Which clinical supervision models best benefit your professional development?

Clinical supervision establishes a formal process of support, reflection, learning and development that is of benefit to both newly registered and experienced health professionals by supporting their individual development

CREDIT: This is an edited version of an article that originally appeared on NHS Employers

Some of the key benefits of clinical supervision include:

• improved patient care through increased knowledge and skills;
• reduction in stress levels and complaints, and an increase in staff morale;
• increased confidence and a reduction in burnout and emotional strain;
• increased knowledge and awareness of potential solutions to clinical problems;
• creation of new nursing roles, such as professional nurse advocates (PNAs) and legacy nurses.

There are many different clinical supervision models that can be considered which will be suited to different team dynamics and organisations. 

Proctor’s three-function models

This popular framework is defined by having three separate areas of supervision. This is considered the definitive model upon which the other models, below, are based.

• The first area is normative; this focuses on the managerial aspects of learning, which could include core mandatory training and continuing professional development.
• The second is formative; this focuses on using professional development to enhance knowledge and skills and on using self-reflection as a tool to further develop self-awareness. It aims to increase the practitioner’s reflection of their own practice.
• The third is restorative; personal development focusing on support, preventing burnout, and learning to better manage stress. This supervision can take place as one-to-one supervision, peer group supervision, or a combination of both types.

This model is considered to clearly outline the different elements that comprise a substantial programme of clinical supervision, as well giving them equal weighting to ensure that practitioners consider their own wellbeing as well as personal and professional development. It is also heralded as providing individuals with another avenue for feedback that is beyond the normal managerial feedback process, offering the opportunity for individuals to identify skills to develop, or focus on. Whilst offering a solid base to develop clinical supervision models, it does not consider it important to understand why we have an emotional response to a situation, nor does it identify service improvement as crucial.

Resilience-based clinical supervision 

Resilience-based clinical supervision is a framework developed by the University of Nottingham that focuses on understanding the emotional systems that prompt a certain response to a situation. It teaches participants how to alleviate this emotional response through understanding and reflecting on why they have responded in a certain way and, in due course, to be able regulate this response whilst paying attention to their own wellbeing.

• This framework is useful to the practitioner in a variety of different situations as it focuses on the root emotional response.
• It creates a safe space for healthcare workers to discuss and explore their feelings, engaging with others but also practicing self-reflection.
• The mindfulness techniques suggested as part of this framework can be used during the working day to refocus and respond positively to difficult situations.
• It helps practitioners to recognise situations beyond their control, and to mitigate critical self-response.

Restorative supervision: A-EQUIP model

The A-EQUIP model takes elements of Proctor’s three-function model and develops these further, moving beyond the idea of three functions of supervision by including a further strand which focuses on personal action and quality improvement. It keeps the restorative elements of Proctor’s model but also introduces the concept of using supervision to develop skills to advocate for others such as patients, nurses and other healthcare staff. By using clinical supervision to teach staff how best to champion the patient view, personal care and service delivery are positively affected. This model:

• integrates the patient view as a central part of clinical supervision, positively shaping service delivery and providing the organisation with ongoing feedback on service improvement;
• continues to incorporate the other three elements of Proctor’s model keeping continued professional development, self-reflection, and stress management central to effective supervision;
• encourages innovation which, in turn, leads to higher job satisfaction;
• is implemented at the heart of the organisation, through expressly training professional nurse advocates to champion and guide others through the A-EQUIP model.

Johns reflective model

A tool for structured reflection, Johns (1993) suggests that, when you reflect, you need to make sure that you ‘look inwards’ (consider your own thoughts and feelings), and ‘look outwards’ (consider the actual incident or situation, including things like your actions in the situation and whether they were ethical, and the external factors that influenced you).

Nicklin practice-centered model

Nicklin’s practice-centred model (1997) of clinical supervision focuses on the roles and functions of the organisation (managerial, education and support) working together, where a change in one will impact the others. The model presents supervision as a cyclical process of analysis, problem-identification, objective-setting, planning, action and evaluation.

Rogers and Topping Morris problem-focused model

Rogers and Topping-Morris problem-focused model (1997) of supervision was developed in a forensic science unit. The supervisor and supervisee identify the clinical problem and use problem-solving strategies to provide a solution that is structured and measurable.

Action learning sets

Action learning sets are not intended to be used a supervision model in themselves, but instead to complement and develop clinical supervision by offering the opportunity for individuals to work together to resolve issues that they have identified in the workplace. They provide participants with a forum in which to reflect on their own development, discuss clinical issues, dynamics of the team and support those who are feeling inexperienced or unsupported.

Implementation strategies 

There are some practicalities to consider when implementing clinical supervision, and it is important that the supervisor and supervisee agree:

• the aim of clinical supervision and the process used;
• the expectations of both the supervisor and supervisee roles.

You will also need to consider how clinical supervision is implemented and delivered:

• face-to-face/virtual learning;
• one to one/group, interprofessional model of learning;
• structured framework and documentation;
• responsibility of organising meetings (voluntary/optional versus pre-booked/mandatory);
• pre-meeting planning, such as supervisee reflection;
• content of supervision, what is appropriate/not appropriate to discuss;
• recording the supervision, and responsibility for documentation;
• confidentiality, which needs to maintained at all times.