles
- Coinsurance
- Copays
- Payer reimbursements
- Medicare/Medicaid government payment systems
- Medical billing and coding terminology
In addition to educating patients about the financial aspects of health care, nurse advocates can help identify medical billing and coding mistakes and help to resolve them. Nurse advocates who specialize in this type of work are sometimes referred to as case managers, and may do it as a full-time job at a health maintenance organization. Their primary duties are to help patients understand billing and insurance, and to help them save money on medical expenses.
Nursing Advocacy with Patients’ Families
In some cases, patients’ families disagree with the course of action that doctors and medical professionals recommend. Controlling family members or family members who have unproven theories about what treatments should be used can put patients in a dangerous situation.
To prevent harmful decisions from being made on behalf of patients, sometimes nurse advocates must intervene to help guide patients’ family members to the decisions that yield the most positive outcomes. Forging this connection and taking the time to educate patients’ families may help avoid mistakes that can be harmful.
Nursing Advocacy That Connects Patients to Resource
Often, patients and their families require additional support and resources above and beyond what hospitals and health systems provide. Nursing advocacy can help connect patients with the people and organizations that meet their unique needs. For instance, nurse advocates can assist patients in securing financial assistance, outpatient care, and transportation to and from follow-up appointments.
Nursing Advocacy at the Policy Level
Health care policy ultimately shapes the processes and decisions made in any given hospital or health care facility. It’s incredibly broad in scope, and virtually every aspect of health care is tied to policy in one way or another. Access to health care, how it’s delivered, how much it costs, and privacy are all subject to rules and regulations that have been set forth by lawmakers at the national and state levels.
Nurse advocates with DNP degrees have a comprehensive understanding of health care policy, how it benefits and protects patients, and when it’s not being followed. Some examples of health care policies include:
- Patient care policies establish the protocols and workflows that are to be followed by medical professionals when treating a patient. When a patient is experiencing a certain health care issue, patient care policies dictate health care providers’ response.
- Employee health policies establish rules to mitigate employees’ risk of being exposed to illness, dangerous chemicals, or other threats. Employee health policies also pertain to self-inflicted acts that compromise health, such as the use of drugs or alcohol.
- Drug policies ensure that controlled and noncontrolled substances are properly handled and administered. These policies also address what procedures to follow in situations where drug inventory goes missing, if drugs are improperly handled, and if medications are incorrectly prescribed.
- Security and privacy policies define what constitutes a security threat and what to do during those situations. Examples of security threats include active shooters, individuals who are verbally or physically abusive toward hospital staff, individuals who are stealing equipment or hospital resources, and situations where a patient has been abducted. These policies also dictate rules around patient data and privacy. For instance, the HIPAA Privacy Rule protects patients’ medical records from being released to the public. Failure to comply with this policy may result in a fine of $50,000 or more, with subsequent penalties and disciplinary action.
When health care policies aren’t followed, patients, health care workers, and organizations can all be at risk. In some cases, it takes nurse advocates’ intervention to call out issues and involve the necessary parties to remedy them.
Systemic Changes Through Nursing Advocacy
Systemic changes are typically implemented to improve the patient care experience. For instance, one major systemic change that many hospitals and health care facilities are undergoing is the digitalization of patient records. Digital patient records are far easier to access, update, and share, creating greater efficiency in patient care — and often yielding more positive outcomes.
Another recent systemic change in nursing is the expansion of telehealth in the wake of the COVID-19 pandemic. Adopting telehealth allows for health care facilities to broaden access for patients and ease the challenge of clinician shortages. In terms of improving the patient experience, telehealth allows patients to stay in the comfort of their own homes. This removes the burden of patients needing to travel while mitigating the risk of exposing others to disease.
Where Nurse Advocates Work
Nursing advocacy occurs at every level of health care — from patient to policy — which means that advocates can be found in a variety of settings. This includes hospitals, insurance companies, nonprofit organizations, government agencies, and patient advocacy businesses. Some patient advocates work on a volunteer or pro bono basis.
The Effect of Nursing Advocacy on Policy and Legislation
Macro-level nursing advocacy focuses on changing policy and legislation. Since health care policy determines how health care services are administered, policies are often amended or created to yield more positive patient outcomes. The policies themselves may apply to one specific department, a facility, or the entire health care system. Advocate work requires collaboration and communication with health care leaders, attorneys, and state and federal government officials who influence policy legislation.
The American Nurses Association (ANA) is one of the leading organizations engaged in nursing advocacy focused on policy and legislation. The following are some of the key issues they’ve worked on at the state level:
- Advanced practice registered nurse state laws and regulations
- Nurse staffing shortages
- Establishing protections for the title of “nurse”
- The interstate Nurse Licensure Compact
- Reducing workplace violence
Additionally, the ANA engages in advocacy on key issues at the national level. These issues include:
- Reducing gun violence
- The nationwide nursing shortage
- Workplace health and safety
- Environmental health
- Health system transformation
- Nurse workforce development
- Home health care
- The opioid epidemic
Prepare for a Career in Nursing Advocacy with a DNP Degree
Nursing advocacy provides support to patients in numerous ways, including empowerment through education, catching errors on patients’ behalf, protecting patient rights, assisting patients in securing essential resources, and helping patients overcome financial challenges. However, advocacy in nursing isn’t necessarily performed on a one-on-one basis.
Nurse advocates can also operate at the macro level, promoting positive change that benefits patients via policy and legislation. Health care delivery is far from a perfect system, which is why it’s vital to have highly educated, dedicated nurse advocates serving as voices for change.
The best way to get started in nursing advocacy is by acquiring the educational and professional experience that qualifies individuals to serve as health care leaders. Regis College’s online MSN to Doctor of Nursing Practice program prepares nursing students to become leaders in their field with courses such as:
- Cultural Perspectives in Health Care
- Health Ethics and Law
- Concepts in Nurse Leadership
- Health Policy, Politics, and Perspectives
The MSN to DNP program is offered in eight different concentrations, which means students can specialize their education to pursue opportunities on the clinical or administrative side of health care. Find out how Regis College can help you embark on a career in nursing advocacy.
Recommended Readings
Telehealth Policy and Procedure: Developing Guidelines for Nurses
What Is Health Equity, and Why Does It Matter?
Nursing Leadership Roles for DNP Graduates
Sources:
American Association of Colleges of Nursing, DNP Fact Sheet
American Association of Critical-Care Nurses, Policy & Advocacy
American Nurses Association, Advocacy
American Nurses Association, Federal Issues
American Nurses Association, “Health System Transformation”
American Nurses Association, State
Indeed, “11 Patient Advocacy Examples in Nursing (Plus Types)”
Johns Hopkins Medicine, “The Power of a Health Care Advocate”
Own Your Health, “Professional Patient Advocates: What They Do and How It Works”
Policy, Politics, & Nursing Practice, “Policy Advocacy and Nursing Organizations: A Scoping Review”
Verywell Health, “How to Become a Patient Advocate or Navigator”