Understanding the relationship between the sustainability of the Professional Nurse Advocate Role, Organisational Culture and Quality Improvement Strategies in Healthcare: An Integrative Review

Aim: To understand the relationship between organisational culture and quality improvement strategies (QI) in healthcare and how this applies to the sustainability of the Professional Nurse Advocate (PNA) role.

Background: In response to nurse burn-out experienced throughout and following the coronavirus pandemic, NHS England launched the PNA role to support nurses through the Advocating and Educating for Quality ImProvement (A-EQUIP) model (NHS England, 2021). Uptake of the role has been disparate, and organisational culture may be one factor contributing to this. However, as the PNA role is relatively new, there is limited research in this field. Therefore, organisational culture was explored in relation to QI strategies more widely to understand if there are findings transferable to the PNA role and its sustainability.

Method: Following ethical approval, The Toronto (2020) six-phase integrative review method was followed. CINAHL, Medline, Embase, Emcare, HMIC and grey literature databases were systematically searched. 799 articles were retrieved and screened, with 20 articles being included in the review, displayed via Preferred Reporting Items for Systematic reviews and Meta Analysis (PRISMA) and critically appraised. Qualitative literature was analysed using thematic analysis, whilst mixed method and quantitative literature were synthesised narratively.

Findings: 6 key themes were identified relating to organisational culture and implementation of QI strategies: 3 facilitators (Leadership, collective action and shared ideology) and 3 barriers (Leadership, disconnection and external influences). An association between collective action and the uptake of QI was identified that could link to PNA implementation and sustainability. However, discussion of sustainability in relation to implementation was lacking and warrants further research.

Implications for practice: There is a clear link between cultures that allow collective action and successful implementation efforts. However, this review highlights the need for further research on the relationship between collective action and sustainability of initiatives such as the PNA role.