Advocacy

Advocacy is one of the most important and under utilised components of a Nurses job. It sits at the very core of our being, the reason behind every action, and heart behind every conversation with a Doctor. Recently, whilst caring for a patient, I didn’t exercise my right to advocate for them, and as such they have continued to be mis-managed. For confidentiality reasons I will not disclose particulars of the patient, but will instead refer to them as Jeff. I have come up with a nemonic of ABCDE to remind me of the components of Advocacy for the future, and I hope they will help you too.

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Always

As some of you are aware I am both an Enrolled Nurse, and a student Registered Nurse. I am also on my last placement before graduating at the end of the year. I felt that because Jeff was a patient of mine, whilst under supervision, as a student I couldn’t or shouldn’t raise my concerns and subsequently Advocate for them. I was wrong. As Nurses we should always feel empowered to Advocate for our patients. It doesn’t matter if you are a LPN, EEN, AIN, GRN, RN, CN, or NUM you should feel comfortable to stop what is happening and Advocate for your patient. I have been beating myself up since the event, and cannot seem to console myself regarding my inaction. Jeff continues to be, in my opinion, mismanaged because I, and others, feel that we cannot raise our voices and say STOP, this isn’t in the best interest for the patient. STOP, we need a different course of action. STOP, we are not caring for and treating this patient, we are treating our own conveniences. I wish I had spoken up, but now I know what a difference it could have made, and how lousy it feels when I don’t, I will never step down from Advocacy again and I will encourage others to do the same.

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Back Up

When Advocating for a patient we should remember we aren’t just individual Nurses, we are part of a team, and we are stronger together. That wasn’t supposed to sound like a chant for a Union, but there you go. If we don’t feel strong enough to confront a Doctor directly, enlist help from other Nurses in the team, bring in the Supervisor, the Shift Coordinator, the Clinical Educator, the Clinical Facilitator, or even the Nurse Unit Manager. Together you can approach the Doctor and Advocate appropriately, it will look less like an idea from a solo Nurse and more like a considered idea, and it is good to know that you are justified in your Advocacy when you have the assistance of another. This won’t come across as “Ganging Up” if done correctly, and could be the component you need to successfully Advocate for your patient.

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Considerate

As Nurses we pull some pretty long and random hours, with things like Late-Early shift, overtime, Double Shifts, and a myriad of other whacky ways the roster seems to wind up. Our job is physically demanding by being on our feet all day, lifting and rolling patients, performing care, and everything else we do in a shift. Our job is also emotionally and mentally draining with supporting the patients and their families, dosage calculations, evaluating observations, constantly assessing a patient, and somewhere in all of that is Advocacy. Now, we all know what we do is demanding and exhausting, we justify the extra coffee, the second bar of chocolate, or ignoring the phone on breaks because of it. We flay ourselves over jobs missed, or errors in judgement, and we feel terrible when things are late. Now, our Doctors may not be there for the hands on cares, the lifting and rolling, the supporting the patient during mobility, but they are carrying the burden. The Doctors are trying to manage a massive patient load, the medications, the investigations, the outcomes, the families, and the demands we as Nurses put on them. The Doctors are under the pump all the time. They can’t ignore the phone, their breaks are constantly cut short, they are the ones that get to explain to the patient and their family about a poor prognosis. They have a huge burden to carry. When we advocate for our patients we need to be Considerate and keep in mind these burdens. Don’t Advocate by telling them they are wrong and should be doing it a different way, or calling into question their education. Come along side of the Doctors and show them what you are seeing and suggest the alternative course of action.

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Don’t forget the Patient

We shouldn’t forget that the reason we advocate is for the best outcome for the patient, as such we shouldn’t forget to include them in the decision making process. It may be entirely necessary, and entirely justified to discuss your concerns with the patient prior to stepping up in front of the Doctor. Some patients, despite the best intentions you may have won’t want to take differing actions to what the Doctor has ordered. This is why it is important to discuss your concerns with the patient, or if the patient is unable to then a discussion with the next of kin may be appropriate. This seems simple, but can be just as difficult, if not more difficult to achieve. Discussing with a patient that the care that has been prescribed isn’t the best, and a different action would be better, can be seen as conniving, sinister, arrogant, or just plain rude. A polite tongue and respective tone when discussing this matter will need to be adopted, and under no circumstances should the Nurse belittle or bad mouth the Doctor, or professional prescribing the care. We are all a team, we need the Doctors just as much as we need them, nobody wants to be seen as “That Nurse” and as such we shouldn’t behave that way.

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Evidence

Whilst we should advocate for our patients, always, we need to make sure we have the evidence required to back up our claims. This can be something as simple of observations, blood work, an x-ray, comment made by family or friends of the patient, or statements made by the patient themselves. We may also have written evidence from Journals, textbooks, Research Articles, or recently attended workshops or conferences. It may be something as simple as showing the doing guide from MIMS or the product information leaflet enclosed with the medication. We as Nurses need to be prepared when confronting Doctors in relation to our patients, it may not be enough for us to simply say “I am not happy, we need to do something differently”. Being educated, well read, up to date, best practice using badasses we are we need to show the Doctors that we know what we are talking about, and that we need to be listened to.

These five components; Always, Back Up, Considerate, Don’t forget the Patient, and Evidence or ADCDE, will help you remember what needs to be considered when Advocating for your patient. Don’t end up where I did with Jeff. Don’t be afraid to stand up and be heard. Don’t think that you are just a Nurse. You are the patient Advocate, exercise the right, but do it properly.

Maintain the Rage

Luke Sondergeld

Student Voice

For those of you who have read my previous blogs Maintaining My Rage and Controlled Chaos you will know already that I am passionate about leaving the World better than when I found it. I am also passionate about legacy and passing on knowledge to the next generation hence the reason why I am a Scout Leader. But I am also a strong advocate for students at CQUniversity, of both the TAFE and Higher Education persuasion. I believe that all students should have a voice in the way their school is run, what services it provides and ensuring the school (even the local high school) keeps its focus on its students and not the press. That’s why I volunteer my time on the Student Representative Council (SRC) and Student Participation and Retention Committee (SPARC). So to that end I believe that a students voice should be comprised of three things; Advocacy, Reformation and Honesty.

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Advocacy

Advocacy, in all of its forms, is the simple act of providing a voice, and subsequent defence, for someone who does not have one, or cannot be heard. I know this sounds like something from the Oxford Dictionary but it is true. As a nursing student we are taught from day one that we are the advocate for our patients, we are there to stand up for them to other medical staff and to defend them if we believe that a treatment plan for them is inappropriate or unwanted. My belief in advocacy is no different. On the SRC and SPARC my role is to ensure that issues of the student body in relation to campus life, retention, support, tutoring, mentoring, access to equipment, safety, or any other facet of student life is heard, and heard well. Thankfully both the SRC and SPARC either have the ear of members of staff who can effect change or are the body that makes up the majority of the committee. We have been empowered by the University to question, raise concern, hold to account and disagree with the decisions made by the University and propose better solutions for the students. This in turn brings around good change for the students, not just change for change sake, and that is why Advocacy is such an important part of the student voice.

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Reformation

Reformation isn’t just something that the Church went through in the 16th Century after a gentleman nailed his ideas to his bosses door, it is the idea that change, real change, can be made by those who are willing to stand for what is right and true. The idea that women can vote, that those of colour should be born and allowed to be free, that divorce is a thing, same sex couples are not evil, and that a New South Wales supporter doesn’t have two heads, are all reformative ideas. They all took, with the exception of NSW, someone to stand up and voice the concerns for the people, to say This isn’t right!  The student voice is no different, and I am glad that CQUniversity have given such a reformative voice to the SRC. One of my ideas that developed into a project, that is currently going through the costing and budgetary stage, was the idea of students supporting students to pass through the course, the idea of you have to collaborate to graduate. It sounds simple enough, it even sounds like an idea that already exists, but not an idea that is formally supported by Universities, and certainly not in the TAFE sphere. So I pitched it to the SRC. It was met with a wondrous curiosity, that led to many meetings and discussions with many of the staff regarding the who, what, where and how. After these discussions CQUniversity have finally decided on a model which works for them and are now, as previously mentioned, going through the costing and budgetary phase to conduct a two year trial program in the Diploma of Nursing. A student voice that effected reformation.

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Honesty

The student voice does have an obligation to be honest, this does mean that if a particular choice is the best for the student long term, even if not the popular choice, it should be the one chosen. The message to the student body then has to be equally honest. I have been engaging in discussions with a dear friend of mine over the seeming lacking financial support for over 30 year old students. It would appear that if you are under 25, live in a remote or regional area, are of Aboriginal or Tourist Straits descent, or are studying Engineering then the World is your oyster. As for anyone else, you are on your own. After doing some research into unemployment and education statistics it would seem that the support for the aforementioned is well placed and therefore not that unbalanced. Youth unemployment in Australia is at 12.8%, compared to the National Unemployment of 5.5%, and that number has been steadily increasing since its all time low of 7.8% in 2008. This coupled with the increased cost of living, on average 10.84% higher than that of the US not including rent, has meant that more and more support is needed for these groups. But what about the over 30s? According to Australian social research firm McCrindle the over 30s average Australian is 37 years old, employed and earning about $60,330 per year, exercising 3 times per week and sleeping 7 hours a night. So from a statistical point of view not someone who needs a lot of support. And this is where it becomes tricky for anyone who is a position to be heard. You want to support those who have asked for it, or who you perceive to need the assistance, but the reality is, the battles need to be picked or the voice will fall on deaf ears if there isn’t enough data, facts or truth behind the words. So though Honesty may not be the most glamorous or politically beneficial portion of the Student voice it is the most important.

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I hope this either helps people understand the Student Voice a little more and what I strive to do every time I enter a meeting, I also hope this spurs others to step up and use their collective voice for real change. If you have a voice, no matter how small you think it is, or want to share something that you feel needs to be heard, write it in the comments below, alternatively email me on the connect page and lets chat.

Maintain the Rage,

Luke Sondergeld