Patient Advocacy: Our Guiding Principle

Collective Advocacy

The Union and Patient Advocacy

RNs have independent ethical and professional obligations, and therefore a right as patient advocates to initiate actions that, in their independent judgment, are necessary to protect patient safety and health — even if these actions might be contrary to their employer’s directives. Having a union gives nurses the legal authority and the foundation for engaging in patient advocacy on a collective basis with a unified union voice.

The Right to Bargain on Patient-Care Issues

There are many examples of management decisions to restructure or redesign patient-care delivery methods, including changes in staffing skill mix, abandonment or modification of acuity systems, introduction of new technologies, and imposition of new responsibilities for RN clinical supervision of unlicensed personnel. These decisions can severely burden RNs and pose significant risks of harm to patients.

These same decisions are mandatory subjects of bargaining under the National Labor Relations Act and public employment labor laws. The reason they are mandatory is because they directly affect RN workload and job responsibilities, and may actually jeopardize an RN’s license by preventing competent performance of professional responsibilities.

The Tools

Active RN participation gives power to the legally mandated consumer-protection role of licensed registered nurses and creates the opportunity to influence the systemic changes that are at the root of the decline in quality care. RNs can promote patient advocacy on a facility level using the patient care protection tools negotiated into our contracts, which typically include the Professional Practice Committee (PPC), the Assignment Despite Objection (ADO) form, and the following:

Staffing-Ratio Protections

Staffing plans are negotiated into contracts to protect against future attacks. Disputes over staffing are settled by a neutral third-party arbitrator.

Zero-Lift Policies

Contract language to ensure safer lift policies, including “appropriately trained and designated staff” to assist with patient handling, available 24 hours a day.

Technology Won’t Replace RN Judgment

Precedent-setting language that prevents new technology from displacing RNs or RN professional judgment. 

Floating-Policy Improvements

Floating not required outside the RN’s clinical area, and no floating allowed unless RN is clinically competent.

Ban on Mandatory Overtime

Prevents nurses working when they are exhausted, which protects patients. 

Resource RNs

Nurses who are not given a patient-care assignment or counted in the patient acuity mix are available to assist as needed on their units.

Patient-protection Toolbox

As rapid changes are implemented in health care settings, RNs are often witnesses to unsafe or compromised patient care conditions. Advocating for safe, therapeutic, and effective care for your patients is one of the most important activities that you as a registered nurse can undertake to protect yourself and your patients. Our contracts provide important tools for protecting patients and your license in these situations.

Assignment Despite Objection Form

One of the first steps in the advocacy process is documentation. Fill out an Assignment Despite Objection form every time you and coworkers are given an unsafe assignment. Remember, an unsafe assignment may simply be one where you were unable to provide all the care that each patient needed in a timely manner, while allowing you appropriate rest and meal breaks. A patient does not have to have a sentinel event for an assignment to be unsafe.

ADOs are admissible in court, with regulatory agencies, and are protected under federal labor law. It’s unlawful for the employer to discipline or retaliate against an RN for filing an ADO.

Encourage your coworkers to fill out ADO forms when appropriate. Try to have everyone on the shift in question sign the form. There is strength in numbers.

The Professional Practice Committee at Your Facility

The Professional Practice Committee is a direct-care RN-controlled committee, negotiated into every contract, with the authority to document unsafe practices and the power to make real changes. Direct-care RNs elect representatives to serve on the committee, which meets in the hospital on paid time. 

The PPC tracks unsafe conditions utilizing ADOs. The PPC discusses practice and staffing problems on various units by analyzing the ADOs for trends and recurrent issues. Information requests are submitted as needed, to ensure that the committee has all the facts that might be useful in crafting a solution. The PPC may also elect to report the problem to the appropriate regulatory agencies.

Technology and Professional RN Judgment

Over the past decade, U.S. health care corporations have invested upward of $700 billion on information technology systems. Computer experts, hospital management, and investors cheer the advance of new hospital technologies, which is a multibillion-dollar market. They claim these systems save time and money, improve patient care, and combat the liability of medical errors by keeping more accurate and comprehensive records.

RNs who use these systems day in and day out have found that the kind of care they can provide with this new technology is limited. The programs and machines are often counterintuitive, cumbersome to use, and sometimes they simply malfunction, prompting many RNs to worry whether they are also still making errors, just new kinds. Nurses are finding that the machines take time away from patients. Perhaps worst of all, they say that the introduction of these technologies is fundamentally changing the nature of nursing: Instead of using our full attention to observe and assess the patient, our eyes are constantly on a monitor and our hands are clicking a computer mouse.

Patient-Care Technology Review Procedures 

In anticipation of these kinds of troubles at hospitals across the country, our union has for several years more aggressively pushed for RNs to play a greater role in reviewing and approving new technologies before they are introduced.

Social Advocacy

Defending the Public's Health

Often, it is necessary to take our advocacy beyond the walls of the facilities in which we work.

Our members have fought to preserve vital health care services in our communities, fighting hospital closures and cutbacks in care. We have rallied to keep our rights as union members and the protections that allow us to advocate for our patients, and we have campaigned for safe staffing and health care reform in the halls of our legislatures.

Learn more about NNU's social advocacy starting on page 24 of RNs in Motion »