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res dem s i.essage Advocacy--An integral part of

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emergency nursing ! Anne Manton, Rig, PhD, CEN, New Haven, Connecticut

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D O yOU inc lude t h e w o r d s "pa t ien t advoca te" in your d e s c r i p t i o n of w h a t you do as an emer-

g e n c y nurse? My g u e s s is t ha t for mos t of us, t he a n s w e r wou ld be a r e s o u n d i n g "yes." For yea r s I have w i t n e s s e d e m e r g e n c y nur ses go ing far b e y o n d the

e x p e c t e d to se rve as p a t i e n t advoca te s , even to t he po in t of p u t t i n g t h e m s e l v e s in difficult pos i t ions , to p rov ide p a t i e n t s w i th t he b e s t ca re poss ib le . In fact, I be l i eve the re a re t rue he roes a m o n g us!

M a n y innova t ions in p a t i e n t care a re a resul t of e m e r g e n c y nurses ' ac t iv i t i es on beha l f of p a t i e n t s and thei r families:

• Who in i t i a t ed the d i s c u s s i o n of a l lowing family m e m b e r s to b e p r e s e n t du r ing r e s u s c i t a t i o n efforts (and why), or a l lowing family m e m b e r s to v i ew the b o d y of a d e c e a s e d loved one?

• Who s t o p p e d the in te rn after t he th i rd s t i ck and cal led the ped i a t r i c IV nurse?

• Who d e c i d e d t ha t pe r sons who h a d b e e n r a p e d

d e s e r v e d the expe r t i s e of a sexua l a ssau l t nu r se examiner , and s o u g h t to ga in t ha t exper t i se?

• Do you r e m e m b e r w h e n p a r e n t s w e r e no t a l lowed to r e m a i n w i th thei r ch i ldren who were h a v i n g l ace ra t ions su tu r ed or ca s t s app l i ed? Who w a s an a d v o c a t e for a l lowing pa r en t s to r e m a i n w i th the i r ch i ldren?

• Who r e c o g n i z e d t h a t cord less p h o n e s wou ld al low p a t i e n t s to b e in t ouch wi th loved ones more eas i ly? E m e r g e n c y nu r se s have also b e e n a d v o c a t e s in

the i r commun i t i e s : • Who has p r o p o s e d a n d s u p p o r t e d leg is la t ion to

p ro t ec t hea l th ca re workers? * Who has p l a n n e d even t s to inform the pub l i c

a b o u t var ious safe ty i s sues?

Anne Manton is Assistant Professor of Nursing, Fairfield University, Fairfield, Connecticut, and a Staff Nurse, Emergency Department, Hospital of St. Raphael, New Haven, Connecticut. J Emerg Nuts 1998;24:113-4. Copyright © 1998 by the Emergency Nurses Association. 0099-1767/98 $5.00 + 0 1.8/61./89517

• Who has worked t i re less ly for t he e n a c t m e n t of leg is la t ion r e g a r d i n g the u se of s ea t bel ts and he lme t s?

• Who has e n c o u r a g e d gun safe ty and d i s t r i bu t ed t h o u s a n d s of gun locks?

The examples of e m e r g e n c y nur ses as a d v o c a t e s are vir tual ly endless!

Some reCent e x p e r i e n c e s a n d obse rva t ions (both

m y own and those of e m e r g e n c y nu r s ing col leagues) s u g g e s t t ha t t he a d v o c a t e role is b e i n g p u s h e d to t he b a c k g r o u n d as acu i t y and work loads i nc rea se and s taff ing levels d e c r e a s e in U.S. e m e r g e n c y care facili- t ies. Some e m e r g e n c y d e p a r t m e n t s have a d e s i g n a t - ed p e r s o n - - o f t e n a non-nur se v o l u n t e e r - - t o b e THE pa t i en t advoca te ! I sn ' t th is w h a t w e as nu r ses do? Ala rm bells should b e go ing off in our heads . Are w e really wil l ing to g ive a w a y this impor t an t pa r t of our

role? If w e g ive up our a d v o c a c y efforts, it will be at g r ea t cos t n e t only to the public , b u t to nu r ses as well.

In the d e c a d e s s ince N igh t inga l e revolu t ionized

nurs ing, t he pub l i c has r e c o g n i z e d and a p p r e c i a t e d t ha t nurses , w h e t h e r in hosp i ta l s or in the c o m m u n i - ty, could be c o u n t e d on to ac t in t he p a t i e n t ' s b e s t i n t e r e s t - - n o m a t t e r what . It is th is pub l i c suppor t t ha t has enab l ed us to g row as nu r ses and cont inual - ly e x p a n d our roles and respons ib i l i t i es . It is th is pub- lic suppor t t ha t will see us t h rough the cha l l enges t ha t no d o u b t lie a h e a d for nurs ing.

Our efforts have not b e e n l imi ted to a d v o c a c y for ind iv idua l p a t i e n t s b u t have often b e e n e x t e n d e d to inc lude a d v o c a c y for famil ies and communi t i e s . On a larger scale, the role of a d v o c a t e is w h a t dr ives nurs- es to b e c o m e involved wi th leg is la t ive i ssues , to deve lop and /o r t ake par t in injury p reven t ion pro- grams, to p a r t i c i p a t e in hea l th p romot ion ac t iv i t ies , and to ac t in so m a n y other w a y s on beha l f of t he U.S. popu la t ion ' s hea l th and well be ing .

Think abou t your own nu r s ing p r a c t i c e area. Are you se i z ing the oppor tun i ty to be a p a t i e n t advoca te , to d e m o n s t r a t e tha t nu r se s ca re and are able and will- ing to se rve as a d v o c a t e s ? Or are you m i s s i n g t h e s e

April 1998 ~ 3

JOURNAL OF EMERGENCY NURSING/Manton m

oppor tuni t ies and feel ing i ncomple t e at the end of the

day? Pa t ien ts and their families m a y not know you

could have done more for them, bu t you know. If you

are a m a n a g e r or administrator , your staff m a y not

know h o w m u c h more you could have ins i s ted on, on

their behalf, bu t you know. A d v o c a c y is a major par t

of the reason m o s t of us b e c a m e nurses in the first

place. We w a n t e d to help people!

Many pa ths and m a n y oppor tuni t ies for advoca-

cy exis t in e a c h of our lives, w h e t h e r the focus is

pa t ients , families, communi t i e s , fellow nurses, or the

publ ic at large. Look for the a d v o c a c y oppor tuni t ies in

your life. Be wil l ing to share your knowledge , skill,

insights , energy, and t ime on behalf of others.

Through our advocacy efforts, great or small, w e can

make a difference. That 's why we ' r e e m e r g e n c y nurses!

Reviewers' Acknowledgment The Journal of Ernergency Nursing gratefully acknowledges the time, effort, expertise, and advice donated by the following reviewers of this issue's content:

Debra Adkins Marlene Jezierski Mathilda Merker Sherri-Lynne Alrneida Rhonda Jolliffe Tricia Mian Joan Begg-Whitman Jill Jones Cindy Nigre Dorean Begley Linell Jones Andrea Novak Nancy Bonalumi Sandra Jutras Janet Parker Frank Cole Nigel Keep Kathy Robinson Susan ConneI1 Regina Kellner Kathleen Rourke Carol Cramer Jane Koziol-McLain Susan Craig Schulmerich Laura Criddle Diane Lapsley Rene~ Semenin-PIolleran Frank Cunningham Genell Lee Daun Smith Sue Currier Marge Letitia T. Smith Karen Daley Anne Lewis Joan Snyder Dianne Danis Ruth Malone Marjorie Stenberg Laurie Flaherty Anne Manton Donna Strawser Barbara Foley Christine May Kieron Thayre Iris Frank Carole Mays David Unkle Terry Fulmer Kay McClain Debbie Upton Patricia Geary Carrie McCoy Kristi Vaughn Emilie Goudey Jeanne McKay Kathy Wruk Bernard Heilicser Bea McPherson Linda Yee Maryfran McGonagle Hughes Elli Meeropol Polly Gerber Zimmermann Linda Jackson

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114 Volume 24, Number 2