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INNOVATION

Protecting time for clinical supervision

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Clinical supervision is often sacrificed on busy wards but holding sessions over lunch can mean time is protected and the process more relaxed, but still beneficial

Citation: Warrender D (2016) Protecting time for clinical supervision. Nursing Times; online issue 9: 5-6.

Author: Dan Warrender is a lecturer in mental health at Robert Gordon University, Aberdeen, and honorary staff nurse at NHS Grampian.

Introduction

The Nursing and Midwifery Council (2006) considers clinical supervision (CS) to be a valuable form of continuing professional development. Defined as “an exchange between practising professionals to assist the development of professional skills” (Butterworth, 1992), it involves a nurse or group of nurses meeting regularly with their supervisor, an experienced practitioner, to discuss clinical issues. CS has three key functions:

  • Providing support;
  • Facilitating learning;
  • Ensuring professional accountability (Proctor, 1986).

These are linked to emotionally healthy staff who reflect on experiences to grow professionally and maintain professional standards, such as ensuring patient care is safe, person-centred and effective (Scottish Government, 2010). However, CS is often seen as a luxury in busy environments, especially as the healthcare system is underfunded and overstretched (Campbell, 2016; Hodgekiss and Pickles, 2015).

The evidence base for CS is limited but shows that it benefits the three domains identified by Proctor (1986). Support from peers and relief from stress is the most obvious benefit (Brunero and Stein-Parbury, 2008) that nurses experience, with CS also considered valuable in preventing burnout among nurses (Koivu et al, 2012). Measuring the impact of supervision on patient care is difficult (White and Winstanley, 2011). Although there is no reliable evidence to directly link CS to improved outcomes, it can be reasonably assumed that emotionally healthy and peer-supported staff will be in a better position to provide high-quality patient care.

The essence of CS is reflection on clinical experiences, with this reflection supported by an experienced practitioner and used as a basis for learning (Driscoll, 2007). Although there is a long-standing view that nurses reflect on their practice daily, and therefore do not need to set aside specific reflective time (Driscoll, 2007), this could shift with the NMC’s revalidation process. Revalidation requires evidence of a reflective discussion and many nurses and midwives have said this discussion was one of the most rewarding parts of the process (NMC, 2016).

Acute mental health

Acute mental health wards are notoriously busy and the nursing role in these environments has sometimes been described as ‘fire-fighting’ (McGeorge and Rae, 2007), as staff are often forced to react to the demands of an ever-changing roster of patients and a high frequency of intense clinical situations. In such daily, unpredictable situations, it is easy to see how planned CS can be challenging to execute, with staff nurses having difficulty finding protected time (Warrender, 2015). Ironically, the times when nurses sacrifice their arranged supervision – for example, during clinical emergencies and staffing crises – are the experiences that need to be processed and likely to be the most valuable.

Soup, Sandwich and Supervision

Because acute mental health wards are unpredictable and forward planning is sometimes difficult, something needs to change to ensure staff nurses are able to routinely and regularly access CS.

Although healthcare can be busy and unpredictable, it is a fair assumption that staff will have some time to eat lunch. In May 2015, an initiative called Soup, Sandwich and Supervision was introduced in an acute mental health facility in Grampian to facilitate individual supervision over staff lunch breaks. The scheme has so far facilitated supervision for eight staff members. While eating enables nurses to meet the physical demands of the job, it could be argued that CS provides the mental nourishment they need to process challenging experiences and continue practising well.

The scheme is optional and staff can be seen as gaining an opportunity for reflection rather than losing a break. The experiences of two acute mental health staff nurses (Box 1) have supported this and demonstrates that CS itself is valuable and the ‘protecting’ factor of a lunch break is comforting. In addition, food can convert a formal process into a more relaxed yet equally effective one. Soup, Sandwich and Supervision has proved to be effective at protecting time, while maintaining the expected benefits of a more formal supervision process.

The future

Financial constraints, an ageing population and an ageing workforce mean healthcare is likely to become more, rather than less, busy (Johnson, 2015). In this environment, nurses’ experiences may have a high emotional impact, and if they do not have space in which to process them, continued high-quality practice is unsustainable.

People regularly meet over food to catch up and discuss their lives, and nursing could adopt this approach to provide CS. Nurses in busy environments would still have a regular chance for reflection and the much-needed mental nourishment required to fulfil difficult roles.

While the emphasis of healthcare is understandably on patient care, without an equal focus on staff care, we could miss opportunities to sustain and retain high-quality practitioners, and allow them to improve. Soup, Sandwich and Supervision, if adopted, could ensure CS, and reflection, are not seen as a luxury, but as routine and as necessary as eating.

Box 1. Case studies

“Attending clinical supervision is possibly be the best decision I have made since becoming a mental health nurse. It is vital and allows people to look at situations from different perspectives. Since commencing CS I have not been as stressed, felt alone or as though I had to basically ‘just get on with’ situations and bury my emotions. [The] job does affect you emotionally, and my supervision says this emotional response is normal and you are allowed to feel upset, angry or happy because you’re human. Hearing my supervisor say this reassures me.
I have tried scheduled and lunchtime CS with my supervisor, and lunchtime CS has been more beneficial. You may be self-conscious as you are sitting across from another person while eating a meal, but the other person is also eating, and lunch ensures protected time.
Lunchtime supervision has been very beneficial to my practice. Knowing I have the added protective factor of ‘lunch time’ has made me feel more at ease and given me something to look forward to.”

Kelly Cooper, staff nurse

“As a newly qualified mental health nurse I place a lot of value on CS. It gives me a space to reflect on my practice and discuss difficult issues and situations that can arise on an adult acute mental health ward. This helps me develop personally and professionally, and helps me identify solutions to problems that arise; as a result, this can improve patient care. Having this time makes me feel supported, which reduces stress levels and emotional exhaustion – which can be all too common for mental health nurses.
My experience of CS over lunch has been positive. Initially I felt a bit self-conscious [but] this quickly disappeared. Attending CS over lunch can seem like you are not really having a lunch break but after attending my first session I did not feel this way. Time and resources are two important factors for CS to take place. Furthermore, having lunch with my supervisor makes for a more relaxed and informal atmosphere, making it easier to open up and discuss difficult issues. As a result, I am able to reflect more, aiding my professional development.”

Mhairi Tennant, staff nurse

Key points

  • Clinical supervision can encourage life-long learning and maintain professional standards
  • Clinical supervision is often seen as a luxury
  • The Nursing and Midwifery Council’s revalidation requirements for registrants to undertake reflective practice could change the current view of clinical supervision
  • In busy healthcare environments, it can be difficult to protect time for clinical supervision
  • Having clinical supervision during staff lunchtime ensures time is protected, without reducing the benefits
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