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Clinical supervision: separating the fact from the fancy

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It is now more than 25 years since I co-directed a landmark research project to evaluate clinical supervision (CS), funded by the Department of Health and the Scottish Home and Health Department.

edward white

Findings from this two-year study helped to establish the essential contours of nursing CS in the UK and beyond. Data also permitted an internationally validated CS evaluation instrument, the MCSS-26©, to be developed.

The roll-out of local CS arrangements which then followed in local healthcare settings were encouraged by public statements from many professional and government organisations. Over time, multiple claims to the benefits of CS have emerged.

But what does the present-day national CS landscape now look like and what is the actual foundation for these subsequent claims? The straight answers are ‘unknown’ and ‘uncertain’, respectively.

“The visibility of clinical supervision on the national policy agenda seems to have declined.”

In my opinion, it is woeful that the clinical supervision landscape has not been scoped for well over two decades.

Amid continuing reports into tragic care failings and amid the Nursing and Midwifery Council revalidation requirements – practice related feedback, written reflective accounts and reflective discussions – I imagined that the process of CS offered a good fit for some of these workplace conditions and requirements.

I also imagined that it would have stimulated considerable professional interest/public discussion. Instead, the visibility of CS on the national policy agenda seems to have declined. There are commentators who will argue that this is because CS is sufficiently well-established in professional nursing practice.

“How can the fact be separated from the fancy; the evidence, from the folklore?”

But then, how would they know? Others, like me, argue it is more likely to reflect the continuing underdevelopment of CS research and education. Perhaps, even wilful blindness.

In so far as the claims to the causal benefits of CS are concerned, how can the fact be separated from the fancy; the evidence, from the folklore?

These days, there is reducing doubt that CS can have a positive effect on the personal wellbeing of supervisees. Moreover, the transfer effect that this has on [say] the reduction of staff burnout is well established in the international research literature.

However, even in this discrete area, a prudent caveat is necessary; not least, because it not uncommon for it to be [wrongly] assumed that merely ‘having’ CS will automatically reap this and a raft of other such benefits.

“It is vital for a follow-up survey of the present national clinical supervision circumstance to be commissioned, in tandem with an evaluation of the efficacy of clinical supervision provision at local level.”

I assert that it is only if/when the provision of CS achieves a demonstrable quality threshold, that a desired effect may be observed in some nominated outcomes. Crucially, continuous evaluation is essential in this important regard, to ensure ongoing confidence in the place of CS on the clinical governance agenda.

In my opinion, therefore, it is a timely moment to re-visit the potential reach of CS to add value to professional nursing practice.

It is vital for a follow-up survey of the present national CS circumstance to be commissioned, in tandem with an evaluation of the efficacy of CS provision at local level, if a creditable evidence base for practice is to be established and to encourage clinicians and their employing organisations to manage expectations.

Dr Edward White is a Director of Osman Consulting Pty Ltd



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