How do front-line workers use rules to maintain and change organizations and institutions? Using a [...]comparative qualitative research design, I find that patient advocates, a type of pressure specialist, encounter breaches in the interpersonal, operational and institutional order. Analyses revealed that they drew from a repertoire of four rule use patterns to repair breaches. Repairing breaches with rules, in turn, maintained, and more rarely changed, organizations and institutions. While most research has focused on high-powered actors' use of rules to create institutions, I help unpack how pressure specialists use rules to maintain organizations and institutions. I offer theoretical implications for our understanding of institutional work, embedded agency and the pressure specialist role.