Clinical and practice supervision

1. Clinical and practice
supervision

2. Professional skills development
• Whether you are a student or a qualified
practitioner, you should be receiving some
form of supervision for your practice.
• If you are a student you will have a mentor or
practice/clinical supervisor.
• If you are qualified, you will have a line
manager and hopefully a practice/clinical
supervisor.

3. Professional skills development
(cont.)
Practice/Clinical supervision for qualified practitioners:
• Mental health nurses and psychological therapists are more likely to
be familiar with this formal role. However, it can also be informal and
you may already have some form of clinical or practice supervision,
either from your line manager or perhaps a peer or peer group.
• If you are in social care, you may have a practice supervisor which
fulfils a similar role to the health clinical supervisor.
• If you cannot identify a form of practice or clinical supervision after
exploring what this should entail, you should try to identify ways to
establish this in some form in your current practice*
*every nurse should have access to clinical supervision (NMC 2008)

4. Making best use of supervision
(Webb, 2009)
Practice/Clinical supervision
in its best forms should:
– Be a practice-focused
professional relationship
between supervisor and
supervisee.
– Aim to support practice and
standards of care.
– Encourage open discussion
of development needs.
Practice/Clinical supervision
should not be:
– Used as a management
process.
– Focused only on errors and
failings.
– Conducted as merely
tokenism.

5. What is good practice/clinical
supervision?
(Proctor, 1986)
• Normative
– It should provide a structure to your practice – it should be part of
your normal work.
• Restorative
– Providing support for personal and professional development
such as confidence and morale.
• Formative
– Enabling a sharing of knowledge and skills among staff – sharing
experiences, knowledge and problem-solving; developing
practice skills.

6. Case example: Ralph
A practice nurse was worried about Ralph and
discussed this with her supervisor.
Ralph has recently realised he is alcohol dependent
and is very keen to undergo rehabilitation, however
he seems in a rush to ‘get on with it’ and ‘be cured’.
The nurse has never met someone so eager for
recovery and is unsure if he has really considered
the seriousness of his dependency.

7. Case example: Ralph
• They discussed the case together, exploring Ralph’s possible over-
eagerness (known as ‘flight to health’) but aware of not putting
barriers in his way to recovery.
• The nurse decided that she would explore Ralph’s understanding of
dependency with him at his next appointment.
• She and Ralph could discuss his understanding of what rehab is
and the commitment he would be making.
• She could also assess his information needs and discuss these with
Ralph.

8. Case example: Ralph
• Normative
– The nurse had an established supervisor to turn to and could bring
the case up at a regular meeting. This means her issue with Ralph
is not seen as a skills failure.
• Restorative
– The nurse was relieved to hear that Ralph’s flight to health is a
cause of concern and is quite common. She was worried that her
doubt might stop him from accessing treatment.
• Formative
– The nurse learned about managing someone in Ralph’s frame of
mind and was helped to develop problem solving skills in
managing this case.

9. References
• NMC (2008) Clinical Supervision for Registered Nurses. London, Nursing and
Midwifery Council.
• Proctor B (1986) Supervision: A co-operative exercise in accountability. In: Marken &
Payne, Enabling and Ensuring. Leicester, National Youth Bureau.
• Webb L (Ed) (2009) Communication for personal and professional development. In:
Nursing: Communication skills for practice. Oxford, Oxford University Press.