Patient Advocacy in Acute-Care Hospitals: A Comparison Between Nurses, Social Workers, and Medical Residents

Background. Jansson (2011) identified seven core problems often faced by patients in healthcare settings: 1) violations of ethical rights, 2) lack of quality care, 3) lack of culturally-competent care, 4) lack of preventive care, 5) lack of affordable care, 6) lack of mental health care, and 7) lack of community-based care. Codes of ethics of nursing, social work, and medicine require members of these healthcare professions to engage in advocacy to help patients resolve problems. Yet the extent they actually do so, feel ethically committed to doing so, and have the skills to do so was unknown until the recent development of instruments with which to measure these variables. This study sought to explore whether nurses, social workers, and medical residents in acute-care settings differ with respect to their engagement in patient advocacy (PA), the extent they report being ethically committed to PA, and the extent they report possessing skills to engage in PA.

Methods. A sample of 100 nurses, 100 social workers, and 100 medical residents was randomly drawn from the rosters of eight hospitals in Los Angeles County. Participants responded to a survey containing scales that were validated as part of the larger project described in this symposium, including those that measure PA engagement, ethical commitment, and skills. Data analysis proceeded through descriptive and inferential phases, with ANOVAs performed to explore differences between the three professions on the outcome variables.

Results. Overall sample (N=300) was comprised of 70% females and 46% Caucasians. Significant differences were found between the professions on PA engagement, with social workers reporting more engagement than nurses or medical residents (F=9.76, df=2, p<.001). Medical residents reported significantly lower levels of ethical commitment than nurses and social workers (F=7.31, df=2, p=.001). Significant differences were also found regarding the extent members of the three professions believe they possess necessary PA skills, with social workers more likely than nurses or medical residents to report possessing such skills (F=31.24, df=2, p<.001).

Conclusion. Our findings demonstrate important differences between the three professions; these differences have broad practice implications. Social workers appear more likely than the other professions to engage in PA; they also report high levels of ethical commitment and skills. This suggests a prominent role for social workers in acute-care settings to detect and advocate when certain patient problems arise. Yet, interventions that increase PA engagement, ethical commitment and skills among nurses and medical residents are warranted. The above seven core problems include some areas typically outside the purview of social work, such as evidence-based and preventive care. Patients experiencing unresolved problems in these areas likely require advocacy from healthcare professionals with medical training. Second, all three professions are ethically mandated to engage in advocacy. The demonstrated low level of ethical commitment, particularly among medical residents, suggests the need for increased awareness of this mandate. With the move toward patient-centered care ascribed in the ACA, all healthcare professions might benefit from education to help them work together to advocate for patients experiencing unresolved problems in the seven core areas.