Conclusion
DISPLAY 6.8 Tips for Interacting With the Media
11. Provide the reporter with contact information for follow-up and needed clarifications
LEARNING EXERCISE
6.7
Preparing for a Media Interview
Y
ou are the staffing coordinator for a medium-sized community hospital in California. Minimum staffing ratios were implemented in January 2004. Although this has represented an even greater challenge in terms of meeting your organization’s daily staffing needs, you believe that the impetus behind the legislative mandate was sound. You also are a member of the state nursing association that sponsored this legislation and wrote letters of support for its passage. The hospital that employs you and the state hospital association fought unsuccessfully against the passage of minimum staffing ratios.The local newspaper contacted you this morning and wants to interview you about staffing ratios in general as well as how these ratios are impacting the local hospital. You approach your chief nursing officer, and she tells you to go ahead and do the interview if you want but to remember that you are a representative of the hospital.
A S S I G N M E N T:
Assume that you have agreed to participate in the interview.
1. How might you go about preparing for the interview?
2. Identify three factual points that you can state during the interview as your sound bites. What would be your primary points of emphasis?
3. Is there a way to reconcile the conflict between your personal feelings about staffing ratios and those of your employer? How would you respond if asked directly by the reporter to comment about whether staffing ratios are a good idea?
Integrating Leadership Roles and Management Functions in Advocacy
Nursing leaders and managers recognize that they have an obligation not only to advocate for the needs of their patients, subordinates, and themselves at a particular time but also to be active in furthering the goals of the profession. To accomplish all of these types of advocacy, nurses must value autonomy and empowerment.
However, the leadership roles and management functions to achieve advocacy with patients and
subordinates and for the profession differ greatly. Advocating for patients requires that the manager create a work environment that recognizes patient’s needs and goals as paramount. This means creating a work culture where patients are respected, well informed, and empowered. The leadership role required to advocate for patients is often one of risk taking, particularly when advocating for a client may be in direct conflict with a provider or institutional goal. Leaders must also be willing to accept and support patient choices that may be different from their own.
Advocating for subordinates requires that the manager create a safe and equitable work environment where employees feel valued and appreciated. When working conditions are less than favorable, the manager is responsible for relaying these concerns to higher levels of management and advocating for needed changes.
The same risk taking that is required in patient advocacy is a leadership role in subordinate advocacy because subordinate needs and wants may be in conflict with the organization. There is always a risk that the
organization will view the advocate as a troublemaker, but this does not provide an excuse for managers to be complacent in this role. Managers also must advocate for subordinates in creating an environment where ethical concerns, needs, and dilemmas can be openly discussed and resolved.
Advocating for the profession requires that the nurse-manager be informed and involved in all legislation affecting the unit, organization, and the profession. The manager also must be an astute handler of public relations and demonstrate skill in working with the media. It is the leader, however, who proactively steps forth to be a role model and active participant in educating the public and improving health care through the political process.
KEY CONCEPT
KEY CONCEPT
Advocacy is helping others to grow and self-actualize and is a leadership role.
Managers, by virtue of their many roles, must be advocates for patients, subordinates, and the profession.
It is important for the patient advocate to be able to differentiate between controlling patient choices (domination and dependence) and assisting patient choices (allowing freedom).
Since the 1960s, some advocacy groups, professional associations, and states have passed Bills of Rights for patients. Although these are not legally binding, they can be used to guide professional practice.
In workplace advocacy, the manager works to see that the work environment is both safe and conducive to professional and personal growth for subordinates.
Although much of the public wants wrongdoing or corruption to be reported, such behavior is often looked on with distrust, and whistleblowers are often considered disloyal and experience negative repercussions for their actions.
Leader-managers must be willing to advocate for whistleblowers who speak out about organizational practices that they believe may be harmful or inappropriate.
Professional issues are ethical issues. When nurses find a discrepancy between their perceived role and society’s expectations, they have a responsibility to advocate for the profession.
If nursing is to advance as a profession, practitioners and managers must broaden their sociopolitical knowledge base to better understand the bureaucracies in which they live.
Because legislators and policy makers are more willing to deal with nurses as a group rather than as individuals, joining and actively supporting professional organizations allow nurses to have a greater voice in health-care and professional issues.
Nurses need to exert their collective influence and make their concerns known to policy makers before they can have a major impact on political and legislative outcomes.
Nurses have great potential to educate the public and influence policy through the media as a result of the public’s high trust in nurses and because the public wants to hear about health-care issues from a nursing perspective.
Additional Learning Exercises and Applications
LEARNING EXERCISE
6.8
Ethics and Advocacy
Y
ou are a new graduate staff nurse in a home health agency. One of your clients is a 23-year-old man with acute schizophrenia who was just released from the local county, acute care, behavioral health-care facility, following a 72-hour hold. He has no insurance. His family no longer has contact with him, and he is unable to hold a permanent job. He is noncompliant in taking his prescription drugs for schizophrenia. He is homeless and has been sleeping and eating intermittently at the local homeless shelter; however, he was recently asked not to return because he is increasingly agitated and, at times, violent. He calls you today and asks you “to help him with the voices in his head.”You approach the senior registered nurse (RN) case manager in the facility for help in identifying options for this individual to get the behavioral health-care services that he needs. She suggests that you tell the patient to go to Maxwell’s Mini Mart, a local convenience store, at 3 PM today and wait by the counter.
Then she tells you that you should contact the police at 2:55 PM and tell them that Maxwell’s Mini Mart is being robbed by your patient so that he will be arrested. She states, “I do this with all of my uninsured mental health patients, since the state Medicaid program offers only limited mental health services and the
“patients really have a chance of getting better.” She ends the conversation by saying, “I know you are a new nurse and don’t understand how the real world works, but the reality is that this is the only way I can advocate for patients like this, and you need to do the same for your patients.”
1. Will you follow the advice of the senior RN case manager?
2. If not, how else can you advocate for this patient?
LEARNING EXERCISE
6.9
Letter Writing in Advocacy
I
dentify three legislative bills affecting nursing that are currently being considered in committee, the House of Representatives, or the Senate. Select one and draft a letter to your state assembly person, representative, or senator regarding your position on the bill.LEARNING EXERCISE
6.10
Determining Nursing’s Entry Level
G
randfathering is the term used to grant certain people working within the profession for a given period of time or prior to a deadline date the privilege of applying for a license without having to take the licensing examination. Grandfathering clauses have been used to allow licensure for wartime nurses—those with on- the-job training and expertise—even though they did not graduate from an approved school of nursing.Some professional nursing organizations are once again proposing that the bachelor of science in nursing (BSN) become the entry-level requirement for professional nursing. Some have suggested that as a
concession to current associate degree in nursing (ADN) and diploma-prepared nurses, all nurses who have passed the registered nursing licensure examination before the new legislation, regardless of educational preparation or experience, would retain the title of professional nurse. Nonbaccalaureate nurses after that time would be unable to use the title of professional nurse.
A S S I G N M E N T:
Do you believe that the “BSN as entry level” proposal advocates the advancement of the nursing profession? Is grandfathering conducive to meeting this goal? Would you personally support both of these proposals? Does the long-standing internal dissension about making the BSN the entry level into professional nursing reduce nursing’s status as a profession? Do lawmakers or the public understand this dilemma or care about it?
LEARNING EXERCISE
6.11
How Would You Proceed?
Y
ou are an RN case manager for a large insurance company. Sheila Johannsen is a 34-year-old mother of two small children. She was diagnosed with advanced metastatic breast cancer 6 months ago. Traditional chemotherapy and radiation seem to have slowed the spread of the cancer, but the prognosis is not good.Sheila contacted you this morning to report that she has been in contact with a physician at one of the most innovative medical centers in the country. He told her that she might benefit from an experimental
Sheila contacted you this morning to report that she has been in contact with a physician at one of the most innovative medical centers in the country. He told her that she might benefit from an experimental gene therapy treatment; however, she is ineligible for participation in the free clinical trials because her cancer is so advanced. The cost for the treatment is approximately $250,000. Sheila states that she does not have the financial resources to pay for the treatment and begs you “to do whatever you can to get the insurance company to pay; otherwise, I’ll die.”
You know that the cost of experimental treatments is almost always disallowed by Sheila’s insurance company. You also know that even with the experimental treatment, Sheila’s probability of a cure is very small.
A S S I G N M E N T:
Decide how you will proceed. How can you best advocate for this patient?
LEARNING EXERCISE
6.12
Conflict of Values
Y
ou are a case manager in an outpatient disease management program assigned to coordinate the care needs of Sam, a 72-year-old man with multiple chronic health problems. His medical history includes myocardial infarctions, implantation of a pacemaker, open-heart surgery, an inoperable abdominal aneurysm, and repeated episodes of congestive heart failure. Because of his poor health, he cannot operate the small business he owns or work for any length of time at his gardening or other hobbies.Although Sam has told you that death would be a relief to his nearly constant discomfort and depression, his wife dismisses such talk as “nonsense” and tells Sam that “she still needs him and will always do everything in her power to keep him here with her.” In deference to his wife’s wishes, Sam has not completed any of the legal paperwork necessary to create a durable power of attorney or a living will should he become unable to make his own health-care decisions. Today, Sam takes you aside and suggests that “he wants to fill out this paperwork so that no extraordinary means of life support are used,” and he
“wants you to witness it so that his wife will not know.”
A S S I G N M E N T:
Decide what you will do. What is your obligation to Sam? To his wife? To yourself? Whose needs are paramount? How do the ethical principles of autonomy, duty, and veracity intersect or compete in this case?
LEARNING EXERCISE
6.13
Peer Advocacy
Y
ou are a nursing student. Like many of the students in your nursing program, sometimes you feel you study too much and therefore miss out on partying with friends, something many of your college friends do on a regular basis. Today, after a particularly grueling exam, three of your nursing school peers approach you and ask you to go out with them to a party tonight, off campus, which is being cohosted by Matt, another nursing student. Alcohol will be readily available, although not everyone at the party is of legal drinking age, including you and one of your nursing peers (Jenny). Because you really do not want to drink anyway, you agree to be the designated driver.Almost immediately after you arrive at the party, all three of your nursing peers begin drinking. At first, it seems pretty harmless, but after several hours, you decide the tenor of the party is changing and
becoming less controlled, and that it is time to take your friends home. Two of your peers agree, but you cannot find Jenny. As you begin searching for her, several partygoers tell you that she has been drinking
“kamikazes” all night and that she “looked pretty wasted” the last time they saw her. They suggest that you check the bathroom because Jenny said she was not feeling very well.
When you enter the bathroom, you see Jenny slumped in the corner by the toilet. She has vomited all over the floor as well as her clothing and she reeks of alcohol. When you attempt to rouse her, her eyelids flutter but she is unable to wake up or answer any questions. Her breathing seems regular and unlabored, but she is continuing to vomit in her “blacked-out” state. Her skin feels somewhat clammy to the touch and she cannot stand or walk on her own. You are not sure how much Jenny actually had to drink or how long it has been since she “passed out.”
You are worried that Jenny is experiencing acute alcohol poisoning but are not very experienced with this sort of thing. The other two nursing students you brought to the party feel you are overreacting, although they agree that Jenny has had too much to drink and needs to be watched. One of your peers suggests calling the new young, clinical instructor in the nursing program, who offered just the other day to provide rides to students who have been drinking. You think she might be able to provide some guidance.
Another one tells you that she feels Jenny just needs to “sleep it off” and that she will stay with Jenny tonight to make sure she is OK, although she has had a fair amount to drink herself.
You think Jenny should be seen in the local emergency department (ED) for treatment and are contemplating calling for an ambulance. One partygoer agrees with you that Jenny should be seen at the hospital but suggests you drop Jenny off anonymously at the front door of the ED so “you won’t get in any trouble.” Matt encourages you not to take her to the ED at all because he is afraid the incident will be reported to the local police because Jenny is a minor and that he could be in “real trouble” for furnishing alcohol to a minor. He argues that this could threaten both his progression and Jenny’s in the nursing program. He says that she can just stay at the house tonight and that he will check in on her on a regular basis.
To complicate things, you, Jenny, and the other two students you brought to the party live in the college dormitories and they lock down for the evening in another 30 minutes. It will take you at least 20 minutes to gather the manpower you need to get Jenny down to your car and up to her dormitory room by
lockdown, if that is what you decide to do. If you are not inside the dormitories by lockdown, you will need to find another place to spend the evening. In addition, there will likely be someone at the door to the dormitory assigned to turn away students who are clearly intoxicated.
A S S I G N M E N T:
Decide what you will do. How do you best advocate for a peer when they are unable to advocate for themselves? Does it matter if the risk is self-induced? How do you weigh the benefits of advocating for one person when it can result in potential harm or risk to another person?
R E F E R E N C E S
Agency for Healthcare Research and Quality. (2013). Guide to patient and family engagement in hospital quality and safety. Rockville, MD: Author. Retrieved March 9, 2016, from
http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/index.html
American Cancer Society. (2014). Patient’s Bill of Rights: There’s more than just one Patient’s Bill of Rights.
Retrieved March 6, 2016, from
http://www.cancer.org/treatment/findingandpayingfortreatment/understandingfinancialandlegalmatters/patients- bill-of-rights
American Hospital Association. (2006–2016). Engaging health care users: A framework for healthy individuals and communities. Retrieved March 9, 2016, from
http://www.aha.org/research/cor/engaging/index.shtml
American Nurses Association. (2009). Nursing administration. Scope & standards of practice. Silver Spring, MD: Author.
American Nurses Association. (2015a). Code of ethics for nurses with interpretive statements. Washington, DC: Author.
American Nurses Association. (2015b). Scope and standards of practice (3rd ed.). Silver Spring, MD: Author.
American Nurses Association. (2016). Things to know about whistle blowing. Retrieved March 7, 2016, from http://nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/workforce/Workforce- Advocacy/Whistle-Blowing.html
Consumer Watchdog. (n.d.). The California patient’s guide. Your health care rights and remedies. Retrieved March 8, 2016, from http://www.calpatientguide.org/index.html
Death with Dignity. (2016). Take action. Death with dignity around the U.S. Retrieved March 7, 2016, from https://www.deathwithdignity.org/take-action/
Gallagher, C. [Casey]. (2016, February 24). Death with dignity. The East County Californian. Retrieved March 8, 2016, from http://www.eccalifornian.com/article/death-dignity
Gallagher, C. [Coleen], Hernandez, C., & Walker, M. (2012). A progressive step toward healthcare equality.
Healthcare Executive, 27(5), 54–56.
Genetics Home Reference. (2016). The Genetic Information Nondiscrimination Act (GINA). Retrieved March 8, 2016, from http://ghr.nlm.nih.gov/spotlight=thegeneticinformationnondiscriminationactgina Huston, C. (2017a). The nursing profession’s historic struggle to increase its power base. In C. Huston (Ed.),
Professional issues in nursing: Challenges & opportunities (4th ed., pp. 332–346). Philadelphia, PA:
Wolters Kluwer.
Huston, C. (2017b). Professional identity and image. In C. Huston (Ed.), Professional issues in nursing:
Challenges & opportunities (4th ed., pp. 347–361). Philadelphia, PA: Wolters Kluwer.
Huston, C. (2017c). Whistle-blowing in nursing. In C. Huston (Ed.), Professional issues in nursing:
Challenges & opportunities (4th ed., pp. 280–292). Philadelphia, PA: Wolters Kluwer.
Illinois General Assembly. (n.d.). Medical Patient Rights Act. Retrieved November 4, 2015, from http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1525&ChapterID=35
Jansson, B. S., Nyamathi, A., Heidemann, G., Duan, L., & Kaplan, C. (2015). Predicting patient advocacy engagement: A multiple regression analysis using data from health professionals in acute-care hospitals. Social Work in Health Care, 54(7), 559–581.
Jarrett, S. (2015). Advocacy. Supporting nursing’s key values. Colorado Nurse, 115(3), 1–2.
King, C. A. (2015). Nursing advocacy 101: Start where you are to do what you can. Tar Heel Nurse, 77(2), 12–16.
King, S. (2015, Winter). Words and deeds: Advocacy and our code of ethics. Oregon Nurse, 3.
McGreevy, P. (2016, January 19). Guidelines issued for California’s assisted suicide law. Retrieved March 8, 2016, from http://www.latimes.com/politics/la-pol-sac-guidelines-california-assisted-suicide-law- 20160120-story.html
MedlinePlus. (2015). Patient rights. Retrieved March 9, 2016, from