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Engaging With Clinical Supervision

Clinical supervision was formally introduced into mainstream nursing almost twenty years ago. Despite an increased legitimacy for its widespread adoption through clinical governance schemes particularly in the NHS (UK), there remain challenges to its full implementation in practice, although the international literature on nursing clinical supervision is now quite extensive. For instance, the term 'clinical' and 'supervision' do not best describe its supportive intentions. The former being suggestive of clinging to a medical model of practice, whilst the latter might be viewed with suspicion as a form of organizational surveillance.

Having been personally involved with the development of clinical supervision in healthcare throughout this time and offered a small contribution to that literature the three main components of supervision in healthcare practice can be summarized as;

  • Supervised practice and learning (mentoring, often involving a component of assessment on practice)
  • Organizational supervision (performance management e.g. appraisals, caseload supervision, day to day feedback and management supervision etc.)
  • Supportive supervision (lifelong learning and professional development e.g. clinical supervision, development coaching, modified action learning)
With a range of supervision available in practice (and this does not include competing ad-hoc and informal support...or the mortar that holds the bricks together), it is important to distinguish what the characteristics of clinical supervision are. They seem to me to be;

  • A planned and intentional event in practice with agreed boundaries from the start
  • An opportunity for regular reflection on practice (and action) with others
  • A formal process of practitioner support and practice based learning that will impact on practice / service delivery
  • Differs from, but can enhance managerial supervision
  • A flexible process as no one model will fit all
  • Is supervisee..rather than supervisor led
  • A process in which all 'clinical supervisors' are also 'supervisees'
At its axis is the clinical supervision relationship between the clinical supervisor and supervisee(s) if it is to be sustained and have an impact on practice. Within this apparent simplicity, lies a complex myriad of choices and challenges not just for those individuals or groups involved in clinical supervision but for healthcare organizations themselves. This in turn makes the sustained implementation of clinical supervision a challenging but dynamic process, directly involving healthcare practitioners in the way it is shaped and evidenced in practice. Against this backdrop, clinical supervision will continue to be shaped by the tensions in practice as well as by individual health professionals and their own preferences. Within that same hurly-burly of change and increased accountability through expanded roles and increased demands for our time, I would suggest there is an urgent need to regularly stop, draw breath and take stock, not just about what we have been doing, but how and why we have been doing ...surely a function of clinical supervision!

Please feel free to contact me regarding clinical supervision workshops, residential weekends, supervisor training, bespoke implementation schemes or your experiences of just being engaged in clinical supervision, as well as help develop this resource site with your own contributions.

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John Driscoll
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