Respectful Conversations & Genuine Curiosity: Crucial for Nurses, Patient Advocates, & Collaborative Care

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In all honesty, I read Jacqueline O’Doherty’s article “Why Hospitals Need Patient Advocates” in 8/10/12 Hospital Impact with some concerns.  In fact, I read it twice looking for the word ‘nurse’.  It’s absence is worrisome especially since nurses are the backbone of hospital care and so much of what the author was saying about the patient advocate’s role, as these excerpts suggest is that of the nurse!

“…coordinate care and ensure a smooth transition from hospital to home.”

“…work with the client to make sure they understand the medications and ensure medication management.

“…the patient needs to be clearly educated about their illness, prognosis and post-discharge instructions.”

“…patient education and continuity of care.”

“It’s the job of the patient advocate to ensure all the physicians are talking to each other and are all on the same page regarding the patient’s diagnosis and prognosis.”

Ok, I felt a little defensive, irritated even.  I wanted to shout out, “Hey, nurses are patient advocates for ALL patients!”, and “If we had enough staff, time and supplies we’d be more successful!”, and “What about liability, staffing, education?”   I could go on, but when I feel tension like this, I recognize it as a potential red flag.  A guardedness that takes my energy into a protective rather than creative place.  So I wondered, do other nurses and patient advocates feel any of this and is there a way to use it more productively?

Since I believe curiosity, true curiosity is a mainstay of collaboration and conflict management then it stands to reason that it is a crucial factor in the evolution of the relationships between nurses and patient advocates and ultimately safer care!

What Nurses Might be Curious About

  • How could Patient Advocates be a resource for our patients?
  • What do I/we need in order to provide effective teaching and safe discharge for all patients?
  • What do I need to know about Patient Advocates’ work and what do I want them to know about nursing?
  • What concerns do I/we have about working with Patient Advocates and how can we address them?

What Patient Advocates Might be Curious About

  • What barriers do nurses face in providing safe patient care and how can I/we help?
  • What do I/we need to understand about the nurse’s role in patient education & discharge planning?
  • What would I/we like to have nurses understand about the mission and training of Patient Advocates?
  • What concerns do I/we have about forming collaborative relationships with nurses?

In my mind, there is no doubt that with the right process, knowledge, and training,  there is a collaborative opportunity for nurses and patient advocates that will contribute to safer care.  Respectful conversations with genuine curiosity seem extremely important along the way!

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6 Responses to Respectful Conversations & Genuine Curiosity: Crucial for Nurses, Patient Advocates, & Collaborative Care

  1. Jim Murphy says:

    If I were a nurse, I would probably feel that patient advocates were intruding on my territory. Still, one can see areas in which such advocacy address matters that nurses should not be expected to deal with – insurance issues, for example.

    In addition, it may be that nurse and patient interests occasionally diverge. A patient might have a case for more service than the nurse can provide and advocacy to that effect might result in hospital improvement.

    Certainly the respectful conversations that Beth calls for would tend to improve things for patients and nonpatients. So of course would similar discourse between nurses and doctors, doctors and administrators, etc.

    But wait a minute – – –

    Are we seeing a classic case of how administrative problems are solved by creating more administration – and in the long run more problems? Patient interests get lost in the bureaucracy – so we will create another layer of bureaucracy (instead of organizational changes that would harmonize all existing interests).

    We all know the problems that students face in the educational bureaucracy; should a profession of student advocates be created? Restaurant patrons sometimes have issues with waitstaff; why not have diner advocates? Flight attendants and those they serve don’t always get along; so why not have passenger advocates?

    A quick look at the Internet sees to justify such fears about patient advocates. One page (http://patients.about.com/od/caringforotherpatients/ss/becomeadvocate.htm) asks these questions: “Are you a medical professional who is looking to shift your career in a different direction?” “Are you a social worker who would like to apply your skills to the healthcare field?” “Are you a parent or child or spouse who has navigated healthcare on behalf of a loved one and would like to do that kind of work for others?” “Are you an entrepreneur looking for a growing market niche?” “Are you a neighbor or friend with time on your hands which you’d like to apply to helping others, perhaps as a volunteer?” “Are you interested in a career in the health field and are exploring possibilities?”

    Does one sense an industry being created here? There are books, blogs, firms – and even some movement toward certification (http://patients.about.com/od/caringforotherpatients/f/Are-Patient-Advocates-Certified-Or-Credentialed.htm).

    Healthcare funding is one the most crucial issues of the day, and adding to the bureaucratization of hospitals would surely not help that crisis. If I were a nurse, I might think that all the money being spent on patient advocates would be more productive if used to hire more nurses and raise their pay.

    • Beth Boynton says:

      Thanks for your astute comments, Jim. I so appreciate your points about adding more bureaucracy and had fun envisioning the passenger advocates, restaurant patron advocates, and student advocates. Having just returned from full flights out of FL and NC yesterday, my vision included over-crowed planes not getting off the ground and much chaotic commotion! Of course the woman in the wheel chair who needed special help got special help. So the trick is, as I see it, is to get a clearer picture of who needs what help, and what help is and isn’t available, and what help should be available, and what do we do to ensure it is. If we do this FIRST and with input from the people i.e. nurses on the front line, then we can have a better understanding of the problem(s). Solutions will naturally be more effective. Not only that, but we can engage and respect all parties as part of the process. Seems simple, but I guess isn’t!

      Beth

  2. I am an RN and I believe that every patient is safer with an advocate. That advocate does not need to be a formally trained advocate, although that could be better in some cases. A trusted loved one, or family friend can step in and advocate. Keeping track of medications, taking notes on visits by different Heath care providers, small tasks, like helping with turning, walking, toileting, eating and hand hygiene, both for the patient and reminding caregivers. A trusted advocate can make a huge difference in the safety and quality of care that a patient receives and it should be encouraged for every patient to have one.

    • Meg says:

      I believe nurses make the best advocates for all patients though they may not always have the time; it’s imperative they make the time to advocate for the family etc when they have serious questions they need to ask the doctor etc. Pt advocates (I feel) should be trained by nursing in order to be effective when asking questions; help with planning (discharge planning etc) when the nurse can’t be there to “do the advocating) I believe this is a 100% nursing responsibility and not one to give away at this stage in health care. Nurses have given away far too much already. It is crucial nurses remain the advocates and be involved in training advocates and let’s face it: we are the first and foremost pt advocate; always have been and always will be.
      Meg Helgert FNP

      • Beth Boynton says:

        Hi Meg,
        Thanks for your comment and as with my response to Kathy Day, RN, below, sorry for my delayed response! I think your point about it being “imperative” for nurses to take the time to educate patients/families is extremely important. And when we can’t, to speak up about it. “I need more time to talk with Mrs. Jones. She has a lot of questions about her colostomy care and is having a lot of anxiety.” Then we can look to our Nurse Managers and senior leaders to ensure that time is available. This may be a staffing issue, or training around delegation or asking for help.

        In any case, I’m willing to bet that nurses, if asked and listened to, will have all sorts of creative ideas and insights.

        Beth

    • Beth Boynton says:

      Hi Kathy,
      Thank you for your comment and sorry for my delayed response. (I was at a National Nurses in Business conference and then visiting my mom!).

      I agree that trusted advocates can make a huge difference. My concern is that if we don’t solve underlying issues like staffing and resources AND introduce new players in the field with a respectful process including understanding each other, than we are likely to create more problems.

      As a nurse, if I have 100 urgent things to do, but time to do 80 right, then an advocate may make a difference for one patient and cause a problem for another. If we don’t make sure that we have pathways to discuss and problem solve together, the underlying issues are likely to remain hidden and power struggles and resentments will contribute to more problems.

      Beth

What are your thoughts?