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

Background: The Professional Nurse Advocate (PNA) programme is delivered through the Advocating and Educating for QUality ImProvement (A-EQUIP) model (NHS England, 2023). An evaluation (Lees-Deutsch et al., 2023) noted a lack of quantifiable evidence of improvements in patient care initiated from PNA Quality Improvement (QI) work.

Aim: To describe and analyse the extent to which PNAs have been able to impact patient outcomes and experience through the implementation of QI work.

Methods: Mixed methods including thematic analysis of interviews, a national survey on QI work and QI case examples. The evaluation was guided throughout by an expert group of PNAs and Laschinger’s (2001) theoretical framework.

Results: The interviews revealed four main themes; 1) PNA preparedness for QI work and identifying projects, 2) implementing projects and collaboration, 3) monitoring and reporting on QI projects, and 4) impact on patient outcomes, reach of projects and sustainability. Key facilitators for quality improvement work included feeling empowered through RCS, multidisciplinary teamwork, and supportive structures. Barriers included lack of protected time, financial constraints, and insufficient QI training. The survey had 105 respondents. The median rating for impact on patient care outcomes was ‘High’ and for patient experience it was ‘Moderate’. PNAs positively rated the influence of QI work on their professional growth and development.

Implications for Practice: Established data collection 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. Sustainability of QI projects are 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.

References:
1. NHS England. 2023. Professional Nurse Advocate A-EQUIP model: A model of clinical supervision for nurses [online]. Available at: https://www.england.nhs.uk/publication/professional-nurse-advocate-a-equip-model-a-model-of-clinical-supervision-for-nurses/

2. Lees-Deutsch, L., Palmer, S., Adegboye, A., Bayes, N., Chauntry, A. & Kneafsey, R. 2023. National Evaluation Report of the Professional Nurse Advocate Programme: Mixed Methods Study. ISBN - 978-1-84600-1154

3. Laschinger, H. K., Finegan, J. & Shamian J. 2001. Impact of Structural and Psychological Empowerment on Job Strain in Nursing Work Settings. Expanding Kanter’s Model. Journal of Nursing Administration, 1, 260-272. http://dx.doi.org/10.1097/00005110-200105000-00006