It Is Time for Nurses to Advocate for Nurses

Introduction

I started my journey in advocacy after realizing that all the inefficiencies in health care could be fixed if those within the broken systems began to engage in problem-solving. I began by initiating change at the unit level, then at the health system level, and now at the state and federal levels. At the unit level, I was able to institute changes through quality projects, committee participation, and creating unit-based projects to tackle specific issues. I managed the unit's incident reports and used that information to support necessary initiatives. Other units later adopted many of the initiatives I instituted in my nursing unit until they achieved hospital-wide adoption. These initiatives included tackling issues such as length of stay, mislabeled specimens, falls, process breakdowns, and utilization of high-alert armbands. At this level, I often advocated for resources, and during this time, I realized the importance of articulating the why associated with each request and the importance of communicating the risks and benefits associated with each request. During this time, I actively engaged with the American Nurses Association and served on Issues Panels, such as the Moral Distress Professional Issues Panel and #EndNurseAbuse Professional Issues Panel. This experience enhanced my advocacy network and my ability to support change with research and evidence-based practice.

At the health system level, I worked with leadership to develop retention recovery programs for nurses, which included simulated training for difficult conversations, and through this process, I developed nursing career paths to provide growth opportunities at the bedside and beyond. I advocated for systemwide increased nursing recognition and a system-wide nursing diversity, equity, and inclusion committee. I advocated for community outreach efforts and worked with the system to strengthen the workforce pipeline by engaging kindergarten through 12th grade students in nursing career exploration. During this time, I learned one size does not fit all, and if one wants to advocate for change, one must understand each unique landscape, culture, and the audience's needs. Understanding organizational policy and the process for policy change is a valuable skill.

Each experience and learning opportunity provided skills and knowledge for the work I am doing now. This is an example of how your participation at any level will only provide avenues for your advocacy skills to grow. I have been a steadfast advocate for workplace violence prevention at the state and federal levels. One example is partnering with the United States Department of Labor Women's Bureau to speak on the impacts of workplace violence and possible solutions. This is an example of educating the public about our issues in nursing to gain support. I served as the Director of Health Policy and Advocacy with the Louisiana State Nurses Association for 2.5 years. I now serve as Executive Director of the Louisiana State Nurses Association. I currently serve on multiple legislative task forces and committees, and through the Nurses on Boards Coalition initiatives, I advocate for more nurses on boards. Nurses need to be at the decision-making table, and we need to lead discussions, especially when the outcomes will directly impact our profession.

Participating in policy and advocacy is self-care for nurses. Many issues we face in the nursing profession are finding their way to the legislature, such as resource allocation, healthy work environments, workplace violence prevention, workforce development, and so much more. Just as we advocate for our patients, we must fiercely advocate for those in our profession. The Code of Ethics for Nurses highlights the active role nurses must take to maintain our ethical responsibilities and protect human rights, which can be interpreted as our duty to advocate (Ballard, 2023). Nurses are well-equipped to lead at the bedside, boardroom, and state capitol in efforts to drive positive change and improve outcomes. It is imperative that nurses role model advocacy efforts for nursing students and actively include them in initiatives. Nursing students are faced with some of the same issues licensed nurses are faced with, such as workplace violence during their clinical experiences, at which time they could be considered more vulnerable due to their limited exposure and ability to address abusive behaviors (Dafny et al., 2023). The purpose of this editorial is to highlight the importance of nurses advocating for nurses and to offer several suggestions on how to get started.

Issues plaguing the nursing profession are not new, but I believe they are exacerbated. Our profession recently lost a nurse to suicide, and the letter she left highlighted the ways she felt abused by her profession (Smith, 2023). After reading her letter and examining what she referred to as abuse, it was evident that system failures, broken processes, and lack of resources are negatively impacting the nursing profession. The rate of suicide among nurses is higher than that of the public, and nurses are exposed to more risk factors (Lange, 2023). Nurses' work environments directly impact patient safety, and health care leaders have a duty to address threats to nurses' work environments, which can harm patients and nurses (Lee & Friese, 2021).

I have been working to create a healthier work environment through policy change, and there is room for other nurses to participate in these efforts nationwide as well. In Louisiana, I led the efforts related to the passage of the state's first comprehensive workplace violence law named after Lynne Truxillo, a nurse we lost to workplace violence. This bill successfully became law because nurses worked together through coalition-building efforts and brought other critical stakeholders to the table to support our efforts. Most recently, I led efforts to make Louisiana the 12th state to pass smoke evacuation legislation with the coordination and support of the Louisiana State Nurses Association, Louisiana's local Association of periOperative Registered Nurses (AORN) chapters, and the Association of periOperative Registered Nurses (AORN) national office. Again, this law resulted from many nurses working together and leveraging our professional organizations through actions, such as providing testimony, writing letters to legislators, obtaining letters of support from stakeholders outside of nursing, and educating the public on the issue. Professional nursing organizations often employ lobbyists who are instrumental in amplifying advocacy efforts, and that is a benefit of membership.

It is in everyone's best interest to advocate for nurses but as nurses we must demand better. When individuals discuss nursing shortages, that conversation should include work environments and turnover. Nurse burnout is directly related to turnover, which creates negative financial impacts on organizations, and burnout is related to work environments (Muir et al., 2022). Numerous factors have been associated with intent to leave, such as staffing/workload, lack of leadership support, and burnout (Skillman & Toms, 2023).

Ways to advocate include:

• Researching the issues that you are interested in impacting.

• Joining a professional organization and participating in a health policy and advocacy committee or council.

• Supporting existing efforts by associations and organizations by participating in letter-writing campaigns and events.

• Establishing a relationship with your elected officials and sharing your experiences as a nurse.

• Educating the public on issues facing the nursing profession.

In conclusion, I encourage nurses at all levels to become involved in advocacy efforts, especially those efforts to support and protect the nursing profession. I hope that each nurse believes they can contribute to advocacy efforts in some way after reading this editorial, whether recommending improvements to your institution's policy, contacting your legislators, joining a committee, or educating yourself on current nursing issues. We all have a voice, and people will listen to nurses when we speak, so let's work toward building a better future.

Ahnyel Jones-Burkes, DNP, RN-BC, NEA-BC

Executive Director

Louisiana State Nurses Association

Baton Rouge, Louisiana

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