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)

Abdulmohdi, N., Tuckwell, A., Goldspink,, S. and Engward, H. (2023) 'Exploring the integration and impact of nurse and midwifery advocate roles on staff well-being and retention: a cross sectional survey study', RCN Education Forum and National Conference 2024.

Flack, L. and Abdulmohdi, N. (2023) 'Designing and delivering a professional nurse advocate training module', Nursing Times [online], 119, pp. 11.

Engward, H., Goldspink, S., Abdulmohdi, N. and 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

Qualifications and training
1997: RMN Dip(HE)
2001: BA(Hons) Health Studies
2011: MSc Advanced Practitioner
2018: Athena Leadership Programme, Kingsfund
September 2022: enrolled on Professional Doctorate with University of Essex.

Marie qualified as a mental health nurse in Ipswich in 1997. She has worked in a number of hospital, community and clinical education roles, including two years with Health Education England in the regional senior nursing team from 2019-2021.

Since March 2022 Marie has been the Associate Chief Nurse for Education and Research at East Suffolk and North Essex NHS Foundation Trust with a portfolio that includes all pre and post-registration nurse, midwifery and allied health professional education, advanced clinical practice and the development of clinical academic roles.

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.


15 January 2024

ESNEFT survey now closed

As part of our ongoing evaluation of Professional Advocacy, we would like to thank everyone in ESNEFT who completed our survey. Over 400 nurses and midwives responded from across the Trust between 9 October and 22 December 2023. We are most grateful for their time and input. We will use the survey data to help us to better understand what staff in ESNEFT need from their professional advocacy service.

13 November 2023

Maria Buaki-Sogo appears on panel at Nursing Live 2023

Maria Buaki-Sogo appeared on the Inspiring Careers in Nursing panel at the 2023 Nursing Live conference in Liverpool on 10 November. She spoke on the topic of 'unlocking professional development', giving voice to some of her colleagues and sharing her own story to inspire attendees to recognise and build upon their considerable nursing experience.

Maria Buaki-Sogo speaking on a panel, with panel chair Joanne Bosanquet looking on, holding a tablet

Maria Buaki-Sogo on stage with panel chair Joanne Bosanquet

10 November 2023

Article by Maria Buaki-Sogo, Sally Goldspink, and Hilary Engward features on front page of Nursing Times

An article written by the PNA/PMA impact project team features in, and appears on the cover of the November 2023 Nursing Times magazine. The article, titled 'Workforce assets: recognising the value of long-serving nurses and midwives', aims to start a conversation about the experience, role and value of long-serving nurses and midwives, and how these can inform workplace planning.

Read 'Workforce assets: recognising the value of long-serving nurses and midwives' (login may be required)
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.

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