Remembering the Mean Girls

In Fall 2010, about 150 health advocates, many of whom were just considering entering the profession, convened in Washington DC for the Second Annual NAHAC Conference. I was there at the invitation of NAHAC, to both be a vendor, and to give a presentation about marketing for advocates. The conference was a resounding success in my estimation, using my two conference-success measuring sticks: 1. I met so many smart, wonderful, passionate people and 2. I learned so much more than I imparted.

But there was one aspect to the conference that left a bad taste in my mouth, marring the experiences of too many, and lighting a fire under me.

That is – there was a group of nurses – all women – who behaved, for lack of a better description, like the mean girls.

Yes – the mean girls – who insisted that everyone who is a patient advocate must be a nurse, and looked down their noses at anyone who wasn’t a nurse. Their words and their body language spoke their bullying truth. Their clarity of opinion left more than one non-nurse attendee reeling, including the handful that contacted me about it afterwards.

Those mean girls were wrong and misguided* (in my not so humble opinion.)

I have written on this topic twice before, but was reminded of it again this week. So I decided that I’d bring it up again, both for the new folks who have begun reading this blog since 2010, and to show that my original posting on this topic in 2010 has only been proven over and over again in the 4+ years since.

My previous points have been about all the reasons you do NOT have to be a nurse. They include the fact that as advocates, our services are specifically NOT medical, and that many of the services must be performed by people with skills that are most certainly non-medical, like insurance claims, billing in general, and negotiation.

This time around I have history on my side. When I look at some of our most successful advocates, I’ll point out that they have/had many varied backgrounds, with no nursing or medical/clinical experience. Ken Schueler tops the list. Elisabeth Russell, Lisa Berry Blackstock, Caryn Isaacs, Ilene Corina, Linda Adler, Dalia Al Othman, Kathryn Gohman, Rick Pugach, Jackie O’Doherty, Maureen Lamb, Steve Okey — I could go on and on… None of these people are doctors or nurses. All of them have helped clients enormously in many and varied ways. All have been/were in successful business for a number of years, and (all but Ken, of course) will continue to help patients get exactly what they need on their journeys through one or more aspects of the healthcare system.

Further – just noted in the APHA Forum by one of our members – we now have some research on our side, too. This report on the success of non-clinical care coordinators, in particular in the services they provided that were not medical, showed a 43 percent reduction in non-emergency use of the emergency room, and a 60 percent reduction in 30-day readmissions for targeted groups based on a study done by three Pennsylvania hospitals. These are only corners of what some of our advocates do – but they are tangible proof that non-medical care coordinators can make an enormous difference.

Yup – it’s true – those care coordinators studied weren’t nurses. Take that, you mean girls.


I do have a concession to make, though. That is, there are some advocacy services that will best be served by someone who does have a medical, clinical background, because they may better know the questions to ask, or the resources to uncover for clients who need that kind of help. Examples: They may better understand the definitions of medical words. They know how to review medications. They better understand why drugs conflict, causing a client to have strange symptoms. They speak a doctor’s language. I also think that when someone has worked within a health system or a hospital, they know which providers to avoid – and that’s no small thing. I could cite many other examples, too.

I have one other concession to make on the topic of “you don’t need to be a nurse to be a patient advocate.”  That is, that smart, ethical, and effective advocates know their limits, and know when to reach out to the person who can fill the gaps. Sometimes the gaps need to be filled by a nurse or doctor. Other times, even a nurse-advocate needs to reach out to a medical billing professional to help her client, or find a negotiator to work with the family. Every one of those successful people listed above knows when it’s time to reach out to someone else, to refer work, or bring someone else into their practice to compliment their own skills.

Here is the important truth for us all to embrace:

Our advocacy profession benefits the patient-clients who choose to work with us BECAUSE we are a rich melting pot of many skills, many backgrounds, many talents, many experiences – plus empathy, passion, and strong, ethical backbones.

backboneI must note here that many of the original mean girls now understand this point. Most now embrace and support the need for a variety of skills and background experiences to help their own clients.

Unfortunately, though, there are a few mean girls still out there; some more vocal than others. I write this post today not just to renew my assertion that those nurses are wrong, but to give you, who may have been similarly bullied, a tool to use to combat that negativity.

If any of them try to bully you, send them a link to this post, or tell them to take it up with me. Your time working with your clients is far too valuable, and my gloves are already off.


Here are the other posts I’ve written on this topic:

*Since 2010, I’ve become good friends with and a huge supporter of the work of many of these nurses. Most, but not all, now realize that their “you must be a nurse” mantra was incorrect. Sadly, some of them have also left the profession, unable to manage it as a business the way private, independent advocates must.

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Share your experience or join the conversation!


4 thoughts on “Remembering the Mean Girls”

  1. I hope I never am thought of as a “mean girl” because I am a nurse…but I have no trouble admitting my strengths and knowing when I need the skills of another professional to complete my advocacy. We all bring something to the same table and at my first conference this past fall, in Chicago, I met a lot of advocates who were not mean – and some were nurses. Thanks, as always, for this great reminder of diversity.

    1. Margaret – thanks for commenting.

      To be clear – being a nurse doesn’t make one a “mean girl.” Not at all.

      The mean girls I’m referring to are the ones who have intentionally bullied others who are not nurses – vocally (in person) and through email. My own observations, and the experiences that have been relayed to me, would make your toenails curl. They should be ashamed of themselves.

      All nurses are advocates. But not all advocates need to be nurses.

      There is no room for divisiveness among advocates. Our profession is strengthened when we embrace our differences and move forward, united in purpose, appreciating the skills and talents of all to help the patient-clients who need us.

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