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.
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.