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Rise and shine: A story about advocacy

Maine, Jillian BSN

doi: 10.1097/01.NURSE.0000437483.75992.04

Becoming a patient advocate

Jillian Maine is a student at Holy Family University in Philadelphia, Pa.

The author has disclosed that she has no financial relationships related to this article.

ONE OF THE EARLIEST and most important nursing roles I experienced during my clinical rotations was that of patient advocate. On the first day of my gerontology clinical rotation in an assisted living facility, I was assigned to Mrs. K, who was 98 years old and sharp as a tack. She seemed happy to have someone spend time with her and very quickly began telling me all about her family and life in the assisted living facility.

One day as I was taking away her breakfast tray, I noticed that she hadn't touched her scrambled eggs. When I asked her if she wanted me to leave the tray, she told me with a grimace that she absolutely despised scrambled eggs but got them on her tray every single day.

At this point, I was confused. I asked Mrs. K if she'd ever told anyone about her breakfast preferences. She said, “Yes, countless times, but nothing changed. So finally I just stopped bringing it up.” This didn't sit well with me. Mrs. K was a permanent resident at a costly facility, and she couldn't even get a breakfast she liked? Where's the autonomy in that?

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What's for breakfast?

I first approached my clinical instructor with the situation, and she suggested that I speak to the charge nurse. When I asked the charge nurse if we could substitute something else for the eggs, she appeared to be very understanding and said, “Absolutely, no problem.”

The following week I went back to the facility feeling pretty good because I thought I'd made Mrs. K's life a little more enjoyable...until I picked up her breakfast tray. What did I find? A heaping pile of scrambled eggs.

Week after week, I'd go back and find no change in Mrs. K's breakfast menu. I asked the charge nurse about the situation and she said that the information had been passed along to Mrs. K's nurses and kitchen staff.

I wanted to speak with the dietician, but she was never on the unit on the same day I was. My instructor and I made it clear we wanted to speak to her whenever she was available. In the meantime, I wouldn't even take the tray into Mrs. K's room without removing the eggs first.

I felt extremely frustrated because no one seemed to be listening and, worse, no one seemed to care. That's when I thought, “Just imagine how Mrs. K has felt all this time.” I promised myself I'd solve this problem before my 10 weeks of clinical rotation were over.

The week before the final day of my rotation, the dietician and I were on Mrs. K's unit at the same time. When I spoke to her, I finally felt as though someone was listening. She sat at the computer and eliminated everything containing eggs from Mrs. K's recommended menu, and informed me that this was the first she'd heard about Mrs. K's preference.

I crossed my fingers that this would work; I was a little skeptical after all the previous false reassurances. But on my final day of clinical, I brought Mrs. K her breakfast tray and there wasn't a trace of eggs on it.

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Becoming Mrs. K's voice

This was a very valuable lesson in patient advocacy for me. By taking a stand and changing something as simple as her breakfast, I helped Mrs. K start her day off right, which allowed her to feel more in control of her life. Besides helping to restore a patient's sense of control, patient advocacy can sometimes avert potentially serious complications, such as a severe food allergyor an adverse medication reaction.

To be a true patient advocate, I think that you have to take a few minutes out of your day to get to know your patients—their likes, dislikes, how they're feeling, and how they'd like to feel. Communicating and really interacting with patients and other members of the healthcare team is an integral part of patient advocacy.1

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Be the squeaky wheel

At times as nursing students, we can be nervous, anxious, and hesitant to speak up about situations we feel should be addressed. In reality, for the sake of our patients, speaking up is our duty. My experience was initially frustrating and disappointing, but the resolution was very rewarding. There's no better feeling than advocating for your patient and seeing the sincere look of appreciation on his or her face.

My encounter with patient advocacy taught me two powerful, positive lessons: the squeaky wheel gets the grease, and you always need to be a voice for your patients, whether it's for their physical health or their breakfast.

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1. Hanks RG. The medical-surgical nursing perspective of advocate role. Nurs Forum. 2010;45(2):97–107.
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Ronch JL. Many ways to advocate. 2011.
    © 2013 by Wolters Kluwer Health | Lippincott Williams & Wilkins.