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Professional nurse advocates give clinical and well-being support to colleagues, in a role underpinned by new education standards
Professional nurse advocates provide professional clinical leadership in their clinical settings, says the RCN. This includes leading quality improvement programmes, developing positive learning cultures, and facilitating restorative clinical supervision (RCS) of nurses and healthcare staff, a process that supports individuals to have reflective conversations involving open feedback.
Nursing Standard. 38, 8, 55-56. doi: 10.7748/ns.38.8.55.s20
Published: 02 August 2023
PNAs provide clinical and well-being support for colleagues. This may take the form of:
» Advocating for patients.
» Creating collaborative care plans.
» Supporting change in clinical areas.
» Demonstrating inspirational leadership.
» Discussing professional issues, ranging from stress to career progression.
» Enabling reflection after a traumatic or stressful event.
The professional nurse advocate programme was established in 2021 by NHS England and was the first of its kind for nurses anywhere in the world. ‘It came in at a time when the nursing workforce was burnt out,’ says RCN professional lead for mental health Stephen Jones.
‘Staff had been challenged with the pandemic and there were clear issues with mental well-being. Initially, it was a response to all of that.’
What makes the role unique is that it’s more than clinical supervision training with an extra quality improvement aspect, says Mr Jones.
‘It’s a complex role and people have implemented it very differently,’ he says.
‘Some have created dedicated PNA roles with senior leads in that position. Others are released for a set amount of time on top of their job, while some are just expected to do it as part of their dayto-day work.’
Foundation of Nursing Studies chief executive Joanne Bosanquet says: ‘PNAs are establishing that a component of nurses’ work is to include reflective practice. Before this role, it was an addon and may not have been done.’
For PNA lead Martin Hogan, the role is pivotal in recruitment and retention, reducing sickness absence, and improving clinical practice and safety. ‘It feeds into everything strategically that every organisation is trying to do,’ he says.
It’s also reassuring for nursing students. ‘I tell them, when you qualify, every organisation will have a PNA. Something I didn’t have when I was at my most vulnerable. It’s a real selling point, especially in the current climate.’
There is a level 7 postgraduate-accredited programme that usually runs for ten days, although there’s some variation among the institutions providing the training, says NHS England.
The programme features academic assessment, poster presentations and competency portfolios.
While there has been extensive uptake by education institutions and employers to support the PNA role, there are discrepancies in what’s provided by universities, with RCN members reporting very different learning experiences, says Mr Jones.
The first section looks at PNA education:
» Learning culture is ethical, open and honest, conducive to safe learning and respect equality and diversity principles
» Education governance and quality complies with all legal and regulatory requirements
» Student support provides opportunities to achieve desired proficiencies and programme outcomes
» Educators and assessors are prepared, skilled and supported
» Curriculum and assessment enable learners to achieve the outcomes required to practise safely and effectively as PNAs
The second focuses on training programmes:
» Selection, admission and progression
» Restorative approach to clinical supervision
» Enabling nurses to undertake personal action for quality improvement
» Monitoring, evaluation and quality control
» Promoting education and development of nurses
Source: tinyurl.com/rcn-pna-standards
‘The challenge for education is to ensure quality assurance, particularly when something has been rolled out quite quickly,’ he says.
To address these challenges, NHS England commissioned the RCN to work with stakeholders in NHS trusts, universities and charities to produce standards for education and training programmes and modules. These were published in April 2023. This means education institutions and academies can now seek RCN accreditation.
‘The framework will help ensure the quality of education can be assessed and measured,’ says Mr Jones. ‘We want nurses to have the best possible learning experience.’
The RCN standards require learners to:
» Have active registration with the Nursing and Midwifery Council.
» Be employed in a registered nursing role.
» Practise in a setting that provides NHS or NHS-commissioned services.
» Provide evidence of holding a level 6 certificate in education – for example, a bachelor’s degree in adult nursing, or above.
» Provide evidence of learning, for those without a level 6 certificate.
Ideally, learners should have experience of receiving restorative clinical supervision from a trained PNA, says the framework.
‘It’s beneficial for anyone who delivers clinical supervision to access PNA training,’ says Mr Jones. ‘It improves a nurse’s skill set, both for their own learning and the learning of others.’
Throughout his 22-year nursing career, Martin Hogan has looked out for his colleagues’ mental health and well-being – but discovering the professional nurse advocate (PNA) role has opened up new possibilities for him.
‘A couple of years after qualifying, I thought this is actually a hard job – and I’m someone who’s an extrovert and very good at seeking support,’ says Mr Hogan, pictured. ‘As a band 5 nurse, I signed up to be a health and well-being champion because I could see my colleagues needed extra support.’
When the opportunity arose for PNA training, he grabbed it. ‘I thought this is what I’ve been waiting for.
‘Probably until after the pandemic, we didn’t talk about how we were feeling. It took that first wave for us to realise we needed to look after each other, because there wasn’t anyone else.’
Five months ago, Mr Hogan became a lead PNA at Central London Community Healthcare NHS Trust.
His day usually starts with supervision or an educational career conversation, which may lead to ideas for quality improvement. He has a ‘teaching Tuesday’ clinic for those on PNA programmes.
‘They get to practise in privacy with me as the guinea pig,’ says Mr Hogan.
He feels his career is reinvigorated. ‘It’s been a lifeline, taking me back into my passion for nursing,’ he says. ‘Now I feel there’s an understanding of what it’s been like for us and we’re getting something back.
‘I’ve often felt I’ve never had an invite to sit at the table, but since doing my PNA course, I just bring my fold-up chair and sit down.
‘It’s given me confidence that all these amazing transferable skills I have as a general nurse, in mental health, intensive care or the community, I can bring to any situation.’
Contact your local PNA regional team, advises Mr Jones. ‘They will be able to identify a provider, although this may not be local to you and it could involve learning remotely.’
For many people, it may be the next step after preceptorship, but you don’t need to have done any specialist training or leadership courses before joining a programme. ‘I would always say don’t just do it because it’s available,’ says Mr Jones. ‘Especially if you don’t feel as if you’re standing on your own two feet as yet. The role can be demanding.’
As it’s a level 7 programme, it gives credits towards a master’s degree or may help the learner top-up to achieve their master’s, says Mr Jones. The role may strengthen the individual’s personal and professional boundaries, providing a tool kit that supports their and others’ development.
But in practice, how much you can actually achieve as a PNA depends greatly on your employer, says Mr Jones. ‘Just because you’ve done a course, your trust may not be receptive to actually doing anything with the role – we know that’s sometimes the case,’ he says.
In contrast, others have the prospect of various development opportunities. ‘Organisations need to think about how they support those who are doing the course, so they can better use their skills,’ says Mr Jones.
Becoming a PNA can up open up other doors, says Ms Bosanquet. ‘It can take a nurse down a different career path to the one they might have thought possible,’ she says. ‘There are lots of potential opportunities in education and academia.
‘It also helps leadership and the way nurses can build their own professional identity, improving confidence. I think the programme enables nurses to look outwards a lot more, seeing the system as a whole and not just their immediate surroundings.’
NHS England: About professional nurse advocates training
Read more on what professional nurse advocates can do rcni.com/role-of-pnas
