Appendix A

v Supervision Instruments

The following instruments appear in this Appendix. 
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Supervision Questionnaire (Ladany, Hill, & Nutt, 1996) [a measure of supervisee perceptions of the quality and outcomes of supervision).

§       Supervisory Styles Inventory (Friedlander & Ward, 1984).

§       Supervisory Working Alliance Inventory (Efstation, Panon. & Kardash, 1990).

§       Role Conflict and Role Ambiguity Inventory (called "Supervisor Perceptions of Supervision;" Olk & Friedlander, 1992).

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Supervisee Levels QuestionnaireRevised (McNeill, Stoltenberg, & Romans, 1992).

Copyright American Psychological Association. Reprinted with permission.

 ■ Supervision Questionnaire

  1. How would you rate the quality of the supervision you have received?
1 2 3 4
Excellent  Good Fair  For
  1.  Did you get the kind of supervision you wanted?
1 2 3 4
No, definitely not No, not really Yes, generally Yes, definitely
  1. To what extent has this supervision fit your needs?
1 2 3 4
Almost all of my needs have been met Most of my needs have been met Only a few of my needs have been met  None of my needs have been met
  1.  If a friend were in need of supervision, would you recommend this supervisor to him or her?
1 2 3 4
No, definitely not  No, I don't think so  Yes, I think so Yes, definitely
  1. How satisfied are you with the amount of supervision you have received?
1 2 3 4
Quite satisfied Indifferent or mildly dissatisfied Mostly satisfied  Very satisfied
  1. Has the supervision you received helped you to deal more effectively in your role as a counselor or therapist?
1 2 3 4
Yes, definitely Yes, generally No, not really   No, definitely
  1. In an overall, general sense, how satisfied are you with the supervision you have received?
1 2 3 4
Very satisfied  Mostly satisfied  Indifferent or mildly dissatisfied  Quite dissatisfied
  1. If you were to seek supervision again, would you come back to this supervisor?
1 2 3 4
No, definitely not No, I don't think so Yes, I think so  Yes, definitely 

 

■ Supervisory Styles Inventory

For trainees' form: Please indicate your perception of the style of your current or most recent supervisor of psychotherapy/counseling on each of the following descriptors. Circle the number on the scale from 1 to 7, which best reflects your view of him or her.

For supervisors' form: Please indicate your perception of your style as a supervisor of psychotherapy/ counseling on each of the following descriptors. Circle the number on the scale from 1 to 7, which best reflects your view of yourself.

 

1

not very

 2 3 4 5 6 7

very

 
1. goal-oriented  1 2 3 4 5 6 7
2. perceptive  1 2 3 4 5 6 7
3. concrete  1 2 3 4 5 6 7
4. explicit  1 2 3 4 5 6 7
5. committed 1 2 3 4 5 6 7
6. affirming  1 2 3 4 5 6 7
7. practical 1 2 3 4 5 6 7
8. sensitive  1 2 3 4 5 6 7
9. collaborative 1 2 3 4 5 6 7
10. intuitive  1 2 3 4 5 6 7
11. reflective  1 2 3 4 5 6 7
12. responsive 1 2 3 4 5 6 7
13. structured 1 2 3 4 5 6 7
14. evaluative 1 2 3 4 5 6 7
15. friendly 1 2 3 4 5 6 7
16. flexible 1 2 3 4 5 6 7
17. prescriptive 1 2 3 4 5 6 7
18. didactic  1 2 3 4 5 6 7
19. thorough 1 2 3 4 5 6 7
20. focused 1 2 3 4 5 6 7
21. creative 1 2 3 4 5 6 7
22. supportive 1 2 3 4 5 6 7
23. open  1 2 3 4 5 6 7
24. realistic  1 2 3 4 5 6 7
25. resourceful  1 2 3 4 5 6 7
26. invested  1 2 3 4 5 6 7
27. facilitative 1 2 3 4 5 6 7
28. therapeutic 1 2 3 4 5 6 7
29. positive 1 2 3 4 5 6 7
30. trusting  1 2 3 4 5 6 7
31. informative 1 2 3 4 5 6 7
32. humorous  1 2 3 4 5 6 7
33. warm 1 2 3 4 5 6 7
 

Scoring Key for SSI

Attractive:                        Sum items 15,16, 22, 23, 29, 30, 33; divide by 7.

Interpersonally sensitive:   Sum items 2, 5, 10, 11, 21, 25, 26, 28; divide by 8.

Task oriented:                  Sum items 1, 3, 4, 7, 13, 14, 17, 18, 19, 20; divide by 10.

Filler items:                      6, 8, 9, 12, 24, 27, 31, 32.

Developed by M.L. Friedlander & L.G. Ward (1984). Unpublished instruments. 

 

■ Supervisory Working Alliance Inventory: Supervisor Form

Instructions: Please indicate the frequency with which the behavior described in each of the following items seems characteristic of your work with your supervisee. After each item, check (X) the space over the number corresponding to the appropriate point of the following seven-point scale:

 

1 2 3 4 5 6 7
Almost Never Almost Always

  1. I help my trainee work within a specific treatment plan with his/her client.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I help my trainee stay on track during our meetings.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My style is to carefully and systematically consider the material that my trainee brings to supervision. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My trainee works with me on specific goals in the supervisory session. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. In supervision, I expect my trainee to think about or reflect on my comments to him or her. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I teach my trainee through direct suggestion. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. In supervision, I place a high priority on our understanding the client's perspective. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I encourage my trainee to take time to understand what the client is saying and doing. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. When correcting my trainee's errors with a client, I offer alternative ways of intervening. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I encourage my trainee to formulate his/her own interventions with his/her clients. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I encourage my trainee to talk about the work in ways that are comfortable for him/her. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I welcome my trainee's explanations about his/her client's behavior.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. During supervision, my trainee talks more than I do. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I make an effort to understand my trainee. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I am tactful when commenting about my trainee's performance. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I facilitate my trainee's talking in our sessions. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. In supervision, my trainee is more curious than anxious when discussing his/her difficulties with me. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My trainee appears to be comfortable working with me. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My trainee understands client behavior and treatment techniques similar to the way I do. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. During supervision, my trainee seems able to stand back and reflect on what I am saying to him/her. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I stay in tune with my trainee during supervision. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My trainee identifies with me in the way he/she thinks and talks about his/her clients. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My trainee consistently implements suggestions made in supervision. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

Scoring

The supervisor form of the SWAI has three scales. Rapport, Client Focus, and Identification. They are scored as follows:

Rapport:

 Sum items 10-16, then divided by 7.
Client Focus:

 Sum items 1-9, then divided by 9.
Identification: 

Sum items 17-23, then divide by 7.

The supervisor and supervisee forms of the Supervisory Working Alliance are reprinted with permission by the American Psychological Association. From: Efstation, J. E, Patton, M. J., & Kardash, C. M. (1990). Measuring the working alliance in counselor supervision. Journal of Counseling Psychology, 37, 322 329. 

■ Supervisory Working Alliance Inventory: Trainee Form

Instructions: Please indicate the frequency with which the behavior described in each of the following items seems characteristic of your work with your supervisee. After each item, check (X) the space over the number corresponding to the appropriate point of the following seven- point scale:

1 2 3 4 5 6 7
Almost Never Almost Always

  1. I feel comfortable working with my supervisor.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1.  My supervisor welcomes my explanations about the client's behavior. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor makes the effort to understand me.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor encourages me to talk about my work with clients in ways that are comfortable for me. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor is tactful when commenting about my performance. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor encourages me to formulate my own interventions with the client.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor helps me talk freely in our sessions.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor stays in tune with me during supervision..

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I understand client behavior and treatment technique similar to the way my supervisor does.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I feel free to mention to my supervisor any troublesome feelings I might have about him/her.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor treats me like a colleague in our super visory sessions. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. In supervision, I am more curious than anxious when discussing my difficulties with clients.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. In supervision, my supervisor places a high priority on our understanding the client's perspective.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor encourages me to take time to understand what the client is saying and doing.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor's style is to carefully and systematically consider the material I bring to supervision.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. When correcting my errors with a client, my supervisor offers alternative ways of intervening with that client. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor helps me work within a specific treatment plan with my clients. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. My supervisor helps me stay on track during our meetings. 

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7

  1. I work with my supervisor on specific goals in the supervisory session.

 ___ ___ ___ ___ ___ ___ ___
1 2 3 4 5 6 7
 

Scoring

The trainee form of the SWAI has two scales, Rapport and Client Focus. They are scored as follows:

Rapport: Sum items 1-12, then divide by 12.

Client Focus: Sum items 13-19, then divide by 6. 

■ Supervisee Perceptions of Supervision

Instructions: The following statements describe some problems that therapists in training may experience during the course of clinical supervision. Please read each statement and then rate the extent to which you have experienced difficulty in supervision in your most recent clinical training.

I have experienced difficulty in my current or most recent supervision because:

 

Not at all Very much so

  1. I was not certain about what material to present to my supervisor. 

 1 2 3 4 5 6 7

  1. I have felt that my supervisor was incompetent or less competent than I. I often felt as though I was supervising him/her. 

 1 2 3 4 5 6 7

  1. I have wanted to challenge the appropriateness of my supervisor's recommendations for using a technique with one of my clients, but I have thought it better to keep my opinions to myself. 

 1 2 3 4 5 6 7

  1. I wasn't sure how best to use supervision as I became more experienced, although I was aware that I was undecided about whether to confront her/him. 

 1 2 3 4 5 6 7

  1. I have believed that my supervisor's behavior in one or more situations was unethical or illegal and I was undecided about whether to confront him/her. 

 1 2 3 4 5 6 7

  1. My orientation to therapy was different from that of my supervisor. She or he wanted me to work with clients using her or his framework, and I felt that I should be allowed to use my own approach.

 1 2 3 4 5 6 7

  1. I have wanted to intervene with one of my clients in a particular way and my supervisor has wanted me to approach the client in a very different way. I am expected both to judge what is appropriate for myself and also to do what I am told. 

 1 2 3 4 5 6 7

  1. My supervisor expected to me to come prepared for supervision, but I had no idea what or how to prepare.

 1 2 3 4 5 6 7

  1. I wasn't sure how autonomous I should be in my work with clients. 

 1 2 3 4 5 6 7

  1. My supervisor told me to do something I perceived to be illegal or unethical and I was expected to comply.

 1 2 3 4 5 6 7

  1. My supervisor's criteria for evaluating my work were not specific. 

 1 2 3 4 5 6 7

  1. I was not sure that I had done what the supervisor expected me to do in a session with a client.

 1 2 3 4 5 6 7

  1. The criteria for evaluating my performance in supervision were not clear. 

 1 2 3 4 5 6 7

  1. I got mixed signals from my supervisor and I was unsure of which signals to attend to.

 1 2 3 4 5 6 7

  1. When using a new technique, l was unclear about the specific steps involved. As a result, l wasn't sure how my supervisor would evaluate my work. 

 1 2 3 4 5 6 7

  1. I disagreed with my supervisor about how to introduce a specific issue to a client, but I also wanted to do what the supervisor recommended. 

 1 2 3 4 5 6 7

  1. Part of me wanted to rely on my own instincts with clients, but I always knew that my supervisor would have the last word. 

 1 2 3 4 5 6 7

  1. The feedback I got from my supervisor did not help me to know what was expected of me in my day-to-day work with clients. 

 1 2 3 4 5 6 7

  1. I was not comfortable using a technique recommended by my supervisor; however, l felt that I should do what my supervisor recommended

 1 2 3 4 5 6 7

  1. Everything was new and I wasn't sure what would be expected of me. 

 1 2 3 4 5 6 7

  1. I was not sure if I should discuss my professional weaknesses in supervision because I was not sure how I would be evaluated. 

 1 2 3 4 5 6 7

  1. I disagreed with my supervisor about implementing a specific technique, but I also wanted to do what the supervisor thought best. 

 1 2 3 4 5 6 7

  1. My supervisor gave me no feedback and I felt lost. 

 1 2 3 4 5 6 7

  1.  My supervisor told me what to do with a client, but didn't give me very specific ideas about how to do it. 

 1 2 3 4 5 6 7

  1. My supervisor wanted me to pursue an assessment technique that I considered inappropriate for a particular client. 

 1 2 3 4 5 6 7

  1. There were no clear guidelines for my behavior in supervision. 

 1 2 3 4 5 6 7

  1. The supervisor gave no constructive or negative feedback and, as a result, I did not know how to address my weaknesses. 

 1 2 3 4 5 6 7

  1. I didn't know how I was doing as a therapist and, as a result, I didn't know how my supervisor would evaluate me. 

 1 2 3 4 5 6 7

  1. I was unsure of what to expect from my supervisor. 

 1 2 3 4 5 6

7

Scoring Key

Role ambiguity items:       1, 4, 8, 9, 11, 12, 13, 18, 20, 21, 23, 24, 26, 27, 28, 29

Role conflict items:           2, 3, 5, 6, 7, 10, 14, 15, 16, 17, 19, 22, 25

From M. Olk and M. L. Friedlander (1992). 

■ Supervisee Levels Questionnaire-Revised

Please answer the items that follow in terms of your own current behavior. In responding to those items use the following scale:

Never  Rarely Sometimes Half the time Often  Most of the time  Always
1 2 3 4 5 6 7

  1. I feel genuinely relaxed and comfortable in my counseling or therapy sessions.

 1 2 3 4 5 6 7

  1. I am able to critique counseling tapes and gain insights with minimum help from my supervisor.

 1 2 3 4 5 6 7

  1. I am able to be spontaneous in counseling or therapy, yet my behavior is relevant.

 1 2 3 4 5 6 7

  1. I lack self-confidence in establishing counseling relationships with diverse client types.

 1 2 3 4 5 6 7

  1. I am able to apply a consistent personalized rationale of human behavior in working with my clients. 

 1 2 3 4 5 6 7

  1. I tend to get confused when things don't go according to plan and lack confidence in the ability to handle the unexpected.

 1 2 3 4 5 6 7

  1. The overall quality of my work fluctuates; on some days I do well, on other days I do poorly. 

 1 2 3 4 5 6 7

  1. I depend on my supervision considerably in figuring out how to deal with  my clients. 

 1 2 3 4 5 6 7

  1. I feel comfortable confronting my clients. 

 1 2 3 4 5 6 7

  1. Much of the time in counseling or therapy I find myself thinking about my next response instead of fitting my intervention into the overall picture. 

 1 2 3 4 5 6 7

  1. My motivation fluctuates from day to day. 

 1 2 3 4 5 6 7

  1. At times, I wish my supervisor could be in the counseling or therapy session to lend a hand. 

 1 2 3 4 5 6 7

  1. During counseling or therapy sessions, I find it difficult to concentrate because of my concern about my own performance.

 1 2 3 4 5 6 7

  1. Although at times I really want advice or feedback from my supervisor, at other times I really want to do things my own way.

 1 2 3 4 5 6 7

  1. Sometimes the client's situation seems so hopeless. I just don't know what to do.

 1 2 3 4 5 6 7

  1. It is important that my supervisor allow me to make my own mistakes.

 1 2 3 4 5 6 7

  1. Given my current state of professional development I believe I know when I need consultation from my supervisor and when I don't.

 1 2 3 4 5 6 7

  1. Sometimes I question how suited I am to be a counselor or therapist.

 1 2 3 4 5 6 7

  1. Regarding counseling or therapy, l view my supervisor as a teacher or mentor. 

 1 2 3 4 5 6 7

  1. Sometimes I feel that counseling or therapy is so complex I never will be able to learn it all. 

 1 2 3 4 5 6 7

  1. I believe I know my strengths and weaknesses as a counselor sufficiently well to understand my professional potential and limitations.

 1 2 3 4 5 6 7

  1. Regarding my counseling or therapy, l view my supervisor as a peer or colleague.

 1 2 3 4 5 6 7

  1. I think I know myself well and am able to integrate that into my therapeutic style.

 1 2 3 4 5 6 7

  1. I find I am able to understand my clients' view of the world, yet help them objectively evaluate alternatives. 

 1 2 3 4 5 6 7

  1. At my current level of professional development, my confidence in my abilities is such that my desire to do counseling or therapy doesn't change much from day to day. 

 1 2 3 4 5 6 7

  1. I find I am able to empathize with my clients' feeling states, but still help them focus on problem solution.

 1 2 3 4 5 6 7

  1. I am able to adequately assess my interpersonal impact on clients and use that knowledge therapeutically. 

 1 2 3 4 5 6 7

  1. I am adequately able to assess the client's interpersonal impact on me and use that therapeutically.

 1 2 3 4 5 6 7

  1. I believe I exhibit a consistent professional objectivity and ability to work within my role as a counselor without undue overinvolvement with my clients. 

 1 2 3 4 5 6 7

  1. I believe I exhibit a consistent professional objectivity and ability to work within my role as a counselor without excessive distance from my clients. 

 1 2 3 4 5 6 7

Scoring key for the three scales

 Self and Other Awareness:   1, 3, 5, 9, 10*, 13*, 24, 26, 27, 28, 29, 30

                           Motivation:   7, 11*, 15*, 18*, 20*, 21, 23, 25

    Dependency-Autonomy:   2, 4*, 6*, 8, 12*, 14, 16, 17, 19*, 22

*Indicates reverse scoring. To score: sum the items in the scale and then divide by the number of items.

From B.W. McNeill, C.D. Stoltenberg, & J.S. Romans (1992).

Appendix B

The following is excerpted from the UKCC position statement on clinical supervision for nursing and health professionals.

Introduction

  1. This statement presents the UKCC's position on clinical supervision, the context within which it works and the principles (key statements) which contribute to its effective establishment. To emphasize principles, the statement does not set out matters of detail. These must be addressed during development at a local level.

  2. The incorporation of the UKCC's key statements into systems of clinical supervision will allow more effective professional development of nurses and health professionals. This will assist patients and clients to receive high quality safe care in a rapidly changing service environment.

Clinical Supervision in Context

  1. Professional development and support similar to clinical supervision have been available to some practitioners for years on an ad hoc basis. No single model is preferred by the UKCC, although one to one, group and peer group models among others are thought to be effective (ref.1) . The establishment of a model of clinical supervision is best achieved by selecting and using elements of recognised models to suit local requirements.

  2. The potential impact on care and professional development is sufficient to merit investment in clinical supervision. It also makes a significant contribution to clinical risk management (ref.2) while maintaining staff morale and aiding recruitment.

  3. Clinical supervision assists practitioners to develop skills, knowledge and professional values throughout their careers. This enables them to develop a deeper understanding of what it is to be an accountable practitioner and to link this to the reality of practice more easily than has previously been possible.

  4. Clinical supervision is not to be a statutory requirement for nurses and health professionals. This position may be reviewed if the need arises.

  5. Potential benefits are not thought to be limited to patients, clients or practitioners. A more skilled, aware and articulate profession should contribute effectively to organisational objectives.

  6. Clinical supervision should, therefore, contribute significantly to an organisation's ability to meet such a priority. 

What Is Clinical Supervision?

  1. Clinical supervision brings practitioners and skilled supervisors together to reflect on practice. Supervision aims to identify solutions to problems, improve practice and increase understanding of professional issues.

  2. Clinical supervision is not a managerial control system. It is not, therefore:

10.1 the exercise of overt managerial responsibility or managerial supervision;

10.2 a system of formal individual performance review or

10.3 hierarchical in nature.

  1. Links between clinical supervision and management are important. These links are best described in the local policy and ground rules. Management will wish to evaluate the impact of clinical supervision and its service benefits. Development and establishment of clinical supervision should, therefore, involve managers and practitioners with the emphasis on a `light touch' management influence.

The UKCC's Key Statements

Key statement 1

  1. Clinical supervision supports practice, enabling practitioners to maintain and promote standards of care.

Rationale

12.1 By encouraging reflection on practice issues, the practitioner's skills, knowledge and professional values will be enhanced and career development and lifelong learning will be promoted. Clinical supervision is aimed at clinical practitioners. The UKCC believes that supervision for colleagues in educational and managerial settings should also be developed.

Key statement 2

  1. Clinical supervision is a practice-focused professional relationship involving a practitioner reflecting on practice guided by a skilled supervisor.

Rationale

13.1 It is important to establish who is involved in clinical supervision. The practitioner needs to prepare for the supervision session by asking themselves `what do I want to raise or discuss?' (ref. 6) . The supervisor's skills can assist reflection and where possible focus attention on pertinent matters. As a result, outcomes can be agreed, acted on or used in personal development plans. Outcomes may also be entered into a professional portfolio to assist practitioners to meet post-registration requirements. 

Key statement 3

  1. The process of clinical supervision should be developed by practitioners and managers according to local circumstances. Ground rules should be agreed so that practitioners and supervisors approach clinical supervision openly, confidently and are aware of what is involved.

Rationale

14.1 By enabling practitioners to influence the development of clinical supervision, the resultant system can be trusted by all, avoiding the perception or actuality of management imposition.

14.2 Ground rules need to be comprehensive and written down so that practitioners and supervisors are fully aware of the purpose and benefits of supervision. This includes stating how issues are raised, discussed or recorded and how confidentiality is dealt with. Written records of supervisory sessions are confidential and should only be disclosed with the consent of the supervisee If clinical supervision is included in employment contracts, records may be requested by employers.

Key statement 4

  1. Every practitioner should have access to clinical supervision. Each supervisor should supervise a realistic number of practitioners.

Rationale

15.1 Clinical supervision systems should be set out in local policies. Statements about how supervisors are chosen or changed and details of what model of supervision is used should be included.

15.2 The ratio of supervisees to supervisor should be determined locally and can be adjusted by experience.

15.3 In some instances, supervision may be offered by someone other than a nurse or health visitor. Whilst this is exceptional, it would normally be in addition to supervision from a fellow practitioner. This does not preclude a nurse or health professional supervising another registered professional.

Key statement 5

  1. Preparation for supervisors can be effected using `in house' or external education programmes. The principles and relevance of clinical supervision should be included in pre-and post-registration education programmes. 

Rationale

16.1 Preparation of supervisors is crucial to the success of clinical supervision. Relevant practice experience is important, as well as the development of the necessary skills, qualities and characteristics. These include listening, facilitating constructive reflection and guiding practitioners to appropriate outcomes.

16.2 Incorporating the principles of clinical supervision into pre-registration programmes should ensure that the concept and mechanisms of clinical supervision become part of professional culture early in a practitioner's career. Post-registration programmes can build on this by developing skills and an understanding of the value of clinical supervision.

Key statement 6

  1. Evaluation of clinical supervision is needed to assess how it influences care, practice standards and the service. Evaluation systems should be determined locally.

Rationale

17.1 Some areas have established clinical supervision whilst others have not. There is currently a lack of information on the benefits and outcomes of clinical supervision. It is important, therefore, that evaluation addresses this deficit. Information from clinical audit can form a baseline against which the impact of clinical supervision is measured.

17.2 Indicators of benefit could include safer practice; reduced untoward incidents and complaints; better targeting of educational and professional development; better assessment of patient/client opinion; increased compliance with post-registration education requirements; increased innovation/practice development; reduced stress among staff; improved levels of sickness or absenteeism; improved confidence and professional development; greater awareness of accountability; better input into management appraisal systems; better managed risk and better awareness of effective evidence-based practice.

Conclusion

  1. The UKCC endorses the establishment of clinical supervision in the interests of maintaining and improving standards of care in an often uncertain and rapidly changing health and social care environment. The UKCC commends this initiative to all practitioners, managers and those involved in negotiating contacts (ref.6) as an important part of strategies to promote high standards of nursing and health care into the next century. 

References

  1. NHS Executive, Clinical Supervision - A Resource Pack, Department of Health, London, 1995.

  2. Darley M A, Clinical Supervision: The View From the Top, Nursing Management, Vol. 2,3 pp 14-15, Scutari, London, 1995.

  3. UKCC, Midwives Rules, London, 1993 UKCC, The Midwife's Code of Practice, London, 1994

  4. NHS Executive, Priorities and Planning Guidance for the NHS: 1996/97, Department of Health, London, 1995.

  5. UKCC, Standards for Post-Registration Education and Practice (PREP), London, 1995.

  6. UKCC The Council's Proposed Standards for Incorporation into Contracts for Hospital and Community Health Care Services, London, 1995.

Source: United Kingdom Central Council for Nursing, Midwifery and Healthy Visiting