CLINICAL SUPERVISION

in NURSING
Widyawati, SKp., M.Kes., Ph.D.
 What clinical supervision is and what it is not?
CLINICAL SUPERVISION IS:
An exploration of the relationship between actions and
feelings
A tool for professional development
A safe place
A place of learning
Supportive
A place to share burdens of work
A structure framework for reflection
Mutually supportive for all
Open to questions and challenges
About listening and being heard
Inclusive
Affirming
Self-driven/self-owned by participants
Supportive of personal accountability
CLINICAL SUPERVISION IS NOT:
A means of checking up on practice
A judgment on you or your practice
An assessment
A performance management tool
Therapy (although it may be therapeutic)
Counselling or an opportunity to practie as a counsellor
Controlled and delivered by managers
Part of the reporting process
A teaching session
Mentoring by the facilitator
Appraisal
A “person soap box”
A place for snooping
A place for blame
A place to run down other members of the team
A place for the facilitators’ agenda
A dumping ground, or place for gossiping or moaning
What is professional supervision?
• A formal process that provides professional support to enable
practitioners to develop their knowledge and competence, be
responsible for their own practice, and promote service users’ health,
outcomes and safety.
• Regular, protected time for facilitated, in-depth reflection on clinical
practice. It aims to enable the supervisee to achieve, sustain and
creatively develop a high quality of practice through the means of
focused support and development. The supervisee reflects on the
part she plays as an individual in the complexities of the events and
the quality of her practice.
Common elements of clinical/professional supervision:
• Focused on the wellbeing of service users (patient’s need)
• Focused on providing effective innovative service delivery
• Aimed at building your supervisee’s clinical and practice skills
• Aimed at expanding your supervisee’s knowledge base and ethical competence
• An opportunity for reflection and learning
• Supportive of their personal and professional development
• The responsibility of both you and your supervisee
• Empowering, building your supervisee’s confidence and self esteem
• A facilitative and structured process
• Regular and occur throughout your supervisee’s career
• Driven by your supervisee’s need
• A confidential process
 How might clinical supervision be delivered?
Description Possible Benefits
Indivi • May be provided regularly for individuals with a • Development of trusting relationships between
dual single named facilitator over an extended period of facilitator and participant maximising opportunity for
time. challenge and growth
• Can be ad hoc, as requested to deal with specific • Ad hoc sessions useful for providing more immediate
incident or issue. support and opportunities for learning from difficult
• May include brief interventions. situations that arise.
Peer • Usually involves two or more participants • May be easier for some people to engage with –
facilitating their own sessions. These participants comfort in using skills and resources of trusted
are usually experienced in clinical supervision or colleagues to support reflection on actions/events.
have previously acted as facilitators. • Can be helpful as usually those involved will be familiar
• Can also involve participants rotating into the role with the situation being discussed.
of observer who gives feedback at the end of the
session (also known as triadic supervision).
Group • Can be provided in fixed groups of peers or • Safety and trust can built up over time in fixed groups.
colleagues operating at similar level with regular • Great potential to share knowledge and experience and
named facilitator. learn from each other.
• Or in fluid drop-in groups with a pool of alternating • Cost effective way of providing access to regular clinical
facilitators supervision
 Possible Challenges
Individual Expensive to deliver to large numbers of people on regular basis
Facilitator and participant need to be appropriately matched.
Need enough identified and trained facilitators in an organization to be able to provide an
ad hoc service reliably.
Peer Sessions may become too informal, lacking the process and challenge to enable growth.
Group Facilitators need to be skilled at managing group dynamics as well as the reflective process
Drop-in groups can feel too unsettled for some participants.
Ground rules and process need to be agreed at each drop-in session which can be time
consuming
Proctor’s Model of Clinical Supervision

Accountability:
Normative

Clinical Supervision
Support: Learning:
Restorative Formative
• Educative/Formative : Focuses on developing supervisee’s skills,
understanding and abilities

• Administrative/Normative: Focuses on developing your supervisee’s

understanding of the professional and ethical requirements of their
practive.

• Supportive/Restorative: Focuses on developing your supervisee’s

ability to cope with the emotional effects of their work.
 Functions of clinical supervision
Accountability Accountability is also referred to as the normative component. It focuses on supporting individuals
to develop their ability and effectiveness in their clinical role, enhancing their performance for and
within the organization. The aim is to support reflection on practice with an awareness of local policy
and codes of conduct.
- support delivery of a high standard of ethical , safe and effective care
- enhances performance.
Learning Learning is also referred to as the educative component. It enables participants to learn and
continually develop their professional skills, fostering insightfulness through guided reflection. It
focuses on the development of skills knowledge, attitude and understanding.
- supports personal and professional development.
- encourages and supports lifelong learning.
- helps to identify further training and development needs.
Support Support is also referred to as the restorative component. It is concerned with how participants
respond emotionally to the work of caring for others. It fosters resilience through nurturing supportive
relationships that offer motivation and encouragement and that can also be drawn upon in times of
stress.
- supports self-care and well-being
- provides insight into our emotional responses
- enhances morale and working relationships.
Heron’s Model
• Authoritative
• Supervision interventions:
• Prescriptive – direct behaviour
• Informative – information giving/instruct
• Confronting – challenge

• Facilitative
• Cathartic – release tension, strong emotion
• Catalytic – encourage self exploration
• Supportive – validate/confirm
Powell’s Model
• Components
• Administrative
• Evaluative
• Clinical
• Supportive

• Conceptualization of supervisor as a ‘servant leader’ who is:

• Self aware
• Operates with focus and energy
• Proficient in many aspects of the job
• Shares power and values people by caring-partnership approach
Current Supervision Debates
• Qualifications of the supervisors
• From the same discipline
• A different discipline
• A peer colleague
• Expertise
• Content of care
• Processes of development
• Guided reflection vs. more traditional clinical
supervision
• Collaborative supervision
• May not challenge each other sufficiently (Walsh et al.,
2003)
Evidence - Supervision Effectiveness
(Kilminster & Jolly, 2000, p. 833)

• Supervision has a positive effect on patient

outcome & lack of supervision is harmful to
patients.
• Supervision has more effect when the trainee is less
experienced.
• Self-supervision is not effective.
• The quality of the relationship between supervisor
& supervisee is probably the single most important
factor for effective supervision.
• Behavioral changes can occur quickly – changes in
thinking & attitude take longer.
Who can be a clinical supervisor?
Supervisor qualifications:
• A license to practice in the area in which supervision is going to be provided
• Specific coursework in supervision and/or a specified minimum number continuing
education hours
• A minimum of three years of post licensure experience in a supervisory role
• Have no active sanction by a disciplinary proceeding
• Have formalized training in supervision and ongoing participation in the professional
development of supervision
• Have experience and expertise in the supervisee’s work setting and the patient
population served
• Be familiar with the administrative and organizational policies of the workplace
setting of the supervisee
• Be familiar with the community resources available to the supervisee for appropriate
referrals of patients
Characteristics of Effective Supervisors
• Empathetic
• Supportive
• Flexible
• Interested in supervision
• Track supervisees effectively
• Link theory with practice
• Engage in joint problem-solving
• Interpretative
• Respectful
• Focused
• Practical
• Knowledgeable
Characteristics of Ineffective Supervisors
• Rigid
• Low empathy
• Low support
• Failure to consistently track supervisee concerns
• Failure to teach or instruct
• Indirect & intolerant
• Closed
• Lack respect for differences
• Non-collegial
• Lacking in praise & encouragement
• Sexist
• Emphasize evaluation, weaknesses, & deficiencies
Ethical Issues in Clinical Supervision
• Informed consent, should be clear in advance (role and
responsibilities)
• Confidentiality, should be aware of the fact that information might be
shared with persons who have some stake in their evaluation.
• Dual Relationships, often tricky because of the fact that the clinical
supervisor often has more than one professional relationship with the
supervisee.