Patient advocacy in nursing: what role do nurses play?

In healthcare settings, patients are often at their most vulnerable and may not always have the ability to speak up for themselves. Research shows that almost 60 per cent of Australian adults have low health literacy, meaning many struggle to understand medical information or navigate complex systems of care.

With nurses positioned at the frontline of patient care, they are often regarded as a powerful voice in patient advocacy. In this article, we’ll explore what patient advocacy means, the important role that nurses play and share real-world examples from our nurse coaches that illustrate what patient advocacy looks like in practice.

What is patient advocacy?

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Patient advocacy has been a core part of nursing practice for decades, with a recent article published by the International Council of Nurses describing it as the ability to “represent and support those who cannot advocate for themselves, ensuring patients’ needs and rights are upheld.”

While advocacy is the action, according to the International Council of Nurses Code of Ethics for Nurses an advocate is someone “actively supporting a right and good cause; supporting others in speaking for themselves or speaking on behalf of others who cannot speak for themselves.”

Healthcare professionals, particularly nurses, embody this role by serving as steadfast advocates. Patient advocacy is a critical component of ethical nursing practice and nurses are empowered to speak up and support patients’ needs and rights to ensure they receive the best possible care and attention, especially when patients are vulnerable or face barriers to advocating for themselves.

The main themes of patient advocacy

Representing patient interests

Ensuring the patient’s concerns and preferences are clearly communicated to healthcare providers and that their wishes and preferences are safeguarded.

Protecting patient rights

Stepping in when patients are vulnerable or unable to speak for themselves and ensuring that their legal, ethical and personal rights are upheld throughout their care journey.

Educating patients

Helping patients understand their options, navigate the healthcare system and make informed decisions about their treatment and care.

What is the difference between good care and patient advocacy?

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Good care refers to the standard and expected level of care that every healthcare professional provides as part of their routine. It is foundational, consistent and forms the baseline of safe, effective and high-quality care. Patient advocacy, on the other hand, goes beyond the expected standard of care. It involves stepping in when something isn’t working and is often reactive or situational.

As clinical nurse and nursing career specialist Michelle Deroubaix explains, “Good care is a given. It’s when the system isn’t working for [patients] that you’re the advocate for them.”

Nurse coach and emotional health educator Madeline Kessler builds on this, noting that advocacy is not just about delivering quality care, but about being willing to push past the comfort of routine practice to ensure patients receive the best possible support.

What role do nurses play in patient advocacy?

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With nurses spending around 37 per cent of their time with patients, this close and consistent presence positions them to be crucial advocates. They are well-placed to speak up for patients who cannot, protecting their wellbeing, communicating their wishes and ensuring they receive the care and attention they need.

The International Council of Nurses Code of Ethics for Nurses, which all nurses in Australia follow, highlights how nurses play a role in patient advocacy. These include:

Upholding a patient’s rights

Nurses are responsible for safeguarding a person’s right to give and withdraw consent to access their personal, health and genetic information. This responsibility can also extend to aspects such as privacy, confidentiality and the right to refuse care.

Madeline shares that when she first started out in nursing, patients had less of a say in decisions about their care. These days, she states that nurses are “a lot more respectful about people’s rights to not continue treatment if they don’t want to. This is especially massive in aged care.”

Upholding a patient’s rights also means protecting vulnerable patients from discrimination, coercion and mistreatment. As Michelle highlights, “They [patients] are very vulnerable. Just expect that they are at a vulnerable part of their life and you are their voice.”

Championing patient safety

Nurses play a vital role in advocating for patient safety. This involves identifying and reporting errors or near misses, speaking up when safety is at risk, promoting transparency and working collaboratively to reduce potential harm. “If you know something isn’t right, you’ve got to act on it,” Madeline explains.

Fostering effective communication

By serving as the bridge between patients, families and healthcare teams, nurses have a responsibility in ensuring that important information such as concerns and preferences are relayed. Encouraging open dialogue also helps ensure that everyone is aligned in delivering optimal care and that the patient’s best interests remain the primary focus.

Recognising health disparities

Nurses understand the impact of the social determinants of health and advocate for patients who may face barriers to accessing care. They also contribute to and support policies and programs that aim to reduce these disparities, helping to ensure that all patients, regardless of background, have access to quality healthcare.

In addition to the above, some other roles that nurses play in patient advocacy include:

Educating patients

Nurses educate patients on how to manage their conditions, prevent complications and improve their overall wellbeing. By helping patients gain a clearer understanding of their diagnoses, treatment options and the potential risks and benefits, it empowers patients to make informed and educated decisions pertaining to their care.

Helping patients navigate the system

As the healthcare system can often feel confusing and difficult to navigate, nurses play an important role in helping patients overcome these barriers. This might involve guiding them through procedures, explaining next steps or connecting them with the right resources and support services. In doing so, nurses help ensure that patients are able to overcome barriers and access the care and support they need.

Navigating ethical decision-making

When ethical dilemmas arise, nurses advocate for patients by ensuring decisions reflect their values and beliefs rather than the preferences of healthcare professionals or family members.

Madeline shares that two decades ago, patients were strongly guided by healthcare professionals to determine the best options for their health. In her 30-year career, she has seen a shift in respecting individuals' wishes and autonomy to have more of a say regarding their own care decisions.

The importance of patient advocacy in nursing

Patient advocacy is an essential part of nursing as it embodies a nurse’s commitment to fight for their patients by protecting their rights and ensuring their voices are heard.

Patient advocacy can also reap significant benefits including enhancing the quality of care and reducing medical errors. Here are some of the ways patient advocacy in nursing creates positive outcomes for patients, the wider team and healthcare organisations such as hospitals.

Benefits of patient advocacy

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For patients

The primary beneficiaries of advocacy are the patients. By defending and promoting patient rights and amplifying their voice, it can lead to preservation and protection of a patient’s rights and safety, positive health outcomes and elevating a patient’s sense of empowerment.

For nurses

Patient advocacy not only benefits patients but also has a positive impact on nurses. A research paper investigating professional autonomy and patient advocacy in nurses highlights that advocating for patients can increase a nurse’s professional satisfaction, motivation, self-confidence and autonomy.

For the wider healthcare team

Patient advocacy also brings plenty of benefits for the wider healthcare team. By facilitating open dialogue between healthcare professionals, advocacy may result in stronger teamwork and foster a more collaborative environment. This culture of open communication and sharing knowledge and perspectives may also improve relationships within teams and strengthen the delivery of competent care.

Michelle shares that certain areas of nursing may provide more opportunities for relationship building than others. “In acute care, you have a closer relationship with the doctors in these high-pressure areas because they’re there all the time. You still have to advocate for the patient, but your relationship is better, your communication is better and you’ve got a better rapport with the doctor as you’re working with them all the time.”

For healthcare organisations

For healthcare organisations, patient advocacy contributes to improved outcomes on multiple levels. Better health outcomes lead to greater patient satisfaction, while stronger collaboration within teams promotes a culture of advocacy that may also boost staff morale and retention. Together, these benefits can help boost the organisation’s reputation and strengthen its track record for quality and safety.

Barriers to patient advocacy

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Although patient advocacy in nursing offers many benefits, there are also barriers that can limit or impair a nurse’s ability to advocate effectively. Failing to advocate can lead to serious consequences such as compromised patient safety and breach of professional responsibility.

Barriers to advocacy can arise at multiple levels, stemming from patients, nurses, the wider healthcare team or the organisation.

From patients

Although patient-related barriers are not the most common, they can still play a role. Some patients may be reluctant to share information because of fear, stigma or a lack of trust in the healthcare system. Limited health literacy or difficulty understanding medical information can also prevent patients from fully engaging in decisions about their care. Additionally, cultural differences, language barriers or strongly held beliefs may influence how patients perceive treatment options and whether they accept or refuse certain aspects of care.

To address these challenges, nurses can strengthen their practice by developing cultural competence, adapting their communication style and using strategies such as the teach-back method to confirm understanding. Where appropriate, involving family members or trusted support networks can also help ensure that patients’ voices are heard and their needs are represented.

From nurses

Personal barriers such as a lack of assertiveness, confidence or sufficient knowledge and experience can be barriers for patient advocacy. Madeline explains that advocating for patients as a nurse can be challenging, especially when “you’ve got to stand up and be unpopular, at times, potentially stepping out of line.” Still, she emphasises, “At the end of the day, you know you’re first and foremost a patient advocate.”

Michelle also acknowledges the difficulty, especially when advocacy requires challenging more authoritative individuals. “Sometimes you’ve just got to keep persisting if you know something isn’t right. At times you may need to escalate it, but you have to be courageous enough to do that,” she shares.

Some ways that nurses can build their patient advocacy skills include upskilling with a postgraduate healthcare course, practising with others to boost confidence and seeking support from colleagues when faced with situations that call for advocacy.

From the wider healthcare team

Barriers to patient advocacy can also arise from poor teamwork and collaboration within the wider healthcare team. When communication breaks down, it can lead to misunderstandings and affect patient safety and outcomes.

Research shows that another barrier that can affect patient advocacy is the perception of physician-nurse power imbalance where nurses report fear of confrontation, concerns about retaliation and a sense of powerlessness when their judgement is questioned or dismissed by physicians. Madeline shares that this can be particularly challenging because of the non-confrontational nature of many nurses. “As nurses, we’re carers, we’re people pleasers and so it’s not naturally within our discourse to create too many ripples and waves or to disagree with doctors.”

This behaviour, however, can negatively affect patient outcomes. Michelle recalls an experience where a lack of trust in her judgement could have led to serious consequences. “When I worked at a new hospital with a patient who I knew was going to arrest, I went up to the intensivist and said, ‘Look, I’ve got this happening.’ And they weren’t really listening. The girl on the other side said, ‘Michelle’s an ex-emergency nurse, I think you should listen to her.’ That patient arrested within half an hour. I did get the intensivist to see him, but it was in a really roundabout way because they didn’t know me and didn’t trust that I had the right experience.”

To overcome these barriers, organisations need to adopt a more collaborative approach to patient care and integrate it within the leadership structure. Building mutual trust and rapport with healthcare professionals also plays a crucial role. As Michelle reflects, “When I worked on the cardiac ward and I’d ring the medical officer, they would know I was worried about someone and they’d say, ‘Okay, do this Michelle, that’s fine.’ So if you have the trust of the medical staff, they’re more likely to take your advice.”

From healthcare organisations

According to a research paper on advocating for patient safety, power dynamics and organisational structures can be a major barrier to patient advocacy in nursing. These factors shape how healthcare teams work together, how confident nurses feel in raising concerns and affects the quality of care that patients receive. When a nurse’s voice is suppressed, their confidence eroded or advocacy efforts unsupported, it can foster a culture of silence.

In such environments, nurses may hesitate to speak out for fear of backlash or losing their jobs, while those who continue to advocate for patients may experience burnout due to a lack of support from the organisation.

As such, it is important for organisations to create a culture that actively supports and values advocacy. When advocacy is championed at the organisational level and a top-down approach is adopted, a culture of advocacy will naturally filter through the system.

Tips on advocating for patients in nursing

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Patient advocacy can be tricky, especially if you are new to nursing and still building your confidence. The good news is that advocacy is a skill you can strengthen with practice. Here are some practical tips from Michelle and Madeline on advocating for patients in nursing.

Be thorough

Madeline emphasises the importance of being thorough when raising concerns, “I think it’s important that if you’re going to present a case that you’re concerned about with a patient, that you have all your facts. Here’s what their blood pressure was when they came in preoperatively and here is what it is now, for example. Or we’ve got these four or five symptoms that are potentially illustrating that they’ve got a bowel obstruction or a respiratory tract infection. You’ve got to have all your facts there when you present them back to the doctors to say, this is the situation.”

Michelle echoes this advice, adding, “If a doctor rings you about someone, they want to know everything. So before you speak to him, get all that information and write it down so you can give a really good handover to them and you don’t have to go, ‘oh, I’m not sure about that.’”

Be assertive

Being assertive can be uncomfortable for some, but it is often necessary when advocating for patients.

Developing a clear and assertive communication style can make a big difference when it comes to raising concerns. “When you’re advocating for them, you’re pushing for them,” Michelle shares. “So you’ve got to be quite articulate about what’s going on. You need to have all the information to come across in a professional way.”

If you’re a new graduate, seeking support can make a huge difference. Having someone beside you can help confirm that the concerns you’re raising are valid and also reinforce the patient’s case.

As Madeline shares, “It would help to reach out to your superior, your charge nurse, your associate in charge nurse or your colleague that you’re working with and go, ‘Hey, this patient’s come through. We’ve got these red flags and I’ve also got a bad feeling.’” Once you’ve reached out to a colleague and run through your concerns, Madeline then suggests going to the doctor as a team to highlight the situation instead of individually.

Learn through observation

When developing your skills in patient advocacy, it can be helpful to observe the people around you. “See what other people are doing and what type of behaviour you want to have as a registered nurse,” Michelle explains. By paying attention to how others act and communicate, you can pick up positive behaviours while also recognising approaches you may wish to avoid.

Patient advocacy courses

Another way to strengthen your patient advocacy skills is by pursuing a postgraduate healthcare course. Here are some courses listed on GlobalHealth Education that have a patient advocacy aspect.

Graduate Certificate in Advanced Nursing at the University of Technology Sydney

This online course is suitable for individuals who want to drive better outcomes in advanced clinical settings and can be completed in eight months full-time. A key learning outcome of the course is to provide ethical, inclusive and patient-centred care by building the skills needed to advocate for patient rights, safety and equity across diverse healthcare settings.

Graduate Certificate in Acute Care Nursing at the University of Technology Sydney

Offered entirely online and designed for flexible study, this course equips you to deliver ethical, safe and patient-centred acute care by strengthening your ability to advocate for patient rights, safety and best-practice interventions across a range of dynamic healthcare settings.

Graduate Certificate in Critical Care at the University of Technology Sydney

Through units such as Professional Practice in Critical Care and Specialty Clinical Practice, you will build the capability to deliver safe, ethical and person-centred care by developing the confidence to advocate for patient dignity and safety across a variety of healthcare settings.

Graduate Certificate in Diagnostic and Interventional Radiology Nursing at the Australian College of Nursing

This course can be completed online and focuses on diagnostic medical imaging and interventional radiology nursing. Upon successful completion of this course, you will develop the competencies to critically reflect on the cultural and ethical issues affecting individuals and groups and advocate for safe, holistic and person-centred care.

Graduate Certificate in Aged Care Nursing at the Australian College of Nursing

Delivered fully online and designed to be completed in 12 months part-time, this course includes units such as Assessment of the Older Person and Advancing Professional Practice. Upon completing the course, you will be equipped with the skills to advocate for older people within all aged care environments.

Graduate Diploma in Aged Care Nursing at the University of New England

Designed for those looking to deepen their knowledge in aged care, this course features core units such as Perspectives on Ageing and Management Practices in Health and Social Care. A key learning outcome of the course is developing the skills and confidence to effectively advocate for the needs and wellbeing of older adults.

Master of Palliative Care at the University of Technology Sydney

Delivered face-to-face over 18 months full-time, this course offers a comprehensive selection of core subjects and electives to build your expertise in palliative care. Upon completion of this course, you will develop the ability to lead change and advocate for inter-professional care across diverse populations and settings.

Master of Nursing at the Queensland University of Technology

If you’re looking to move into a nurse leadership role, this course is designed to strengthen both your clinical expertise and leadership capabilities. One of the key learning outcomes is developing the ability to use your influence to advocate for ethical, evidence-based and culturally responsive change. The course also offers several pathways, allowing you to focus on areas such as intensive care nursing or cancer nursing.

Master of Advanced Nursing at the University of Technology Sydney

If you want to strengthen your ability to drive better outcomes in person-centred care across diverse healthcare settings, the Master of Advanced Nursing could be the right course for you. One of the key learning outcomes is developing the capability to advocate for ethical and person-centred care by championing inclusivity, equity and patient advocacy. You can also choose to specialise in areas such as critical care, acute care and chronic and complex care.

Build your patient advocacy skills

As patients are often vulnerable within healthcare settings, nurses have a responsibility to amplify their voice, protect their rights and prioritise their safety.

If you’re looking to enhance your proficiency in patient advocacy, explore the range of postgraduate nursing courses available on GlobalHealth Education. From graduate certificates to graduate diplomas and master’s degrees, there are a range of options to choose from. Courses are also available in a range of other disciplines such as psychology, social work, physiotherapy, health leadership and mental health.