Professional Advocates: Investing in practitioners to achieve excellence in service delivery

By Vanessa Whatley, @whatleyvj : Deputy Chief Nurse, The Royal Wolverhampton NHS Trust,

Lisa Stephens ,@sagefemme2000 : Lead Midwife for  Education, University of Worcester, and

Michelle Sterry, @michelleSterry2 :  Lecturer in Midwifery, University of Worcester

The role of the Professional Advocate (PA) is a vehicle for deploying the four elements of the Advocating for Education and Quality Improvement (A-EQUIP) model (NHSE, 2017), which evolved in response to a monumental change in the regulation of Midwifery practice (NHSE, 2017; Ariss et al, 2017). The A-EQUIP model, originally implemented through Professional Midwifery Advocates (PMA), heralded a significant opportunity to enable and empower midwives to be supported through an employer led model created to prioritise individual midwifery wellbeing and resilience, influence positive staff cultures (Sterry, 2018) whilst developing sustained and meaningful education and quality improvement in practice.

Professional advocacy not only supports professional and accessible restorative clinical supervision (RCS) for practitioners, it also upholds a commitment to continuous quality improvement and education in practice that can facilitate the excellent care delivery required to ensure safety and improved outcomes for women and their families.

One of the early pioneering PMA conversion courses was launched in 2017 at the University of Worcester (UW). This primary cohort consisted of supervisors of midwives who had elected to become PMAs by undergoing a transformative process requiring realignment of professional values and broadening the professional mindset to the potential of this model. This group were instrumental in acting as PMA supervisors for the long programme which was designed for those who were not previously supervisors of midwives (Martin, Stephens and Dennis, 2018). These first PMAs demonstrated exceptional leadership as they embedded the PA concept and developed an implementation strategy within their employing organisations (Stephens, 2019; Sterry, 2019)

Midwifery and Nursing education programmes effectively prepare students to be accountable, safe, confident, compassionate, and proficient practitioners at the point of registration and, therefore, it is essential that training includes A-EQUIP model education to support a deep understanding, experience, and expectation of the PA role in practice. Additionally, students are offered access to the academic PMAs for guidance and experience of RCS ahead of becoming professional registrants.

The benefits and outcomes attributed to the PMA service in clinical practice has been widely recognised for nursing and in response a generic PA level 7 module is now offered entirely online. This has presented a unique opportunity to foster the collaboration of the two professions, embedding the framework with energy and passion to strengthening relations, align values and enable a cohesive, standardised approach to implementation of all four quadrants of the model across the professions.

As an example, The Royal Wolverhampton NHS Trust (RWT) have had a positive experience of developing and embedding the PMA role since 2017; subsequently introducing PA to nursing colleagues in 2020. The Professional Nurse Advocate (PNA) role has huge potential and presents a pivotal opportunity for professional nursing empowerment and support in the workplace which has been endorsed by the Chief Nursing Officer for England (May, 2021).  Clinical supervision in nursing was introduced in the 1990’s yet a consistent approach to professional support has not been firmly established (Sawbridge & Hewison, 2013). Numerous reviews following high-profile failings in NHS care have exposed a lack of nursing voice and empowerment when concerns are identified (Frances, 2013, Keogh, 2013 and Gosport Independent Panel, 2018). Clinical supervision may be open to misinterpretation, focusing on organisational objectives rather than the practitioner and patient (Snowdon, Leggat and Taylor, 2017). Placing the service user central to the A-EQUIP model, gathering views on experiences and responding to feedback can positively influence the delivery of safer, more effective care and support a thriving clinical workforce and, therefore, user inclusion should be considered crucial to its success.

In collaboration with the UW, RWT has provided 40 nurses an opportunity to undertake the PA module in preparation for the PNA role. Alongside, high-quality training is a need for organisations to establish how the PNA role will be deployed in practice as it is an employer-led model of supervision. RWT established a steering group, developed an overarching framework with a communication plan as a guide for implementation in preparation for organisational readiness. A feedback mechanism is in place and evidence of effectiveness and outcomes are measured such as routine activity data and impact on nurse retention, sickness reduction and work satisfaction.

Acting as an early adopter of an innovation can be daunting in the absence of other organisations’ experiences to draw upon, but it can also bring rewards. The COVID-19 pandemic has highlighted the importance of staff wellbeing and resilience (Woodford et al, 2020) and this has prompted a surge in interest from organisations to invest in PA. Quality improvement, safety and a thriving, valued workforce is essential not only in midwifery but nursing too (West, Bailey and Williams, 2020) and this has never been needed more than now as we navigate a journey into a post Covid recovery in healthcare.



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