Clinical supervision: from staff nurse to nurse consultant Part 1: What is clinical supervision? John Fowler
Poorly understood Clinical supervision has been part of the formal terminology of nursing in the UK since the early 1990s when it was defined by the Department of Health (DH) (1993), the UKCC (1996) and the King’s Fund (Kohner, 1994). It is currently taught in pre-registration courses and forms part of many qualified nurses’ experience. Despite its established place in UK nursing terminology, a number of qualified nurses and managers seem to be unaware of either its existence or its purpose. I am frequently asked to give talks on clinical supervision or assist in its implementation and am amazed at the general lack of understanding of, and commitment to, clinical supervision. With the general public’s increasing concern over nursing standards in some areas, a number of trusts are revisiting strategies in the hope that they can provide assurance of the quality of nursing care. Clinical supervision, if undertaken with genuine commitment by managers and clinical staff, offers a significant role in maintaining and assuring high standards. Yet clinical supervision is not a panacea that will cure all the NHS’ ills. This is particularly true if it is implemented in a tokenistic, under-resourced way by managers and clinical staff alike. In my workshops, I hear of a
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number of people’s examples whereby clinical supervision is nominally set up, but without any thought to staffing implications, structure or evaluation. The result is that staff find it difficult to make time for supervision; if they do make a session, it often feels instructed and of no value. Conversely, I have met many staff for whom clinical supervision has been of enormous value, either to themselves in preventing burnout or providing professional development, or to their clients and patients in terms of care delivery or alternative ways of working. This series will help you look at your own experiences of clinical supervision and help you develop the way you use it. If you are not currently part of clinical supervision, it will give you the incentive to revisit the process.
Defining clinical supervision So what is it? And is it relevant to you? The development of a formal system of clinical supervision in the nursing profession is thought to have arisen from significant changes in the way nursing was managed in the late 1970s and early 1980s. At this time, task-oriented nursing was being replaced by more holistic care, the working week of a nurse had been reduced to 37.5 hours, the staffing overlap between different shifts was drastically cut and the role of the ward sister changed significantly. The pernicious effect of these changes resulted in reduced time and commitment for direct supervision, support and teaching down the hierarchy of matron, ward sister, staff nurse, student and healthcare assistant. When the nursing profession began to realise that the changes were creating a gap in the informal supervision, support and training of its staff, the creation of a more formal process of ‘clinical supervision’ was proposed to safeguard the important processes that were being eroded.
Clinical supervision in practice The practice of clinical supervision will and should vary because the practice of nursing varies across different environments and patient
groups. But there are common principles: ■■ It is a restorative process whereby the practitioner feels able to share concerns and difficulties regarding their clinical nursing practice. There may be frustrations at not being able to work in the way they would like to and difficulties with resources or the pressures of working in today’s health service ■■ It is a normative process whereby a practitioner with greater experience is able to provide the clinician with feedback on the quality and standard of their nursing care. This may be by direct observation or more general discussion of patient care ■■ It is a formative process whereby the clinician is able to develop their practice under the guidance or direction of someone with greater experience than themselves.
Conclusion Clinical supervision is not a tickbox exercise, but a formal process that requires genuine commitment and recourses from both the Trust and the individual. If embedded in the structure of the nursing profession and clinical care management, it will help maintain and BJN develop the standard of nursing care. UKCC (1996) Position Statement on Clinical Supervision for Nursing and Health Visiting. UKCC, London Kohner N (1994) Clinical Supervision in Practice. King’s Fund Centre, London Department of Health (1993) A Vision for the Future. HMSO, London Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to Primary Care Trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2013 MA Healthcare Ltd
T
his is the start of a 12-part series on clinical supervision. The series will examine how clinical supervision can be used to advance your practice, whether you are a staff nurse or nurse consultant. It will examine the Nursing and Midwifery Council’s (NMC) perspective on clinical supervision, how it developed and what it aims to achieve. It will explore the differences between preceptorship, mentoring and clinical supervision. The series will examine the practical steps of setting up clinical supervision, running a session, different sorts of ways of implementing it, the use of records and confidentiality, evaluating clinical supervision and, most importantly of all, making time for clinical supervision.
British Journal of Nursing, 2013, Vol 22, No 13
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.031.207.222 on October 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
Poorly understood Clinical supervision has been part of the formal terminology of nursing in the UK since the early 1990s when it was defined by the Department of Health (DH) (1993), the UKCC (1996) and the King’s Fund (Kohner, 1994). It is currently taught in pre-registration courses and forms part of many qualified nurses’ experience. Despite its established place in UK nursing terminology, a number of qualified nurses and managers seem to be unaware of either its existence or its purpose. I am frequently asked to give talks on clinical supervision or assist in its implementation and am amazed at the general lack of understanding of, and commitment to, clinical supervision. With the general public’s increasing concern over nursing standards in some areas, a number of trusts are revisiting strategies in the hope that they can provide assurance of the quality of nursing care. Clinical supervision, if undertaken with genuine commitment by managers and clinical staff, offers a significant role in maintaining and assuring high standards. Yet clinical supervision is not a panacea that will cure all the NHS’ ills. This is particularly true if it is implemented in a tokenistic, under-resourced way by managers and clinical staff alike. In my workshops, I hear of a
786
number of people’s examples whereby clinical supervision is nominally set up, but without any thought to staffing implications, structure or evaluation. The result is that staff find it difficult to make time for supervision; if they do make a session, it often feels instructed and of no value. Conversely, I have met many staff for whom clinical supervision has been of enormous value, either to themselves in preventing burnout or providing professional development, or to their clients and patients in terms of care delivery or alternative ways of working. This series will help you look at your own experiences of clinical supervision and help you develop the way you use it. If you are not currently part of clinical supervision, it will give you the incentive to revisit the process.
Defining clinical supervision So what is it? And is it relevant to you? The development of a formal system of clinical supervision in the nursing profession is thought to have arisen from significant changes in the way nursing was managed in the late 1970s and early 1980s. At this time, task-oriented nursing was being replaced by more holistic care, the working week of a nurse had been reduced to 37.5 hours, the staffing overlap between different shifts was drastically cut and the role of the ward sister changed significantly. The pernicious effect of these changes resulted in reduced time and commitment for direct supervision, support and teaching down the hierarchy of matron, ward sister, staff nurse, student and healthcare assistant. When the nursing profession began to realise that the changes were creating a gap in the informal supervision, support and training of its staff, the creation of a more formal process of ‘clinical supervision’ was proposed to safeguard the important processes that were being eroded.
Clinical supervision in practice The practice of clinical supervision will and should vary because the practice of nursing varies across different environments and patient
groups. But there are common principles: ■■ It is a restorative process whereby the practitioner feels able to share concerns and difficulties regarding their clinical nursing practice. There may be frustrations at not being able to work in the way they would like to and difficulties with resources or the pressures of working in today’s health service ■■ It is a normative process whereby a practitioner with greater experience is able to provide the clinician with feedback on the quality and standard of their nursing care. This may be by direct observation or more general discussion of patient care ■■ It is a formative process whereby the clinician is able to develop their practice under the guidance or direction of someone with greater experience than themselves.
Conclusion Clinical supervision is not a tickbox exercise, but a formal process that requires genuine commitment and recourses from both the Trust and the individual. If embedded in the structure of the nursing profession and clinical care management, it will help maintain and BJN develop the standard of nursing care. UKCC (1996) Position Statement on Clinical Supervision for Nursing and Health Visiting. UKCC, London Kohner N (1994) Clinical Supervision in Practice. King’s Fund Centre, London Department of Health (1993) A Vision for the Future. HMSO, London Dr John Fowler is a general and mental health nurse. He has worked as an Educational Consultant to Primary Care Trusts and as a Principal Lecturer in Nursing for many years. He has published widely on educational and professional topics and is series editor of the Fundamental Aspects of Nursing Series and the Nurse Survival Guide Series for Quay Books
© 2013 MA Healthcare Ltd
T
his is the start of a 12-part series on clinical supervision. The series will examine how clinical supervision can be used to advance your practice, whether you are a staff nurse or nurse consultant. It will examine the Nursing and Midwifery Council’s (NMC) perspective on clinical supervision, how it developed and what it aims to achieve. It will explore the differences between preceptorship, mentoring and clinical supervision. The series will examine the practical steps of setting up clinical supervision, running a session, different sorts of ways of implementing it, the use of records and confidentiality, evaluating clinical supervision and, most importantly of all, making time for clinical supervision.
British Journal of Nursing, 2013, Vol 22, No 13
British Journal of Nursing. Downloaded from magonlinelibrary.com by 129.031.207.222 on October 15, 2015. For personal use only. No other uses without permission. . All rights reserved.
