Clinical governance Combining clinical and management supervision

'Barriers to overcoming the barriers': A scoping review exploring 30 years of clinical supervision literature

Aims/Questions

To explore the barriers and facilitators to nurses accessing clinical supervision; explore the barriers and facilitators to organizations implementing clinical supervision and capture what skills nurses require to facilitate clinical supervision.

Design

Scoping review of peer‐reviewed research and grey literature.

Data sources

CINAHL, Medline, PsychINFO and Scopus were searched for relevant papers published between 1990 and 2020. Google, Google Scholar, OpenGrey & EThOS were used to search for grey literature.

Review Methods

PRISMA‐ScR guidelines were used during the literature review process. Eighty‐seven papers were included, and data were extracted from each paper using a standardized form. Data synthesis was undertaken using Seidel's analytical framework.

Results

Five themes were identified: Definitions and Models, (Mis) Trust and the Language of Supervision, Alternative Parallel Forums and Support Mechanisms, Time and Cost and Skills required.

Conclusion

Since its inception in the 1990s, clinical supervision has long been regarded as a supportive platform for nurses to reflect on and develop their practice. However, this review highlights that despite an awareness of the skills required for nurses to undertake clinical supervision, and the facilitators for nurses to access and organizations to implement clinical supervision, there have been persistent barriers to implementation. This review identifies these persistent factors as ‘barriers to overcoming the barriers' in the clinical supervision landscape. These require critical consideration to contribute towards moving clinical supervision forward in the spirit of its original intentions.

Impact

This review progresses the debate on clinical supervision through critically analysing the barriers to overcoming the barriers. To this end, the review is designed to stimulate critical discussions amongst nurses in different clinical spaces and key stakeholders such as policy makers and regulatory bodies for the nursing profession.

Clinical Supervision

The NHS Plan (DoH 2000) states that the modern National Health Service (NHS) will be driven by a cycle of continuous quality improvement. This will enhance the efficiency, productivity and performance of the NHS. The aim of this article is to examine clinical supervision as a quality assurance initiative. To achieve this, clinical governance and lifelong learning will be evaluated within a theoretical framework with the focus on clinical supervision.

Anaesthetic nurse specialist role: leading and facilitation in clinical practice

Leadership and its effectiveness is becoming more prevalent within the nursing profession with anaesthetic nurse specialists showing their ability to lead, inspire and motivate others to work towards a shared vision in the rapidly changing peri-anaesthesia environment. Anaesthetic nurse specialists must therefore be aware of their personal leadership skills and continually develop these within clinical practice. They are also well placed regarding the facilitation of learning.

The Integration of Clinical and Managerial Supervision: A Critical Literature Review

The introduction of a new development review process, the Knowledge and Skills Framework (KSF), has placed a greater demand on occupational therapists within the health service to be more accountable for practice. It has been proposed that the KSF may provide a useful structure for supervision in order to ensure continual development. Therefore, this literature review looked at the appropriateness of addressing both clinical and managerial issues within the supervisory process.

The results indicate that despite many professions being unsure of how best to deliver supervision, there is a common understanding that a structure combining clinical and managerial supervision, such as the KSF, may be useful. It is, however, recommended that the roles of appraiser and supervisor remain separate, because many researchers found conflict within this duality of role as having an impact upon the effectiveness of supervision. It is also recommended that further research be undertaken in order to evaluate formally the effectiveness of integrating the KSF into supervision.

Fostering a culture of support in mental health settings: alternatives to traditional models of clinical supervision

Clinical supervision [CS] for mental health nurses in inpatient settings in Sydney, Australia, is virtually nonexistent despite over a decade of discussion regarding its benefits to staff, patients, and organisations. Whilst there is general agreement about the merit of CS, its ad-hoc implementation and the use of models that do not correspond to the realities of the environment have led to its adoption being somewhat half-hearted. It is unsurprising then that there is an absence of achievable policy regarding CS making its integration into modern inpatient units even harder to attain. In this paper, we outline some pragmatic issues concerning CS and advocate for facility-specific professional development and support processes that incorporate succession planning opportunities. This we believe has the potential to promote professional behaviour, continuous learning and development, cohesive teamwork, and ultimately a change in culture regarding CS.

Clinical supervision: beginning the supervisory relationship

While much has been written on clinical supervision (CS) in the nursing literature, there appears to be minimal attention afforded to the supervisory relationship and in particular the early phases of this relationship. It is understood that the quality of the supervisory relationship has a significant contribution towards the efficacy of CS. In acknowledging the struggles in demonstrating the effectiveness of supervision it seems reasonable to turn attention towards the relationship between supervisor and supervisee. This article begins by providing an overview of the supervision literature concerned with the supervisory relationship. Following this, attention is focused on the commencement of this alliance by describing the processes and attributes needed to commence a supervisory relationship.A comprehensive template for establishing a supervision agreement is presented. However, it is suggested that this template does not have to be confined for use in this particular clinical context but may be applicable to a variety of nursing environments. It is proposed that such an agreement/contract facilitates healthy beginnings for the supervisory relationship and goes some way towards enhancing the trajectory of this alliance.