Need to No – Giving Too Much

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One of my favorite things about patient advocates and navigators is that they are very generous, kind and giving people. They figure out what needs to be done, and they step up to the plate to do it.

But one of my frustrations with patient advocates is that some are too generous, too kind, too giving.  Too many have never learned where to draw limits, how to assess when they’ve taken on too much, or are in danger of taking on too much. They just don’t know how or when they “need to (say) no.”

Conversations with two APHA members remind me of this.  And it’s worth sharing with you because it may give you the kick in the backside needed to learn to say no when you know you should.  Sometime before you begin dropping all those balls you’re juggling.

One case is an advocate who I will call Molly.  (We have no members named Molly, so don’t try to figure out who I’m talking about!)  She lamented the fact that she just didn’t have enough work, and was worried about keeping her business afloat – yet – she told me how busy she was with clients. I finally figured out that all those clients were people she was helping for free.  They needed help, they could not afford to pay her, so she just began helping them anyway.

How very generous!  Remarkably generous, really.  And I applaud her for that – except – in effect, she was volunteering her way right out of business.  All her time was being spent helping those folks for free, instead of doing marketing, making phone calls, drumming up some speaking opportunities – tasks that could help bring in paying business.

Not to mention the level of stress  (and loss of sleep) when we are not only overworked, but worried that business isn’t going well.

“But,” you say. “Those people need help too!”  And I agree.  But there needs to be a point where you realize that if you spend your time working for free, and don’t stick to building your business, you will go out of business.  At that point, you can’t help anyone all.  No one. Not on a paid basis OR on a volunteer basis, because you will have to go out and get a job that will make up the difference. It’s not worth it.

The solution?

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Standing Up for Our Patients – Those Aretha Franklin Moments

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This post asks the question:  At what points do we go to the wall for our patients?  And when we need to go there, what’s the best approach?

Scenario: You’ve accompanied your patient-client to a medical appointment and the receptionist is rude to your patient when you check in.  Do you say or do anything?  And if so – how?

Scenario:  As you sit by your patient’s hospital bedside, a nurse comes in to change a dressing already wearing gloves.  You ask her to wash her hands and put on new gloves and she cops an attitude.  Do you insist?  And if so, how?

Scenario:  Your client needs to make a very difficult medical decision and has asked for your help to weigh the pros and cons, and to uncover additional possibilities.  You’ve walked him through all the possibilities – including those the doctor provided, and others you learned about through some research you did on his behalf.  His choice is not the same as the doctor’s recommendation, but when he gets to the appointment with his doctor to share his decision, the doctor tells him he’s making the wrong decision. Clearly uncomfortable, your client begins to backpeddle, to default to what the doctor has recommended.  Do you speak up on your patient’s behalf?  And if so, where do you start?

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Do I Have to Be a Nurse to Be a Patient Advocate?

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The answer is simple.  No.

So why do I ask this question?  Earlier this month, while attending the NAHAC Conference, the question was asked by a number of people.  As if the qualification to be an effective patient advocate relied on a nursing education.

Now please don’t get me wrong.  I am a huge supporter of nurses and nursing, in its many important forms.  I’ve written many times at About.com about nurses, nurse practitioners, and why I believe training as a nurse is far more patient-centered than other forms of medical training.  Most of my commentary comes from my appreciation for the “whole patient” approach most nurses provide.  I’m a fan – a BIG fan – of nurses and the nursing model for patient care.

Here are five reasons why a patient advocate does not need to come from a nursing background:

1.  Patient advocates actually perform a number of services, many of which have nothing to do with nursing.  Some are medical bill reviewers, some do research and writing about medical problems…. Nursing isn’t the right background or training for these kinds of services.

2.  Patient advocates are facilitators, but they are not decision-makers.  Patient advocates do not perform medical functions.  They provide options and background information to their patients, but never make decisions on their patients’ behalf.  Since they aren’t making medical decisions, they don’t even need a medical background.  (Not to say a medical background wouldn’t be helpful.  It might be.  It just isn’t necessary.)

3.  No matter what the background of the patient advocate, he or she knows when it is time to find helpful resources to help his or her client.  If the advocate is a nurse, then she knows when to call in a doctor or an insurance expert.  If the advocate is not a nurse, then she knows when to call in a nurse if one is needed.  That means a patient advocate can have almost any type of background and experience…. He will simply set up his system of resource people accordingly.

4.  Patients who need an advocate’s help are all over the map when it comes to what they can afford.  Someone who is not a nurse, or does not have medical training, will charge less (or should charge less) in many instances than an advocate who does have nursing training, making him more affordable than someone who does have a nursing or medical education.

5.  Finally – to make my points – some of the best known and most effective patient advocates, real pioneers in our emerging business of patient advocacy, have no nursing experience or education in their background.  Ken Schueler, perhaps the premier patient advocate in the United States and abroad, does not have an MD or RN after his name. (He did study at Sarah Lawrence in its patient advocacy course.)  Joanna Smith of Healthcare Liaison and President of NAHAC, has a social work background. Elisabeth Schuler Russell learned her skills while advocating for her baby daughter.

Smart advocates will find their training where they can, when they need it, for a particular reason.  For example, an advocate who decides to focus on cancer patients might take courses in understanding oncology.  Or an advocate who needs help understanding extensive medical terminology might take a course to better understand it.

All nurses are patient advocates.  But not all patient advocates need to be nurses to begin with.

If you are considering a career as a patient advocate, then start where you are planted.  But start.

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