Advocating for patient safety: Power dynamics in nurse advocacy practice in Australia—An integrative review

Introduction: Nurses play a vital role in advocating for patient safety, yet their ability to fulfil this role is influenced by the power dynamics within healthcare systems.Understanding the relationship between power and nurse advocacy in Australia is essential to fostering a supportive environment for effective advocacy.Aim: This integrative literature review aims to identify and examine the relationship between power and the advocacy role of nurses in Australia.Methods: The review followed an integrative literature review design, guided by the approach outlined by Toronto and Remington.A comprehensive search was conducted in electronic databases such as Medline, CINAHL, Emcare, Scopus, ProQuest Health & Medicine, and Informit.The search terms used were 'nurse OR nursing OR nurses' AND 'advocacy OR whistleblowing' AND 'Australia.'A total of 2507 articles were retrieved, and 26 studies met the inclusion criteria, comprising 18 qualitative studies, one quantitative study, one mixed-method study, one review of existing literature, and four editorial commentaries.The search was completed in May 2023.Findings: The findings suggest that enhancing nurses' advocacy for patient safety requires a multifaceted approach.This includes empowering nurses through professional development and leadership opportunities, fostering a culture of patient safety, and engaging in political action to advocate for policies that support advocacy efforts and patient safety.This approach aims to advance patient well-being and elevate the professional standing of nurses within the healthcare system.Discussion: Power dynamics significantly shape nurse advocacy practices.Nurses with greater personal power are more likely to advocate confidently, while those with less power may be hesitant.Healthcare organisations can either support or hinder advocacy efforts, with unsupportive systems creating barriers and fostering a culture of silence.Whistleblowing, as a form of advocacy for patient safety, is also affected by organisational culture and power structures.Conclusion: Power dynamics play a critical role in determining how effectively nurses can advocate for patient safety.Empowering nurses and addressing organisational barriers are crucial for promoting advocacy in healthcare.This review highlights the need for healthcare systems to cultivate environments that support and facilitate nurse advocacy.