Clinical Supervision: why we need it but need to sort it out.

I passionately believe in the benefits of clinical supervision for nurses from all fields of practice, and I wanted to share my takeaways and opinions regarding clinical supervision and the Royal College of Nursing Forums’ “Barriers to overcoming the barriers” scoping review exploring 30 years of clinical supervision literature” published in the Journal of Advanced Nursing.

https://onlinelibrary.wiley.com/doi/10.1111/jan.15283

While there is universal acknowledgement regarding the importance and benefit of clinical supervision for all nurses, especially restorative supervision, there is a lack of clarity regarding how to successfully and meaningfully implement it in practice. Implementing a universal, standardised, formulaic (tick box) approach to clinical supervision will not work and will be counterproductive, especially if, as is the rightful intention, is for all nursing fields to adopt the practice.

In practice, where clinical supervision is provided, there is an increasing occurrence of a hybrid model being adopted, coupling it with line management supervision. These should be distinct, as any amalgamation deviates from the initial intention of clinical supervision. The amalgamation of clinical supervision with line management supervision potentially leads to disengagement, a lack of buy-in and a failure to see the relevance or benefit of clinical supervision in its intended form for those in receipt of it, as it is an alien concept to them.

These negative consequences also apply to facilitators and supervisors. While clinical supervision and nurse line management are both vital to support nurses and for their continuous professional development and, ultimately, patient safety and service delivery, they must remain distinct and be given equal value.

However, it is evident due to staffing and time constraints, or a failure to acknowledge the benefit of clinical supervision, that clinical supervision fails to be offered or that sessions are frequently cancelled or amalgamated with other supervision as described. There must be a protected time allowance for clinical supervision.

Additionally, there must be institutional buy-in from organisations who must educate and equip facilitators with the necessary skills to deliver complex clinical supervision both meaningfully and impactfully. Moreover, recognising the benefits clinical supervision has regarding improved patient safety and outcomes in addition to staff support and development, our professional regulator the Nursing and Midwifery Council (NMC) must be more explicit in mandating the need for provision in the NMC Code and in all professional standards for nurses of all fields.

However, the more I reflect, the more I think the term clinical supervision is a barrier itself. The name suggests someone is supervising your “clinical” skills, i.e. line management supervision, or that you are undertaking a supported improvement plan to help support you in practice. The name, clinical supervision, seems divorced from its intent, especially if the call is for us to focus on the more restorative element.

Individuals also take umbrage with the term supervision. Many people, when they hear the term supervision have connotations of micromanagement or removal of their professional autonomy. Again, this is divorced from the intent of clinical supervision. It is meant to help professionals reflect on scenarios that have affected them and support them through these experiences. Whereas in line management supervision, the line manager may identify areas for improvement, is the intent of clinical supervision not to let professionals bring development needs they have autonomously decided they want to work on? Professionals need to feel ownership over this kind of relationship like they are the drivers with a supportive copilot.

I do not profess to have all the answers; however, I think clinical supervision’s most significant barrier is these identified two words, “clinical” and “supervision”. Would “Professional Support and Development” not be much more indicative of the intent and a more appealing offer? We all agree we need this supportive, developing relationship as professional practitioners. But if we do not get the name right, we will continue to experience misunderstanding and failure to engage.

Coming Out Day

Today is #ComingOutDay. Serendipitous that it comes after #WorldMentalHealthDay.

I always knew I was “different”. Aged five, my first ever crush was the Little Mermaid’s Prince Eric (I mean, who didn’t love those blue eyes?).

And I vehemently do not buy into the fact that sexuality is a choice. But I wish I was braver and came out earlier, saving myself years of trauma. But only do it when it’s right for you.

One of the reasons I didn’t come out till I was 18 and essentially ran away to London to study acting, where I could come out and be my authentic self, was because I was scared of letting my family, my parents and especially my dad down. However, they are now among my biggest supporters.

I know that sadly everyone isn’t that lucky. Coming out will always be difficult. For me, coming out to myself was the hardest thing. I was heavily involved in the church as a child, and couldn’t understand how God could have made me “wrong”. Also, I grew up in the times of Section 28. A devastating time. I was bullied at school for being “gay” before I’d even acknowledged it to myself. But teachers couldn’t discuss with me that being gay was okay. Therefore, I internalised my homophobia: the biggest regret of my life.

That is why allyship and supporting our #LGBT+ communities is so important. No one should feel forced to come out if they don’t want to. Never forget: your journey is your journey. If you ever need to talk, though, my dms on Twitter are always open.

Live your life, be you, and love whoever the hell you like! #ComingOutDay2020

All my love now and always, Craig www.twitter.com/CraigDavidson85

My proudest moment…

I have been open and frank throughout my blog posts about the challenges I have faced in the past regards my mental health. The insight these experiences have given me, I believe, will make me a better nurse. I am more compassionate, empathetic, understanding and non-judgemental because of them. Having experienced mental health problems is a major contributing factor in my advocacy for better mental health support for nurses and nursing students. Also, why I champion the inclusion of mental health conditions and how best to support individuals who live with them in nursing education for all fields of practice.

I mention this because to understand my proudest moment; you have to know how much I have been able to turn things around in under three years – from being at my lowest point ever to where I am now. I am proud of that and grateful to those who have helped and supported me.

However, my proudest moment is the advocacy work I have undertaken on behalf of other student nurses and for the nursing profession.

As I have mentioned in previous blog posts, I am about to enter my third year studying BSc Nursing Studies (Adult) at Glasgow Caledonian University (GCU). I first completed an HNC in Care & Administrative Practice at Glasgow Clyde College, which allowed me to apply for direct entry into the second year at GCU. I gained one of 28 places on this articulation programme. Throughout my college and university education, I have always been a champion of the student’ voice and was elected class representative. Subsequently, I am now the School Officer for the Department of Nursing and Community Health at GCU, as well as Vice President of GCU’s Nursing Society. I passionately believe in advocating for students and nurses; especially around the areas of inclusivity, diversity, mental health support, and bespoke funding for nursing students.

My passion for promoting and developing an inclusive nursing recruitment drive led me to apply to be the Scottish representative on the Royal College of Nursing’s (RCN) UK Students’ Committee, which I was successfully elected to. I have voiced my concerns about making nursing more attractive to men and raised this at RCN Congress this year. Subsequently, I am now supporting lead of the student committee’s school project, which aims to promote nursing as an attractive profession to all.

I am proud of these achievements but prouder to be able to give a voice to others who may not feel as though they can. I will always be an advocate for others; it’s something I am incredibly passionate about. However, I will always aim to advocate without promoting a personal agenda. True advocates listen and relay the concerns and opinions of those they represent. They must be transparent and honest, maintaining a continuous open dialogue, which is what I do now and how I will endeavour to continue.

Craig

@CraigDavidson85