Professional Development
Clinical supervision: from staff nurse to nurse consultant
Part 9: models of implementation John Fowler
T
his series explores the principles and applications of clinical supervision. Previous articles have examined its development, mentoring and preceptorship, confidentiality, the Nursing and Midwifery Council’s perspective, practicalities of running a session, a Trust perspective, and the responsibilities of the clinical manager.This article examines the different ways in which clinical supervision can be implemented. It is important to emphasise that there is no single model of clinical supervision that fits all clinical areas and the different levels and experiences of staff. There are the general principles, which are being covered in this series, but there is no one ‘magic formula’. Sadly, I still hear of Trusts investing considerable sums of money to train staff in the latest fashion in supervision, be it John’s, Paul’s, George’s, Ringo’s, restorative, explorative or normative. The principles of clinical supervision have and always will be fundamentally simple—a more experienced person gives time to a less experienced person, during which time they examine practice from one or a combination of support, development and standards (restorative, formative and normative: Fowler, 1998). The skill in making it work is not to keep reinventing it, but to support its implementation and ongoing practice. Clinical supervision can be implemented as a one-to-one relationship or group supervision. The other consideration is whether supervision is peer, team or multidisciplinary. Consider how these may work in practice.
© 2013 MA Healthcare Ltd
One-to-one clinical supervision One-to-one is usually developed by staff in the same profession—in our case, nurse-tonurse—with the ‘supervisor’ being the more experienced nurse, but not necessarily the most senior managerially. This is a fairly common model, particularly for junior staff and provided time is safeguarded, it works well. For experienced specialist nurses, however, it is often very difficult to find another nurse who
British Journal of Nursing, 2013, Vol 22, No 21
has greater experience than themselves. In these situations, clinical supervision often takes the form of ‘peer’ supervision, whereby staff of similar experience and profession ‘co-supervise’ each other. Thus, two clinical specialists of the same specialty will meet and offer each other the elements of supervision. Another option for these staff is to receive supervision from someone with greater experience, but who is not a nurse, but very often a medical consultant.
Group clinical supervision There are three possible ways to organise group clinical supervision: peer, team and multidisciplinary. Peer group clinical supervision is a group of typically no more than eight staff, all of similar grades and experience. It might be a group of staff nurses, clinical managers, healthcare assistants or clinical nurse specialists (CNSs). They do not necessarily work on the same ward or clinical area, but they usually work in similar specialties. Since they are ‘peers’, there is no obvious leader or supervisor, so they can either take turns chairing and organising hospitality or they can sometimes have an elected person for a 6-month period and rotate responsibilities. The problem with these groups is that they lack obvious leadership, and if this is not addressed in their initial meeting, they often lose focus and direction. However, provided someone takes the lead, they can become very effective. Team group supervision occurs within the established hierarchical clinical team.This could be the district nursing team and all the staff on ward 23 or the ‘blue team’ of ward 23, the ‘red team’ of ward 23, and so on. There is already an established leader of the team and they usually (though not always) take responsibility for running the clinical supervision session. The main problem to avoid with this style of supervision is to make sure it stays focused on the principles of supervision, as opposed to ward business. Also, the established hierarchical nature within the existing relationships can be
problematic at times, as can the releasing of all the ‘blue team’ at the same time. Yet, in the right circumstances, these groups can be very effective too. The final form of clinical supervision is multidisciplinary group supervision. This tends to occur where multidisciplinary staff work closely together, such as a psychiatric day hospital, or care of the elderly or rehabilitation units. Similar to the other forms of group supervision, they require leadership and time commitment, but have proven very effective. A healthcare trust or hospital may use all these different models of clinical supervision within a single organisation, tailoring them to the needs and resources of different clinical areas and staff. A nurse may also experience different styles and models of supervision as they progress through their career. A number of nurses may be part of two or, occasionally, three different models at the same time. For example, a clinical manager may be part of a peer supervision group with other managers; a one-to-one with a clinical nurse, to ensure her clinical skills are up to date; and part of a team supervision group. I am sure that many of you are now asking how to make the time for clinical supervision when work is so busy? This is the subject for BJN the next article in this series. Fowler J (1998) The Handbook of Clinical Supervision: your questions answered. Quay Books, Wiltshire
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
1261
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved.
Clinical supervision: from staff nurse to nurse consultant
Part 9: models of implementation John Fowler
T
his series explores the principles and applications of clinical supervision. Previous articles have examined its development, mentoring and preceptorship, confidentiality, the Nursing and Midwifery Council’s perspective, practicalities of running a session, a Trust perspective, and the responsibilities of the clinical manager.This article examines the different ways in which clinical supervision can be implemented. It is important to emphasise that there is no single model of clinical supervision that fits all clinical areas and the different levels and experiences of staff. There are the general principles, which are being covered in this series, but there is no one ‘magic formula’. Sadly, I still hear of Trusts investing considerable sums of money to train staff in the latest fashion in supervision, be it John’s, Paul’s, George’s, Ringo’s, restorative, explorative or normative. The principles of clinical supervision have and always will be fundamentally simple—a more experienced person gives time to a less experienced person, during which time they examine practice from one or a combination of support, development and standards (restorative, formative and normative: Fowler, 1998). The skill in making it work is not to keep reinventing it, but to support its implementation and ongoing practice. Clinical supervision can be implemented as a one-to-one relationship or group supervision. The other consideration is whether supervision is peer, team or multidisciplinary. Consider how these may work in practice.
© 2013 MA Healthcare Ltd
One-to-one clinical supervision One-to-one is usually developed by staff in the same profession—in our case, nurse-tonurse—with the ‘supervisor’ being the more experienced nurse, but not necessarily the most senior managerially. This is a fairly common model, particularly for junior staff and provided time is safeguarded, it works well. For experienced specialist nurses, however, it is often very difficult to find another nurse who
British Journal of Nursing, 2013, Vol 22, No 21
has greater experience than themselves. In these situations, clinical supervision often takes the form of ‘peer’ supervision, whereby staff of similar experience and profession ‘co-supervise’ each other. Thus, two clinical specialists of the same specialty will meet and offer each other the elements of supervision. Another option for these staff is to receive supervision from someone with greater experience, but who is not a nurse, but very often a medical consultant.
Group clinical supervision There are three possible ways to organise group clinical supervision: peer, team and multidisciplinary. Peer group clinical supervision is a group of typically no more than eight staff, all of similar grades and experience. It might be a group of staff nurses, clinical managers, healthcare assistants or clinical nurse specialists (CNSs). They do not necessarily work on the same ward or clinical area, but they usually work in similar specialties. Since they are ‘peers’, there is no obvious leader or supervisor, so they can either take turns chairing and organising hospitality or they can sometimes have an elected person for a 6-month period and rotate responsibilities. The problem with these groups is that they lack obvious leadership, and if this is not addressed in their initial meeting, they often lose focus and direction. However, provided someone takes the lead, they can become very effective. Team group supervision occurs within the established hierarchical clinical team.This could be the district nursing team and all the staff on ward 23 or the ‘blue team’ of ward 23, the ‘red team’ of ward 23, and so on. There is already an established leader of the team and they usually (though not always) take responsibility for running the clinical supervision session. The main problem to avoid with this style of supervision is to make sure it stays focused on the principles of supervision, as opposed to ward business. Also, the established hierarchical nature within the existing relationships can be
problematic at times, as can the releasing of all the ‘blue team’ at the same time. Yet, in the right circumstances, these groups can be very effective too. The final form of clinical supervision is multidisciplinary group supervision. This tends to occur where multidisciplinary staff work closely together, such as a psychiatric day hospital, or care of the elderly or rehabilitation units. Similar to the other forms of group supervision, they require leadership and time commitment, but have proven very effective. A healthcare trust or hospital may use all these different models of clinical supervision within a single organisation, tailoring them to the needs and resources of different clinical areas and staff. A nurse may also experience different styles and models of supervision as they progress through their career. A number of nurses may be part of two or, occasionally, three different models at the same time. For example, a clinical manager may be part of a peer supervision group with other managers; a one-to-one with a clinical nurse, to ensure her clinical skills are up to date; and part of a team supervision group. I am sure that many of you are now asking how to make the time for clinical supervision when work is so busy? This is the subject for BJN the next article in this series. Fowler J (1998) The Handbook of Clinical Supervision: your questions answered. Quay Books, Wiltshire
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
1261
British Journal of Nursing. Downloaded from magonlinelibrary.com by 130.194.020.173 on November 13, 2015. For personal use only. No other uses without permission. . All rights reserved.
