Evaluation of the Impact of the Professional Nurse Advocate’s Role in Quality Improvement: Interview study.

Background: In 2021 during the aftermath of Covid-19, the Professional Nurse Advocate Programme (PNA) was introduced in England to support the wellbeing and retention of nurses. The programme is delivered by PNAs through the Advocating and Educating for QUality ImProvement (A-EQUIP) model of professional leadership and restorative clinical supervision (RCS).1 An evaluation explored programme impact on PNAs and nurses receiving RCS, which identified positive differences to nurse morale and potential to retain nurses in practice, who other might leave.2 A lack of quantifiable evidence of improvements in patient care arising from PNA initiated Quality Improvement (QI) work was also observed.Aim: Describe and analyse the extent to which the successive cohorts of PNA’s have been able to impact patient outcomes and experience through the implementation of QI work.Methods: Interviews and thematic analysis. An expert group of PNAs and Laschinger’s theoretical framework guided topic guide.3 Results: Four main themes developed namely, 1) identifying projects and PNA preparedness to undertake, 2) implementing projects and collaboration, 3) monitoring and reporting on projects, and 4) patient outcomes and reach of projects. Key facilitators for commencing quality improvement work included feeling empowered through restorative clinical supervision, multidisciplinary teamwork, and supportive structures. Major barriers were lack of protected time, financial constraints and insufficient QI training. Discussion: Established data collection, QI and reporting structures within organisations, underpinned all successful QI work. Although direct measures of patient outcomes and experience were not explicit in almost all QI work, a strong association was implicit, indicating the potential for QI work to positively impact patients, by proxy.Conclusion: Sustainability of QI projects is crucial for realisation of long-term impact and to extend the reach beyond individual departments. The agency to disseminate improvements made by PNAs through the A-EQUIP model could be achieved with improved individual and organisational structural empowerment.