Setting the scene: the PMA and PNA role

The professional midwifery advocacy (PMA) role is designed to modernise supervision, strengthen staff wellbeing and improve quality of care (Rouse 2019). The role is underpinned by the Advocating and Educating for Quality Improvement (A-EQUIP) framework (NHS England 2017), which integrates Proctor’s (1986, 2001, 2008) clinical supervision functions of formative, normative and restorative, while adding a fourth element, personal action for quality improvement.

Similarly, professional nursing advocates (PNAs) who are in a clinical leadership role in nursing practice share similar responsibilities, enabling professionals to use advocacy, supervision and quality improvement tools to empower and support staff, and enhance their emotional and physical wellbeing (Lees-Deutsch et al 2025).

The role of the advocate has become increasingly central in contemporary maternity care. However, the A-EQUIP model is often interpreted differently and, therefore, the effectiveness of restorative circles and implementation of all aspects of the A-EQUIP framework varies (Capito et al 2022).

Additionally, unlike counsellors, who are required to participate in compulsory supervision sessions where they can review their own emotional responses to professional issues (Watkins & Milne 2014), many PMAs and PNAs (PMNAs), are working in isolation, often without structured support for the emotional burden their role can engender. Further, in practice, PMNAs are often not provided with protected time and have little access to continuing professional development (CPD) opportunities (Sharman et al 2025).