Nurse-led clinical supervision role should not be eroded

Why RCN congress 2019 is debating clinical supervision of registered nurses by other professions

Why RCN congress 2019 is debating clinical supervision of registered nurses by other professions


No one can doubt that clinical supervision is crucial to providing safe and effective care to patients.

It gives nurses opportunities to reflect on clinical practice in a secure environment. This allows them to develop professionally by sharing good practice, discussing near misses and developing strategies to address challenging situations with a trusted professional colleague.

Clinical supervision provides a nurturing environment for newly registered nurses to learn and develop. It is also a forum for established workers to take stock, and an opportunity to develop as role models and inspirational leaders.

Bassett (2015), lamenting diminished clinical supervision, argues that it is the key to high-quality care because it gives nurses a chance to share their workplace stress with colleagues and so reduce it.

A well established system of clinical supervision can enhance the normative, formative and restorative features so vital to the provision of high-quality nursing care.

Seeking assurance

It therefore makes sense that leaders in healthcare organisations seek assurance that their nurses can access clinical supervision.

If it is assumed that a typical supervision session lasts for one hour, a team of 20 community psychiatric nurses all providing and receiving regular clinical supervision every 4-6 weeks will invest about 40 hours a month in supervision.

This represents a challenge for nurse leaders as one week each month is spent looking after the team rather than being devoted to nursing care.

We are all familiar with the drive for cost improvement, synergies, and recurrent and non-recurrent cost savings in the NHS. We are also familiar with the call for clinically led and quality-driven services.

The financial case for those 20 nurses attending a one-hour clinical supervision session clinically led by a psychologist is obvious. Yet we see financiers, managers and other bureaucrats opportunistically eroding nurse-led clinical supervision.

The electronic staff record can be updated to say all nurses receive clinical supervision, and the public can be assured that we are safe and effective nurse practitioners, but at what professional cost?

Positive role models

The involvement of other healthcare professionals, such as psychologists, denies nurses positive role models and undermines their professional development. It can also lead to resentment of colleagues who are paid at a higher band, but have significantly smaller caseloads due to their expert intervention.

This is not to suggest that there is anything wrong with a multi-professional approach to providing care; all nurses value the expert interventions of their colleagues.

In addition, specialist interventions or caseloads may require specialist supervision. Approved mental health professionals (AMPHs), for example, may seek specialist case load supervision from fellow AMPHs in different professional groups.

However, there should be no doubt that the role of supervisor in important clinical supervision relationships should be taken up by a fellow registered nurse.

A major review by the Foundation of Nursing Studies into mental health nursing (Dean 2017) shows that access to clinical supervision is insufficient in the UK, especially in community mental health teams.

There is rarely time for nurses to have appropriate clinical supervision due to the demands of high caseloads and increased workloads.


About the author

Phil_ColePhil Cole is staff side lead at Black Country Partnership NHS Foundation Trust and a member of the RCN Birmingham West and Sandwell Branch

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