POLICY/PROCEDURE FOR SUPERVISION Prepared by:
Naomi Reay
Approval Information:
Patient Care & Professions Date Approved: COMMITTEE:
Lead Director:
Sheila Dilks
Responsible Area:
Core/Development standard
Performance indicators
History of Document
12th September 2007 PEC
Version No. Approved:
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Review Date:
September 2009
C1, D1, C5, C7 1. Increased number of PCT staff receiving supervision 2. Increased number of PCT staff who have attended supervisor training 3. Evidence of staff attedning awareness raising events 4. Changes in levels of clinical incident reporting (increase or decrease) Based on North Kirklees PCT policy approved June 2006 & Huddersfield South & Central PCT Supervision policy & supervision guidance documents approved July 2006. Individual & Group consultations within Kirklees PCT 2007 see appendices
CONTENTS Section No.
Page No’s
1.
Introduction/Overview
2
2.
Values underpinning this policy 2.1 Associated Policies and Procedures
2 2
3.
Aims & Objectives 3.1 Purpose 3.2 Aim 3.3 Background on Supervision
2 2 3 4
4.
Kirklees PCT responsibilities and Supervision 4.1 Trust responsibilities for supervision 4.2 Link between Clinical Governance and supervision 4.3 Delivering Supervision 4.4 Models of Supervision 4.5 Database 4.6 Recording 4.7 Confidentiality 4.8 Ground rules and a written contract 4.9 Training 4.10 Audit 4.11 Evaluation
5 5 5 5 6 6 6 7 7 8 8 8
5.
References & Bibliography
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6.
Appendices
10
Abbreviation list: PCT – Primary Care Trust NMC – Nursing & Midwifery Council HPC – Health Professions Council
NICE Guidance Once NICE guidance is published, health professionals are expected to take it fully into account when exercising their clinical judgement. However, NICE Guidance does not override the individual responsibility of health professionals to make appropriate decisions according to the circumstances of the individual patient in consultation with the patient and/or their guardian or carer.
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1.
Introduction/Overview Supervision as referred to in this policy, is based upon Clinical Supervision, a process for the support of staff and the development of practice. This process is key to clinical professions such as nursing and allied health professionals, and it is anticipated that it will also be applicable to all staff with face to face contact with the public. Supervision should be available to all PCT staff. It is a requirement that all Nursing Midwifery Council and Health Professionals Council registered staff working for Kirklees Primary Care Trust (Kirklees PCT), access Supervision in line with this policy. This policy has been formulated by drawing upon several sources: • Guidance from professional bodies • Academic literature and research evidence of Clinical Supervision • Existing policies and guidance of the two pre-merger PCT’s, Huddersfield PCT and North Kirklees PCT • Experience of Kirklees Primary Care Trust staff • University of Huddersfield staff
2.
Values underpinning this policy The values of the policy are founded in the Vision and Value statements of Kirklees PCT which include: ‘To have a positive learning environment which supports innovation’ ‘Be accountable for the decisions we make, the work we do and the resources we use’ ‘People at the heart of everything we do’ ‘Provide high quality, safe and efficient services which are responsive to need’ ‘Open, clear honest communication’
2.1 Associated Policies & Procedures NMC Guidance – Nursing and Midwifery Council (2002) – Supporting nurses and Kirklees PCT Training Policy
3.
Aims & Objectives This document aims to state the policy for Supervision within Kirklees PCT. It will include policy on the structure, training and documentation of supervision within Kirklees PCT.
3.1 Purpose It is recognised that staff should have regular opportunities for support, and that supervision can fulfil some support needs by: 1. Identify solutions to problems Approval Committee: Version No: Date Approved:
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2. Increase understanding of professional issues 3. Improve standards of care/service delivery 4. Identify training issues 5. Identify and manage risk Supervision will deal with only some of the support needs of staff. It should be recognised that this is not its primary purpose and there is need for both parties to be aware of the options should the supervisee require access to an independent support agency.
3.2 Aim Butterworth (1997) provides much of the key academic work around supervision and suggests that participation in supervision by clinical staff leads directly to improved levels of professional confidence and competence and enhanced standards of patient care. It is hoped that non-clinical staff will experience similar benefits. The principle of supervision in clinical practice is to improve the quality of patient care to a consistently high standard. In 1994 the Chief Nursing Officer and director of Nursing NHS Management Executive stated in a professional letter. ‘I have no doubt as to the value of Supervision and consider it to be fundamental to safeguarding standards, the development of professional expertise and the delivery of quality care’ (NHS 1994)
Supervision should have three equally important functions: 1. Formative - The educative process of developing skills 2. Restorative - a supportive approach for staff working constantly with stress and distress 3. Normative – the organisational and quality control aspect of practice (Proctor 1991) In combination, these aspects ensure that a clear focus to Supervision is kept. In practice this entails discussing topics within supervision, based on the supervisee agenda, with the supervisor summarising using the three aspects of this model and sometimes guiding the supervisee towards these areas if they appear to be ‘stuck’. The individual member of staff is responsible for their own supervision and is encouraged to select their own supervisor who may be from within or external to their team and discipline. In exceptional circumstances supervisors external to the PCT may be appropriate. If external, travel time and expenses must be agreed and met by their line manager. Approval Committee: Version No: Date Approved:
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3.3
Background on supervision
The concept of supervision has evolved from the process of Clinical Supervision, which focuses around clinical staff. This has been recommended as ‘an integral part of lifelong learning’ by the Nursing and Midwifery Council (2002). Its aim is to bring staff and skilled supervisors together to reflect on practice in order to:
Identify solutions to problems Increase understanding of professional issues Improve standards of care Identify and help to manage risk Identify training issues
It is also stated that clinical supervision brings increased feelings of support and personal well being. (Cutcliffe and Proctor 1998 citing Butterworth et al 1996). It is anticipated that broadening the availability of supervision to staff at the interface with the public will provide these staff with the mechanism to provide both support and improve quality.
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4.
Kirklees PCT responsibilities & Supervision 4.1 Trust responsibilities for supervision The trust is committed to ensuring that supervision is available across all staff involved in the patient interface of care, both qualified and unqualified. All staff will be offered training to enable them to undertake the role of clinical supervisee and/or supervisor. Time will be allocated to attend supervision meetings (see section 4.6)
4.2 Link Between Clinical Governance and Supervision Clinical Governance can be defined as: ‘a framework through which NHS organisations are accountable for continuously improving the quality of their services and safeguarding high standards of care by creating an environment in which clinical excellence will flourish!’ (DoH 1993 Vision for the Future) Research has shown that clinical supervision has an important role to play in the clinical governance agenda (Butterworth et al 1997). Clinical supervision offers clinicians guidance, support and education and is fundamentally concerned with quality, safety and protection. Participating in supervision in an active way is a clear demonstration of an individual exercising their responsibility under clinical governance. Organisations have a responsibility to ensure that individual clinicians have access to appropriate supervision and support.
4.3 Delivering Supervision
Definitions As the term ‘Supervision’ may be familiar in several contexts, this document defines Supervision and its associated terms to clarify its meaning in the context of this policy.
Supervision Supervision is a formal, recorded arrangement that enables people to discuss and reflect upon their work with an experienced supervisor. This is distinct from supervision provided in a line manager capacity, and also from Child Protection supervision, arrangements for which fall outside of this policy.
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Supervisor An appropriately trained and skilled person (with training beyond that of a supervisee) who provides a supervision service within PCT guidelines and policy.
Supervisee An appropriately informed member of staff receiving supervision.
4.4 Models of Supervision One to one Supervision 1. With an experienced clinician from your own discipline 2. With an experienced clinician from another discipline 3. With a peer
Group Supervision 1. Peer group – with either no formal leader or where leadership alternates 2. Led by a facilitator/supervisor whose role is to organise the time, enforce ground rules and summarise key learning points. It is suggested that this be kept to a maximum of 5 participants to allow opportunity for all members to contribute
4.5 Database A database will be established and maintained containing a list of all current staff. They will then have their supervision training recorded and their role as a supervisor identified if they are appropriately trained. All supervisors must also receive supervision. The database will be updated with audit information as it is submitted. This database of staff who has received training will be held in the training/governance department. Initially staff seeking matching will contact training/governance for a list of supervisors; however this will be done electronically by the individual staff member when software training is established. When this software is established, supervisors and supervisees will document their supervision electronically.
Matching of Supervisee to Supervisor As this is a constructive relationship it is important that there is good communication between both parties, therefore the supervisee should be able to identify their preferred supervisor who will decide if they are able to accept them. If the supervisor is unable to accept then the supervisee must make a second selection.
4.6 Recording All supervision sessions will be recorded. A record sheet (appendix 6) will be completed and a copy held by the supervisor and the supervisee. A portfolio record sheet (appendix 8) will be completed with details of dates and sessions held and kept in the supervisee’s portfolio, which can be seen by their line manager. Approval Committee: Version No: Date Approved:
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4.7 Confidentiality All sessions are confidential. However, if issues are raised by the supervisee that the supervisor feels the need to be acted on then the supervisor must inform the supervisee’s line manager with the supervisee’s knowledge. This way supportive action can be instigated and the supervisor will have discharge their responsibility.
4.8 Ground rules and a written contract of supervision between the supervisee and supervisor should include the following elements (see Supervision Contract – appendix 9): 1. How often the sessions will take place – it is recommended to occur at 4-8 weekly intervals, for part time staff this may extend to 12 weekly intervals. a. Length of session – approximately one hour 2. Format of the session – Discussion of which model of supervision will be used. 3. Expectations of the session – so that both parties are clear about their roles 4. Purpose and function of the supervision – which should be re-enforced by the supervisor if required 5. To determine how unsafe practice will be dealt with in line with professional regulatory guidance such as Nursing and Midwifery Council Policy (NMC 2004), or relevant Kirklees PCT policies 6. To review and define the boundaries of confidentiality and to clarify that it may be possible for supervision documents to be called upon in the event of an investigation. 7. Documentation – The Primary Care Trust require that the Supervision record (Appendix 1) must be completed and submitted for audit. It is recommended that the supervisee should keep a personal record of their development and reflection. There are suggested formats for this record (Appendices 2,3,4,5). 8. The supervisor must ensure that the supervisee’s line manager is notified if a supervisee has not received supervision for four months, unless the individual is on leave. These records must be available for audit. 9. Re-scheduling in the case of cancellation is the responsibility of the person cancelling. This should be done within 2 weeks of the original date except in circumstances where sick leave is long term. The reasons for cancellation must be recorded and submitted for audit. 10. A system to address supervision which is not benefiting the supervisee or from which either party wishes to withdraw should be outlined in the supervision contract. If a supervision relationship is ended, the supervisee’s line manager should be notified immediately to facilitate re-selection.
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4.9 Training It is recommended that training be made available for all staff on a two tier bases:
For staff who are supervisees A basic introduction to the purpose, process and benefits of Supervision will be undertaken as part of a rolling programme of in house training.
For staff who are both supervisees and supervisors Further training, which includes the development of the skills, required to facilitate effective Supervision (Sloan 1998, 1999 – for example as provided by the University of Huddersfield). This training will be documented on the central database and it is anticipated that this be updated by further support or training if considered appropriate by either the member of staff or the Primary Care Trust. The Supervisor should be able to set their own limits for how many supervisees they are to be allocated.
4.10 Audit It is recommended that Supervision be regularly audited. Key statement 6 of the NMC position Statement on Clinical Supervision for Nursing and Health Visiting states: ‘Evaluation of Clinical Supervision is needed to assess how it influences care, practice standards and the service….(NMC, 2002) Minimum criteria for audit will be: 1. 2. 3. 4. 5.
Frequency of supervision – dates of the supervision sessions Percentages of those receiving individual and group supervision Documentation of Supervision training received Register of supervisors Identification of staff not attending supervision once they have a supervisor
This data should be submitted (using form appendix 1) after every other supervision session (approximately 4 monthly) as described above, initially in paper form and then electronically as software is developed. This data will be incorporated into an electronic database (for example the A.T learning database). NMC and HPC registered staff (if not on leave) and who have a supervisor and who have not attended Supervision for over 4 months will be identified and notification will be sent to their line manager.
4.11 Evaluation Evaluation across all staff involved in Supervision will be carried out on an annual basis by anonymous postal questionnaires. Outcomes to be considered include staff’s own experience of Supervision, staff stress levels and increased levels of incident and Approval Committee: Version No: Date Approved:
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near miss reporting. This evaluation will focus on the experiences of those involved and be used to inform Supervision service, policy and guideline review.
5.
References & Bibliography Butterworth et al (1997) – It is good to talk, an evaluation study in England and Scotland, University of Manchester. 5. References and Bibliography Cutcliffe J R Proctor B (1998) – An alternative training approach to clinical supervision: 1. British Journal of Nursing, Vol 7 No 5 Moores Y (1994) – Clinical supervision for the nursing and health visiting profession, Chief Nursing Office professional letter, 94) 5_, Department of Health Proctor B (1991) On being a trainer, in Dryden W and Thorne B, training and supervision for counselling in action, Sage publication London NHS (1994) Clinical supervision for the nursing and health visiting profession, chief Nursing Office professional letter. 94 (5), Department of Health NMC- Nursing and Midwifery Council (2004) Code of Professional Conduct: Standards for conduct, performance and ethics NMC: London NMC – Nursing and Midwifery Council (2002b) Position statement on clinical supervision for nurses and health visitors Sloan G (1998) – Clinical supervision: Characteristics of a good supervisor. Nursing Standard. June Vol 12, Iss 40, p42 Sloan G (1999) – Understanding clinical supervision from a nursing perspective. British Journal of Nursing. April-May Vol 8, Iss 8 pg 524-530.
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APPENDIX 1 Supervision record for audit purposes Supervisor Date of and supervision Supervisee names
Group/Individual If cancelledreason for cancelling
Contact details Supervisor Name Job Title Workplace Telephone E mail Line Manager – Name and telephone number Supervisee Name Job Title Workplace Telephone E mail Line Manager – Name and telephone number Approval Committee: Version No: Date Approved:
The following Appendices, Appendix 2, 3, 4 and 5 are included as examples of documentation for potential use and are not obligatory
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APPENDIX 2 Reflective Diary – Supervisee A reflective diary can highlight issues to bring to supervision. Models of reflection can help in structuring a clinical supervision session ensuring all the steps in the reflective process are covered. There are many different models of reflection: Johns (1993) devised a useful model based on the following: 1. Description: Where you describe and experience, focusing on an issue. 2. Reflection: Where you might explain the consequences and what you were trying to achieve 3. Influencing factors: What events of factors influenced the supervisees decisions? 4. Alternative strategies: Could the situation have been handled better or differently? 5. Learning: How can the supervisee now make sense of the experience? How will they deal with this issue in the future?
When starting the reflective diary concentrate on stages 1 and 2. Stages 3, 4 and 5 can be thought about and talked through with your supervisor With acknowledgement to Pat Perry of Calderdale Primary Care Trust
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APPENDIX 3 Learning Log Date Week commencing
……………………………………………………
Significant experience
Description
Analysis Did I break out of accustomed practice and experiment with new ways of doing things?
Did I allow invalidated assumptions about situations or misplaced perceptions of people to affect what I did?
How aware was I of my inner needs that were driving what I did, and how well did I handle them?
Did I use my feeling constructively or allow them to block me?
Conclusions
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APPENDIX 4 Reflective Practice Case Discussion Select a patient/client on your caseload who you would like the opportunity to discuss at supervision. It may be a case that is causing you concern. Patient personal details should not be included in this document. Briefly describe the package of care. (Diagnosis, family dynamics, care package, other agency involvement). What is troubling you with regard to this case?
Reflect on the package of care in relation to: Strengths
Weaknesses
Opportunities
Threats
Share this reflection at supervision
What were the agreed actions with your supervisor?
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APPENDIX 5 Reflective Practice – Use of a Critical Incident Description of the event
Why was the event important to you and how do you feel about it?
On reflection: What was satisfactory?
What was most troubling?
What might you have done differently?
What was the outcome of reflecting on this in supervision?
What were the agreed actions with your supervisor?
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APPENDIX 6 Supervision Record Sheet Date:…………………………. Supervisee…………………………………………. Designation………………….. Supervisor………………………………………….. Designation:…………………. Internal/External……………………………………. Content of Session:
Action to be taken:
Signed:………………………………… ……………………………… Supervisee Supervisor Approval Committee: Version No: Date Approved:
APPENDIX 7 Evidencing Experiential Learning (Tool adapted from Dr V Cross 2001)
What have I done recently?
Date(s):…………………………………...
Location:…………………………………………
Description of activity / experience:
Do I have anything to support what I have done?
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What did I learn from the activity?
What will I do with the learning?
How does it relate to my professional standards, competencies, personal objectives etc?
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APPENDIX 8 PORTFOLIO RECORD OF SUPERVISION SESSIONS Name of Supervisee…………………………………………………… Date Held
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Supervisor
APPENDIX 9 SUPERVISION CONTRACT Supervisee (please print name) ………………………………………………… Supervisor (please print name) ………………………………………………… We agree to: • Meet………………………………………………(please specify frequency) For……………………………………….(please state duration of meetings) • Keep signed supervision records sheets of all sessions (both partners) • Keep a portfolio record of supervision sessions (supervisee only) • Respect confidentiality at all times, however take appropriate action as identified in section 4.7 above wherever unsafe practice is identified or suspected • Be familiar with the supervision policy • Rearrange sessions cancelled within 2 weeks of original date except where sick leave is long term • Submit 4 monthly audit sheets to Training and Education Co-ordinator
This contract can be terminated by either party at any time. Where this is the case the Supervisee’s line manager should be informed Signed…………………………………………………………………...(supervisee) Signed…………………………………………………………………...(supervisor) Date………………………………………………………………………
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6.3 Consultations with individuals/groups or subcommittees for the bringing together of the North Kirklees and Huddersfield South and Central PCTs policy, guidance and training. Individuals (January to June 2007) Name
Base
Gillian Brearly – Modernisation Karen Woodhead – Modernisation Karen Armitage – Professional Development Facilitator Anne Heley – School Nurse Team Leader Claire Johnson – Senior Lecturer Elaine Sargeant – Modernisation Naomi Reay – Professional Development Facilitator Liz Barker – District Nurse Robert Flack – Director Provider Unit Julie Livesey- Locality Manager Joan Booth – Locality Manager Tracy Small – Deputy Director of Clinical Development and innovation Caitlin Edwards – Lead Occupational Therapist
Mirfield HC Dewsbury HC PRCHC Mill Hill HC University of Huddersfield Dewsbury Health Centre PRCHC Fartown HC St Lukes House Holme Valley Mill Hill PRCHC Dewsbury Hospital
Groups Kirklees Policy Development Group – July 2007 Cohort 1 – Supervision training group – March 2007 Locality Managers – presented to Kirklees PCT locality managers June 2007 Kirklees Training and Education Group – July 2007
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