Thoughtful and Sustainable Advocacy in Everyday Practice

This is the first in a four-part series exploring advocacy as part of everyday professional practice.

I feel compelled to turn attention towards advocacy skills, as we can all see how needed these skills are at present. When we chose a career in healthcare, we may not have appreciated that we’d have to advocate for the value of the client services in the way it is necessary right now.

Advocacy helps us protect the very conditions needed for quality care, professional integrity and sustainable practice. Along the way, I’ll acknowledge some of the very real challenges we face, while looking at how we can build advocacy capabilities with greater confidence, strategy and clarity, and recognise when responsibility needs to be shared rather than carried alone.

There are times when it is hard not to wonder why we are have to make the case for things we already know are necessary.

Enough time to provide good care. Realistic workloads. Appropriate resources. Access to supervision. The conditions to deliver the evidence-informed, best practice care we were trained to provide.

Most of us would rather be using our time and energy doing the work we were trained to do. Supporting clients, using our professional judgement, collaborating with colleagues and contributing to services that make a difference to our clients and that we can feel proud of.

Yet across our sector, many of us have found that advocacy is crucial for protecting the conditions that make that possible.

The frustration is understandable because we know what is at stake. Quality professional practice is not simply about getting more done. It is about being able to practise with dignity and professional integrity, take responsibility for the things that genuinely sit within our role, and expect organisations and systems to take responsibility for the conditions they have the authority to influence.

So, while we might reasonably wish some of this advocacy were unnecessary, here we are.

The question is how we can advocate in ways that are thoughtful, strategic and sustainable, without taking responsibility for fixing everything ourselves.

Advocacy is already part of our work

We can sometimes think of advocacy as something separate from our everyday professional role. Yet much of it happens through the work we are already doing.

We advocate when we raise concerns about a client's access to appropriate care, make the case for necessary supports or funding, question an unrealistic workload, document when service constraints are affecting care, seek supervision around an ethical or professional concern, or maintain a boundary when what is being asked of us is not sustainable.

Self-advocacy belongs here too.

Raising concerns about workload, role clarity, supervision, resources or our capacity to practise safely is not simply about protecting ourselves. These conditions can also affect the quality and sustainability of the work we provide.

The distinction that matters is between taking professional responsibility and taking responsibility for the whole problem.

We may have a responsibility to notice something, document it, raise it or escalate it.

That does not mean we are responsible for personally resolving an underfunded service, inadequate staffing model or wider systemic problem.

• We can recognise where we have a role to play, and where others need to be involved.

• We can contribute to finding a way forward without assuming we have to do it alone.

• We can seek support when an issue extends beyond our role, authority or expertise.

And importantly, advocating for a gap to be addressed is different from personally filling it.

Why advocacy can feel so difficult

When we can see what good practice requires but the funding, resources or workforce conditions do not make it possible, it is understandable that many of us feel compelled to keep pushing for something better.

There is a name for some of this experience.

Moral distress describes what can happen when we know the ethically appropriate course of action, but organisational or institutional constraints make it difficult or impossible to act (Jameton, 1984).

More recent work on moral injury has also challenged us to consider whether some of the distress experienced by health professionals comes not from an inability to cope, but from repeatedly working in circumstances that conflict with deeply held professional values (Dean et al., 2019).

This helps explain why advocacy can carry such weight.

We may care deeply about an issue and feel responsible for pursuing it. When there is no straightforward solution, or when the authority and resources required sit elsewhere, it can be easy to keep carrying the concern ourselves.

Psychological safety matters too.

Before we can raise a concern, we need to be able to notice it, trust our professional judgement enough to explore it and feel able to seek another perspective.

Supervision and trusted professional relationships can give us space to test our thinking before deciding what needs to happen next.

Developing advocacy capabilities

Effective advocacy does not mean responding to every concern with maximum effort.

It means making considered decisions about where our effort is most useful.

Across this series, we are going to look at three things that can make advocacy more effective and sustainable:

• Confidence: Can we identify and raise what matters, while recognising that asking for support is also part of effective advocacy?

• Strategy: Is this the right issue, person, forum and time? Do we need a conversation, documentation, supervision, escalation or the involvement of others?

• Clear messaging: Can we explain what is happening, why it matters and what is needed in language that connects with the responsibilities and priorities of the people who can act?

These capabilities help us use our existing professional role and influence more effectively, rather than simply putting more effort into advocacy.

• Sometimes thoughtful advocacy means speaking up.

• Sometimes it means asking a question rather than assuming we understand why a decision has been made.

• It might mean seeking supervision before acting, documenting a concern so there is an accurate record, or raising a workload or resource issue with clear examples of its impact on quality, safety or sustainable practice.

• And sometimes it means maintaining a professional boundary when what is being asked of us would compromise professional standards or our capacity to practise safely.

Sustainable advocacy also means knowing when the concern needs to be shared.

This might mean seeking supervision to test our thinking, involving colleagues who bring another perspective, or using an appropriate escalation pathway when addressing the issue requires decisions or action from others.

Sharing a concern can strengthen our understanding of the issue and help identify the most appropriate next step.

There will always be things in our work that matter deeply to us but are bigger than any one of us can resolve.

Perhaps the question is not, How do we fix this?

Perhaps it is: What is within our influence here, what needs to be shared, and what would thoughtful and sustainable advocacy look like in this situation?

Want to read more?

Stephen R. Covey's The 7 Habits of Highly Effective People (1989) includes his well-known distinction between our Circle of Concern and Circle of Influence. It offers a useful prompt for considering where we direct our effort, while remembering that organisational accountability and responsibility for systemic conditions remain important.

References

• Covey, S. R. (1989). The 7 habits of highly effective people: Powerful lessons in personal change. Free Press.

• Dean, W., Talbot, S. G., & Dean, A. (2019). Reframing clinician distress: Moral injury not burnout. Federal Practitioner, 36(9), 400–402.

• Jameton, A. (1984). Nursing practice: The ethical issues. Prentice-Hall.

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