Clinical and practice supervision

Professional skills development

• Whether you are a student or a qualified practitioner, you should be receiving some form of supervision for your practice.

• If you are a student you will have a mentor or practice/clinical supervisor.

• If you are qualified, you will have a line manager and hopefully a practice/clinical supervisor.

Professional skills development (cont.)Practice/Clinical supervision for qualified practitioners:

• Mental health nurses and psychological therapists are more likely to be familiar with this formal role. However, it can also be informal and you may already have some form of clinical or practice supervision, either from your line manager or perhaps a peer or peer group.

• If you are in social care, you may have a practice supervisor which fulfils a similar role to the health clinical supervisor.

• If you cannot identify a form of practice or clinical supervision after exploring what this should entail, you should try to identify ways to establish this in some form in your current practice*

*every nurse should have access to clinical supervision (NMC 2008)

Making best use of supervision (Webb, 2009)

Practice/Clinical supervisionin its best forms should:

– Be a practice-focused professional relationship between supervisor and supervisee.

– Aim to support practice and standards of care.

– Encourage open discussion of development needs.

Practice/Clinical supervision should not be:

– Used as a management process.

– Focused only on errors and failings.

– Conducted as merely tokenism.

What is good practice/clinical supervision? (Proctor, 1986)

• Normative – It should provide a structure to your practice – it should be part of

your normal work.

• Restorative– Providing support for personal and professional development such

as confidence and morale.

• Formative – Enabling a sharing of knowledge and skills among staff – sharing

experiences, knowledge and problem-solving; developing practice skills.

Case example: RalphA practice nurse was worried about Ralph and discussed this with her supervisor.

Ralph has recently realised he is alcohol dependent and is very keen to undergo rehabilitation, however he seems in a rush to ‘get on with it’ and ‘be cured’.

The nurse has never met someone so eager for recovery and is unsure if he has really considered the seriousness of his dependency.

Case example: Ralph• They discussed the case together, exploring Ralph’s possible over-

eagerness (known as ‘flight to health’) but aware of not putting barriers in his way to recovery.

• The nurse decided that she would explore Ralph’s understanding of dependency with him at his next appointment.

• She and Ralph could discuss his understanding of what rehab is and the commitment he would be making.

• She could also assess his information needs and discuss these with Ralph.

Case example: Ralph• Normative

– The nurse had an established supervisor to turn to and could bring the case up at a regular meeting. This means her issue with Ralph is not seen as a skills failure.

• Restorative– The nurse was relieved to hear that Ralph’s flight to health is a cause

of concern and is quite common. She was worried that her doubt might stop him from accessing treatment.

• Formative– The nurse learned about managing someone in Ralph’s frame of mind

and was helped to develop problem solving skills in managing this case.

References• NMC (2008) Clinical Supervision for Registered Nurses. London, Nursing and

Midwifery Council.

• Proctor B (1986) Supervision: A co-operative exercise in accountability. In: Marken & Payne, Enabling and Ensuring. Leicester, National Youth Bureau.

• Webb L (Ed) (2009) Communication for personal and professional development. In: Nursing: Communication skills for practice. Oxford, Oxford University Press.