Professional advocacy: widening the scope of accountability

Abstract Advocacy has proven a slippery concept for nursing. Although the nursing profession has adopted the term ‘patient advocacy’ to denote an ideal of practice, the meaning, scope and implications of the concept have not yet been adequately defined. Poorly defined concepts lead to practice problems and these ultimately impact patient care. This article clarifies some basic underlying assumptions of the term ‘advocacy’ in the interest of facilitating the goals of nursing. The origins and meanings of the term are traced. It is noted that ‘advocacy’ as descriptive of verbal actions on behalf of others is an expression initially used in legal settings. Nursing's use of this term is explored and because the term is also discovered in the literature of other disciplines to denote either a standard (Law) or ideal (Medicine) of practice it proved helpful to compare the various perspectives. Additionally, the link between advocacy and notions of professional responsibility, obligation and accountability is investigated. Although advocacy for nurses is discovered to be a broad concept it has typically been seen as applying to individual situations and immediate contexts. However, actions taken with the purpose of advocating for a given patient (or group of patients) necessarily affect more than the person for the sake of whom the actions are taken. Thus, patient advocacy commits nurses to an examination both of the immediate practice environment and of the wider context in which nursing occurs. This is because nursing's purpose of furthering ‘health’ extends both to individuals and society. For these reasons it is suggested that the term ‘professional advocacy’ viewed as actions stemming from professional role objectives more accurately captures the scope of nursing responsibilities than does either ‘advocacy’ or ‘patient rights advocacy’.