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Nurse burnout: the course helping staff to be advocates for self-care among colleagues

Course aims to meet nurses’ emotional needs using clinical supervision model

Programme uses a model of restorative clinical supervision already proven to boost midwives well-being and patient outcomes

NHS England and NHS Improvement launched the professional nurse advocate (PNA) programme in March, towards the end of the third wave of COVID-19.

This model of clinical supervision, which has its origins in midwifery, is the first of its kind for nursing not just in England but globally.

The course is based on the A-EQUIP (advocating for education and quality improvement) model, which has been used in midwifery since 2017 when the supervision and regulation of midwives were separated.

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Programme uses a model of restorative clinical supervision already proven to boost midwives’ well-being and patient outcomes

The course was developed with the challenges thrown up to clinicians by the pandemic in mind. Picture: iStock

NHS England and NHS Improvement launched the professional nurse advocate (PNA) programme in March, towards the end of the third wave of COVID-19.

This model of clinical supervision, which has its origins in midwifery, is the first of its kind for nursing – not just in England but globally.

The course is based on the A-EQUIP (advocating for education and quality improvement) model, which has been used in midwifery since 2017 when the supervision and regulation of midwives were separated.

Facilitated by professional midwifery advocates, outcomes from the model’s use in practice included improved staff well-being and retention, alongside better patient outcomes.

The four functions of A-EQUIP

The A-EQUIP model has four functions:

  • Clinical supervision (restorative).
  • Personal action for quality improvement.
  • Education and development.
  • Monitoring and evaluation.

Restorative clinical supervision

One of the essential elements of the course is to provide nurses with the skills to facilitate restorative clinical supervision (RCS) of their colleagues. RCS addresses the emotional needs of staff and supports resilience in the workplace, with time set aside for staff to stop and think so they can ‘slow down’ both physically and mentally.

The course was developed in recognition of the widespread challenges faced by nurses during the COVID-19 pandemic, particularly in relation to their mental health. Nurses have reported feeling stressed and burned out, with some even experiencing post-traumatic stress disorder.

Through a process of discussion, reflective conversation, supportive challenge and open and honest feedback, RCS supports nurses to contemplate different perspectives and helps inform their decision-making. Research has shown it reduces stress and has a positive impact on physical and emotional well-being, job satisfaction and relationships with colleagues.

Programme’s first phase is prioritising critical care nurses

Canterbury Christ Church University is one of 15 universities in England to offer the master’s-level PNA course, with our first cohort of 20 critical care nurses completing their training in May.

‘Many attendees say the course has helped them become more self-compassionate’

Critical care nurses have been prioritised for the first phase of the programme due to the particular pressures and challenges they have faced during the pandemic, and we are working with a second cohort of critical care nurses.

Phase two is also underway, with four cohorts – from mental health, community, learning disability and children and young people’s nursing – starting the 12-week course in April, and we have a further eight cohorts due to start in September.

Training will be offered to more than 5,000 nurses across the UK over the coming year.

What does the professional nurse advocate course involve?

The course prepares the professional nurse advocate (PNA) to lead on the A-EQUIP model, promoting all elements of the model in the clinical environment.

There are five, online, interactive study sessions, with a further five directed study days, run over approximately 12 weeks.

The sessions, which each last around six hours, cover all aspects of the A-EQUIP model, with an emphasis on supporting nurses in practice, building resilience using RCS, and demonstrating the importance of a safe and confidential space to allow time to reflect on and make sense of workplace issues.

  • Education and development Focuses on developing knowledge and skills through education and can help inform the appraisal process, revalidation, and leadership development. The PNA can support others by facilitating guided reflection and helping colleagues consider how they can influence change and improve patient care, increasing their self-awareness and self-confidence
  • Restorative clinical supervision (RCS) As experienced professional midwifery advocates, teaching about the power of RCS is underpinned by our own clinical expertise, and of using the RCS model to construct ‘time to talk’ sessions for service users who have experienced trauma as a result of care and treatment. Real-life examples of positive outcomes following RCS are used to validate learning. In the sessions on leadership, nurses consider how compassionate leadership promotes effective teams and collective competence. One example is to be a critical friend – someone who will offer support but is prepared to challenge ideas, thoughts and practice – to nurses involved in incidents and complaints
  • Personal action for quality improvement Using the ABC framework of core work needs, the course promotes continuing professional development and encourages the ethos of autonomy and belonging, along with contribution through learning and understanding about the need to be involved in and to promote quality improvement
  • Monitoring and evaluation All those undertaking the course complete a final summative assessment. This is a competency-based portfolio, where the nurses demonstrate transferable skills and their understanding of the power of RCS by reflecting on sessions they have facilitated. There is also a formative presentation at the end of the course, which aims to develop and support an element of the portfolio. This uses representational art to encourage people to consider how they are feeling, personally and professionally. Using reflection, they critically analyse their feelings and consider how to use the learning gained in future practice. So far, this element has produced some outstandingly insightful work
Initial cohorts have praised the programme Picture: iStock

Feedback from the first cohorts

Evaluation from the first cohorts has been overwhelmingly positive, with many attendees saying how the course has helped them become more self-compassionate.

Others said that an understanding of RCS, along with improved knowledge of collective leadership and the power of being involved in quality improvement, has given them a better understanding and appreciation of the PNA role, and its far-reaching impact and benefits.

There has also been collective support of the virtual platform used.

We have been running professional midwifery advocate courses for the past three years at the university, training our midwifery colleagues.

A-EQUIP model has much to offer nursing and other health professions

As the facilitators of the PNA course, we are keen to share our knowledge and skills with the nursing profession and are excited about how we can take this forward into next year.

We believe the A-EQUIP model has a lot to offer every healthcare professional. Our aim is to open this up to other professions, such as health visitors, operating department practitioners and paramedics.

By working collaboratively in mixed groups, we hope to enhance in-class discussion and learning and encourage networking across the different health and social care professions.


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Karen Hammond is sessional midwifery lecturer in the school of nursing, midwifery and social work at Canterbury Christ Church University

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