The Voice of Florence Nightingale on Advocacy

Louise C. Selanders, RN, EdD, FAAN; Patrick C. Crane, MSN, RN

Disclosures

Online J Issues Nurs. 2012;17(1) 

In This Article

Advocacy in Nursing

Advocacy has been defined as an active process of supporting a cause or position (Illustrated Oxford Dictionary, 1998). However, advocacy has not always been a clear expectation in nursing. Seminal documents in the development of the American nursing curriculum, such as Nursing and Nursing Education in the United States (Goldmark, 1923) and A Curriculum Guide for Schools of Nursing (National League of Nursing Education, 1937), do not explicitly mention advocacy. Early nursing education emphasized conformity and a position subservient to the physician. Isabel Hampton Robb, an early leader in the development of American nursing education, encouraged obedience as the primary activity of the nurse. In 1900 Robb stated:

Above all, let [the nurse] remember to do what she is told to do, and no more; the sooner she learns this lesson, the easier her work will be for her, and the less likely she will be to fall under severe criticism. Implicit, unquestioning obedience is one of the first lessons a probationer must learn, for this is a quality that will be expected from her in her professional capacity for all future time…. (Hamric, 2000, p. 103).

While Nightingale expected obedience in following the rules and medical direction, her intent was to allow nurses the autonomy of purpose to advocate for patients and the profession (Nightingale, 1893). It is probable that she would have disapproved of Robb's emphasis on obedience.

The term 'advocacy' was first utilized in the nursing literature by the International Council of Nurses in 1973 (Vaartio & Leino-Kilpi, 2004). Today the American Nurses Association (ANA) states that high quality practice includes advocacy as an integral component of patient safety (ANA, n.d.). Advocacy is now identified both as a component of ethical nursing practice and as a philosophical principle underpinning the nursing profession and helping to assure the rights and safety of the patient. Nurses are seen as advocates both when working to achieve desired patient outcomes and when patients are unable or unwilling to advocate for themselves.

Since 1973 advocacy has been considered a major component of nursing practice - politically, socially, professionally, and academically. Despite the seeming lack of a professional focus on advocacy before the early 1970s, it is argued that Nightingale implicitly laid the foundation for nurse advocacy and established the expectation that nurses would advocate for their patients.

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