Professional Advocacy in Focus: A Qualitative Descriptive Study of Nurses and Midwives Perceptions in one UK NHS Trust

Background This study was conducted within the National Health Service (NHS), the publicly funded healthcare system in the United Kingdom (UK), which provides hospital and community care to a diverse population. The NHS is currently facing significant workforce challenges, including high vacancy rates, staff burnout, and low morale. In response, the Professional Advocacy (PA) role was introduced to support midwives and nurses through structured peer support and restorative clinical supervision and has since been extended to include allied health professionals. While early evidence suggests PA can improve staff wellbeing and retention, there is limited understanding of how the role is perceived and experienced by practitioners. This study aimed to explore nurses’ and midwives’ perceptions of PA, focusing on its implementation, accessibility, and impact within one NHS Trust. Methods A qualitative descriptive design was used, involving online focus groups with nurses and midwives who had varying levels of engagement with PA services. Thirteen focus groups were conducted with fifty-three participants, including those who had accessed PA, those who had not, and those training or registered as professional advocates. Data were transcribed verbatim and analysed thematically using an inductive approach supported by NVivo software. Results Four key themes surfaced during analysis: awareness and understanding of PA, barriers to engagement, perceived benefits, and recommendations for strengthening the service. Participants who had accessed PA described it as a valuable source of emotional and professional support, contributing to improved wellbeing and retention. Barriers included limited awareness, stigma around help-seeking, inconsistent availability, and unclear organisational integration. Participants recommended improving visibility and accessibility, and strengthening the perceived legitimacy of PA by ensuring it is recognised as a credible, well-supported part of the organisation, rather than a peripheral or optional service. Conclusions PA is a promising but underutilised resource within the NHS. While it offers clear benefits for staff wellbeing and retention, its impact is constrained by systemic and cultural barriers. Addressing these challenges through targeted organisational strategies could enhance the integration and effectiveness of PA services. This study contributes to the growing evidence base and offers insights into embedding PA into routine practice to support a more resilient workforce.