Revisiting the Mean Girls in Our New Advocacy Environment

The “mean girls” are at it again… or so I’ve been warned by a handful of APHA members.

I’m not sure I agree. But I know one thing for sure: the world of the mean girls has shifted.

Who are the “mean girls?” I first applied the moniker about three years ago to refer to nurses who believed that no one should be a patient advocate unless he or she is a nurse. I cited instances when a small handful of nurses had bullied other non-nurse advocates both at conferences, and through emails – yes, actively bullied. I outlined once and for all, and very specifically, all the reasons one does not need to be a nurse to be an effective patient advocate. None of that has changed.

Now – because in the past I have been accused of stepping on nurses’ toes when I bring this up (which is never my intention) – let me be perfectly clear. I LOVE nurses! I LOVE their passion and commitment to improving the lives and quality of lives of their patients! I respect nurses for their knowledge, experience, and abilities! And I wholeheartedly support their segue into the world of independent advocacy, with gratitude that they are willing to move to the bright side.

I am also very sure that the “mean girl” concept applies only to a VERY small handful; and certainly not to all nurse-patient-advocates.

However, the “mean girls” concept came up again recently because a group of patient advocates who are nurses, who belong to a nurse-advocacy organization, have begun raising money to fund patient education. A solicitation email went out to many people (dozens, hundreds?), with an emphasis on the fact that the organizers are nurse patient advocates and therefore they are the right people to be supporting this work.

It was then forwarded to several dozen (hundreds?) more advocates…

The problem is: not everyone who received the email is a nurse-advocate, and some of the non-nurses took umbrage. While I am sure that no one who sent the email intended for it to come across in the mean-girl sort of way – it did. (I also think that those non-nurses who have been bullied in the past are still sensitive. It’s time for them to move past that.)

I actually applaud the fund-raising nurse-advocates for their goals, and their thought process, even if I subtract a few points for tact and awareness of their surroundings.

But I also suggest there is a point they haven’t yet integrated into their thinking which must be a part of this more general “mean girl” discussion. So this seems as good a time as any to bring it up.

What exactly is a nurse-advocate? Nurses who call themselves health or patient advocates must now be careful of how they use that title.

The question has been asked many times through the years about to what extent nurses can use their medical education, knowledge, and skills to do health or patient advocacy work. The line has always been drawn at “no hands-on medical work“– with “medical” meaning anything from listening to a client’s heart, to taking a pulse, to filling pill organizers, to recommending supplements or alternative treatments. And – client-patient autonomy – meaning, as advocates, we cannot make recommendations like telling a client what doctor to see, or making a treatment choice recommendation. We simply provide options.

Yet, I know from anecdotal information shared both by nurse-advocates and by people who have watched them in action, that some cross those lines. The nurses explain it away by saying it’s their training, it’s in their DNA, or they don’t even realize they are doing it.

However – there are two reasons they can no longer get away with those excuses.

The first reason was raised two years ago regarding the line that cannot be crossed; that is, being insured as a patient advocate while performing nursing tasks. Mixed Messages Are Just a Lawsuit Waiting to Happen

But recent events caused a second reason for all nurses, and not just the “mean girls.” That is the new BCPA (Board Certified Patient Advocate) certification.

Many nurse-advocates took the exam to become certified and now, proudly, boast the BCPA initials after their names. (Congratulations! That’s great news!) But they may not realize that by using those initials they must be even more careful to very specifically NOT promote their work as being nurse-related, and not to cross the line.*

A review of the Ethics, Standards and Competencies required to earn one’s BCPA makes this very obvious. Again, the non-medical work, and the tenet of patient autonomy, are clear, front and center. There is no gray area.

So where does that leave us? There are actually several important takeaways to this post:

  1. That a generous group of advocates who happen to have a nursing background are raising money for a very worthy cause. They just need to make wiser wording choices when framing their fundraising outreach to other advocates.
  2. That those advocates who were victims of the “mean girls” in the past need to work on getting beyond that bullying.
  3. That all nurses who call themselves health or patient advocates must be constantly conscientious about not crossing those nursing and autonomy lines when performing their work as advocates.

The real truth is: we are all in this together! One advocate’s success (regardless of background) will lead to more advocates’ successes. We must respect each other (much improved since the last “mean girls” post) and share a cohesive, standardized message (we help client-patients, but we aren’t medical, and we don’t make their decisions for them).

The consistencies of respect and standardization will help our profession grow, and will make us stronger.

*Nurses: please be clear… no one is saying you shouldn’t highlight your nursing background when you promote your work. Your background and experience are important and germane. But nursing can’t be the focus of the work you do as an advocate. There is a big difference between mentioning your nurse education and background on an “About Us” webpage – vs – emphasizing that your work is nursing-based, or wearing a uniform in your web photos.


5 thoughts on “Revisiting the Mean Girls in Our New Advocacy Environment”

  1. Trisha:
    I echo your statements, and agree that nurse advocates are passionate and many are successful as patient advocates. While the overwhelming majority of patient advocates are nurses, there are many of us who are social workers, geriatric case managers, psychologists, and often people who understand patient advocacy because they have lived it through a family member. Much of what we do is based on our ability to establish and maintain relationships with our clients based on confidence and integrity. Clients are not necessarily looking at our resumes, but are most concerned about how we relate to them and understand their needs.
    I think it is important that nurses who are advocates recognize that there is a Code of Ethics which we must all abide by. We don’t sell insurance; prescribe medicines; diagnose patients, or practice nursing with our clients.
    The key to our success is that each of us has to know what we know, and know what we don’t know. If we don’t know how to handle a case, we have an ethical responsibility to refer the case to another advocate.
    This applies to all of us: nurses, social workers, psychologists, counselors etc.

  2. Thank you Trisha! We all have something to offer our clients.
    I am in the unique position of having completed the nursing program in 1980 but didn?t take my boards. When I’m asked about my background, this is part of my explanation. Not because I want the ?points? for the nursing education, quite the opposite. I?ve spent 25+ years in the healthcare industry in sales and marketing. I enjoyed positions with Home Health agencies, Home IV companies, Home Care, Hospice, DME, Wound Care products, and a Regional position with and National network of SNF’s. I love to explain that had I taken my boards and worked as s nurse my experience most likely would have been limited to a clinical position in a hospital, SNF, or physicians office. I refer to my background as ?my quilt of experience?. I’m proud of my experience and it allows meet to meet the needs of my clients across the Care Continuum.

  3. I am currently exploring patient advocacy as a future career. I am an RN for over 30 years. I am currently helping someone whose daughter has severe hand numbness and inability to write at only the age of 28. No one knows what is wrong. She has been to many neurologists, orthopedics, had scans and lab work.

    As nurse, my nurse brain runs through all the neurological conditions it could be which have all been ruled out so I asked her if the daughter had seen an infectious disease doctor. That there are tick born diseases that are not Lyme disease that could cause symptoms or some other infection that left this residual. I found an infectious disease doctor and suggested the mother determine if their insurance would cover a visit. The daughter is thrilled to have one possible option no one had suggested to her before.

    Nurses think like nurses, they look for the less clear, more subtle causes of patient problems, or small details that no one considered. Or inconsistencies in symptoms (the daughter’s hands are affected but not her feet). So are nurses different than other advocates, yes, they are by training. They aren’t necessarily better advocates but for some things they are better suited.

  4. Wondering if you could do a follow up article on your specific concerns related to potential issues RNs may face with PACB certification? I an and RN and work in community medicine, a certified case manager, and am exploring this new certification as it encompasses a lot of what I do already. In my opinion, the PACB certification does not nullify or restrict a state license in nursing. It feels like these two knowledge bases go hand in hand. I cannot find any information on your caution to RNs to “specifically NOT promote their work as being nurse-related, and not to cross the line”. I see nothing in the linked ethics or competencies that restricts any kind of nursing interventions other than prescribing medications, and actual medical diagnoses. Only masters level specific track RNs prescribe and./or provide actual medical diagnoses. Associates and Bachelors level RNs diagnoses are essential to our plan of care, and I do not believe that breaches any ethical or competencies listed. We do not provide actual medical diagnoses like COPD, hypothyroidism etc… what we DO do is take those existing medical diagnoses and then use them with specific nursing diagnoses like risk for impaired skin integrity on an immobile patient, which I then may be able to provide education on avoidance. Lack of knowledge related to medication regime or disease state which I then may be able to provide education on, or actual pathological deficiencies related to a chronic or acute disease state like insufficient air exchange with a pulmonary patient, which I then may be able to monitor better, and connect to resources if needed. My State license allows me to do all of this. I cant imagine PACB is trying to cut the legs off any nurse or put us in some sort of Ethical black hole, as the PACB ethics pretty much mirror ANA ethics with very slight variation. Insight?

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