The American Nurses Association (ANA) emphasizes that advocacy is fundamental to nursing practice in every setting. See Figure 10.1[1] for an illustration of advocacy. Advocacy is defined as the act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for individuals, groups, organizations, communities, society, or policy issues[2]:
Individual: The nurse educates health care consumers so they can consider actions, interventions, or choices related to their own personal beliefs, attitudes, and knowledge to achieve the desired outcome. In this way, the health care consumer learns self-management and decision-making.[3]
Interpersonal: The nurse empowers health care consumers by providing emotional support, assistance in obtaining resources, and necessary help through interactions with families and significant others in their social support network.[4]
Organization and Community: The nurse supports cultural and social transformation of organizations, communities, or populations. Registered nurses understand their obligation to help improve environmental and societal conditions related to health, wellness, and care of the health care consumer.[5]
Policy: The nurse promotes inclusion of the health care consumers’ voices into policy, legislation, and regulation about issues such as health care access, reduction of health care costs and financial burden, protection of the health care consumer, and environmental health, such as safe housing and clear water.[6]
Advocacy at each of these levels will be further discussed in later sections of this chapter.
Figure 10.1 Advocacy
Advocacy is one of the ANA’s Standards of Professional Performance. The Standards of Professional Performance are “authoritative statements of the actions and behaviors that all registered nurses, regardless of role, population, specialty, and setting, are expected to perform competently.”[7] See the following box to read the competencies associated with the ANA’s Advocacy Standard of Professional Performance.[8]
Competencies of ANA’s Advocacy Standard of Professional Performance[9]
Champions the voice of the health care consumer.
Recommends appropriate levels of care, timely and appropriate transitions, and allocation of resources to optimize outcomes.
Promotes safe care of health care consumers, safe work environments, and sufficient resources.
Participates in health care initiatives on behalf of the health care consumer and the system(s) where nursing happens.
Demonstrates a willingness to address persistent, pervasive systemic issues.
Informs the political arena about the role of nurses and the vital components necessary for nurses and nursing to provide optimal care delivery.
Empowers all members of the health care team to include the health care consumer in care decisions, including limitation of treatment and end-of-life care.
Embraces diversity, equity, inclusivity, health promotion, and health care for individuals of diverse geographic, cultural, ethnic, racial, gender, and spiritual backgrounds across the life span.
Develops policies that improve care delivery and access for underserved and vulnerable populations.
Promotes policies, regulations, and legislation at the local, state, and national levels to improve health care access and delivery of health care.
Considers societal, political, economic, and cultural factors to address social determinants of health.
Role models advocacy behavior.
Addresses the urgent need for a diverse and inclusive workforce as a strategy to improve outcomes related to the social determinants of health and inequities in the health care system.
Advances policies, programs, and practices within the health care environment that maintain, sustain, and restore the environment and natural world.
Contributes to professional organizations.
Reflective Questions
What Advocacy competencies have you already demonstrated during your nursing education?
What Advocacy competencies are you most interested in performing next?
What questions do you have about ANA’s Advocacy competencies?
