In the early 1990s, clinical supervision was hailed as the solution to many of nursing's problems. It was seen as a way to improve standards of nursing practice, giving nurses the opportunity to discuss the issues surrounding their practice so that they could learn from each other and their supervisors.
So why hasn't it worked out the way it was planned?
The main reasons why clinical supervision is not happening are time and expense (see p30). Clinical supervision sounds like a good idea, but it does not work in reality because of the amount of time needed to develop and implement it. The cost incurred when staff take time out of the working day to reflect on their practice is also viewed cynically by some employers.
In the modern NHS, where everything is constantly changing, staff have little time to complete their personal development reviews and keep up with developments in practice. Spending time discussing practice issues is often seen as a luxury rather than a necessity. Unless staff are doing something that is visibly performance-related they are not seen as doing the work they have been employed to do.
Performance indicators do not necessarily have to be directly measurable in time and cost. For example, if an adverse event is avoided as a result of clinical supervision, how much time and cost has been saved?
Clinical supervision can help to change practice, but nurses must be given an opportunity to engage in the process without being made to feel guilty that they are not 'working' on the shop floor.
Can time for clinical supervision ever be considered as part of a normal day's work? The culture of the NHS is slowly changing to enable this to happen. From an educational perspective, hopefully future students will be writing about their experiences of clinical supervision and how it has helped to develop their practice, rather than about how they intend to implement it.
From a managerial perspective, clinical supervision should be implemented as part of the clinical governance agenda to nurture improvements in quality through the principles of openness and honesty. Can we afford not to invest in supporting the best resource the NHS has - its staff?