Advocacy is a foundational pillar of nursing, essential to advancing patient care, shaping healthcare systems, and supporting the nursing workforce. Advocacy is addressed in the Scope and Standards of Practice for nursing and nursing leadership and is an accountability and standard of practice for all leaders (ANA, 2024; 2021). The American Nurses Association (ANA) defines advocacy as “The act or process of pleading for, supporting, or recommending a cause or course of action. Advocacy may be for persons (whether as an individual, group, population, or society) or for an issue” (2025a). The ANA Code of Ethics also emphasizes the role of nurses in advocating not only for patients but for health or social policy (ANA, 2025b). As healthcare becomes increasingly complex within a changing legislative landscape coupled with few legislators having healthcare expertise, nurses can be valuable expert policy developers and educators (Elliott, 2025).
Health policy is one of the eight concepts of nursing education identified by the American Association of Colleges of Nursing (AACN) (2022). The AACN tool kit for incorporating health policy into the nursing curriculum identified this as a challenge because policy is an abundant and sometimes nebulous element throughout healthcare, yet it is integral for nurses to know how to get involved. A systematic review showed a variety of factors hindering nurse involvement in policy advocacy and emphasized the need to empower and equip nurses with the education, resources, and skills necessary to fulfill this role (Hajizadeh et al., 2021). Although policy advocacy is a leadership activity, it is not necessarily specifically addressed in broad nursing leadership styles or theories. On a similar note, advocacy models such as, A Model of advocacy to Inform Action, focuses on types and skills of advocacy but does not focus specifically on leadership traits (Earnest et al., 2023).
A leadership model for advocacy was developed upon reflection of Dr. Edna Cadmus’ career and the leadership qualities she demonstrated in her policy advocacy role. Dr. Cadmus was the Executive Director of the New Jersey Collaborating Center for Nursing and Clinical Professor with the Rutgers School of Nursing. Upon her retirement in June 2025 after 49 years of service to the nursing profession, a joint legislative resolution in celebration of her career was issues and stated, “Within all spheres of her life and work, Dr. Cadmus has established a model to emulate and set a standard of excellence toward which all others might strive” (The State of New Jersey, 2025). She was experienced and talented in policy advocacy, educating legislators on a plethora of topics throughout her career, beginning as a staff nurse to chief nurse officer President of the Organization of Nurse Leaders New Jersey, and Executive Director of NJCCN. The CADMUS Leadership Model of Advocacy, representing Dr. Cadmus’ leadership traits of Courageous and Authentic, Determined, Moral and Understanding, and Savvy, provides a framework for nurses to utilize in their advocacy efforts (Figure 1 and Table 1). While initially designed for the legislative policy arena, the model can be adapted for various policy and advocacy contexts.
Figure 1.
