nurse holding hand of senior patient

The New Nurse Advocacy Standard: What Nurses Need to Know

The American Nurses Association (ANA) has added nurse advocacy as a standard in the new Nursing Scope and Standards of Practice, 4th Edition. But what does that mean for nurses?

“Advocacy has many faces,” said Patty Bartzak, DNP, RN, CMSRN, TCRN, a staff nurse in infectious disease at Lahey Hospital and Medical Center in Massachusetts and co-chair of the 2019-2020 Nursing Scope and Standards Revision Workgroup, during a webinar introducing the standards. “It begins with the acknowledgement that passive acceptance must be addressed, and it’s incumbent on the nurse to voice a challenge and actively work toward the highest and best care to achieve wholeness and optimal outcomes.”

In the latest Scope and Standards of Practice, the ANA also changed the definition of nursing to include caring, compassionate presence, the connection of all humanity, and advocacy in the care of individuals, families, groups and communities. The new fourth edition also adds a nursing practice model, a look at the regulatory model and the importance of respect, diversity and inclusion.

Why a nurse advocacy standard?

The 2019-2020 Nursing Scope and Standards Revision Workgroup decided to add advocacy as a standard of professional performance after discussions about the need to advocate for patients, Bartzak said.

In one example, nurses had a passive acceptance of a patient’s persistent, mildly elevated vital signs, without investigating why.

“While status quo may seem benign, the complacency of nursing in action set in,” Bartzak said. “We need to recognize these moments, and it’s at these moments that nursing must be very alert to the opportunity and possibility of patient advocacy.”

The second case involved a nursing student participating in peaceful protests who given a zero according to school policy. The nurse educator felt compelled to speak up for the student with college leadership and explore creative alternatives.

Advocating for patients

One of the advocacy competencies in the standard is being the voice of the patient, which could include speaking out about the appropriate level of care and timely transitions, Bartzak said.

Other ways nurses can advocate for patients is to ensure they know their rights and their privacy is maintained.

Nurses play an active role in advocating for honoring patients’ wishes at the end of life, said Janice Linton, DNP, APRN, ANP-BC, CCRN, ACHPN, assistant professor/nurse practitioner at Nova Southeastern University in Fort Lauderdale, Florida, at the 2021 American Association of Critical-Care Nurses (AACN) National Teaching Institute & Critical Care Exposition (NTI).

Patients often cannot voice their wishes as death nears. Only 37 percent of patients have advance care directives, Linton said. Barriers exist even when people have completed advance directives. For instance, a family might what to continue with futile care.

“Nurses are integral to advance care planning, identifying and advocating for patients’ wishes,” Linton said. “Nurses hear the stories of the lives well lived outside of this illness exacerbation and what matters most to patients.”

That makes nurses ideal advocates.

Advocating for the profession and community

Other competencies involve advocating for improvements in system operations, contributing to nursing professional organizations to further the profession’s knowledge base, and advanced practice nurses promoting full practice authority to meet the healthcare needs of populations, Bartzak said.

Nurses can and should advocate for appropriate staffing, said Nancy Blake, PhD, RN, CCRN-K, NEA-BC, NHDP-BC, FAAN, chief nursing officer at Harbor UCLA Medical Center in Los Angeles at the AACN NTI Conference.

“This is our moment to try to push for more staffing,” Blake said, citing the importance of nurses during the COVID-19 pandemic. However, to be successful, “you need to advocate with data, not just anecdotal stories.”

Nurses also can advocate for the profession, including full practice authority for advance practice nurses. Julie Stanik-Hutt, PhD, ACNPC, CCNS, FAAN, a professor at The University of Iowa College of Nursing in Iowa City, speaking at the AACN conference, outlined how to get started in advocacy to change public policies with lawmakers.

Stanik-Hutt advised nurses to focus on the patients, since what is good for them is good for nurses, and to establish a reputation that nurses are patient-centered.

Advocacy can start with baby steps, such as joining one’s state nursing association, reading its newsletters, signing up for action alerts and acting on them. Visit with legislators. Read the newspaper and watch the news. Volunteer to serve on healthcare advisory groups. Reach out to others to build support and alliances with other health professionals. Prepare. And register to vote--and then vote, Stanik-Hutt advised.

“Always be on your best behavior,” Stanik-Hutt recommended. “Be kind. Don’t be rude. They are always watching you. Do not badmouth another profession.”

The new advocacy standard defines competencies for advocating for patients, to improve work environments and to change policy.  

As nurses, “our job as advocates is very secure,” Stanik-Hutt said.



How Nurses Can Advocate Effectively for Safety

Nursing Advocacy: Standing Up for Patients and the Profession


Learn more about the updated Fourth Edition of the Nursing Scope and Standards of Practice and the new advocacy standard by watching the free American Nurses Association webinar


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