Clinical Supervision

[maxthecat]

How many of you receive regular structured clinical supervision? If you do receive regular supervision, how does your program work? Thanks.

[Whispera, MSN, RN]

When I first began working as a staff nurse on a psych unit, I met with an advanced practice nurse once a month, to talk about my concerns and to ask questions. I found it very helpful, but after about 6 months, we decided I could contact her on an as-needed basis. That's what I did, but mostly, after that, I'd talk about concerns to a trusted peer. I don't know how common it is for nurses to have clinical supervision other than the boss keeping a watchful eye on them.

[Jules A, MSN]

Supervision? Hmmm I'll have to google that word and get back to you. Not complaining for the most part though because its got to be better than having a bunch of administrators breathing down my neck.

[StuPer]

Clinical Supervision is a valuable tool in maintaining your sanity and keeping perspective in a psych role. It is not part of the management structure and certainly nothing said in a clinical supervision session should ever leave the room. It is supposed to be carried out by your clinical peers, but is also supposed to be someone you respect and trust, it is never, ever supposed to be your manager or anyone who functions in a management capacity who has some line management responsibilities that include your position.

StuPer

[Whispera, MSN, RN]

that's how mine was

[Thunderwolf, MSN, RN]

Clinical supervision is an excellent professional tool. Consider it 1:1 time with a mentor, closed door...like seeing a counselor...but focused on your clinical work with the mutual goal of better patient clinical outcomes and your professional growth. Excellent way to learn or to improve one's critical decision making skills and to sort out ethical issues. I am a firm believer in this process. Was actively involved in this process when I was a clinical counselor in the past...regarding supervision of other clinicians, as well as for myself. Highly recommended. If it is offered at your establishment, jump on it and make it work for you. Can't say enough good things about it.

[Jules A, MSN]

Clinical Supervision is a valuable tool in maintaining your sanity and keeping perspective in a psych role. It is not part of the management structure and certainly nothing said in a clinical supervision session should ever leave the room. It is supposed to be carried out by your clinical peers, but is also supposed to be someone you respect and trust, it is never, ever supposed to be your manager or anyone who functions in a management capacity who has some line management responsibilities that include your position.

StuPer

Well now its painfully obvious that we don't have it at my facility as I didn't even know what it really was.

[Mr Ian]

Just took a new post as team manager (small team) - and one of the first things I did was make sure they all had a CS.

I have to correct StuPer's otherwise agreeable CS model on just one issue - matters of dangerous clinical practice or illegal behaviour that might be raised in CS need to be raised outside. This is a mandatory clause of CS and is the responsibility of the supervisor - much like the "when to breach patient confidentiality" issue.

I know it's common nursing sense - and I doubt StuPer was ignoring it or suggesting otherwise - but it needs to be included.

[Whispera, MSN, RN]

Just a clarification, MrIan...you're saying issues of dangerous clinical practice or illegal behaviour should be raised outside clinical supervision. Agreed. And they can be raised within supervision too. If not raised "outside" to the "boss" it's the supervisor's role to encourage such raising, to see that it is done. Correct?

[Mr Ian]

Yes, Whispera. There's a clear time when dangerous or illegal behaviour has to be reported. Supervisers are not exempt from accountability on the confidentiality clause and they always remain responsible for the well begin of the patient as paramount.

Mostly it is possible to address concerns by asking the supervisee to attend to the matters and discuss with managers. But sometimes you just have to take matters into your own judgment.

To breach this confidence tho it has to be pretty dangerous (giving out frequent wrong meds or deliberately slipping a little extra in that wasn't charted; significantly breaching professional boundaries) or illegal (locking patients in rooms or striking a patient, etc).

It's a poo-ey thing but clinical supervision was made almost mandatory after Beverley Allitt (uk) and now medics are having to do it (again, uk) since Harold Shipman.

The only other time would be perhaps where the staff member was showing signs of burn out or fatigue yet doesn't recognise or accept it.

[Whispera, MSN, RN]

I had supervison more than 10 years ago. I think I was the only one getting it (I was the newbie). I don't know that anyone after me, where I worked, got supervision sessions. At least I never heard about it.

I know for certain that the second psych treatment facility in which I worked provided no supervision for the staff nurses. I suspect it's rare.

MrIan...unsure where you are located...America? UK?

I'm not saying it's not a good idea. I think supervision is wonderful and should be mandatory.

[Mr Ian]

Oz.

That supervision 10 years ago sounds more like Practice Supervision - purposefully to blend you into the role - usually called Preceptorship.