What is clinical supervision and why do we need it? This article, which forms the text of a
forthcoming leaflet, aims to stimulate ideas about setting up such an
approach. By D. Bainbridge, C.
Butterworth and J. Mills
Clinical Supervision in the workplace was introduced as a method of enabling
continuous professional development by way of reflective practice and the
sharing of experiences.
It is supported by the UKCC and fits well within the framework of clinical
governance, since, in developing systems for clinical supervision, the nursing profession
is developing a quality framework which helps it improve practice.
What clinical supervision is not is a management tool. Rather, it is
"super vision" and could also be called professional supervision.
Clinical supervision comes in many guises and the UKCC statement emphasises
the importance of creativity in approach. This article is an introduction,
asking some basic questions such as "Why have it?", "What is
it?" and "How can it be implemented?". The aim is to stimulate
ideas and to encourage colleagues to embark on setting up supervision in the
spirit of experiment.
There is no one model and the development phase can be exciting as long as
an open mind is kept. We hope to provide some solutions and ideas but recommend
that selective reading is carried out, and a variety of available sources are
tapped into.
Why clinical supervision?
Clinical supervision is important for continuous professional and personal
development. It can be seen as a tool which supports elements in clinical
governance, for example:
– Improvement of quality
– Risk management and management of performance
– Systems of accountability and responsibility.
Clinical supervision enables a structured approach to reflecting, in greater
depth, on clinical practice, thus improving practice and client care, and
contributing to clinical risk management.
How will clinical supervision help?
Clinical supervision will help nurses meet the requirements of PREP by
ensuring continuous professional development.
It will enable nurses to reflect upon working practices and identify room
for improvements in their practice. It also provides the opportunity to develop
expertise, gain support, and have direction for learning opportunities.
Clinical supervision aims to be motivational, client-centred and to
safeguard standards of client care. It will bring benefits in the following
ways:
– It will enable the evaluation of services delivered
– Provide opportunities, and assist the process that develops
– Assist in the recruitment and retention of staff
– Enable improved efficiency and effectiveness that promotes capability to
meet the needs of the business.
Introducing clinical supervision into practice
Introducing clinical supervision has resource, cost, and time implications.
The commitment and support of key members of staff is essential in the early
stages of planning.
There may be a forum already in place within the organisation into which
clinical supervision can slot, so that the time factor is rationalised.
Which model will work for me?
OH nurses work in a variety of settings and sometimes in isolation.
Therefore, it is important to be creative and to consider ways of utilising the
resources available to suit individual supervisory needs.
It is best to find a model that works well for nurses and their team in
terms of the learning process, the numbers in the team, frequency of meetings,
available venue and required outcomes. There are a variety of models and
approaches for clinical supervision. The following are some types of models but
it is best not to feel too constrained by an academic approach.
Proctor
– Educative – (formative) – develops skills, understanding and ability;
works on how to understand the client better, develops awareness of one’s own
reaction, reflects on interventions and explores other ways of working.
– Supportive – (restorative) – explores how OH staff react emotionally to
pain, conflict and other emotions raised when implementing client care. The
ability to address this issue effectively can reduce burn out.
– Managerial – (normative) – addresses quality control aspects, ensures that
nurses’ work reaches appropriate standards.
Developmental model
Jean Carr’s 1988 Model of Clinical Supervision looks at levels of
supervision:
– Childhood – apprentice
– Adolescence – journeyman
– Early adult – independent craftsman
– Mature adult – master craftsman
Here are some examples of how to develop a structured forum for peer
supervision:
– Meet up with colleagues in a local OH group
– Meet with nurses from other organisations
– Consider partnership in supervision with non-OH professionals
– Seek provision from an outside OH organisation
– Facilitate group supervision
– Conduct one-to-one peer review with professional colleagues
– Set up group supervision with selected leader
– Perform peer group supervision
Characteristics of clinical supervision
Clinical supervision sessions should be carefully structured and managed
with clearly defined aims and objectives.
The template needs a process, an evaluation system and outcomes by which to
measure its success. Ground rules and responsibilities should be clearly
defined and there should be a contract of commitment which includes:
– Commitment to confidentiality
– Open and honest learning
– Sharing best practice
– Seeking research for evidence-based practice
– Enabling learning
– Relevance to clinical practice
– Active listening
– An organisation perspective
– Provision of educational and emotional support
– A formalised method of recording
– Creating opportunities for improvements
– Techniques to manage team dynamics
Clinical supervision is an evolving process developed by experiment whereby
challenge is embraced and built upon.
For further information contact the OH Managers’ Forum at the RCN.
Further reading
1. Butterworth T, Faugier J. (1992) Clinical supervision and mentorship
in nursing. London: Chapman and Hall.
2. Farrington A. (1995) Models of clinical supervision. British Journal of
Nursing; 4(15): 876-878.
3. Faugier J. (1992) The supervisor’s relationship. In Butterworth CA and
Faugier, J. eds. Clinical supervision in mentorship and nursing. London:
Chapman and Hall.
4. Faugier J, ButterworthT. (1994) Clinical supervision: A position paper.
Manchester: University of Manchester.
5. Hawkins P, Shohe R. (1989) Supervision in helping professions. Milton
Keynes: Open University.
6. Johns C. (1993) Professional supervision. Journal of Nursing Management, 1:
9-18.
7. Kohner N. (1994) Clinical supervision in practice. London: Kings Fund.
8. UKCC (1996) Position statement on clinical supervision for nursing and
health visiting. London: UKCC.
D. Bainbridge, C. Butterworth and J. Mills are all members of the
Occupational Health Managers’ Forum at the RCN.
