Debate: Clinical supervision by other professional

This resolution did not pass 

Skills for Care defines supervision as “an accountable process which supports, assures and develops the knowledge skills and values of an individual, group or team”. 

Clinical supervision has benefits for nurses, nursing, patients and service users, carers and also the organisational culture, reflecting the values and behaviours of the organisation and its staff.  It is also linked to good clinical governance. Clinical supervision functions as an emotionally safe space that, in turn, promotes critical reflection and has a positive impact on nurses’ emotional well-being. Clinical supervision provides a strategy to mitigate nurses’ workplace stress and enhance retention.

Clinical supervision can help staff to manage the personal and professional demands created by the nature of their work. A variety of models for Clinical supervision have evolved in different work settings across the UK. Rarely is time for clinical supervision funded or included in the calculation of nurse staffing levels.

Clinical supervision provides an environment in which staff can: explore their own personal and emotional reactions to their work; reflect on and challenge their own practice in a safe and confidential environment as well as receive feedback on their skills; and engage in professional development, identify developmental needs and support revalidation. 

A variety of models for clinical supervision have evolved in different work settings. Within mental health care environments, it is primarily through one-to-one engagement with another registered nurse. Clinical supervision can be carried out by another member of the same profession or group, providing staff with the opportunity to: review professional standards; keep up to date with developments in their profession; identify professional training and continuing development needs and ensure that they are working within professional codes of conduct and boundaries. 

Consequently, it is agreed that clinical supervision is an important mechanism in the provision of high quality, safe and effective clinical care. However, anecdotal evidence from RCN members and CPN colleagues has shown that one-to-one clinical supervision in nursing is being eroded, especially in community mental health teams. This is likely to increase as nurse staffing levels become more difficult to sustain. There is often insufficient time for nurses to have appropriate clinical supervision due to the demands of high caseloads and increased workloads. A major review by the Foundation of Nursing into Mental Health nursing showed that access to clinical supervision was insufficient in the UK. 

Other professions such as midwifery and social work have successfully fought for supervision to be recognised as an essential element of their service.

Whilst some local policies encourage nurses to choose their own supervisor, and there are several models of supervision which encourage staff to seek supervision appropriate to their practice, there remain concerns about the support for meaningful clinical supervision opportunities. This includes evidence within community mental health teams of a move to group supervision which is being imposed and, even more worryingly, it is often led by a psychologist.

We are concerned that removal of 1:1 supervision denies a safe space for learning and undermines a nurse’s right to confidential supervision. Other health professionals, such as psychologists, bring a different perspective from nurses. This denies nurses positive role models, undermines professional development of nurses and can lead to resentment. 

We are not arguing against a multi-professional approach to care giving and we value the expert intervention our health and care colleagues bring to the service users. However we feel the role of supervisor in this important and valuable clinical supervision relationship should be a fellow registered nurse. A well-established system of clinical supervision has been proven to be effective in enhancing the normative, formative and restorative features so vital in the provision of high quality nursing care.