1. Warner, Sandra L. MSN, RN

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I'M A SECOND-CAREER nurse. In 1999, at the age of 40, I graduated with honors from a nursing program in a large New Jersey community college. Last year, I obtained my MSN in nursing leadership and education, and I'm now taking business courses for pleasure. At this rate, I'll still be in school when I'm 60. (Let's not even discuss how old I'll be when I finish paying off my student loans!)

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All this education, and yet I still feel like I missed something in nursing school. After 15 years of clinical nursing practice, I'm realizing that advocacy means far more than just standing up for my patient's needs. In fact, being a patient advocate may necessitate stepping out of my comfort zone as a nurse to take a more active role in the political process. This article explores the ethical obligation nurses have as patient advocates and the extent to which it requires engaging in the political process.


Ethical obligations

Provision 3 in the American Nurses Association (ANA) Code of Ethics for Nurses states that it's a professional nurse's responsibility to support and protect the rights of our patients. This ethical duty obliges us to act decisively and purposefully to advocate for the health and safety of our patients (as we are their only voice), and to raise concerns if we encounter issues that may jeopardize them. In short, the Code calls nurses to act on questionable, unethical, or illegal practices and speak up regarding trepidations about the appropriateness of a patient's care.1


According to the ANA, advocacy is the act or process of pleading for, supporting, or recommending a cause or course of action.1 Advocacy may be for persons (whether an individual, group, population, or society) or for an issue (for example, potable water or global health).1 In Provision 7, the Code of Ethics advocates that nurses must further the profession through research, development of standards, and involvement in health policy.1


When I turned to the Internet to further investigate the political obligations of nurses, I came across an inspiring article that called for all nurses to "get political"-not only because it's our duty to help our patients, but because healthcare practice is regulated and shaped by the political process.2 I've never been an outspoken person when it comes to politics, but I've always been a strong supporter of the underdog. I'm the type of person who takes in stray animals, stands up for someone who's being bullied, and supports those who need help. How could I channel my instincts to protect and support into a nursing advocacy role? My answer is to become politically active.


Getting involved

For me, the word "politics" had a negative connotation-as it does for so many others-so, in order to get involved, I'd need to focus on my desire to help others. Entering the world of politics can be intimidating to someone inexperienced. Dedication, strategy, and persistence can help individual citizens hold elected officials accountable for their actions.3 One way that individuals can influence the action of political leaders is via lobbying, which is a critical part of our political process.4 Lobbyists are usually paid activists who communicate directly with legislators in an attempt to persuade them to support legislation that would benefit the group they represent.5 For example, the pharmaceutical and insurance industries are two of the largest employers of lobbyists.5


However, nurse citizens don't have to be paid lobbyists to make a difference and support change. No advanced skills or specialized knowledge are required to participate in political activities. Therefore, individual citizens are free to find a level of political involvement that works best for them, such as voting, volunteering, joining civic groups, or signing a petition.


As part of the nursing community, we have the ability to join with other nurses to show that we support particular legislation. Consistently ranked the most trusted professionals in the nation, nurses have clout with the public.6 We have many opportunities to identify issues that need to be corrected, and we can stand up and defend the health, safety, and rights of our patients as mandated by our nursing code. Reacting to issues of injustice, inequality, or powerlessness is referred to as political consciousness, and it's what sets policy-shaping in action.7


Nurses are perfectly suited to take on a more political role within our communities because we're accustomed to holding both formal and informal nursing leadership roles, whether at the bedside or behind a desk. We can easily use these skills to advocate for our patients' best interests and effect change.8 Nurses in any role can support the profession, and the patient, by working together to advocate for healthy and safe work environments, equality of care, ethical codes of conduct, and optimized healthcare services.


A collective responsibility

Power and influence do come with significant responsibilities that can't be denied. Each one of us has a responsibility to each other, and society, to take our practice beyond the bedside. Nurses can be highly influential in government roles, professional associations, and the community as they advocate for policies to improve the health of all patient populations, but especially those who can't stand up for themselves, such as the incarcerated, the elderly, the disabled, and the homeless.7 The nursing profession itself provides many opportunities for protecting the interests and safety of our patients.


Patient advocacy isn't necessarily an individual effort; rather, it's a collective responsibility.9 Collectively, through nursing organizations, nurses form formidable collaborations that maximize advocacy efforts. The purpose of nursing organizations is to educate the public, foster high standards of nursing care, promote and encourage professional growth, and support health policies that benefit the public. Nurses who become involved in a professional organization have opportunities to obtain leadership skills and network with other nurses. Membership provides "political newbies" like myself an opportunity to learn about the various public policies and health-related legislation in a supportive environment. For a list of organizations you can join, see Get involved.


If you're like me, it may take a while to embrace politics and find your place within this arena. I've begun the process by taking a more active role in watching and understanding the political topics that affect healthcare. I started my journey by reviewing the priority legislative issues of concern for my state nursing organization and learned as much as I could about one of the issues that interested me. My original plan was to write to my legislator. What surprised me was how passionate I became about the issue-enough that I stepped a bit outside my comfort zone and made an appointment to meet with my legislator in person to share my views. What began as a stretch for me personally resulted in a very engaging conversation, an invitation to come back again, and the courage to do so.


I can't claim to be politically savvy yet, nor am I ready to storm Washington, but I've learned the importance of staying informed about policy changes affecting healthcare. Being aware of current healthcare legislation contributes to my ability to understand and respond to industry changes that may affect the quality of care we give our patients.


Get involved

American Nurses Association


Academy of Medical-Surgical Nurses


American Academy of Nursing


National Student Nurses Association




1. American Nurses Association. Code of Ethics for Nurses with Interpretive Statements. Silver Spring, MD:; 2015. [Context Link]


2. Hilton L. Experts say it's time for all nurses to get political. 2012. [Context Link]


3. Whelan E-M, Woody MP. Lobbying policymakers: individual and collective strategies. In: Mason DJ, Leavitt JK, Chaffee MW, eds. Policy & Politics in Nursing and Health Care. 6th ed. St. Louis, MO: Elsevier/Saunders; 2012:519-526. [Context Link]


4. American Association of Colleges of Nursing. From patient advocacy to political activism: AACN's guide to understanding healthcare policy and politics. 2010. [Context Link]


5. National Conference of State Legislatures. How states define lobbying and lobbyist. 2015. [Context Link]


6. Gallup, Inc. Honesty/ethics in professions. 2016. [Context Link]


7. Leavitt JK, Chaffee MW, Vance C. Learning the ropes of policy, politics, and advocacy. In: Mason DJ, Leavitt JK, Chaffee MW. Policy & Politics in Nursing and Health Care. St. Louis, MO: Elsevier: Saunders; 2012:19-28. [Context Link]


8. Registered Nurses' Association of Ontario. Developing and Sustaining Nursing Leadership Best Practice Guideline. 2nd ed. Toronto, Ontario: Registered Nurses' Association of Ontario; 2013. [Context Link]


9. Mahlin M. Individual patient advocacy, collective responsibility and activism within professional nursing associations. Nurs Ethics. 2010;17(2):247-254. [Context Link]