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Embedding the A-EQUIP model of restorative supervision in a critical care unit by professional nurse advocates

17 August 2023
Volume 32 · Issue 15


The professional nurse advocate (PNA) programme was launched in March 2021, which was towards the end of the third wave of COVID-19 and the start of a critical point of recovery. COVID-19 placed exceptional challenges and pressure on healthcare staff, with many experiencing feelings of stress and burnout. The role of the PNA emerged as a response to the impact this had upon the nursing workforce. PNAs are trained to facilitate restorative clinical supervision and to advocate education for quality improvement, resulting in improvements to patient care and staff wellbeing. The programme started with 400 critical care nurses; since then it has been rolled out to all specialties, with the aim to have 5000 PNAs integrated into the national workforce by April 2022. Criteria for the level 7 PNA training programme requires a registered nurse to be working in a patient-facing role, at band 5 or above, hold a level 6 qualification and have approval from their line manager. The training programme is typically 10 to 12 days in length over a 12-week period. This article explores the implementation of the PNA role in a critical care unit.

Clinical supervision is a term used to describe a formal process of professional support and learning that enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance patient/client protection and safety of care in complex clinical situations (NHS Employers, 2022). Clinical supervision is not a new concept to nursing. The term clinical supervision has been described as an umbrella term that provides little clarity of its function and purpose (Gonge and Buus, 2011). There have been criticisms of clinical supervision in nursing due to strategies being left to local decision-makers, with no clear overall vision as to how it should be introduced and performed. Wallbank and Hatton (2011) suggested that the effect and purpose of clinical supervision has been unclear, resulting in poorly structured and inconsistent approaches.

Numerous reviews following high-profile failings in NHS care have exposed a lack of a nursing voice and empowerment when concerns are identified (Francis, 2010; Keogh, 2013; Kirkup, 2015; Gosport Independent Panel, 2018; Department of Health and Social Care, 2018). One such action that ensued from the evaluation of failings within midwifery services was that statutory supervision was no longer deemed suitable or fit for practice (Rouse, 2019). In response to the action around statutory supervision, the Advocating for Education and Quality Improvement (A-EQUIP) model was introduced in April 2017 (NHS England, 2017) with professional midwifery advocates (PMA) replacing statutory midwifery supervision.

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