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Patient Advocacy and the Culture of Safety: Nurses Are Central

From the patient perspective, the nurse’s most important role is that of patient and family advocate. Patients look to their nurses to be compassionate and competent and to consider patient needs and desires as paramount in all aspects of their care. Upholding a patient’s right to request or refuse treatment on personal or religious convictions can sometimes come into conflict with modern medicine practices and may lead to disagreement with other members of the care team. The patient’s beliefs may come into conflict with those of family, friends, religious organization, or community, and in some cases may come into conflict with a nurse’s own belief structure. The nurse must have the confidence to explore her own feelings about each specific situation, to recognize that the patient’s beliefs are not a threat or an affront to her own, and to understand that supporting the patient’s rights of self-determination is part of the nurse’s duty, even if it means respectfully disagreeing with other caregivers.

Nurses Are at the Heart of a Culture of Safety

One of the most important recent paradigm shifts to take place in healthcare has been from a culture of blame to a culture of safety, wherein caregivers are expected to actively play a part in identifying and addressing behaviors and processes which may contribute to patient harm. As the primary caregiver and advocate for the hospitalized patient, the bedside nurse is exposed to all facets of the patient’s care, including interaction with hospital processes and other caregivers. Naturally, it is the nurse who is most likely to encounter or become aware of instances which may harm the patient, such as prescribing errors, medication contraindications, or unsafe practices throughout the hospital.

The nurse is also likely to be the one with whom patients will address their concerns about the quality or safety of their care. It is essential that nurses have confidence in their right, their ability, and their organization’s support of their efforts to intervene and act on behalf of the patient when harm could occur. It isn’t enough for the nurse to know the steps to follow to report an error or unsafe practice; he or she must feel safe enough to have the confidence to do so. Hospitals must ensure that nurses are not only educated in principles of patient safety and evidence-based practice, but perhaps more importantly that they are empowered to truly act in ways that support the culture of safety without fear, and can feel confident in their highly trusted position of patient advocate.

Skill and Competence Are Necessary

There is no doubt that when a nurse has to call a physician in the middle of the night and advocate for his or her patient, skills and competence are important. He or she needs the skills to recognize subtle changes in the patient’s condition and the competence to formulate an evaluation of what needs to be done. If the physician’s orders are unclear or misaligned with the patient’s wellbeing, the nurse’s confidence will facilitate questioning of those orders on behalf of the patient. Should the nurse observe any aspect of patient care that is inappropriate or not in keeping with organizational policy or sound ethical principles, it is this same confidence that will enable him or her to escalate the discussion within a culture of safety framework using the chain of command… to advocate for the patient and to uphold the most foundational principle of the profession to “do no harm.”

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