Transformational Leadership: A Closer Look at the Effects of Transformational Leadership. 2018. (accessed 19 March 2019)

de Haan E. Supervision in Action: A Relational Approach to Coaching and Consulting Supervision.Maidenhead: Open University Press; 2012

Department of Health and Social Care. Press Release: NHS pledges more support for women with postnatal depression. 2012.

Transference. 2019. (accessed 19 March 2019)

Dryden W, Reeves A. Key Issues for Counselling in Action, 2nd edn. London: SAGE Publications Ltd; 2008

van Ooijen Els Clinical Supervision Made Easy.Philadelphia (PA): Elsevier Science; 2003

Fischer SA. Developing nurses' transformational leadership skills. Nurs Stand. 2017; 31:(51)54-63

Grafton E, Gillespie B, Henderson S. Resilience: the power within. Oncol Nurs Forum. 2010; 37:(6)698-705

Hammond SA. The Thin Book of Appreciative Inquiry, 3rd edn. Bend (OR): Thin Book Publishing Co; 2013

Hawkins P, Smith N. Coaching, Mentoring and Organizational Consultancy Supervision, Skills and Development, 2nd edn. Maidenhead: Open University Press; 2013

Hudnall Stamm B. The Concise ProQOL Manual, 2nd edn. Pocatello (ID): ProQOL; 2010

Hunter B, Warren L. Investigating Resilience in Midwifery: Final Report.Cardiff: Cardiff University; 2013

Inskipp F, Proctor B. The Art, Craft and Tasks of Counselling Supervision Part 1: Making the Most of Supervision, 2nd edn. Twickenham: Cascade Publications; 2001

Jones K, Warren A, Davies A. Mind the gap: Exploring the needs of early career nurses and midwives in the workplace.London: Health Education England; 2015

Kirkham M. The culture of midwifery in the National Health Service in England. J Adv Nurs. 1999; 30:(3)732-739

Maslow A. Motivation and Personality, 3rd edn. New York (NY): Harper and Row; 1987

NHS Education for Scotland. Clinical Supervision for Midwives Unit 1: Fundamentals of clinical supervision. 2017. (accessed 1 March 2019)

A-EQUIP: A model of clinical midwifery supervision.London: NHS England; 2017

Quality, Service Improvement and Redesign Tools: Plan, Do, Study, Act (PDSA) cycles and the model for improvement.London: NHS Improvement; 2018

Realising professionalism: Standards for education and training. Part 1: Standards framework for nursing and midwifery education.London: NMC; 2018

Realising professionalism: Standards for education and training. Part 2: Standards for student supervision and assessment.London: NMC; 2018

Pettit A, Stephen R. Supporting Health Visitors and Fostering Resilience.London: Health Education England; 2015

Proctor B. Supervision: A cooperative exercise in accountability. In: Marken M, Payne M (eds). Leicester: National Youth Bureau Council for Education; 1986

Proctor B. A Guide to Creative Practice.London: Sage; 2004

Are You a Transformational Leader? Psychology Today. 2009. (accessed 10 March 2019)

Rogers C. Client-centered Therapy: Its Current Practice, Implications and Theory.London: Constable and Company; 1951

Why Midwives Leave – Revisited.London: RCM; 2016

Schon DA. Educating the Reflective Practitioner.San Francisco (CA): Jossey-Bass Inc; 1987

Solihull Approach. Welcome to the Solihull Approach. 2015. (accessed 1 March 2019)

Stacey G, Aubeeluck A, Cook G. Resilience-Based Clinical Supervision: A course companion.London: The Foundation of Nursing Studies; 2018

Sterry M. How can Professional Midwifery Advocates use Restorative Clinical Supervision to Positively Influence Staff Cultures in Midwifery?. MIDIRS Midwifery Digest. 2018; 28:(2)157-160

The Person Centred Association. What is the Person-Centred Approach?. 2018. (accessed 1 March 2019)

Restoring Professional's capacity to think. 2014. (accessed 1 March 2019)

Recognising stressors and using restorative supervision to support a healthier maternity workforce: a retrospective, cross-secti. 2013. (accessed 1 March 2019)

Safeguarding restorative supervision – supporting supervisors to work confidently with emotion and challenge in safeguarding. 2016. (accessed 1 March 2019)

Restorative clinical supervision: a reflection

02 April 2019
Volume 27 · Issue 4


A-EQUIP has been rolled out as the model of support for midwives in England since 2017, replacing statutory supervision. The non-regulatory but important supportive aspect of supervision will continue, focusing on restoration, revalidation and education. As a result, the supervisor of midwives role has been replaced by the professional midwifery advocate (PMA). The A-EQUIP model provides a framework for PMAs to deliver support and clinical supervision to midwives, through interventions such as restorative clinical supervision. Providing restorative clinical supervision is explored further in this article, to critically reflect on the beneficial outcomes for midwives facing extreme pressures and the care that women receive.

The Nursing and Midwifery Council (NMC) holds the overall responsibility for regulation of midwives. Following the removal of statutory supervision in 2017, a new model of employer-led supervision, A-EQUIP (Advocating for Education and Quality Improvement) was introduced in England (NHS England, 2017). NHS Trusts should now follow the same investigation and supervision of practice process for all staff (NHS England, 2017). The other three countries in the UK have also adopted employer-led models of supervision, but have chosen to continue to use the term ‘supervisor’ rather than professional midwifery advocate (PMA). A-EQUIP was introduced in seven pilot sites throughout England in 2017 and implemented locally at University Hospitals of Leicester NHS Trust in 2018.

NHS England (2017) studied the needs and requirements for midwives, present and future, during the development of A-EQUIP. Some of the stresses and pressures emphasised in today's workplace are not necessarily new; Kirkham (1999) also highlighted inadequate skill mixes, low staffing numbers and long working hours. More recently, the Mind the Gap report (Jones et al, 2015) discussed ‘Generation Y’ becoming an increasing part of the workforce and highlighted the requirement for employers and educators to consider models of supervision as a strategy to support staff according to the likely needs of each generation. Similar pressures have been recognised by the Royal College of Midwives (RCM) in Why Midwives Leave—Revisited (RCM, 2016). This evidence reinforced the continued strain that midwives face in the workplace and the requirement for support to enable them to manage pressures and carry out their role to the best of their ability. Supervision, in its supportive function, is still considered a principle part of midwifery practice and in light of this, the supervisor of midwives role has been replaced by the PMA (Figure 1).

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month