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A review of the potential impact of professional nurse advocates in reducing stress and burnout in district nursing

02 March 2023
Volume 28 · Issue 3


Background: Stress and burnout has been leading to increased levels of absences, errors and complaints in district nursing. This problem appears to be worsening, necessitating the need for change and introducing new interventions to reverse this trend. The Professional Nurse Advocate (PNA) role is relatively new within nursing and their assitance in such instances could be of benefit to district nursing. Aim: This article aims to explore the potential role of PNAs in district nursing and whether their introduction to community settings could help reduce levels of stress, burnout and absenteeism. Method: The literature is explored with relation to the field of district nursing practice and consideration is given to why burnout is occurring, how PNAs could work to reduce this (using A-EQUIP model), and barriers that could exist. Findings: Burnout in district nursing is a significant problem that can affect quality of patient care. There is clear indication that PNAs, if used effectively, could reduce stress and burnout, and consequently lead to improved attendance, retention and quality of patient care. Conclusion: There is evidence for the potential benefits of PNAs within district nursing in terms of reducing burnout and improving patient care.

Over recent years, one has witnessed increasing levels of stress and associated absences, alongside rising numbers of errors and complaints, within district nursing. The King’s Fund (2020) and The Queen’s Nursing Institute (QNI) (2022) concur, noting that high levels of stress and burnout impact negatively on staff wellbeing in district nursing and, in turn, on the safety and quality of care being provided to patients. Several significant reports have highlighted safety failings across healthcare, necessitating the need for action and for greater support, development and supervision of healthcare professionals (Francis, 2013; The King’s Fund, 2015).

A new model of supervision—Advocating and Educating for Quality Improvement (A-EQUIP)—was introduced into midwifery in 2017. Alongside this came Professional Midwifery Advocates (PMAs), whose role is to lead in supporting midwives and driving implementation of A-EQUIP (Dunkley-Bent, 2017). The success of these measures have led to a move to roll-out professional advocates into nursing, with professional nurse advocate (PNA) training, which commenced in 2021 (Griffiths, 2022). The potential impact and role of PNAs in relation to reducing burnout and improving wellbeing and quality of care in district nursing will be considered in this article.

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