Clinical supervision is a broad concept, having been adopted and integrated into many helping professions. Definitions tend to delimit the boundaries, range, role and depth of supervision. As to the content of clinical supervision, this tends to be informed by its area of application as supervision of a specific mode of intervention may encompass some didactic teaching of skills central to that application. For instance, in nursing, clinical supervision definitions tend to encompass aspects of learning, interpersonal support and oversight-however, not all authors agree on this basic summation. Some others have acknowledged the need for a range of models to address the diversity of practice within nursing. Most models do, however, tend to encompass the above dimensions. Differences in emphasis upon each of the elements may be in evidence according to the issue presented, the developmental level of the supervisor and supervisee, their career stage, the model of supervision used and extraneous factors imposing upon the relationship. For example, a beginning practitioner may need additional oversight and educational input compared to a seasoned practitioner, who may need relatively more interpersonal support.
Supervision models also vary in the emphasis given to each of the above elements, sometimes in accord with the orientation and view of the originating theorist. Models derived by educationalists stress learning, models derived by managers tend to stress oversight, service quality and outcomes and those developed from psychotherapeutic approaches often emphasize interpersonal support. There are very many definitions of supervision, the following being typical:
A term used to describe a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex clinical situations. It is central to the process of learning and to the expansion of the scope of practice and should be seen as a means of encouraging self assessment and analytical and reflective skills.
Clinical supervision serves a number of purposes. It should:
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Establish formal systems for practitioners to explore, discover and examine their practice in a safe and supportive environment ; |
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Allow individuals to develop their thoughts and actions in a way that leads to enhanced care delivery to the patient or client group; |
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Enable practitioners to accept accountability for their own practice and development; |
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Contain the stresses of working in a demanding environment within the workplace. |
When clinical supervision is effective, practitioners feel supported, valued and able to continue their work. The effective use of clinical supervision for all practitioners should contribute to the development of practice throughout the organization.
Supervision, particularly when used in isolation, is often linked to negative perceptions of performance monitoring and discipline of staff by the manager (Butterworth 1992). However, clinical supervision is a vehicle that enables practitioners to develop skills and attitudes that enhance their care delivery, thus meeting their work and professional objectives. Systems of management appraisal and clinical supervision should run parallel to one another.
Appraisal is a management tool, and the manager has a key role in the relationship. The clinical supervisor may or may not be the manager. The practitioner should take an active part in selecting the most appropriate clinical supervisor. This may be a peer, a manager or another professional colleague.
Source: Webb B (1997) Auditing a clinical supervision training programme.
Nursing Standard. 11, 34, 34-39
| Individual | Meeting one to one with a more experienced clinician acting as supervisor |
| Peer | Meeting one to one with an equally experienced clinician |
| Group (led) | Meeting as a group with more experienced clinician acting as supervisor |
| Group (peer) | Meeting as a group of similar level experience with no designated supervisor or group leader |
| Team | Meeting as multi-disciplinary clinical team to address clinical issues, either with or without designated supervisor |
Strengths and Potential Challenges of Individual Supervision
| Strengths | Potential Challenges |
| More time for supervisee | Full weight of focus on individual supervisee |
| Opportunity to create clearer and more focused objectives | Input from only one person (supervisor) |
| Highly personalized | Difficulties if supervisory relationship breaks down |
| Supervisee can work at own pace | Evaluation and feedback from one person's perspective only |
| Noncompetitive environment | Can become collusive with little challenge |
| Allows supervisee to concentrate on one particular issue | Can foster dependency in supervisees |
| Development in supervision can be easily monitored | Less comparison for supervisees regarding other ways of working |
| Supervisor's intentions can be geared specifically towards the learning of the supervisee | Transference issues may hamper task if unresolved |
| Strengths | Potential challenges |
| Input from a number of people | Individuals' needs may not be addressed |
| Supportive atmosphere from peers | Individuals may get `lost' or `hide' within the group |
| Value of listening to others describe their work and problems they face. | Maybe a lack of time for group members with large caseloads |
| Cost effective in time and economics | Not all are suited to group work |
| Can allow experimentation with other interventions | Can be used as a "dumping ground" |
| Can help supervisees deal with issues of dependency on supervisors | Group dynamics may temporarily block the task |
| Evaluation and feedback from a number of people |
Pressure to conform, `Group think' |
| Risk taking can be higher in group setting | Difficulty for newcomers to enter group |
| Emotional support from peers | Some topics may not be of interest to other group members |
| Issues arising from within the group can be addressed | Lessening of confidentiality |
| Dilutes power of supervisor | Overload for some members |
In a supervisory relationship, the supervisor may:
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Create a context for curiosity for the supervisee |
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Generate multiple perspectives on a situation |
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Invite supervisee to arrive at his or her own solutions |
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Give positive feedback |
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Confirm person's ability |
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Create new perspectives on counselor-client relationships |
Clinical supervision is underpinned by an agreement forged by and between the participants. This agreement or `contract' makes explicit the nature and boundaries of the relationship. A session-specific agreement between participants can be negotiated at the beginning of each meeting, which will outline the goal(s) of that session and help clarify the steps needed to achieve them. Time within the sessions themselves may be structured by using models or frameworks for helping understand the pertinent issues and work towards a solution of greater understanding.
Simple Reflective Model (Gibbs amended)
| Description | What happened? Telling the story (uninterrupted) |
| Feeling |
What were you thinking and feeling? (How are you feeling now as you retell the story?) |
| Evaluation |
What was good and bad about the experience? (Why was it good or bad and what are you basing this judgment upon?) |
| Analysis |
What sense can you make of the situation? Think about what this means to you. |
| Conclusion | What else could you have done? (And the reasons why you didn't.) |
| Action plan | If it arose again, what would you do? (the same thing or something different). Is it a situation you expect to deal with again? If not, how could your reflections be applied to other situations? |
Interpersonal Process Recall (Kagan, Adapted By Stern)
This model is particularly suited to beginning practitioners and to self supervision – the development of the `Internal Supervisor'.
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What did you feel? |
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What did you think? |
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What bodily sensations did you have'? |
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What did you do or say? |
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What would you rather have done or said? |
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What would the risks be if you had done/said this? |
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What do you imagine this person was thinking/feeling? |
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What images, associations, memories does this bring up? |
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Anything else? |
Reprinted with permission.
Steve Cottrell. www.clinical-supervision.com