Setting Up Peer Group Setting Up Peer Group SupervisionSupervision

Presented byPresented by

Gytha LancasterGytha Lancaster

New Zealand Institute of Rural HealthNew Zealand Institute of Rural Health

BackgroundBackground

• Rural nurses wanting to know about supervision

• Lack of available trained supervisors

• Nurses requesting supervision

• How to provide supervision for rural nurses

Hurdles and barriersHurdles and barriers

Hidden• Misconception and mistrust: what is supervision,

whose it for and why have it?• Attitude: What’s in it for me?Actual• Cost: Who pays?• Time: Work time or family time?• Distance: Can’t travel, no one near to talk to• Lack of trained supervisors:

Setting up Peer group supervision Setting up Peer group supervision and Overcoming barriersand Overcoming barriers

• Allaying fears, misconceptions, and changing attitudes

• Cost and time

• Structure

• Supervision skills workshops

Misconception and mistrustMisconception and mistrust

• Supervision is just another way for management to oversee your practice

• There’s nothing wrong with my practice so I don’t need it

• Its only for people who have been told to have it by nursing council because of poor practice

• It’s the same as having a mentor

Differences between preceptoring, Differences between preceptoring, mentoring and supervisionmentoring and supervision

Preceptorship Mentoring Supervision

A preceptor is more experienced in a particular area of nursing and works with a less experienced nurses while they learn the necessary skills for their new role

Mentoring is a long term relationship to meet a developmental need to help develop full potential and benefits all partners

(Suzanne Faure as quoted by

the New Zealand Mentoring and Coaching Centre,2010)

Supervision is a process where the supervisee is given the opportunity to have in depth reflection on their practice in order to achieve, sustain and creatively develop a high quality of practice.

What’s in it for me and why should I What’s in it for me and why should I have ithave it

• Focuses on issues of education and development of skills by reflecting on experience in practice.

• Supports personal well being• Encourages self development• Creates awareness of how stresses and distress

in working practice affects individuals.• Helps maintain boundaries, stability and

emotional distance.• Focuses on accountability and quality of care

practiced by the supervisee.

• Encourages awareness of blind spots and prejudices and ensures the highest professional standards are upheld.

• Ensures that policies, practices and procedures are followed

• Increases practitioner’s confidence in their practice.

• Reduces staff turn over• Reflections from the supervision may be used

within the portfolio for nursing council competency and peers can confirm practice.

• A protected environment.• Maintains and safeguards standards of practice

How to overcome misconceptions How to overcome misconceptions and mistrust and mistrust

Supervision

skills workshops

Open discussionWhat is it

Why have it

Learning questioning,

listening, and

facilitation skills

Role playPracticing new skills

Cost and TimeCost and Time

• Peer group supervision reduces cost• Supervision skills workshops provided by NZIRH

for rural nurses within certain DHB areas• Supervision proposal/guideline demonstrates

benefits to employers• 1to 1 &1/2 hours per month (at a time negotiated

by group)• Time: most want supervision in working day:

times: before starting work, lunch time or other

GuidelinesGuidelines

Guidelines for successful peer supervision:

• Set clear boundaries e.g. no gossip, discussion of stories after the session, no post mortems

• Clear ground rule over confidentiality• Have a contract• Keep to the process or structure• Always have someone as the facilitator• When getting feedback, listen, reflect, check whether it is accurate

or relevant and take what is useful and leave the rest.• Focus on the person who is getting the supervision• Its ok to make mistakes and learn from them, you don’t always have

to look competent• Prioritise the sessions and put a high value on it• Respect each other, yourself and your patients/clients

Distance solutionsDistance solutions

• Teleconference• SKYPE: either group or single person to

attend a group. Small charge for groups free for single, free download http://www.skype.com/intl/en/prices

• If travelling: central location, or take turns• May need to have mixed professions e.g.

Nurse, social worker, doctor, Occupational therapist

StructureStructure

Check in: Everyone checks

in at the beginning how they have been

at work etc before starting on the agenda

Peer Supervision: The first person

presents their dilemma/issue Their peers ask reflective questions give feedback or share knowledge

The group review the session what was useful

any changes they want to suggest or anything else they need to do,

arrange next months session

Facilitatorensures groupmembers keep

on track

StructureStructure

• Peer group members: 3 to 5

• Group contract/ground rules

• Facilitator: Always appoint a facilitator for the session whose responsibility is to keep the group on task, keeping to the structure, agenda, and time keeping. (The person facilitating alters each time to ensure everyone takes turns)

• Minutes: Minutes to be recorded, one person is allocated on the roster/facilitation plan (this alters each time to ensure everyone takes turns) to record the session.

• Members bring issues

• Audit: 6 to 12 monthly audit of process to ensure achieving goals

Format to explore issuesFormat to explore issues

1. Identify the issue or what’s happening now– Use clarifying questions to get to exactly what’s

happening and the current reality.– Identify key issues and strengths.

2. Describe how you would like it to be different• Use the questions to build a picture of how they would

like it to be• Using open ended questions enable them to develop

specific goals or what they want to happen• Find out what is stopping them from achieving this right

now.

Explore Options• Use open ended questions to generate options

beginning with ideas from the supervisee• Explore different avenues or actions they could take• If they appear to be out of ideas offer suggestions

carefully or give examples of similar experiences (only if required)

• Make sure options address the key issues

4.Actions to be taken• Ensure they make specific commitments to actions to be

taken with a time frame to accomplish them• Identify any foreseeable obstacles or problems and

identify plans to overcome these• Wrap up and close the session

Supervision skills workshops, Supervision skills workshops, what they entailwhat they entail

• 1 day workshop (certificate of attendance)• Interactive, role play, enjoyable • Explore definitions of supervision• Function of supervision • What to bring to supervision• Skills, active/reflective listening, asking open questions• Format to use to explore issues• Feedback: good and when not useful• Sharing information, what’s wrong with advice• Ethics and responsibilities• Suggested structure• Set of examples of contracts, proposal/guideline and other forms

supplied for adaptation.

ConclusionConclusion

• Education re supervision to reduce barriers• SKYPE or teleconference, or central meeting

place• Supervision proposal/guidelines to get employer

buy in• Protected valued time for supervision sessions• Formal structure of Peer group sessions• Regular audit to ensure Peer group supervision

achieving goals