Now, please know that I’m not dogging on all nurses. Not all all. Instead I’m looking at this as an opportunity to clarify – for everyone’s benefit, not just nurses’.
Last week I answered the question, “Does a patient advocate have to be a nurse?” The question came in response to an experience where nurses had actually looked down their noses at another advocate, a non-nurse, suggesting she did not have the qualifications to be a patient advocate. My answer is no. All nurses are advocates, but not all patient advocates need to be nurses.
This time it’s very different, but no less upsetting to the person who was on the receiving end of the nurse’s defensiveness. The advocate’s name is Ken. He has worked for more than 30 years as both a physician’s assistant and a nurse. In a conversation with another nurse, one who works in an oncology infusion center, he told her his plans for establishing himself as a private patient advocate. She reacted by telling him that there was no room for him in healthcare as an advocate. SHE is the patient advocate for her patients.
Without question, I’m sure she, like most nurses, is an advocate for her patients. But that’s not the same — at all — as a private patient advocate or navigator. The real parallel, perhaps, is a private duty nurse. A private duty nurse is definitely a private patient advocate, too.
But that’s not what Ken’s nurse-friend is. Here are some of the differences, and the reasons why there is room for both nurses and advocates when it comes time to help a patient:
1. Nurses are provider or facility-bound. That is, the patient comes and goes, but the nurse stays, connected to the provider or facility. As long as the patient is inside the nurse’s (provider’s or facility’s) domain, then the nurse can be the patient’s advocate. But there is plenty of need for an advocate outside that domain, too.
2. If every patient only ever had one medical need at a time, went to one doctor at a time, got all their tests at the doctor’s office, took one drug at a time, got one bill at a time for care, THEN a location-bound nurse might be all the help that patient would need. But these days, and in particular as baby-boomers continue to age, many patients do have more than one medical problem they deal with, take more than one or two kinds of drugs, are being treated or are getting therapy for additional problems, and have too many confusing bills… Ken’s friend isn’t the advocate who can help them. A private patient advocate is.
3. Hospital nurses do a yeoman’s job, managing way too many patients, often with at least one arm tied behind their backs. We have all heard stories about when a patient pushes the help button to get up and use the bathroom only to have to wait…. and wait…. and wait…. and wait. We also hear about the wrong drugs being administered, or infections that could have been prevented… A private bedside advocate who is focused only on his or her one patient can be a lifesaver. Ken’s friend can’t do that either.
As healthcare continues to get more and more confusing, as safety problems don’t improve enough to guarantee safety in the hospital, as access becomes more difficult because healthcare reform introduces 32 million new Americans to the care system – patient advocates will continue to grow in numbers, need and stature.
So, nurses (and others who haven’t yet figured out the value of private professional patient advocates and navigators)… Please understand that patient advocates are not trying to get in your way, nor subtract from your domain. Instead, they are there to focus on their patients when you can’t, and to facilitate the communication and collaboration between their patients and their patients’ providers.
There’s clearly a need. There’s plenty of room for all. Let’s work together with some better understanding that both nurses AND advocates play important roles in improving their patients’ quality of life.