CLINICAL

SUPERVISION
NU7410 Advancing
Therapeutic Engagement
Dr Jean Morrissey
 At the end of this lecture you should be better able to:

Explain what is meant by clinical supervision

Identify how clinical supervision might contribute to

enhancing professional development and therapeutic
LEARNING practice.

OUTCOMES Discuss the opportunities and challenges of implementing

clinical supervision in mental health practice.
CLINICAL SUPERVISION
IN MENTAL HEALTH
NURSING

HSE (2015) Clinical

Supervision Framework
for Nurses Working in
Mental Health Services in
Ireland.
HSE (2019) Clinical
Supervision for Nurses
Working in Mental Health
Services; a guide for
managers, supervisors
and supervisees.
 UNDERSTANDING SUPERVISION

What is Clinical Supervision?

Who is it for?
What is it for?
How does it happen?
What are the benefits for clinical supervision?
What challenges does it present for supervisees; supervisors;
organisation and the profession?
SUPERVISION
AND MENTAL
HEALTH NURSING
Origins –
counselling/psychotherapy
UK – 1980s – 1990s
Mandatory/Voluntary
Part of CPD in other ‘helping’
professions e.g. social work,
counselling
Component of CPD – ABA 2000
A Vision for Psychiatric/Mental
health nursing (2012)
 Clinical supervision (CS) provides a safe
and confidential environment for staff to
think about / reflect on and discuss their
work and their professional response to their
work. The focus is on supporting staff in their
WHAT IS personal and professional development and
in reflecting on their practice (Care Quality
CLINICAL Commission 2013).
SUPERVISION?
CS is essentially a learning process whereby
a supervisee meets regularly with an
experienced practitioner - a supervisor, to
discuss clinical and professional issues
relating to the supervisee’s ongoing
learning and clinical practice.
 Purpose is twofold

- to promote and protect ‘the welfare of

the client and the development of the
supervisee’ (Carroll 1996:45)
AIMS OF
CLINICAL - to protect people in care from nurses
SUPERVISION and to protect nurses from themselves
(Barker 1995:67)
 ▪ A management
• A method of surveillance
• A formal performance review
• A form of preceptorship
• Counselling

CLINICAL • Hierarchical

SUPERVISION • Criticism of the individual as a nurse

or person
IS NOT • A form of therapy
• The same thing as training
supervision
(HSE, 2015)
 Organisation

Supervisor Supervisee Client

 Trainees (Student Nurses) –
Training Clinical Supervision

Qualified Staff - Consultative

Clinical Supervision
WHO IS IT
FOR? Multidisciplinary team
members
 Reflective Practice

Mentorship
CLINICAL
SUPERVISION Preceptorship
AND OTHER Supervised Practice
SUPPORTIVE (Bond & Holland, 1998)
SYSTEMS IN
MH NURSING
 MODES OF SUPERVISION

Individual Peer supervision

(one-to-one)
Live supervision

Group
(Small group)
 ONE-TO-ONE (Individual):
Group

WHICH MODE 1.

OF 2.

SUPERVISION 3.

WOULD YOU
PREFER AND
WHY?
 Each format has advantages and
MODES OF disadvantages and presents different
learning opportunities and challenges that
SUPERVISION are often interchangeable and context
dependent (Carroll 1996).
 Numerous models – different
emphasis

These theoretical concepts inform

and guide how supervision is
MODELS OF currently understood and applied

CLINICAL Will depend on the supervisor’s

SUPERVISION theoretical orientation e.g. CBT,
Systemic etc.
 Clinical Supervision

Normative Formative Restorative

(Managerial) (Educative) (Supportive)

Proctor, 1984
 MAKING THE MOST OF SUPERVISION

Thinking about your own practice –

what might you want to discuss if you
were attending clinical supervision this
week?
 ISSUES YOU MIGHT CHOSE TO DISCUSS IN
CLINICAL SUPERVISION
➢Feeling stuck with ➢New clinical area = in-
client/family patient to community
➢Working with ➢new challenges
resistance from clients ➢Emotional support
and/ or colleagues
➢Being therapeutically
➢Transferential issues effective
from yourself and/ or
client ➢Organisational issues
➢Boundaries
THE SUPERVISORY RELATIONSHIP
Establishing a supervisory relationship is seen an
essential element in good supervisory practice (Carroll
1996).

Supervisor and supervisee begin supervision with

expectations and assumptions for the supervisory
relationship' (Holloway 1992: 12).
 THE SUPERVISORY RELATIONSHIP

➢Formal ➢Responsibility
➢Professional ➢Accountability
➢Boundaries ➢Roles
➢Contractual ➢Personalities
➢Task ➢Process
 Nurse: Personal / Professional
support; learning

Client (Patient): Better quality of

BENEFITS care

TO
NURSING Organisation: Standards &
quality maintained and improved;

PRACTICE
staff morale; retention of staff

Profession: Best practice

 What are the advantages of clinical
supervision within a mental health nursing
context?

➢Creates an ethos which fosters staff retention and

IMPLEMENTING morale.
➢Provides an opportunity to learn how to work with
CLINICAL different people in different contexts from
SUPERVISION – experienced practitioners.
OPPORTUNITIES ➢Offers supervisees constructive feedback on their
clinical practice.
➢Offers opportunities to identify Career aspirations
and professional developmental needs can be
discussed and provisions made for these as
necessary.
 ➢CS Misconceived by nurses (Platt –Koch
1986; Wilkin et al 1997; Bishop 1998; Johns
1997)
➢Evidence – beneficial aspect on staff
CLINICAL (Butterworth et al 1997)
SUPERVISION ➢Several qualitative studies – (Johns 1997;
Cutliffe & Burns 1997; Jones 1997)
- OUTCOMES ➢Better patient outcomes (Palsson et al
1994; Webb 1997)
➢Coping with difficult / stressful situations
(Reid 1999; Coyle 2001)
 ➢Need unequivocal evidence to support a
causal relation between CS and better
CLINICAL nursing care

SUPERVISION ➢Paucity of empirical evidence

- OUTCOMES
➢Methodically challenging area
 IMPLEMENTATION – CHALLENGES

Voluntary Mandatory
Supervisor Clinician/Manager

Training Costs

Relationship Trust

Confidentiality Responsibility

Accountability Vicarious liability

Evidence – Improve practice?

Client care? Value for money?
IMPLEMENTING CLINICAL
SUPERVISION – CHALLENGES
Organisational barriers
Availability of appropriate supervisors
Supervision for supervisors
Financial constraints
Confidentiality
Trust
Fear of admonishment
Philosophy of the organisation
Lack of understanding of the concept of clinical supervision
 Clinical supervision in mental health
nursing
▪ An aspect of continuing professional development
▪ Role of MH nurse changing constantly to meet the
needs of service users.
▪ Not a formal requirement as of yet except for ANPs.
▪ Slow to emerge, some anecdotal information about
CLINICAL its existence but a dearth of published literature on
its use etc.

SUPERVISION ▪ Needs to be addressed as roles become more

extended and expanded in line with the scope of

–SUMMARY practice. Role boundaries, fitness to practice issues

etc become more complex and require reflection
and professional development.
▪ Nursing & Midwifery Act (2011) requires nurses to
engage with CPD to maintain competencies for
registration – CS might offer nurses the opportunity
to achieve this in the absence of funds for formal
education strategies.
 REFLECTIVE QUESTION

Mental health nurses often

ask to have supervision As a mental health nurse,
and yet when it is offered how might you explain
to them they are reluctant this?
to engage with it.