I am preparing for an inspection from the Health and Safety Executive, and the evidence requested for this relates to occupational health, including management of work-related stress. This led me to reflect on the increase in understanding and delivery of wellbeing interventions that have evolved during the COVID-19 pandemic.
The NHS People Plan identified the need to ensure a compassionate and inclusive culture, to create a sense of belonging and value for those central to the NHS (NHS England/NHS Improvement and Health Education England, 2020). West et al (2020) reflected that staff health and wellbeing is essential to the quality of care they can provide for patients, and that factors affecting nurses including work-related stress, turnover, absenteeism and presenteeism led to reported issues with retention in 2019. The NHS Staff Survey for 2020 identified increased working pressure during the pandemic—44% of staff reported feeling unwell as the result of work-related stress (a 40% increase from 2019) (Staff Survey Coordination Centre, 2021).
This month I met with six of our professional nurse advocates (PNAs). They were buzzing with enthusiasm following their training and have numerous ideas to scale up our cadre and support the practice environment. Launched in England in March 2021, the PNA programme delivers training and restorative supervision for colleagues. The timing of the launch, towards the end of the third wave of COVID-19, was highlighted as the ‘start of a critical point of recovery: for patients, for services and for our workforce’ (NHS England/NHS Improvement, 2021).
Clinical supervision in nursing was first introduced in the 1990s and, although seen as a good thing, Sawbridge and Hewison (2013) reflected that a systematic embedded approach to professional support had not been firmly established. The course content of PNA training (a level 7 accredited programme) focuses first and foremost on restorative supervision. Beyond this, the focus is on the four functions of the Advocating for Education and Quality and Improvement (A-Equip) model which, as Whatley et al (2021) highlighted, was originally implemented through the professional midwifery advocates (PMA) programme. These are as follows:
- Clinical supervision (Restorative)
- Monitoring, evaluation and quality control (Normative)
- Personal action for quality improvement
- Education and development (Formative).
The aim is for PNA training to provide those on the programme with skills to facilitate restorative supervision for their colleagues and teams, in nursing and beyond, resulting in improved staff wellbeing and retention, alongside improved patient outcomes. The training should equip them to listen and understand the challenges and demands of colleagues, and to lead support and to deliver quality improvement initiatives in response—ultimately improving patient safety and patient outcomes (NHS England/NHS Improvement, 2021; Whatley et al, 2021).
Sonia Wallbank is a well-known expert in this field. Her evaluation of the specific restorative model used, which differs from usual clinical supervision, has been significant in improving the capacity of professionals to function at their optimum level. Her programme was designed to address the emotional demands of staff and support them to build resilience levels, reducing their own stress and burnout levels (Wallbank, 2021).
It has shown that restorative supervision increased compassion and satisfaction (the pleasure one derives from doing your job), as well as reducing burnout and stress by over 40%, and that training professionals to offer restorative supervision improves the capacity of supervisees to think and function at their best—an essential requirement given the current demands profession.
Another key finding from Wallbank was that the effectiveness of the model is inextricably linked to the approach that organisations have taken in developing a more reciprocal relationship with their staff teams and that where staff perceive that they are being supported by the introduction of this model of supervision they are more able to build productive rather than adversarial relationships even when times are difficult.
I feel positive that the NHS is more focused on wellbeing than ever before, but I am extremely positive that the PNA model is a specific intervention for nurses. This programme is the first of its kind for nursing not just in England, but across the world, and NHS England/NHS Improvement is keen to measure and share its impact. An economic evaluation and independent research will be commissioned, which I look forward to.