By Phyllis Kritek. As a registered nurse, I feel great pride in my profession. The list of reasons is long. One factor enjoys external validation, nurses have topped Gallup’s Honesty and Ethics ranking of different occupational groups every year but one since they were added in 1999. The exception is 2001, when firefighters were included on the list on a one-time basis, shortly after the September 11th terrorist attacks. I consider it an understandable outlier.  Apparently citizens think we are ethical and honest.

This amazing achievement is no accident. The ethos of nursing, since Nightingale, has gone well beyond the familiar “Do No Harm”. Ours has been an ethos of patient advocacy. We teach and enforce it with the same intensity of focus we give to medication administration. I think of it as a hybrid ethos, merging the principle-based ethics of Lawrence Kohlberg (read masculine) with the relationship-based ethics of Carol Gilligan (read feminine). Early on, as we became increasingly adept at articulating our “Code of Ethics”, the Hastings Center fretted with our fixation on patient advocacy.  We insisted and persisted. I am proud of that.

This persistence about patient advocacy shapes the daily lives of practicing nurses. It is achieved in health care settings where hierarchic structures are designed to protect the hegemonic power of physicians and health care administrators. It is perpetuated in civic discourse. It is rarely visible, often only made public in whistleblower lawsuits where a nurse was fired for being a patient advocate, i.e., challenging a practice or person that puts the patient at risk.  It is complex work, behind the scenes, often made exceedingly difficult and even career threatening.

When I was a very young nurse, a nurse leader advised me as follows: “If you haven’t been fired by the time you reach the age of 30, you probably have been co-opted”.  At the time I found this advice disturbing. Over time, through a number of experiences that pivoted on professional integrity and the cost of protecting it, I have learned the wisdom of her message. I agree with her.

The media exacerbate the challenge. It may surprise the sponsors of “Nurse Jackie” to discover that thousands of nurses every day take on the challenges she faces and do so without becoming addicted to drugs. Finally, a nurse that is a patient advocate, but apparently only able to do so while abusing drugs and having affairs. The distortion of nurses and nursing by the media is as troublesome as their willingness to render us invisible or their naïveté about who we are, what we do, and how we do it.

But indeed, we persist. We advocate for our patients with a fierceness unknown to most patients and families. We view it as a matter of ethics. As with other fields of endeavor, we have a normal curve distribution of effectiveness in our efforts, courage in our convictions, and success in our outcomes. Nonetheless, I will give here the advice I give to anyone facing an important health event.

Find the best nurse you can. Tell that nurse that you have selected them as your personal advocate. These advocates should be taken to appointments, charged with asking important questions, protective as needed. These advocates should be at bedsides before, during, and after surgeries and other important medical procedures. These advocates should be encouraged to question whatever needs questioning on the behalf of their patients. Most nurses understand this role: they have been doing it for family and friends their entire careers. It would also be nice if you would acknowledge the gift they give in doing this important work.

Patient advocacy, for nurses, is an issue of professional ethics. Count on it!

This entry was posted on Friday, September 3rd, 2010 at 8:15 am and is filed under Advocacy, Caregiving, Health Professions, Patients. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.