A critical analysis of the role of the autonomous practitioner as patient advocate.

According to Mozley and Whitely (1998) the legal definition of advocacy is, a process in which a person pleads for another in court however the Oxford dictionary combines the legal definition with, a person who supports or speaks in favour (Concise Oxford Dictionary 1994). The Code of Professional Conduct identifies that as a nurse you have accountability to Patient, Profession. Public and employer (Nursing Midwifery Council (NMC, 2002) adjacent to this, the Scope of Professional Conduct (NMC 2002) identifies that, As a registered nurse, you should always act in a manner to promote and safeguard well being of patients by ensuring that no action or omission within your professional ability is detrimental to the patients’ wellbeing. This implies that advocacy is needed but does not explain the use of advocacy (United Kingdom Central Council (UKCC, 1992).

The audit commission (1993) suggests that advocacy is, To safeguard the wellbeing and interests of clients, Gastrell et al (1993) agrees with this notion and further states, By acting as advocate, nurses’ maybe in conflict with employers, signifying that true advocacy is difficult to enforce, and possibly patient empowerment is a more feasible option. Gastrell (1996) further identifies, that to act as an advocate the nurse has to be aware that with advocacy comes assertiveness, Slater (1990) supports this view and stresses, that historically nurses have taken on a submissive role. Latter (1998) concludes that. To enable nurses to take on a more assertive position, assertiveness training and self-exploration through education is

required. The nurse working as an autonomous practitioner has the responsibility to see, treat or refer as necessary- it is here the role of advocate comes into play- as the decisions and choices made by the practitioner may have lasting effect on the patients’ wellbeing.

A recent incident at the walk-in-centre highlighted the need for autonomous practitioner to act as a patient advocate. During a referral the nurse expressed concerns regarding inappropriate treatment and advice given to a patient by another medical professional, the nurse then went on to provide secondary advice. This action could be questionable since in taking such stance the nurse could be perceived as a trouble maker, chanced having disciplinary action taken against her and possibly risked ostracising a colleague (Teasdale 1998). Here it is worth noting that it stated within the UKCC Code of Professional Conduct (UKCC 1992) that, if harm is caused by either act or omission, professional duty is unfulfilled and it could be supposed that by not advising the patient the nurse is in breech of the UKCC guidelines.

In this instance, by advising the patient to take another avenue of care the nurse was acting as patient advocate, although by doing so it could be debated that professional boundaries were overstepped despite the UKCC (1992) recognising that, with nurses working in different ways and at higher levels of practice, boundaries are becoming increasingly blurred. In this case the nurse was acting as the patients advocate, perceiving that Duty of Care (NMC 2002) to the patient overrode the concept of professional boundaries as she contradicted previous advice given by the doctor.

Abrams (1978) states, the problems which come with the term advocacy are a numerous, due to the amount of definitions and explanations, this notion is agreed by Aham et al (2002) who identify that ideas range from watchdog, counsellor or representative to potential whistleblower. Not only are various terms used to describe an advocate but the notion of advocacy varies from place to place. Teasdale (1998) distinguishes the Americans view as, Empowering patients by informing and supporting the UK the impression is that advocacy is achieved by attempting to influence a third party