I’ve done advocacy for friends and loved ones all my life. Now I just want to get paid for it.

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screamingladyThose words….  I wish I had a nickel for every time someone told me “I want to join the Alliance of Professional Health Advocates because I’m good at advocacy, I’ve done it for years for friends and family, and now I just want figure out how to get paid for it.”

Honestly?  Sometimes those words make me want to scream, because I know they will never make that leap.

The answer is actually very simple (it’s only four words!), and is provided below. The problem is, no matter how simple the answer, no matter how many opportunities they have – the majority of people who can make that statement will never be paid for independent advocacy work.

Why not?

First, let’s examine who these folks are and what has brought them to this point.

Most nurses who want to become independent advocates (and others too – don’t want you to think I’m picking on nurses!) have spent an entire career working for an employer, in a workplace that has very specific, pre-prescribed, rarely changeable rules. Rules for everything, ranging from how to answer the phone, to exactly how to do their work, how much time they were allowed to spend doing it, and sometimes even what they were expected to wear. If someone broke a rule, it could have dire consequences for many others, including patients (who could get sicker or die) and other personnel, who would look down on the rulebreaker as if he or she was someone to be disdained. If a problem needed a solution for which there wasn’t already a rule, then a new rule was created.

If you are one of those workers, then you understand well how the rules are double-edged:

  • Rules make it easy to know what is expected, even when they make it hard to do the work the way you would want to do it.
  • The rules work for many or most of the patients who need help, but when they don’t work, the result can be devastating.
  • Working within the rules makes collection of a paycheck a regular thing, but it may be at the expense of feeling as if you have done the right thing for all your patients.

And so it is: a workplace with lots of rules, that discourages and inhibits independence and free-thinking, produces a regular paycheck. You never have to ask for it. Sometimes it goes up, sometimes it goes down – but it’s always pretty consistent, and you get paid.

By now you’re beginning to see the problem with getting paid for helping family and friends… It’s a shift to independent advocacy with no rules. And the need to create one’s own paycheck for something that has always been done for free.

Most of the folks who tell me that’s why they want haven’t made the leap to the fact that the paycheck isn’t going to appear, because there isn’t a paycheck-granting entity that exists to support that work. That means that to be independent advocates, doing the work the way they want to do it, means they will have to ask for that money themselves directly from the people they expect to pay them – patients (clients) or caregivers.

Yes – it’s that simple:  They can get paid when they ask for the money (there are the four words!).

But it’s that complex: most have little or no ability to ask.

It IS hard to ask for money!  For a variety of reasons, including the fact that we were taught as children that it is impolite.

Even more so, asking for money makes us feel as if we are asking to be judged. In particular, many nurses have spent a lifetime in a workplace that devalued their contributions, making them feel demeaned and not worthy. Therefore, they have little or no ability to understand how valuable they are to the patients who need their independent thinking – and therefore they find it almost impossible to ask for money – because they aren’t comfortable with the judgment aspects of asking.

“If you think I’m worth it, you will pay me money.  But I’ve spent a lifetime being told I’m not worth it. Therefore I can’t ask for money because I am afraid you’ll say no, and prove the others were right.” (Or something like that – some armchair psychology here.)

Therein lies the crux of the problem.  In fear of judgment (and adhering to childhood lessons) – the very people who can help patients in the ways they desperately need help won’t ask for money, won’t get paid, and therefore cannot commit themselves to full time, independent advocacy.

Now you see why I want to scream when I hear those words!

Through APHA and the Health Advocate Handbooks, I’ve provided many tools for getting past that hurdle of being afraid to ask for money. From “how tos”, to rationale, to figuring out value and how much to charge – all that. But what I can’t do is to rid people’s heads of those ill-conceived (even if well understood) voices in their heads that make them feel as if somehow they should not ask for money because they may not be worthy.

So I challenge you today!  Get over it!  Your skills are needed desperately by patients and caregivers!  You can save lives!  You can prevent financial ruin!  Those voices in your head are wrong!  Your advocacy is badly needed!

You ARE worth it!  and so – yes – it’s time to do the advocacy work you’ve done all your life – and it’s time to get paid for it.

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Agree? Disagree?

Share your experience or join the conversation!


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  1. Victoria Nahum  June 23, 2014

    Experienced patient advocates have much to offer but often they are asked to participate in healthcare events for free. And while I am all for being good natured and helpful to a cause I believe in, I am startled how some people in healthcare who are paid good salaries for a living simply EXPECT patient advocates to contribute to their events with no financial help. For many of us, our only source of income is our advocacy and while no one’s getting rich, we do it because we are mission-minded; we are wholly committed to our work. For my husband and me, it is satisying to us that we get to talk about ways to prevent harm after the loss of our son. It is a healing process, at least for me and I get to meet so many wonderful caregivers who want to be the difference for their patients. But in the end, even though many of us have quit successful careers in other industries to do this work, we are people who still have to pay our mortgages and put gas in our cars and food on the table. So please. When you ask an advocate to contibute their time, experience and wisdom to your next project, consider their value and help them continue in the work you say you value so much. – Victoria Nahum, Safe Care Campaign

  2. Trisha Torrey  June 23, 2014

    Amen Victoria!

    Like you, I get requests frequently to donate my time. From “we would love your input on this – will you provide feedback?” to “we’d love to have you speak at our event (but no, we won’t pay you an honorarium, nor can we afford to cover your travel.)”

    When I was first getting started – almost 10 years ago! – I sometimes accepted those terms, because I gained experience and met movers and shakers, both of which served my early advocacy well. But now I’m the mover and shaker, and in order to stay in this space, I must earn a living. So no longer do I donate my time. I just can’t afford to.

    I did make it easier to reply to those requests, tho. I set up a consulting page on my personal website: http://everypatientsadvocate.com/consultant/index.htm So now I just reply with that link. Those who are serious then understand the parameters.

    So – in effect, I take my own advice. If you want to get paid, you have to understand your value, and you have to ASK 🙂 – no matter what form of advocacy you deliver.

  3. Nancy Ferenstein  June 25, 2014

    So true. … Wonderful advice as always …ok I am going to have some new rules …inspirational


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