Question:
Dear Nancy,
I am work as a patient advocate at a major teaching hospital. My other responsibilities include involvement with risk management issues, including investigating cases for root cause (e.g., for reporting incidents to regulatory agencies). Is this a conflict of interest with my job? Other nurses I have spoken with at other institutions don?t see how the patient advocate role can be ?neutral? if involvement in these other activities for the hospital is expected.
Aretha
Nancy Brent replies:
Dear Aretha,
Patient advocacy is an essential part of nursing and is based in many ethical theories of nursing. Nurses advocate for patients in many ways in varying situations. As a patient advocate, advocacy for you is the central characteristic of your role. The focus of this role, then, is the patient.
Risk management has as one of its goals the identification and elimination of any risks of loss to the organization. Clearly, patient care is one area that needs the proactive approach of the identification and evaluation of patient care problems and then making needed changes in the process of care to patients. The focus, of this role, then is the healthcare organization.
Despite the different focuses, the roles are not necessarily mutually exclusive. Advocating for a patient due to, as an example, the patient not receiving needed care, may also identify a risk management concern that must be evaluated, and if needed, changed.
You did not include in the question how your colleagues defined neutrality. It would be quite difficult to sustain a neutral position in either of the roles. Neutrality has been defined as, among other things, not taking sides in a dispute and being indifferent. Advocacy has been defined as speaking on behalf of or for another. Because risk management requires a proactive approach in resolving the risks to the organization, neutrality would not necessarily be helpful in achieving this goal.
If you believe you are having difficulty in fulfilling the requirements of both of these roles, a frank discussion with your chief nurse officer might be helpful. Sharing concerns with other nurse patient advocates who assume both roles might also be helpful.
Cordially,
Nancy
Nancy J. Brent, RN, MS, JD, is an attorney in private practice in Wilmette, Ill. This information is for educational purposes only and is not intended as legal or any other advice. The reader is encouraged to seek the advice of an attorney or other professional when an opinion is needed.
