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Press and News: Education

Practice Tip of the Week | Patient Advocacy Protections

Tuesday, April 21, 2020   (0 Comments)
Posted by: Shanna Howard
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Nurse with masked patient

By Cindy Zolnierek, PhD, RN, CAE

The role of patient advocate has been long embraced by the nursing profession. Provision 3 of our professional ethics speaks to this duty: “The nurse promotes, advocates for, and protects the rights, health, and safety of the patient.” 

Advocacy means speaking out for or pleading the case of another. Nurses advocate for the safety of their patients every time they report a change of condition, request adequate pain relief, or insist a patient be reevaluated. Nurses also advocate for safety when they raise concerns about their work environment – when they question the safety of a patient assignment, when they report workplace violence, and when they request proper equipment to keep themselves and their patients safe.


The media reports that health care workers, specifically nurses and physicians, have been retaliated against for speaking out about shortages of personal protective equipment in their workplaces. Some recent headlines:

  • Health care workers face punishment for speaking out
  • Hospitals threaten to fire workers for speaking out
  • Fired hospital nurse alleges retaliation for speaking out
  • Nurses and doctors speaking out on safety now risk their job

How can nurses meet their ethical duty to advocate for safety while also protecting their jobs?

In addition to traditional whistleblower laws applicable to health care workers and all public employees, Texas nurses have a number of other advocacy protections in the Nursing Practice Act. Nurses can best address safety concerns and protect themselves from retaliation by understanding these protections and knowing the right time and place to raise their concerns. (Note: some whistleblower and advocacy laws have specific requirements for reporting).


Be deliberate about how, when, and where you raise concerns.

How? Be clear and specific about your concern. General statements, e.g., “this is not safe,” aren’t helpful in communicating what needs to be corrected. Instead, articulate enough details to invite a response, e.g., “The CDC recommends the public wear masks, but masks are not available to patients in the triage area. I need to have masks for patients who do not wear their own.”

When? Raise your concern when it occurs. The best time to raise your concern is when it is identified and can be addressed. If delays occur due to patient care needs, report your concern at your earliest opportunity.

Where? Address the person who is able to respond. Most often this person will be your supervisor: charge nurse, manager, director or nurse executive. Outside this chain-of-command you can also report to quality and safety leadership (quality improvement, infection prevention/control, risk management), corporate compliance or both. If internal reporting is ineffective, licensing and accreditation agencies can be contacted (Texas Department of State Health Services, Texas Health and Human Services Commission, Board of Nursing, The Joint Commission, Centers for Medicare and Medicaid Services).

Frustrated nurses often turn to the media, including social media. However, treat this as a very last resort as some protections do not apply to disclosures to the media.


Finally, nurses need to ask why? Why is advocacy so important to nursing practice?

Nurses are at the “sharp end” of health care – the point where care actually reaches the patient and where the last opportunity exists to prevent harm from reaching the patient. Nurses who identify the potential for harm have a responsibility to speak out and raise their concerns so they can be acted upon.

The threat of retaliation has a chilling effect on advocacy and prevents an organization from preventing potential patient harm. But we are all protected when nurses are protected for speaking out.

TNA has fought for these statutory protections over the past decades. Know your rights and how to exercise them to protect yourself and your patients.

Texas Nurses Association

Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin TX 78759

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