Barriers to Communication:

The selected media report was published on the website of

Health And Disability Commissioner (HDC) New Zealand on

September 20th 2012. The report is about the

commissioner’s decision regarding a medication error

committed by a registered nurse working in a DHB. The RN

in the report negligently attached Mr X’s medication

sheet to Mr Y’s file. The RN then went through Mr X’s

medication on PYXIX (medication software) and checked out

four drugs which were actually prescribed for Mr X, which

she could not find on the miss matched medication sheet.

The RN administered to Mr X medication prescribed for Mr

Y, but after some time she realised her error but did not

report it to anyone. Later Mr X’s condition deteriorated

and he collapsed and died (Health and Disability

Commissioner, 2012). The next day higher authorities

found out that the RN have committed a medication error

and failed to report it. Investigation was conducted by

HDC and confirmed that RN have done a medication error

and she has failed to communicate this error to the nurse

manager and the physician. She was found guilty of

violating right 4(1) of the code of health and disability

service consumer rights. HDC will refer this case to the

director of proceedings as per the section 45(2) of

health and disability commissioner act 1994 (Health and

Disability Commissioner, 2012).

1383879 1

America’s National Centre for Patient Safety has

identified communication failure as the primary cause for

75 per cent of adverse events happening in hospitals

(Victorian Quality Council Secretariate, 2010). One key

barrier which leads to ineffective communication is

significant power distance between nurse and superiors

and nurse and other health professionals. A Second factor

is the difference in training, education and

communication style of different health professionals

( Dingley, Daugherty, Derieg, & Persing,, 2012).

Power distance is defined as “The extent to which an

unequal distribution of power is accepted by members of a

society/organisation” (HOFSTED CENTRE, 2011) .This power

distance develops because of the hierarchical

organisational structure with in the institutions

( Dingley, Daugherty, Derieg, & Persing,, 2012). The

power distance in the hospital prevents the junior staff

from reporting events and clarifying doubts with the

senior staff (Victorian Quality Council Secretariate,

2010). A cross sectional study conducted among nurses in

Taiwan found out that the major perceived barrier in

communicating medication error with higher authority was

fear related to power hierarchy/distance, face-saving

concern, and work environment factors (Chiang & Pepper,

2006).This distance inhibits and restrains effective

communication between health professionals ( Dingley,

Daugherty, Derieg, & Persing,, 2012).

1383879 2

Second barrier is the difference in training and

education style of different health professionals

( Dingley, Daugherty, Derieg, & Persing,, 2012). Nurses

and doctors have been working together in New Zealand’s

primary care setting for over a period of 30 years. In

spite of the experience of working together as a team

their communication is still poor. The possible reasons

are the difference in training style, lack to training to

work as a team and lack of time to engaging in effective

communication. Some other factors are professional

stereotyping and perceived inequality in status (Pullon,

2008). A study was conducted in Chicago, USA to assess

the pattern of nurse –doctor communication the result

showed that Nurses correctly identified patients'

physicians 71% of the time and reported communicating

with them 50% of the time. Physicians correctly

identified the patients' nurses 36% of the time and

reported communicating with them 62% of the time. Nurses

and physicians did not reliably communicate with one

another and were often not in agreement on the plan of

care for hospitalised medical patients (O'Leary , et al.,

2010).

The Nursing Council of New Zealand competencies 3.3 and

4.1 stress effective therapeutic inter-professional

communication and working as a productive member of a

multi-disciplinary team to deliver safe and effective

care to the consumer (NCNZ, 2012). An effective strategy

to improve interdisciplinary communication for nurses is

1383879 3

to utilize SBAR tool while communicating client data’s

(Safer Healthcare, 2013). SBAR is an acronym for:

Situation: What is happening with the client, Background:

What is the client’s clinical background, Assessment:

What does the nurse think the problem is, Recommendation:

What do the nurse think needs to be done for the client (

Dingley, Daugherty, Derieg, & Persing,, 2012). The SBAR,

being a standardised communication tool in patient care,

effectively reduces the differences in communication

style of different professional and helps

multidisciplinary team members to understand each other

effectively (Scalise, 2013).

A study was conducted in Philadelphia, USA to examine the

feasibility and utility of SBAR communication tool in a

long term care facility. The study assessed the pre and

post SBAR utilization responses from nurses and

physicians. The SBAR helped nurses organise their

thoughts and increased their confidence in communication

within the health care team. The tool made communication

clear so that nurses need not guess missed points and

also helped them to effectively report incidents. The

tool was helpful to streamline data, and assist with

remembering everything that needs to be collected before

the contacting the physician or other team member. The

tool diminished the stress on a nurse when communicating

information (Renz,, Boltz, Wagner, Capezuti, & Lawrence,

2013) . The physicians reported that nurses were

consistently providing adequate information regarding

1383879 4

change in client’s status and that this information

influenced the decision-making for hospitalization of

residents. Clear communication not only improves nurses

and medical provider’s satisfaction but also improves

care outcomes and client safety (Renz,, Boltz, Wagner,

Capezuti, & Lawrence, 2013).

Few identified drawbacks of SBAR tool were; some nurses

found it time consuming, the SBAR could not improve the

negative attitude of some physicians and health care

professionals. The tool could not do anything to control

factors such as background noise (Renz,, Boltz, Wagner,

Capezuti, & Lawrence, 2013).

A strategy to address power distance barrier is team

huddle, which is a meeting of a nursing team to set the

day/shift in motion with input from key people , the

meeting will focus on the functioning of a specific unit

and team ( Dingley, Daugherty, Derieg, & Persing,, 2012).

The nursing team huddle strategy was used in a hospital

in Lexington, USA in a 23 bedded telemetry unit with 3

small decentralised nursing stations. The huddle helped

to review the work load of each nurse, which helped the

charge nurse to make effective staff allotments, reduce

stress of nurses and minimise errors. Huddle also

improved the inter- personal communication among the unit

nurses (Dagley & Hill, 2010)

Huddles are led by the nurse manager, charge nurse, or

clinical nurse educator. The huddle helped nurses; to

1383879 5

improve face-to-face communication, Immediately respond

to questions, respond to issues or concerns fast,

Efficiently transfer information’s, improve teamwork ,

reduce hierarchical fear and minimise errors ( Dingley,

Daugherty, Derieg, & Persing,, 2012). Huddles work

because they demand rapid team formation and preparation

at the practice level. They allow the practice to plan

for any changes in the daily work flow, Manage crises

before they arise, and make adjustments in ways that

improves access to patients and quality of life for the

staff (Transformed, 2007).

1383879 6

References

Dingley, C., Daugherty, K., Derieg, M. K., & Persing,, R.

(2012). Improving Patient Safety Through Provider Communication

Strategy Enhancements. Retrieved from

http://www.ahrq.gov/downloads/pub/advances2/vol3/adv

ances-dingley_14.pdf

Dagley, J., & Hill, K. S. (2010). Looking for better teamwork?

Form a huddle. Retrieved from

http://www.reflectionsonnursingleadership.org/pages/

vol36_2_col_hill_dagley.aspx

Health and Disability Commissioner. (2012). Registered Nurse,

Ms C: Executive summary. Retrieved from

http://www.hdc.org.nz/decisions--case-notes/commissi

oner's-decisions/2012/10hdc01201

HOFSTED CENTRE. (2011). What about Panama? Retrieved from

THE HOFSTED CENTRE:

http://geert-hofstede.com/panama.html

NCNZ. (2012). Continuing competence. Retrieved from

http://nursingcouncil.org.nz/Nurses/Continuing-

competence

O'Leary , K. J., Thompson, J. A., Landler, M. P.,

Kulkarni , N., Haviley , C., Hahn, K., . . .

Williams , M. V. (2010). Patterns of nurse-physician

communication and agreement on the plan of care.

Quality and Safty in Heaqlth Care, 19(3), 195-199.

1383879 7

Pullon, S. (2008, March). Competence, respect and trust:

Key features of successful interprofessional nurse-

doctor relationships. Journal of Interprofessional Care,

22(2), 133-147.

Renz,, S. M., Boltz, M. P., Wagner, L. M., Capezuti, E.

A., & Lawrence, T. E. (2013). Examining the

feasibility and utility of an SBAR protocol in long-

term care. Geriatric Nursing, 34(1), 295-301.

Safer Healthcare. (2013, January). What is SBAR and What is

SBAR Communication? Retrieved from Safer Healthcare:

http://www.saferhealthcare.com/sbar/what-is-sbar/

Scalise, D. (2013). Clinical Communication and Patient Safety.

Retrieved from

http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?

dcrpath=HHNMAG/PubsNewsArticle/data/2006August/

0608HHN_gatefold&domain=HHNMAG

Transformed. (2007). Huddles: Increased Efficiency in Mere Minutes a

Day. Retrieved from

http://www.transformed.com/workingPapers/Huddles.pdf

Victorian Quality Council Secretariate. (2010, July).

Promoting effective communication among healthcare professionals

to improve patient safety and quality of care. Retrieved from

http://www.health.vic.gov.au/qualitycouncil/download

s/communication_paper_120710.pdf

1383879 8

Conflict resolution:

Nursing profession is built on collaboration and

therapeutic relationship with consumers and colleagues.

When an issue or situation is viewed and understood

differently by two nurses it can lead to a conflict (CNO,

2009). Intra professional conflicts can lead to poor work

relationships, job dissatisfaction, nursing staff

shortages and poor consumer satisfaction (Duddle &

Boughton, 2007).

The Nursing Council of New Zealand new Code of Conduct

principle 6 instructs nurses to work respectfully with

colleagues to best meet health consumers’ needs.

Principle 6.4 clearly states that nurses must behave

respectfully towards colleagues and should not show

1383879 9

dismissiveness, indifference, bullying, verbal abuse,

harassment or discrimination against any colleagues. It

also prevents nurses from discussing colleagues in public

places (NCNZ, 2012).

The video enacted a scenario of a professional conflict,

how it affected the individuals and possible conflict

resolution strategy. Cecil is a new graduate nurse who is

ambitious and a new member of the nursing team. Her

preceptor Charley is an efficient but busy and demanding

person. Charley was not happy being made a preceptor; he

demonstrated a bullying attitude towards Cecil. He was

not ready to guide her properly and also expected Cecil

to perform at her best. Research studies have shown that

new graduate nurses experiences much stress during the

transition from a student to a registered nurse as they

are expected to rapidly work as a competent nurse. The

research suggested that the new graduate need extended

orientation and effective support to become competent

registered nurses (Casey, Fink , Krugman, & Propst,

2004).

There are two instances in the video where Charley

comments negatively about Cecil’s work in front of the

patient. New graduate nurses are often subjected to

relational aggression in the form of humiliation and put-

downs usually directed towards the nurse’s skills and

ability (Dellasega, 2009). When Cecil approached Charley

to talk about how she felt about his behaviour towards

1383879 10

her, he was aggressive and avoided her. The stress of

being a new RN and bullying will affect the person

adversely and make them feel poorly skilled, lacking

confidence and reduces their self-esteem (Dellasega,

2009). The new graduate in the scenario feels she is

incompetent and worthless, because of Charley’s attitude

towards her. New graduates often experience difficulty in

feeling accepted in their assigned units, which lead to

poor coping mechanisms. This puts the hospitals at risk

for losing the newly graduated nurses within the first

year which reduces the number of nurses to give effective

nursing care and increases the burden on existing nurses

(Bolden, Cuevas, Raia, Meredith, & Prince, 2011).

Charley has increased work load and he is not happy about

it, so he considers the preceptor ship as an extra burden

and accepted it reluctantly. This stress added to the

rift in the professional relationship. A survey study

conducted in Canada showed that being a preceptor can be

a stressful experience, with increased workload being

main reason for stress. The workload resulted in lack of

time, and insufficient feedback and guidance. The study

recommended that both students and preceptors require

proper readiness assessment and preceptor ship

preparation. Preceptor ship stress needs to be

acknowledged by workload adjustments and support from

nurse educators, peers, and managers (Yonge, Krahn,

Trojan, Reid, & Haase, 2002).

1383879 11

Nursing managers spend much of their time addressing

employee conflicts. Commonly seen styles identified to

resolve conflict among nurses are accommodating,

avoiding, collaborating, competing, and compromising

( Iglesias & Vallejo, 2012). Collaboration is the most

sensible approach in resolving a conflict. It is an

assertive and cooperative approach that allows

individuals to think and reach a conclusion ( Hiemer ,

2013). In collaboration every person involved in conflict

meets the problem with equal concern. This helps in the

identification of areas of agreement and disagreement,

and selection of a solution to the problem that

incorporates both parties’ perspectives ( Iglesias &

Vallejo, 2012). A study was done in a paediatric hospital

in Greece to identify causes of conflict and strategy

used to manage it. Out of the 286 nurses surveyed in the

research 75 nurses (45%) used collaboration as an

effective strategy to tackle conflict. Collaboration was

considered as mature behaviour in conflict management by

nurses (Kaitelidou, Kontogianni, & Galanis, 2012). In the

scenario the charge nurse used a collaborative strategy

to solve the issue. She called both parties involved and

discussed about the possible solutions. The new graduate

agreed to join an EKG course and preceptor agreed to

behave more professionally and understood that Cecil can

reduce his work load if trained properly.

Another strategy to manage conflict is accommodation. In

accommodation the nurse who is part of the conflict

1383879 12

accommodates the other person by placing the other

person’s wish first. This strategy is important when the

issue is more important for the other person. It helps to

maintain the harmony in the team (Roussel & Russell ,

2006). Accommodation is sometimes relevant, as it

encourages people to express themselves. This results in

an agreeable relationship between both parties (Vivar,

2006). Overuse of accommodation can cause the

accommodating nurse to become professionally weak and can

lead to another conflict as other members of the team

will start to question the decision (Daniels, 2003). A

study was conducted in Spain among nurses to learn about

their conflict resolution strategies. The results

demonstrated that nurses in the clinical environment used

accommodation as their conflict resolution strategy more

frequently (27.0%) ( Iglesias & Vallejo, 2012). In the

scenario preceptor must have used accommodation strategy

instead of arguing when Cecil came to talk to him about

how she felt when he behaved aggressively towards her.

The same strategy could also have been utilized when he

scolded the new graduate in front of the patient. Instead

of reacting badly and asking her to leave and increasing

the patient’s fear he could have demonstrated the

procedure and helped her to learn.

1383879 13

New nurses in New Zealand find they are less prepared to

face the challenges of new working environment, to face

work place conflict & conflict resolution and stress

management. Bullying and harassment were identified as

being present in 38.2 % of New Zealand nursing work

places (NZNO, 2011).

I, being a new nurse in New Zealand, must be prepared to

handle the stress of the workplace, so conflict

resolution strategies will be immensely helpful in

helping me to tackle the work place conflicts. Nurses in

New Zealand have encountered inter-professional conflicts

especially with doctors. A study conducted in Wellington

among doctors and nurses found that there is less

universal therapeutic inter-professional relationship

between doctors and nurses in New Zealand, and such

relationships are essential to provide comprehensive care

to the consumers (Pullon, Competence, respect and trust:

Key features of successful interprofessional nurse-doctor

relationships, 2008). Understanding conflicts and

learning about conflict resolution strategies can help me

to prevent inter-professional and inter-personal

conflicts and also to manage these conflicts effectively.

I can utilize collaboration strategy to manage the inter-

professional conflicts along with other strategies based

on the situation.

A survey study conducted among new graduate nurses in New

Zealand found that interpersonal conflict or horizontal

1383879 14

violence is a significant issue confronting the nursing

profession. 34% of respondents in the research

experienced rude, abusive and humiliating criticism

from the colleagues ( McKenna, Smith, Poole, & Coverdale,

2003). As I gain more experience as a nurse in New

Zealand, understanding conflict and its resolution

strategies will help me to be an effective preceptor for

new graduates, these strategies, especially accommodation

for a new graduate will help me to understand their lack

of experience and guide them to become competent.

References

Hiemer , A. (2013). Conflict Resolution. Retrieved from RN

Journal:

http://rnjournal.com/journal-of-nursing/conflict-

resolution

Iglesias, M. E., & Vallejo, R. B. (2012). Confl ict

resolution styles in the nursing profession.

Contemporary Nurse, 43(1), 73-80. Retrieved from

http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?

sid=a2d9cfa6-a55d-4b5c-8674-

68af0bea1532%40sessionmgr111&vid=5&hid=103

McKenna, B. G., Smith, N. A., Poole, S. J., & Coverdale,

J. H. (2003). Horizontal violence: experiences of

Registered Nurses in their first year. Journal of

Advanced Nursing, 42(1), 90–96.

1383879 15

Bolden, L., Cuevas, N., Raia, L., Meredith, E., & Prince,

T. (2011). The use of reflective practice in new

graduate registered nurses residency program. Nursing

Administration Quarterly, 35(2), 134-139.

Casey, K., Fink , R., Krugman, M., & Propst, J. (2004).

The graduate nurse experience. The Journal of Nursing

Administration, 34(6), 303-311.

CNO. (2009). Conflict Prevention and Management: Practice guideline.

Retrieved from College of Nurses of Ontario:

http://www.cno.org/Global/docs/prac/47004_conflict_p

rev.pdf

Daniels, R. (2003). Nursing Fundamentals: Caring & Clinical Decision

Making. Clifton prk, NY: Delmar learning Inc.

Dellasega, C. A. (2009). Bullying Among Nurse. American

Journal of Nursing, 109(1), 52-58.

Duddle, M., & Boughton, M. (2007). Intraprofessional

relations in nursing. Journal of Advanced Nursing, 59(1),

29-37.

Kaitelidou, D., Kontogianni, A., & Galanis, P. (2012).

Conflict management and job satisfaction in

paediatric hospitals. Journal of Nursing Management,,

20(1), 571-578.

NCNZ. (2012). A new Code of Conduct for nurses. Retrieved from

Nursing Council of New Zealand:

1383879 16

http://nursingcouncil.org.nz/News/A-new-Code-of-

Conduct-for-nurses

NZNO. (2011). Young nurses in Aotearoa New Zealand. Retrieved

from New Zealand Nurses Organization:

http://www.nzno.org.nz/Portals/0/publications/Young

%20Nurses%20in%20Aotearoa%20New%20Zealand%20(full

%20report).pdf

Pullon, S. (2008, March). Competence, respect and trust:

Key features of successful interprofessional nurse-

doctor relationships. Journal of Interprofessional Care,

22(2), 133-147.

Roussel, L., & Russell , C. (2006). Management and

Leadership for Nurse Administrators. Philadelphia, PA,

United States: Jones and Bartlett Publishers, Inc.

Vivar, C. G. (2006). Putting conflict management into

practice: a nursing case study. Journal of Nursing

Management, 14(3), 201-206.

Yonge, O., Krahn, H., Trojan, L., Reid, D., & Haase, M.

(2002). Being a preceptor is stressful! Journal of

Nurses in Staff Development, 18(1), 22-27. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/11840019

1383879 17

Critical thinking

TASK A

As a requirement of my communication paper I conducted a

health interview with Mr Gyan (pseudo name) a New Zealand

citizen. I used the Gibbs cycle to critically reflect on

the interview. The first stage of Gibbs cycle is

description of the situation without making any judgement

(Counties Manukau DHB, 2013).

The interview was scheduled on xx/xx/xx at Mr Gyan’s

residence, I reached there on time and he welcomed me

with a smile. I informed him the purpose of interview and

obtained informed consent and assured confidentiality. I

explained him that as I am not a NZRN any specific health

related advice cannot be given. During the interview I

could understand his accent and he was able to follow

mine, I clarified if some words where not clear to me. Mr

Gyan repeated those words which had confused me.

The second Gibbs stage is about interviewer’s reactions

and feeling (Counties Manukau DHB, 2013). I felt

1383879 18

comfortable as he showed interest in the interview and

was responding to my questions with a smile. I was more

confident talking with him the second time se we had an

introductory meeting earlier in the week. I was little

concerned because of the situation where I could not give

him any professional advice because I am still in the

process to become an NZRN. He answered all the questions

asked to him in the health interview .There was one

question which asks “what do you expects could happen to

your health in future? “ which I didn’t feel comfortable

to ask considering his age, however he answered it

elegantly and surprised me.

The evaluation stage makes value judgments on what was

good and bad about the experience (Counties Manukau DHB,

2013). The good thing about the interview was I got hands

on experience of communicating with a New Zealander and I

was able to communicate well. The client felt more

comfortable taking about his health issues when he

understood I am already a registered nurse in India. The

bad thing was I could not give him any specific health

related information about his condition as I am not a

NZRN yet. He could also not ask me any question as this

situation was explained at the beginning interview.

In the analysis I felt the interview was valuable

exercise to improve my communication with the local

population. Going through the questionnaire and

literature prior to interview helped me to plan ahead.

1383879 19

The thought that, the health interview being my first

experience in New Zealand made me anxious. New graduates

participated in a research conducted in Florida reported

frequent experiences of less than ideal communication

with health care team members and patients (Dyess &

Sherman) .

After the interview I felt that I could have reviewed

sources on Kiwi slang to understanding some humour and

certain phrases, other than that the communication was

effective. I understood that Mr Gyan enjoyed small humour

in between the conversations. Action plan is the last

step in the cycle which talks about strategies on will

take if the same situations arise again (Counties Manukau

DHB, 2013). In future health interviews I will be well

prepared and will be more structured with questions. I

will review more literature on therapeutic communication

to sharpen my skills.

Therapeutic relationship is a vital aspect in nursing

practice with a focus on meeting the health or care needs

of the health consumer (NCNZ, 2012) There are five

components to therapeutic nurse-consumer relationship:

trust, respect, professional intimacy, empathy and power

(CNO, 2006). I will address these components to develop

therapeutic relationship with Mr Gyan in a clinical

setting.

A trusting relationship with the nurse is essential to

reinforce and strengthen the support system for clients

1383879 20

(Washington , 1990). As I am familiar with Mr Gyan and

his support system I can make a trusting and respectful

relationship with him in hospital. Professional intimacy

is part of therapeutic relationship where nurse interact

with the clients with in the professional boundaries

(CNO, 2006). I will provide care to Mr Gyan by

identifying his need and well with the guidelines of

professional boundaries.

Empathy in nursing means to understand the client’s

feelings and to communicate that understanding to provide

therapeutic care to the client ( Mercer & Reynolds,

2002). As I have an understanding of Mr Gyan’s health

condition and how he feels about his current and future

health status I can understand and relate it to the

multidisciplinary team.

The registered nurse acquires power associated with her

position, specialized knowledge, and relationship with

health care providers and access to privileged

information (NANB, 2011). I will work with partnership to

provide specific nursing care and health information to

Mr Gyan. I will also advocate for Mr Gyan utilizing my

professional power.

1383879 21

References

Mercer, S. W., & Reynolds, W. J. (2002). Empathy and

quality of care. The British Journal of General Practice,

52(Suppl), 9-12.

CNO. (2006). Practice Standard: Therapeutic Nurse-Client Relationship,

Revised 2006. Retrieved from

http://www.cno.org/Global/docs/prac/41033_Therapeuti

c.pdf

Counties Manukau DHB. (2013). Reflection in Nursing Practice.

Retrieved from

http://www.countiesmanukau.health.nz/funded-

Services/PHC-nursing/pdrp/reflection.htm

1383879 22

Dyess, S. M., & Sherman, R. O. (n.d.). The first year of

practice: new graduate nurses' transition and

learning needs. Journal of Continuing education in Nursing,

40(9), 403-410.

NANB. (2011). Practice Standard:The Therapeutic nurse-client

relationship. Retrieved from Nurses association of New

Brunswick:

http://www.nanb.nb.ca/PDF/Practice_Standard-Nurse-

Client_Relationship_E.pdf

NCNZ. (2012). A new Code of Conduct for nurses. Retrieved from

Nursing Council of New Zealand:

http://nursingcouncil.org.nz/News/A-new-Code-of-

Conduct-for-nurses

Washington , G. T. (1990). Trust: a critical element in

critical care nursing. Focus on Critical Care, 17(5), 418-

421.

Task B:

1383879 23

“Nursing advocacy involves engaging others, exercising

voice and mobilizing evidence to influence policy and

practice. It means speaking out against inequity and

inequality. It involves participating directly and

indirectly in political processes and acknowledges the

important roles of evidence, power and politics in

advancing policy options” (CNA, 2013).

Nursing advocacy is an important aspect of the

profession, advocacy help every individual nurse to make

a positive impact on the profession. Advocacy is

essential to impart safe and healthy nursing care and

also to maintain a healthy working environment. Nurses

can advocate for the consumer as well as for the

profession irrespective of their position. Every nurse

can advocate on their own behalf, for colleagues at the

unit level, or for issues at the organizational or system

level (Tomajan, 2012).The nursing council of New Zealand

ensures with their code of conduct and competencies that

nurses acts responsibly and advocate for the consumer to

ensure they receive safe and therapeutic care. Advocacy

is described in principle 3.7 of the code of conduct and

competency 1.5 which says that nurses must advocate for,

and assist, health consumers to access the appropriate

level of health care (NCNZ, 2012).

The Professional organizations in nursing are critical,

as they advocate for the consumers and nurses by

generating energy, flow of ideas, and proactive work

1383879 24

needed to maintain a healthy profession (Matthews, 2012).

The New Zealand Nurses Organisation (NZNO) is the leading

professional nursing body representing over 46,000 nurses

and health workers practicing in New Zealand. NZNO is the

central point of representation, support and advocacy for

nurses (NZNO, 2009) .

NZNO formed a smoke free nurse advocacy group which

positively attracted interest and Commitment from nurses

across New Zealand and funding from the Ministry of

Health. The aim of the group is to address the smoking

epidemic in New Zealand and encouraging nurses to deliver

effective smoking cessation interventions to smokers in

everyday practice ( Wong, Clair, & Tasi‐Mulitalo, 2012).

This advocacy group was formed on a basis of research

evidences and inputs taken from nurses from different

cultural (Māori, Pacifica, Asian and Pākehā) and practice

background. They recommended for the complete ban on

tobacco display in all places. This advocacy group talk

for those who are affected secondarily by the tobacco

smoke, protecting children who are at risk for becoming

smokers and encouraging smokers to quit smoking. This

initiative will eventually help to reduce the economic

burden on the government caused by tobacco (Wong, Nursesfor a Smokefree Aotearoa/New Zealand, 2007)

Nurses are suitable candidates for the roles of patient

advocate, in spite of that there are much controversy

surrounding the issue of nurses in the role of patient

1383879 25

advocate. Some of the issues raised are inability for the

patient to choose his or her nurse; promotion of self-

interest; charges of paternalism; challenges from other

health care professionals and multiple/conflicting other

nursing tasks. The article also says that the most

ethical way of caring is by empowering patients and

promoting self-advocacy (Cameron, 1996).

Nursing advocacy can result in professional and/or

personal difficulties for the nurses involved; two nurses

in Texas had to face professional difficulty being a

nurse advocate. they identified a physicians practice was

putting patients at risk and reported their concern to

the hospital authorities, but their concerns were not

addressed and the situation remained unresolved, so they

reported the physician to the Texas Medical Board. But

both nurses where charged with misuse of official

information and sacked by the hospital (Wood, 2013).

References

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Wong, G., Clair, S., & Tasi‐Mulitalo, L. (2012). Opening

doors with evidence: Creating a sustainable nurse advocacy group.

Retrieved from

http://www.nzno.org.nz/Portals/0/Docs/Groups/Nursing

%20Research/Opening%20doors%20with%20evidence

%20creating%20a%20sustainable%20nurse%20advocay

%20group.pdf

Cameron, C. (1996). Patient advocacy: a role for nurses?

Europian Journal of Cancer Care, 5(2), 81-89.

CNA. (2013). Advocacy. Retrieved from Canadian

Nursesassociation:

http://www.cna-aiic.ca/en/advocacy

Matthews, J. H. (2012). Role of Professional

Organizations in Advocating for the Nursing

Profession. The Online Journal of Issues in Nursing, 17(1),

Manuscript 3.

NCNZ. (2012). A new Code of Conduct for nurses. Retrieved from

Nursing Council of New Zealand:

http://nursingcouncil.org.nz/News/A-new-Code-of-

Conduct-for-nurses

NCNZ. (2012). Continuing competence. Retrieved from

http://nursingcouncil.org.nz/Nurses/Continuing-

competence

NZNO. (2009). About us . Retrieved from

http://www.nzno.org.nz/about_us

1383879 27

Tomajan, K. (2012). Advocating for nurses and nursing.

Online Journal of Issues in Nursing, 17(1), 4-6.

Wong, G. (2007). Nurses for a Smokefree Aotearoa/New Zealand.

Retrieved from

http://www.smokefreenurses.org.nz/site/nursesaotearo

a/files/Future_of_tobacco_displayys.pdf

Wood, D. (2013). The Nurse's Role as Patient Advocate. Retrieved

from

http://www.nursezone.com/nursing-news-events/more-

news/The-Nurses-Role-as-Patient-Advocate_33962.aspx

1383879 28