Prioritising the wellbeing of frontline staff is imperative given the day-to-day challenges of clinical care delivery, not least the intractable workforce shortages.
The professional nurse advocate (PNA) programme for nursing was introduced in March 2021 by NHS England. Its ambition is to train nurses to deliver restorative supervision and respond to care challenges, through enhanced leadership, advocacy and safe effective practice (NHS England, 2023). To date, 9,000 PNA masters-level training places have been offered, with most PNAs now established in practice, working hard to deliver the aspirations of the programme.
“Overall, the introduction of the PNA programme was best characterised as ‘the creation of a large-scale movement’, which forms a transformative element towards personal empowerment and much-needed greater job satisfaction”
During 2022, a national evaluation of the PNA programme was commissioned by NHS England and undertaken by a team of eight researchers at Coventry University (Lees-Deutsch et al, 2023). A theory-driven approach was employed throughout, using an empowerment model (Laschinger et al, 2001) with programme logic to explore the activities, inputs and outcomes. The baseline of support before the PNA programme, perceived benefits, outcomes and impact of the Advocating and Educating for Quality Improvement (A-EQUIP) model were established.
A balance of positive and negative perspectives of the programme were revealed. Prior to the PNA programme, restorative support/clinical supervision was not well developed in the nursing workforce, despite pockets of good practice.
During the early implementation of the programme, senior staff at hospital site level reported ‘juggling workloads’ alongside many other clinical and strategic priorities. There were also early teething problems regarding the lack of parity in the assessment strategy for the programme.
This said, we heard from course leaders at higher education institutions, who responded to early feedback from PNA trainees, adapting the training accordingly. Throughout, the feedback from nurses was that ‘adequate time’ to release staff, together with safe space were imperative for the longevity of the programme implementation.
The positivity conveyed overwhelmingly outweighed other issues identified; nurses receiving restorative supervision describing ‘feeling supported’, with several noting it had enabled them ‘to remain in the profession’.
Others reported ‘progression in their career’ as a direct result of the PNA academic development. PNAs stated that the programme is going from strength to strength, with continued adaption for context-specific issues.
Overall, the introduction of the PNA programme was best characterised as ‘the creation of a large-scale movement’, which forms a transformative element towards personal empowerment and much-needed greater job satisfaction.
Nevertheless, to progress from reported programme outputs, and outcomes, to impact, further quantification of the A-EQUIP model is needed to understand how PNAs are leading changes in practice. Understanding the connectivity between ‘individual projects in practice’ would benefit shared learning at local, regional and national levels.
While delivery of restorative supervision is reported positively, the effectiveness of this in relation to improved nurse wellbeing and reduction in sickness levels over time remains unclear. These were each underreported areas at the point of the evaluation.
Liz Lees-Deutsch is professor of nursing practice and clinical academic nurse at University Hospitals Coventry and Warwickshire NHS Trust and Coventry University (joint appointment). Co-authors: Emma Wadey is deputy director, mental health nursing, NHS England and Rosie Kneafsey is professor of nursing and health services research, Coventry University
Laschinger HK et al (2001) Impact of Structural and Psychological Empowerment on Job Strain in Nursing Work Settings. Expanding Kanter’s Model. Journal of Nursing Administration; 31: 5, 260-272.
Lees-Deutsch L et al (2023) National Evaluation Report of the Professional Nurse Advocate Programme: Mixed Methods Study. Coventry University.
NHS England (2023) Professional nurse advocate A-EQUIP model: a model of clinical supervision for nurses. NHS England.