Academic journal article Online Journal of Issues in Nursing

Registered Nurses as Caregivers: Influencing the System as Patient Advocates

Academic journal article Online Journal of Issues in Nursing

Registered Nurses as Caregivers: Influencing the System as Patient Advocates

Article excerpt

Registered Nurses (RNs) influence the health of individual patients and populations. RNs provide the most value for the healthcare system when they work collaboratively with other healthcare team members, work to their full scope of practice, and when they are engaged and accountable. The American Nurses Association (ANA) Professional Issues Panel (Panel), Barriers to RN Scope of Practice, was established to identify and clarify barriers to RN practice to represent the full extent of their education, experience, and scope of practice (as determined by the relevant state nurse practice act). The Panel Steering Committee worked to identify barriers that prevent RNs from working to the full extent of their education and training, explore the basis for these barriers, and develop recommendations to address them. Findings of the Panel were organized based on four key RN roles in the healthcare delivery system: RN as professional, RN as advocate, RN as innovator, and RN as collaborative leader.

Each of these four roles is the basis of separate articles in this OJIN topic. In this article, we consider the RN as advocate role. As caregivers, all RNs are engaged as advocates on behalf of patients, families, and communities they serve to positively influence systems where care is provided. The article describes our synthesis from the ANA professional issues panel review and analysis of current literature, combined with expertise of the panel, to outline a pathway for action focusing on accountability, engagement, and collaboration.

Nursing practice is based on shared sciences (e.g., biology, psychology), and many nursing actions (e.g., assessment of respirations, dressing changes) may be performed by more than one healthcare professional. However, nursing practice is unique and definable. The American Nurses Association (ANA, 2015) defines nursing as "the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response" (para. 1). The ANA Standards and Scope of Practice (2015), along with individual state practice acts, provide ethical guidance and a rule-based structure to operationalize the definition of nursing for nurses, healthcare systems, and the public (Russell, 2012: Snelling. 2016).

It is critical that nurses can articulate their scope of practice and own responsibility for delivery of nursing care congruent with standards of practice state practice acts. Nurses must define their practice for healthcare team members, healthcare systems, patients, and the public. This requires nurse control over the creation of national, local, and organizational policies that define nursing practice though placement in organizational decision-making positions for defining nursing. Governmental and organizational bodies must respect that nurses are accountable to define scope of practice for all levels of nursing and create processes to prevent infringement by non-nursing professional groups.

Nurses provide the services of caregiving and advocacy. The American Heritage Dictionary of the English Language (n.d.) defines a caregiver as "An individual, such as a physician, nurse, or social worker, who assists in the identification, prevention, or treatment of an illness or disability" (para. 1). The authors combined the ANA definition of nursing with the dictionary definition of caregiver to describe the caregiving role of the nurse. The term caregiving as used by the Barriers to RN Scope of Practice expert panel describes the provision of direct and indirect care focused on the achievement of optimal health. The term advocacy is used to describe the provision of caregiving in a manner that respects individual or population values that have a direct effect on care provided (Hanks, 2008).

Caregiving and advocacy are more than simply delivering task-based care. Patients have a positive experience and quality outcomes when nurses use a scientific knowledge base and critical thinking skills, along with professional empathy, to competently provide safe care (Rchaida, et al. …

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