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Clinical supervision: supervisee reflections

Denise Hadfield
MSc SRN RMN DipCouns(Man)
Teaching Fellow/ Clinical Supervision Consultant
The School of Nursing, Midwifery and Health Visiting
University of Manchester
E:denise.hadfield@man.ac.uk

Contributor:
Nicola Booton
RGN
Practice Nurse
Stonefield Street Surgery
Milnrow
Rochdale
Lancashire

The clinical supervision implementation framework for Tameside and Glossop PCT and Oldham PCT has been described in part one of this series (NiP Jan/Feb 2003;9:58-60). Butterworth and Faugier, in their systematic review of clinical supervision published in 1994,(1) recognised the suspicion and wariness practitioners may have towards clinical supervision and suggested that the term "clinical supervision" tended to reinforce this. However, they went on to recommend that rather than substituting another term (if indeed a more neutral term was available), educational programmes for supervisees and transparent strategies would overcome this initial perception.
Nicola is a practice nurse and supervisee, and the following is an account of her experiences with clinical supervision.

Nicola's story
Clinical supervision was a concept with which I was completely unfamiliar three years ago. I had spent my entire career since qualifying in secondary care, and following a career break returned to nursing as a practice nurse. Despite my having been a ward sister, the differences in the level of responsibility, autonomy, disease management and so on were starkly apparent, and perhaps compounded by my four-year career break. The isolation in which one practises in primary care is not readily apparent to most, but is all too obvious to a nurse from secondary care who, in hindsight, was unappreciative of the high level of peer support available in hospital. Whether as a consequence of regular meetings with senior nursing colleagues, formal or informal, or the opportunity to discuss concerns with everyone from the junior doctor to the extended multidisciplinary team, almost at the drop of a hat support in one form or another was readily available.
I quickly realised as a practice nurse that this level of support was sadly missing. I think that a major reason for this was the inapproachability of the GPs for whom I worked, and their lack of appreciation of the amount of support I felt I needed having made the transition from secondary to primary care. My only retreat for peer support and advice would come from the infrequent drug company-sponsored educational event. Consequently I was, after six uncomfortable months, extremely pleased to hear of a "new" ­initiative - clinical supervision.
The opportunity for regular, protected and confidential sessions to discuss professional issues with peers of a similar background and caseload, led by a mutually agreeable supervisor, was long overdue. I did, however, remain quite apprehensive about the first couple of meetings, partly from fear of whingeing, partly from being open with strangers, and partly as a consequence of doubting my own abilities, engendered by the lack of support in the first six months in general practice. I was surprised though at how quickly the group "settled in" - this was in no small part due to the expertise and experience of the lead supervisor, who encouraged and cajoled us to share our problems, no matter how small or seemingly trivial.
In the first few months I did not bring many of my problems to the attention of the group; I was satisfied to sit, listen and offer my opinion where appropriate, and was content in the knowledge that I was not the only person in the world frustrated with the job I was doing and the people I was working with. My debut to "problem-sharing" was, however, not long in coming thanks to the backward thinking, patronising and increasingly difficult relationship I shared with one of the GP partners. After spending many long nights and days off working towards the ENB A51 (specialist practitioner award), I was told by said partner to "Go back to hospital medicine - this is far too dynamic for this practice, our patients do not expect it!" So following a particularly bad morning session I eagerly escaped to my trusted confidantes, took a deep breath and started to offload. It was not as hard as I imagined it would be - my peers were incredibly supportive, shocked at some comments and dismayed at others. I had bottled so much up, assuming that this was what general practice was about, and had plodded along trying to keep motivated in the face of stubborn reluctance to modernise. It felt extremely good to simply talk, realising that I was not the odd one out, that patients do deserve a better deal than this.
In the weeks that followed it became increasingly obvious that to retain my professional integrity I needed to move to a different practice. Sometimes you have to acknowledge that despite your best efforts you are not going to be able to succeed. Without clinical supervision, I think that I may have left nursing altogether, believing that I was to blame for the failings I saw in the delivery of healthcare to our population. Clinical supervision provided me with professional guidance, confidence in my judgement, an escape valve, and the reassurance of knowing that in the isolated world of primary care, I was not alone.
Today, I have moved to another practice - it remains imperfect, but with the support of clinical supervision I am better informed, self-assured and less easily dissuaded from trying to implement modern healthcare standards. Overall, the influence that clinical supervision has had on my career has been unreservedly positive.

Conclusion
What is clear from Nicola's account is that supervisees need time, space and support to engage with clinical supervision to enable the benefits. Cutcliffe suggests that, rather than providing formal training for supervisors, resources should be invested with supervisees, and recommends a series of six half-day training sessions.(2) This reinforces the view that clinical supervision is for the supervisee's benefit and therefore driven by the supervisee. Assisting supervisees to make the most effective use of their clinical supervision would make sense.
Part 3 of this series will demonstrate that supervisors also require formal preparation for their role.

References

  1. Butterworth CA, Faugier J. Clinical supervision: a position paper. Manchester: School of Nursing Studies. Manchester University; 1994.
  2. Cutcliffe J. An alternative training approach in clinical supervision. In: Cutcliffe J, Butterworth T, Proctor B, editors. Fundamental themes in clinical supervision. London and New York: Routledge; 2001.

Further ­reading

Barton-Wright P. Clinical ­supervision and primary nursing. Br J Nurs 1994;3:23-9
Fisher M. Using reflective practice in clinical ­s­upervision.
Prof Nurse 1996;11:443-4
Fowler J. Nurses' perceptions of the elements of good supervision. Nurs Times 1995;91(22):33-7
Fowler J. Clinical supervision: what do you do after saying hello? Br J Nurs 1996;5:382-5