PNA implementation


Royal Wolverhampton NHS Trust, combined acute and community NHS Trust.

What was the aim/problem?

There was a lack of a consistent approach to clinical supervision in the organisation with retention of the nursing workforce being essential to maintain safe staffing. Clinical supervision was viewed by many as being close to management and was poorly utilised. Keen not to simply reform what we knew was already not working, we incorporated an aim to review nursing communication in the Trust’s nursing strategy.

In the meantime, our Midwifery colleagues had successfully introduced the role of the Professional Midwifery Advocate since 2017 and the reform of midwifery supervision with positive effects on the midwifery workforce. We heard about this in nursing and, as a senior group, there was enthusiasm to explore the role further.

What was the solution?

Replacing the traditional model of Clinical Supervision with the role of Professional Nurse Advocates using the A-EQUIP model offered a solution to the lack of clinical supervision and the common misconception that clinical supervision and management were interlinked. It would also help to address wellbeing and empowerment of nurses through education and continuous quality improvement (CQI).

The aim was to train 40 nurses and health visitors to be PNA’s as part of their substantive role in areas across the Trust by December 2022. The first 4 nurses went on the PMA course in February 2020 and with the emergence of Covid-19 the Trust was able to agree delivery of a further specific PNA course with the University of Worcester for 10 more places, starting in May 2020.

A steering group was established to oversee the role development which quickly worked towards a launch date in the areas the first nurses training in the role were working.

The steering group progressed:

  • Commissioning a University-led education programme to prepare nurses and health-visitors for the role
  • A named lead for implementation (lead also prepared for the PNA role)
  • Implementation overseen by a strategic planning and implementation group and an overarching framework governing the role with PNA and maternity representation
  • Involving trainee PNA’s in the development of a role descriptor and other suggestions
  • A communication plan
  • Committing to evaluation, in the first instance through routine monitoring of supervisor and supervisee experiences in the form of a short on-line survey accessed through QR codes.
  • A feed into the organisation’s governance structures also ensured clear communication of, and support for the purpose, value, and outcomes of the PNA role.
  • An education programme to support PNA’s and a communication group for them to gain peer support when needed.

What were the challenges

The main challenge was to translate the theory in to practice. Training PNA’s struggled to see how they would put the role into use in their places of work. Feedback was sought and a local PNA Framework was developed to guide the role including how many hours were advised in the role per month, how to report their activity to governance meetings, role descriptions, a guide to restorative clinical supervision ground rules etc. The Framework also contained information on how we would communicate the role and evaluate it so that their mangers understood the aims of the role and their support could be gained.

What were the results?

The Trust have now trained 16 PNA’s and have over 20 more in training and will meet our aim of 40 PNA’s trained a year earlier than planned thanks to the introduction of the role nationally supporting education. The launch has been in stages of 8 PNA’s at a time and matrons and ward managers have had training in the use of the role and a copy of the Framework. Some Matrons have invited PNA’s to governance meetings to introduce the role and others have got straight in with supporting their colleagues and feeding themes back locally. Evaluation is not completed yet but there is good feedback from nurses, and we are planning a big bang communication of the role in November 2021 when the next cohort of PNA’s complete their course. As a senior nursing team, we are excited to see the difference the role makes ad are closely watching the early adopter areas.

What were the learning points?

  • Get the steering group up and running, earlier the better,
  • Keep your PNA’s connected with each other for support and ideas on the role
  • Keep matrons and mangers in the loop.

Next steps

The Trust plans to continue training PNA’s make sure all nurses and health visitors have access to a PNA. As nurses relocate weave found we are now employing nurses who are already trained and welcoming them to our communication group steering group. The Trust is linking in with regional groups and finding opportunities to use positive psychology in a range of ways to make a hard job that little bit easier.

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