The Notion That Clinical Supervision Is Crucial to the Development of Professional Practice - Essay Example

Critically discuss the notion that clinical supervision is crucial to the development of professional practice. Introduction The aim and objective of this essay is to evaluate how crucial clinical supervision is to the development of nursing practice I am engaged in. Definition Clinical supervision is a method by which a constructive relationship is established between the practicing professional usually a staff member in an organisation and another professional called clinical supervisor. Bernard and Goodyear defined it as an intervention by senior members provided to junior members of the profession for enhancing their professional function while at the same time monitoring the quality of services rendered to their clients and also acting as gatekeepers for those entering the profession.1 While gate-keeping on the job of nurses is done by Nursing Boards, monitoring of the job quality by line management, the professional enhancement of the job is done by the clinical supervisors.2 Rationale Main objective is to achieve professional development. There can be no personal counselling unless the problems lead to stress and distress in the work place. It is an ongoing process for the health professionals throughout their career regardless of their seniority and experience. Clinical supervision affords professional support to the practitioner, improves clinical practice and clarifies practitioner’s role besides ensuring safety and welfare of patient clients. As the clinical supervisor’s role is crucial to high quality client care, he/she should have the attributes of expertise, experience, acceptability and prior training in the area It aims to reduce exhaustion emotionally for the nurses as the work pressure builds up tensions in them especially when they deal with the lives of human beings whose survival depends very much on them. A good clinical supervision is maintaining relationship rather than bossing around just as key to success for anyone is relationships.3. Supervisor’s role They should be first level nurses qualified and experienced enough with readiness for the supervisory role. They are expected to have communication skills, supportive skills, general skills and specialist skills. For the development of professional practice, supervision in different forms can be availed of by those interested. The different ways of clinical supervision are peer supervision, team supervision, shadow supervision, managerial or tutorial supervision, pair supervision and live supervision.4 The correct form of supervision should be selected in consultation with the supervisees giving due regard to their professional development and service requirements. There should be a continuous evaluation of supervision to judge its effect on the supervisees, to facilitate which there must be mutual trust and respect between the supervisor and supervisee Obviously supervison should cover clinical work, professional standards, personal growth and development and evaluation of work performance.5 As the supervisor comes from outside with lots of skills and experience, a professional gets an opportunity to absorb the supervisor’s capabilities, knowledge and experience in to his/her system, This routine supervising is a kind of monitor to the professional’s own performance without actually feeling the stress of an official fact or fault finding visits. Though it is not mandatory, it is best adopted for its own advantages. Limitations Managerial supervision will be logically aimed at achieving organisational objectives and in the process professional development can become a casualty as clinical issues are of remote concern for the line managers. At the same time the managerial supervison being disciplinary in character, supervisees will ensure standards are maintained. In peer supervision, there will be a tendency not to challenge each other resulting in compromising of issues involved in terms of skills development and clinical standards. As Consedine Mike says 6 nurses can not be fully accountable for the patient’s care because of handing over of the duties to colleagues at the end of the shift. There are line managers and doctors whose responsibilities are wider who will not tolerate dissent. To quote him in his own words “Bad feeling between colleagues, difficulty with the authority and competence of managers and negativity toward the perceived arrogance of medical staff have destroyed any possibility of respectful co-operation in many teams. Lack of respectful co-operation in the team will be reflected in the care of the patient. My experience over fifteen years providing supervision and training others is that as much as 70% of supervision sessions have focused on relationships with other staff. Sometimes they start off with a focus on the patient but often development in staff relationships becomes the key to progress in patient care. This leads me to conclude that it is time nurses defined their own boundaries for clinical supervision – boundaries which are suitable for the environment in which they work – rather than simply borrowing from other professions.”7 Implementation of clinical supervision in the work place is a challenging task indeed. Though the professionals acknowledge it as a tool for their professional growth, in practice do not prioritise its establishment as it is difficult to do so without dedication from a co-coordinator. Besides there are bound to be overlapping mechanisms in the workplace to facilitate regular professional development. “Clinical Supervision was normally left out, perhaps because the results are often less tangible and immediate.”8 My reflections. There are many theories relating to reflection and it depends on the individual which one is followed. Some are very simple such as Maslin – Prothero9 WHAT? SO WHAT? NOW WHAT? Gibbs Reflective Cycle 10 and Kolb’s Learning Cycle11 (see figures in the appendix) are both very similar but go into more detail than that of Maslin – Prothero. The benefits of reflection are high in nursing. It helps the development of nurses’ autonomous practice, and it develops knowledge. Reflection however is only valuable when it is reflective practice and not just thoughtful practice. There is a difference between just thinking about an experience and in – depth exploration of it. To successfully reflect the individual should be open minded, responsible, objective, willing to explore emotions and, adaptable to change. Although nurses constantly learn through practice, it is a good idea to develop good study methods as a back up to the practice. Achieving this means gaining firm knowledge, and ability to learn new and specialist skills. “Clinical supervision therefore is a means of using reflective practice and shared experiences as a part of continuing professional development”12 I work in the emergency ward where I am accountable for whatever decisions I make in giving treatments to patients on emergency. As I am independently responsible and have to distinguish cases beyond my decision making for reference to physicians, all my momentary decisions are crucial to survival of the patients. One can imagine the amount of stress and strain I have to go through each and every time a case comes up for treatment as I am also emotionally attached to the patients coming in. Right from deciding on treating a case as outpatient or inpatient, choosing a line of treatment after initial diagnosis, referring critically ill patients to Physicians, I have to undergo a harrowing experience especially when it comes to life or death for the patient. I have to not only keep the patient assured of recovery but also his/her family members at a comfortable level. Line managers will always keep a distance and to clarify with them line of action or treatment for exceptional cases an every day occurrence will result in loss of my credibility in the ward. This is where the role of my clinical supervisor comes into play as concurrent support from outside. Clinical “Supervision is a dynamic, interpersonally focused experience promotes the development of therapeutic proficiency. One of the primary reasons for all supervision is to ensure that the quality of therapeutic intervention with the client is of a consistently high standard in relation to the client’s needs. Consequently, supervision must be acknowledged as a cornerstone of clinical practice”13 My clinical supervisor is dispassionate and I enjoy a high comfortable level with him. His periodical visits to my ward gives me kind of reassurance that there is some one always available to clarify my doubts, approve of my exceptional treatments, feed me with the latest information in my field. In fact my clinical supervisor is my knowledge base. He evaluates my performance, monitors levels and priorities of my workload, and does individual case reviews. It has been said about clinical supervision as “It should provide a forum to assess the nurse/patient relationship and professional development. It should be supportive and motivational, educative and modelling. Clinical supervision looks at the nurse’s behaviour within the nurse patient relationship.”14 As a matter fact, clinical supervision is a part of UKCC requirement for Post Registration Education and Practice (PREP) 15 It states that all practitioners are accountable and responsible for their own practice and this, combined with the importance of continuing professional education and the fact that many community nurses work autonomously, often in isolation, makes the need for clinical supervision essential”16 Flattening management structure is another reason why clinical supervison from outside should be available to practitioners. “'supervision can be seen as the process of talking to someone else involved in the same system about what one is doing, in order to do it better'”17 Even though support from within among peers in the organisation will be available, clinical supervison in a structured manner should be available as there can be no guarantee that colleagues will or can always lend support given their own workloads. I have not seen a case of colleague coming out of way ignoring his/her own work pressure. I have my self experienced disappointment at their apathy without realising their own plight not very apparent. When their plight is not visible to me, how I can expect mine to be known to them at all. Though clinical supervison is associated with legal discipline, once I was my self confused with the concept of clinical supervison. “In particular, the word 'supervision' is instinctively allied with authority and, therefore, creates confusion in the minds of many nurses who consequently have a poor understanding of the concept 18 To reiterate this point, Kohner19 states that 'straightforward, and comprehensible' information regarding the purpose of clinical supervision should be accessible to everyone. Furthermore, Butterworth asserts 20 “for clinical supervision to be accepted and subsequently effective, it has to have the collaboration, but not the control of management. In addition he states it should not become another requirement from 'above', but be developed and implemented by nurses who are currently practising. If it does become a management imposition, with hierarchical overtones, it is in danger of being seen as a 'checking up exercise' and this would detract from the original aims and objectives”21 As Adcock 22 says Clinical Supervison affords me opportunities of reflecting on the quality of my work. Many a time I have been advised by my clinical supervisor for changing the course of treatment as a suggestion without infringing upon my own ultimate decision. But such incidents have really relived me of complicating situations and dilemmas as to the diagnosis and line of treatment in spite of the management‘s and physicians’ awareness of my predicament. Since the Clinical Supervisor comes with rich experience of his encounters at various other institutions, I find him a walking encyclopaedia for ready reference to any problems. Conclusion It must now be clear for what the purpose of clinical supervision is and why it should be in place even though the supervisor and supervisee are capable of collaborating themselves to soft- pedal on crucial issues. If that is the case then it is Supervisor to blame and not the supervisee. This is the reason why care should be had in selecting clinical supervisors. However chances are very remote for such Supervisors since they will lose their credibility and today the profession would have crumbled. But it is getting reinforced as years pass by. The misgivings are theoretical and no evidence in the literature has been found to denounce the profession itself. The advantages of clinical supervision far outweigh consequences of such trivial issues since the management can not remain passive to such attitudes of clinical supervisor who command respect in their fields of practice. My own reflections convince me that clinical supervison is really blessing for us practitioners and the patients as well. The clinical supervision is therefore essential for one’s professional development and to conclude it need not be mandatory because it is not crucial to development of professional practice is to deny learning opportunities for the professionals to develop their practice in the most painless and stress-free manner. It is a kind of continuing education for the professionals. Though it may adversely suggest on the honesty and integrity of the professional supervisee, in the interest of public policy, it should be availed of by the professionals so that public confidence on the profession is not eroded. Bibliography Bernard J M and Goodyear R K (1997) fundamental of clinical supervision: a guide ISBN: 0205175317 Bishop V (1997) clinical supervision in practice. Palgrave Macmillan Hawkins P& Shohet R (2000) supervision in the helping professions. Open University press, Buckingham Knapman J and Morrison T (2001) Bond M, Holland S (1999) skills of clinical supervision for nurses. Open University press. Buckingham. Driscoll john (2000) practicing clinical supervision. A reflective approach. Balliere tindall. London Making the most of supervision. Pavilion publishing Power S (1999) Nursing supervision. A guide to clinical practice. Sage publications Van Oojen E (2000) Clinical supervision: a practical guide. Churchill Livingstone. Appendix Gibbs’ Reflective Cycle www.trainer.org.uk   Kolb’s Learning Cycle (www.reviewing.co.uk) Read More