This chapter focuses on the ethical responsibilities of nurse leaders to advocate for health. A leader who understands how to use power is more likely to be a successful advocate. Building on Foucault’s work, we know that we must look at the relationship between health, power, and diverse populations. In Canada a focus on the Indigenous populations is required if we are to make a difference.
Nurse leaders must also look at the workplace and examine how the presence or absence of structural empowerment and psychological empowerment for care providers impacts patient care. Critical social theory suggests that reflection upon the roles of nurses in health care systems empowers nurses to be effective advocates. Nurse leaders, intent on advocating for health, can join other nurses in political action directed at changing existing health care practices. When no other solution is available to advocate for the health of vulnerable people, whistle-blowing may be employed as a last resort.
After completing this chapter, you should now be able to:
- Identify the importance of ethics to nursing leadership.
- Describe advocacy.
- Compare the advocate approach to the paternalistic approach in addressing health inequities.
- Determine how the nurse leader uses advocacy to introduce change that addresses health inequities.
- Identify the different types of power.
- Recognize the role nurse leaders can have in political action.
- Verbalize your own response to change.
- Pick a shift from one of your most recent clinical rotations. Examine the actions of nurses during your shift and look for examples of the five different types of nursing power. Did you or your fellow nursing students exhibit personal power, expert power, position power, perceived power, or connection power? What types of power did your preceptor exhibit? What about Staff nurses? The charge nurse? Which nurse do you think was the most powerful on your unit? Why?
- Review the CNA’s “June 2016 Environmental Scan Summary” which was discussed in Essential Learning Activity 10.2.1. Select an issue identified in the environmental scan that you believe will have a serious impact on the health of Canadians when you graduate in one to two years. Develop a plan to advocate for the health of Canadians using the advocacy tools provided on the CNA website.
- Read the research article “Exploring confidentiality in the context of nurse whistle blowing: issues for nurse managers” (Jackson et al., 2011) on whistle-blowing (outlined in the Research Note earlier in this chapter). Identify how confidentiality was used to silence and isolate nurses.
- Think of the commonly heard phrase “Nurses eat their young.” What theory explains this phrase? As a graduate nurse, what steps will you take to ensure that people will not describe you as a nurse who “eats her young”?
Canadian Nurses Association [CNA]. (2017). Code of ethics for registered nurses. Retrieved from www.cna-aiic.ca/~/media/cna/...re-interactive
Canadian Nurses Association [CNA]. (2018). Policy and advocacy. Retrieved from https://www.cna-aiic.ca/en/policy-advocacy
Clune, L. & Gregory, D. (2015). Nursing theory and theorists used in nursing. In d. Gregory, C. Raymond-Seniuk, L. Patrick, & T. Stephen (Eds.), Fundamentals: Perspectives on the Art and Science of Canadian Nursing (pp. 192–204). Philadelphia, PA: Wolters Kluwer.
Conger, J. A., & Kanungo, R. N. (1988). The empowerment process: Integrating theory and practice. The Academy of Management Review, 13(3), 471–482.
Criminal Code, R.S.C., 1985, c. C-46, s.425.1(1). Retrieved from http://laws-lois.justice.gc.ca/PDF/C-46.pdf
Curtin, L. L. (1979). The nurse as advocate: A philosophical foundation for nursing. Advances in Nursing Science, 1(3), 1–10.
Davidson, S. J. (2015). Shifting the balance: Relationship as power in organizational life. Nursing Forum, 50(4), 258–264.
Ellenchild Pinch, W. J. (2000). Confidentiality: Concept analysis and clinical application. Nursing Forum 35(2), 5–16.
Gadow, S. (1980). Existential advocacy: Philosophical foundation of nursing. New York: Springer Publishing Company.
Government of Saskatchewan. (2013). Public Interest Disclosure Act. Retrieved from www.employeeservices.gov.sk.ca/pida
Government of South Australia & World Health Organization. (2017). Progressing the Sustainable Development Goals through health in allpolicies: Case studies from around the world. Adelaide: Government of South Australia. Retrieved from www.who.int/social_determinan...-2017.pdf?ua=1
Griffith, R. (2015). Understanding the Code: Acting in a patient’s best interests. British Journal of Community Nursing, 20(9), 458–461. doi:10.12968/bjcn.2015.20.9.458
Halloran, E. J. (1996). Virginia Henderson and her timeless writings. Journal of Advanced Nursing, 23(1), 17–24.
Havens, D. S., & Laschinger, H. S. (1997). Creating the environment to support shared governance: Kanter’s theory of power in organizations. Journal of Shared Governance 3(1), 15–23.
Hawks, J. H. (1991). Power: A concept analysis. Journal of Advanced Nursing, 16(6), 754–762. doi:10.1111/j.1365-2648.1991.tb01734.x
Health Canada. (2015). First Nations and Inuit Home and Community Care (FNIHCC) 10-Year Plan (2013–2023). Retrieved from http://publications.gc.ca/collection...2-2015-eng.pdf
Jackson, D., Peters, K., Hutchinson, M., Edenborough, M., Luck, L., & Wilkes, L. (2011). Exploring confidentiality in the context of nurse whistle blowing: Issues for nurse managers. Journal of Nursing Management, 19(5), 655–663.
Johnstone, M. (2017). Is nursing ethics good enough? Australian Nursing & Midwifery Journal, 25(3), 19.
Kanter, R. M. (1993). Men and women of the corporation (2nd ed.). New York: Basic Books.
Kohnke, M. (1982). Advocacy, risk, and reality. St. Louis, MO: Mosby.
Macias, T. (2015). On the footsteps of Foucault: Doing Foucualdian discourse analysis in social justice research. In S. Strega & L. Brown (Eds.), Research as resistance. Revisiting critical, Indigenous and anti-oppressive approaches (2nd ed.). (pp. 221–242). Toronto: Canadian Scholars’ Press.
MacPhee, M. (2015). Power, politics and influence. In P. S. Yoder-Wise, L. G. Grant, & S. Regan (Eds.), Leading and Managing in Canadian Nursing (pp. 185–204). Toronto: Elsevier.
Mahlin, M. (2010). Individual patient advocacy, collective responsibility and activism within professional nursing associations. Nursing Ethics, 17(2), 247–254. doi:10.1177/0969733009351949
Manias, E., & Street, A. (2000). Possibilities for critical social theory and Foucault’s work: A toolbox approach. Nursing Inquiry, 7, 50–60.
Mannix, J., Wilkes, L., & Daly, J. (2015). ‘Good ethics and moral standing’: A qualitative study of aesthetic leadership in clinical nursing practice. Journal of Clinical Nursing 24, 1603–1610.
McKinnon, J. (2014). Pursuing concordance: Moving away from paternalism. British Journal of Nursing, 23(12), 677–684. doi:10.12968/bjon.2014.23.12.677
Merriam-Webster Dictionary. (n.d.). Retrieved from https://www.merriam-webster.com/
Milton, C. L. (2016). Power with social media. Nursing Science Quarterly, 29(2), 113–115. doi:10.1177/0894318416630104
Office of the United Nations High Commissioner for Human Rights. (1969). Declaration on social progress and development: Proclaimed by General Assembly resolution 2542 of 11 December 1969. Retrieved from www.ohchr.org/Documents/Profe...t/progress.pdf
Paterson, B. L., Duffett-Leger, L., & Cruttenden, K. (2009). Contextual factors influencing the evolution of nurses’ roles in a primary health care clinic. Public Health Nursing, 26(5), 421–429. doi:10.1111/j.1525-1446.2009.00800.x
Public Servants Disclosure Protection Act, S.C. 2005, c. 46. Retrieved from http://laws-lois.justice.gc.ca/PDF/P-31.9.pdf
Reid, J. (2013). Speaking up: A professional imperative. Journal of Perioperative Practice, 2(395), 114–118.
Risjord, M. (2014). Nursing and human freedom. Nursing Philosophy, 15(1), 35–45. doi:10.1111/nup.12026
Spreitzer, G. (2008). Taking stock: A review of more than twenty years of research on empowerment at work. In C. Cooper, & J. Barling (Eds.), The SAGE Handbook of Organizational Behavior (pp. 54–72). Thousand Oaks, CA: Sage Publications.
Stacey, R. D. (2006). Complex responsive processes as a theory of organizational improvisation. In P. Shaw & R. Stacey (Eds.), Experiencing risk, spontaneity, and improvisation in organizational change: Working lives (pp. 124–138). New York: Routledge.
Stout, M. D. (2015). atikowisi miýw-āyāwin, Ascribed health and wellness, to kaskitamasowin miýw-āyāwin, achieved and wellness: Shifting the paradigm. In M. Greenwood, S. de Leeuw, N. M. Lindsay, & C. Reading (Eds.), Determinants ofIndigenous Peoples’ Health in Canada: Beyond the Social. Toronto: Canadian Scholars’ Press.
Sullivan, E. J. (2013). Becoming influential: A guide for nurses (2nd ed.). Upper Saddle River, NJ: Pearson Education.
Sumner, J., & Danielson, E. (2007). Critical social theory as a means of analysis for caring in nursing. International Journal for Human Caring, 11(1), 30–37.
Trudeau, P. (1968). Trudeau’s Vision of Canada as a “Just Society.” The Canadian National Newspaper, retrieved from https://youtu.be/7ofi2CtT_eY
Udod, S. (2008). The power behind empowerment for staff nurses: Using Foucault’s concepts. Nursing Leadership, 21(2), 77–92.
United Nations. (2015). UN Sustainable Development Goals. Retrieved from https://sustainabledevelopment.un.org/sdgs
World Health Organization. (1986). The Ottawa Charter for Health Promotion. Retrieved from www.who.int/healthpromotion/c...ous/ottawa/en/
Zomorodi, M., & Foley, B. J. (2009). The nature of advocacy vs. paternalism in nursing: Clarifying the “thin line.” Journal of Advanced Nursing, 65(8), 1746–1752. doi:10.1111/j.1365-2648.2009.05023.x