1. Morse, Kate J. RN, CCRN, CRNP, MSN

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I often observe nurses in the ICU acting as patient advocates, although it is not always easy to initiate difficult discussions with the physicians and families. For example, when the patient's wishes are in conflict with the physicians' and families', conflict can ensue. However, many nurses continue to take these risks daily because they believe that patient advocacy is a core value of nursing.

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On the other hand, there are anecdotal reports of patients feeling like no one advocated for them. Therefore, advocacy is still an important and unresolved healthcare issue.


As our healthcare system becomes increasingly complex, advocacy has probably never been more important. The public's awareness of patient advocacy is increasing and other nonnursing providers are filling the gap. This leads me to believe that nurses are not the only ones interested in and taking responsibility for patient advocacy. The role of patient advocate has long fallen under the purview of nurses and we should continue to take a leadership role in patient advocacy.


The American Association of Critical-Care Nurses, in a position statement that defines advocacy, states that the critical care nurse shall do the following:


1. Respect and support the right of the patient or the patient's designated surrogate to autonomous informed decision making.


2. Intervene when the best interest of the patient is in question.


3. Help the patient obtain necessary care.


4. Respect the values, beliefs, and rights of the patients.


5. Provide education and support to help the patient or the patient's designated surrogate make decisions.


6. Represent the patient in accordance with the patient's choices.


7. Support the decisions of the patient or the patient's designated surrogate or transfer to an equally qualified critical care nurse.


8. Intercede for patients who cannot speak for themselves in situations that require immediate action.


9. Monitor and safeguard the quality of care the patient receives.


10. Act as liaison between the patient, the patient's family, and healthcare professionals.1



In the critical care environment, being a patient advocate is the right thing to do, but can also be the more difficult thing to do. I think that the major barriers to patient advocacy in critical care are a lack of physician and administrative support, fear of reprisals, and a prior negative experience. It can be particularly devastating to a new critical care nurse to have a negative experience.


Peer support for newer staff members less experienced in advocacy is extremely important. This skill should be included in critical care orientation, with just as much emphasis as pulmonary artery pressure monitoring. Advocacy should be spoken of often in critical care, examples should be highlighted as exemplary practice, and when there are differences of opinion, they should be discussed in an open and respectful manner with the guiding concept to support the patient.


Kate J. Morse


Editor-in-Chief, Assistant Clinical Professor, Acute Care Nurse Practitioner Tract Coordinator Critical Care Nurse Practitioner, Chester County Hospital West Chester, Pa. [email protected]




1. American Association of Critical-Care Nurses. Position statement: role of the critical care nurse. Available at: Accessed April 24, 2008. [Context Link]