An evaluation of practice impact for the Professional Nurse Advocate and the Professional Midwifery Advocate roles in ESNEFT

This research project, funded by East Suffolk and North Essex NHS Foundation Trust (ESNEFT) is evaluating how the roles of the Professional Nurse Advocate (PNA) and the Professional Midwifery Advocate (PMA) can help with staff wellbeing and staff retention.

A nurse looking thoughtfully out of a window

The purpose of this research is to explore how the role of professional advocacy is embedded in nursing and midwifery in one NHS acute trust.

Professional advocacy, using the A-EQUIP model, was introduced in midwifery in 2017 following the restructuring of statutory processes for supervision. In response to the COVID-19 pandemic, the Chief Nurse for England directed nurses to use the same structured, supervisory model.

NHS East Suffolk and North Essex NHS Foundation Trust (ESNEFT) logo

However, little is known about the impact of advocacy on the day-to-day experiences of the nursing and midwifery workforce. This research seeks to explore the role of the PNA/PMA in ESNEFT, with a focus on staff retention and wellbeing.

The PNA/PMA role places nurses and midwives at the centre of workforce transformation. It does this by advancing personal and professional accountability via professional development and strengthening personal wellbeing.

The need for the PNA/PMA role is clear. In the UK, there are approximately 50,000 nursing and midwifery vacancies and the number of registrants leaving the Nursing and Midwifery Council register is increasing. The two main reasons for leaving tend to be retirement and work-life balance.

The PNA/PMA combines professional nursing leadership and clinical supervision through the Advocating for Education and Quality Improvement (A-EQUIP) model, which in turn is based on Leading change and driving improvement (Proctor, 1986; NHS England, 2017, NHS England, 2021).

The initiatives of PMA/PNA provide useful preconditions for service improvement, yet there is little evidence that informs how best the role can be developed and applied in local organisations. It is not clear how PNA/PMAs themselves implement the role, how the role may be used by advocees, nor if it does impact QiP, staff retention and sense of professional wellbeing.

This research project seeks to explore the PNA/PMA role in ESNEFT, with the outcomes being to provide an evidence base as to how the role is used; and how it can be developed.

The study design is multimethod case study, with four workstreams and one PhD.

  • Workstream 1: To scope the current organisational context in uptake of PNA/PMA roles, current retention, and wellbeing metrics.
  • Workstream 2: To understand the experience being a PNA/PMA.
  • Workstream 3: To understand how staff access/use the PNA/PMAs.
  • Workstream 4: To develop a sustainable model of PMA/PNA implementation efficacy, and uptake in one NHS Trust.
  • PhD research: PhD on long-service nurses’ and midwives’ engagement with professional advocacy.

ESNEFT professional advocacy project flowchart (Word doc)

Engward, H., Goldspink, S., Abdulmohdi, N., Alexander, M. (2023) 'Understanding Professional Advocacy: A Mixed Method Protocol to Explore Professional Nurse Advocacy and Professional Midwifery Advocacy in one UK NHS Trust', JMIR Research Protocols. Available at:

ESNEFT partners

Marie Alexander

Marie Alexander

Marie began training as a mental health nurse in 1994 at the School of Nursing and Midwifery, based at Ipswich Hospital. Following graduation in 1997, she worked in several hospital and community roles before moving into clinical education in 2010.

She transitioned back into clinical services in 2015, holding senior leadership roles including General Manager for adult and specialist mental health with Cambridge and Peterborough Foundation Trust.

In 2019 Marie moved to Health Education England (HEE) as Regional Senior Nurse, a role that provided an opportunity to work on system, region, and national footprints and to lead a number of workstreams including RePAIR, Retention, Mental Health and (during the first wave of Covid) Health and Wellbeing.

Marie then moved from HEE to the Queen Elizabeth Hospital in King's Lynn, working as part of the Divisional Leadership Team in Clinical Support Services.

Most recently, Marie has taken up a new role with ESNEFT as Associate Chief Nurse for Education and Research, with a portfolio that includes all nursing, midwifery and allied health professional learners, Advanced Clinical Practice, and the development of clinical academic roles. She is undertaking a Professional Doctorate with University of Essex.

Cat Cracknell

Cat Cracknell

Cat began her career as a midwife at Ipswich Hospital in 2015 after training at the University of Bedfordshire. She has specialised in perinatal mental health, low risk midwifery care and community midwifery for families with additional and complex needs.

She has been a Professional Midwifery Advocate since 2018 and has recently taken on the role of Lead Professional Midwifery Advocate across ESNEFT.

Cat has Level 2 and 3 qualifications in Counselling, and is passionate about supporting birthing people and staff, and helping them to understand and maintain their mental health and wellbeing.

Cat is often a guest lecturer and has spoken at conferences. Outside of work, she is a trustee for a charity which supports birth mothers whose children live outside of their care.

Andrea Tuckwell

Andrea Tuckwell

Andrea has worked in the NHS & the private sector for 28 years. She is dual qualified as a nurse and a midwife and has undertaken post graduate studies to enhance her knowledge, skills, and personal development.

Her professional background includes working as a Ward Sister, Supervisor of Midwives, Professional Midwifery Advocate (PMA), Crisis Pregnancy Counsellor, Birth Trauma Debrief Clinic & Antenatal Team Lead, Maternity Bleep holder, Vaccination hub nurse, Governance/Audit midwife & Maternal Medicine Specialist Midwife.

Andrea remains committed to women’s health is a Specialist Midwifery Sister, supporting pregnant women with underlying complex health conditions and has facilitated learning and additional skill acquisition for midwives in this area.

As a PMA, Andrea has been actively involved in pastoral welfare and engaging in supportive conversations in the workplace. She will use her knowledge and experience in her role as the project Research Co-ordinator to build links between academic and practice colleagues and promote the research throughout the Trust.


11 September 2023

ESNEFT nurses and midwives to be invited to share their experiences of Professional Advocacy Service

From 2 October 2023, we'll be inviting nurses and midwives working for ESNEFT to complete an anonymous survey on their knowledge and experience of PNA and PMA, as part of Workstream 3 of our evaluation. We'll ask staff about their awareness of professional advocates, whether they have used their services, and how we can make the PNA/PMA service relevant to them.

14 August 2023

Maria Buaki-Sogo to present poster at RCN International Nursing Research Conference 2023

Maria Buaki-Sogo has had a poster presentation, A Narrative Inquiry into Long Serving Nurses and Midwives: Understanding Opportunities, Barriers and Professional Development in an NHS Trust, accepted for the RCN International Nursing Research Conference 2023, taking place on 6-8 September at the University of Manchester.

View Maria's RCN International Nursing Research Conference 2023 poster presentation (PDF)
14 August 2023

Maria Buaki-Sogo to join panel at 2023 Nursing Live conference

Maria Buaki-Sogo has been selected to be part of an expert panel on Inspiring Careers in Nursing at the 2023 Nursing Live conference, taking place on 10-11 November at ACC Liverpool.

Find out more about the 2023 Nursing Live conference