Afsar B. The impact of person-organization fit on innovative work behavior. Int J Health Care Qual Assur. 2016; 29:(2)104-122

Ament SMC, Gillissen F, Moser A Factors associated with sustainability of 2 quality improvement programs after achieving early implementation success. A qualitative case study. J Eval Clin Pract. 2017; 23:(6)1135-1143

Final evaluation report: pilot for new model of midwifery supervision. 2017. (accessed 5 April 2023)

Backhouse A, Ogunlayi F. Quality improvement into practice. BMJ. 2020; 368

Carter V. Can restorative clinical supervision positively impact the psychological safety of midwives and nurses?. Br J Nurs. 2022; 31:(15)818-820

Cheater FM, Hale C. An evaluation of a local clinical supervision scheme for practice nurses. J Clin Nurs. 2001; 10:(1)119-31

Critical Care National Network. Professional Nurse Advocates in Critical Care. 2022. (updated from 2018)

Cutcliffe JR, Sloan G, Bashaw M. A systematic review of clinical supervision evaluation studies in nursing. Int J Ment Health Nurs. 2018; 27:(5)1344-1363

Driscoll J, Stacey G, Harrison-Dening K, Boyd C, Shaw T. Enhancing the quality of clinical supervision in nursing practice. Nurs Stand. 2019; 34:(5)43-50

Edwards D, Cooper L, Burnard P Factors influencing the effectiveness of clinical supervision. J Psychiatr Ment Health Nurs. 2005; 12:(4)405-414

Fleiszer AR, Semenic SE, Ritchie JA, Richer MC, Denis JL. An organizational perspective on the long-term sustainability of a nursing best practice guidelines program: a case study. BMC Health Serv Res. 2015; 15

Fowler J. The organization of clinical supervision within the nursing profession: a review of the literature. J Adv Nurs. 1996; 23:(3)471-478

Hansen H, Ropo A, Sauer E Aesthetic leadership. Leadersh Quarterly. 2007; 18:(6)544-560

Health Care Improvement Scotland. Dementia in hospitals improvement toolkit. 2021. (accessed 5 April 2023)

Keele University. PNA course overview. 2022. (accessed 5 April 2023)

The report of the Morecambe Bay investigation. 2015. (accessed 5 April 2023)

Lee A, Willis S, Tian AW. Empowering leadership: a meta-analytic examination of incremental contribution, mediation, and moderation. Journal of Organizational Behavior. 2018; 39:(3)306-325

Lorencatto F, West R, Christopherson C, Michie S. Assessing fidelity of delivery of smoking cessation behavioural support in practice. Implement Sci. 2013; 8:(1)

Mahachi LC. The role of professional advocate in endoscopy: the A-EQUIP model. Gastrointestinal Nursing. 2020a; 18:S18-S24

Conflict at work: How professional Advocates help cope with challenging situations. 2020b. (accessed 5 April 2023)

I am pleased to announce the roll-out of the professional nurse advocate programme. 2021. (accessed 5 April 2023)

Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol. 2012a; 50:(3-4)462-480

Meyers DC, Katz J, Chien V, Wandersman A, Scaccia JP, Wright A. Practical implementation science: developing and piloting the quality implementation tool. Am J Community Psychol. 2012b; 50:(3-4)481-496

NHS England/NHS Improvement. PNA implementation. 2021a.

NHS England/NHS Improvement. Professional nurse advocate A-EQUIP model. A model of clinical supervision for nurses. 2021a. (accessed 5 April 2023)

NHS England/NHS Improvement. PNA implementation. 2021b. (accessed 5 April 2023)

NHS Confederation. Fourth phase of the NHS response to COVID-19. Headline points and the NHS Confederation's view on guidance on the fourth phase of the NHS COVID-19 response. 2021. (accessed 5 April 2023)

Nursing and Midwifery Council. Standards for competence for registered nurses. 2018. (accessed 6 April 2023)

O'Connor K, Muller Neff D, Pitman S. Burnout in mental health professionals: a systematic review and meta-analysis of prevalence and determinants. Eur Psychiatry. 2018; 53:74-99

Pollock A., Campbell P., Deery R A systematic review of evidence relating to clinical supervision for nurses, midwives and allied health professionals. J Adv Nurs. 2017; 73:(8)1825-1837

Puffett N, Perkins P. What influences palliative care nurses in their choice to engage in or decline clinical supervision?. Int J Palliat Nurs. 2017; 23:(11)524-533

Rouse S. The role of the PMA and barriers to the successful implementation of restorative clinical supervision. British Journal of Midwifery. 2019; 27:(6)381-386

Snowdon DA, Leggat SG, Taylor NF. Does clinical supervision of healthcare professionals improve effectiveness of care and patient experience? A systematic review. BMC Health Serv Res. 2017; 17:(1)

Senge PM. The fifth discipline: The art and practice of the learning organisation, 2nd edn. London: Random House; 2006

Professional nurse/health visitor advocate framework for nursing and health visiting.Wolverhampton: The Royal Wolverhampton NHS Trust; 2021

The Royal Wolverhampton and Walsall Health Care NHS Trust NHS Our new joint trust trategy 2022-2027. 2022. (accessed 5 April 2023)

Webster NL, Oyebode JR, Jenkins C, Bicknell S, Smythe A. Using technology to support the emotional and social well-being of nurses: A scoping review. J Adv Nurs. 2020; 76:(1)109-120

Caring to change. How compassionate leadership can stimulate innovation in health care. 2017. (accessed 5 April 2023)

Whatley V. Learning from the professional midwifery advocate role to revise clinical supervision in nursing. British Journal of Healthcare Management. 2022; 28:(7)159-207

Introduction of the professional nurse advocate role using a quality implementation framework

20 April 2023
Volume 32 · Issue 8



Implementation of the professional nurse advocate (PNA) role and the Advocating and Educating for QUality ImProvement model (A-EQUIP) in nursing is relatively new. The model aims to build personal and professional resilience, enhance the quality of care and support preparedness for appraisal and professional revalidation.


To describe the implementation of the PNA role in a combined acute and community trust in England.


A quality implementation framework was used to appraise and represent locally derived strategic activities for successful implementation of the role in an acute and community hospital in England. The content of this framework was derived from a synthesis of 25 implementation frameworks focusing on important elements understood to represent quality implementation.


The article identifies strengths and weaknesses to implementation and ways to sustain early implementation success.


Using a quality implementation framework can provide a clear path for the successful implementation of the professional nurse advocate role. Professional nurse advocates should be supported to develop a culture of effective supervision within their organisation.

A large, combined acute and community trust has successfully introduced the professional midwife advocate (PMA) role using the Advocating and Educating for QUality ImProvement (A-EQUIP) model (NHS England/NHS Improvement, 2021a) and progressed to adopt the role in nursing, the professional nurse advocate (PNA). Locally, the PNA role is underpinned by a higher education institute (HEI)-led training programme. Currently, there is limited practical guidance for the effective implementation of the role in practice.

Clinical supervision plays an important role in the provision of quality nursing care and has been promoted for nurses in the NHS for some years (Driscoll et al, 2019). The practice is associated with positive patient outcomes (Snowdon et al, 2017) and can help mitigate the impacts of stresses on the nursing role (O'Connor et al, 2018). A variety of models for workplace supervision have evolved, yet uptake has been variable. Despite the Nursing and Midwifery Council (NMC) advocating clinical supervision for all registrants (NMC, 2018), consistent barriers to implementation persist, including a lack of clarity in relation to which model of clinical supervision has better outcomes (Pollock et al, 2017; Driscoll et al, 2019). Many studies that report the benefits of clinical supervision fail to specify the use of a particular model (Fowler, 1996;Cheater and Hale, 2001; Edwards et al, 2005; Puffett and Perkins, 2017). There is also a lack of delineation between clinical supervision and other professional models of support, for example, managerial, and potential confusion between clinical supervision models and clinical supervision functions that can lead to poor quality supervision (Cutcliffe et al, 2018). These barriers have been exacerbated by personal factors such as fear of change, lack of confidence, knowledge, skills or understanding, and failure to recognise the need for clinical supervision, as well as organisational factors, including poor quality training for supervisors, lack of support and time (Ariss et al, 2017).

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content