Beneficent Disruptors: A qualitative descriptive study of professional advocacy in healthcare

Background In England, the Professional Nurse Advocate (PNA) and Professional Midwifery Advocate (PMA) role places nurses and midwives at the centre of workforce retention and transformation. The PNA/PMA role blends professional nursing leadership and clinical supervision through the Advocating for Education and Quality Improvement (A-EQUIP) model, which is grounded in directing change and steering service development. Taken collectively, the overarching impetus for the PNA/PMA role is to improve quality of care whilst developing and sustaining cultures of professional wellbeing and nurse/midwife retention. To date, however, little is known about what the impact the PNA/PMA role might have on the day-to-day practice of nurses and midwives, nor if it improves quality in practice, professional wellbeing, and retention. This NHS-funded study examines the impact of the PNA/PMA role on nurse/midwife involvement in quality improvement, wellbeing, and retention within one public sector healthcare NHS Trust in England.Study design and methods During 2022, fourteen semi-structured interviews were conducted with PNA’s and PMA’s who had completed their training and are included on the NHS Trust PNA/PMA register. The interviews were transcribed verbatim and analysed through qualitative thematic analysis.Results Thematic analysis detected 5 themes and 10 subthemes: (1) Transforming in Tandem (a) Role of Advocacy, (b) Restorative Focus, (2) Creating Safe Spaces, (c) Emotional Support, (d) Interpersonal Relationships, (3) Challenging the Status Quo (e) Counteracting Blame Culture, (f) Empowering Change (4) Empowerment and Development (g) Building Resilience (h) Building Resilience, (5) Types of Advocacy (i) Educational and Emotional Advocacy (j) Coaching and Conversations.Conclusions The findings suggests that the most effective aspects of the Professional Nurse Advocate (PNA) and Professional Midwife Advocate (PMA) roles are those that directly empower individuals and create a supportive, reflective environment. However, while building resilience is vital, it is equally important to recognize its limits and ensure that healthcare professionals are not pushed to the point where their resilience becomes a barrier to their well-being and the overall improvement of their work environment.