North, Central and South Liverpool primary care trusts clinical supervision policy

Clinical governance has been defined as ‘a framework through which NHS organisations are accountable
for continuously improving the quality of their services and safe-guarding high standards of care by creating
an environment in which clinical excellence will flourish’ (Department of Health; 1998).

Clinical supervision is a key mechanism supporting clinical governance by enabling practitioners to examine their practice, their skills, knowledge, attitudes and values in a safe environment. Effective participation in clinical supervision is seen as individuals demonstrating their accountability and taking responsibility for the continuous improvement of their practice.

Purpose

The following policy aims to clarify the position and the principles underpinning the implementation of clinical supervision for nurses within North, Central and South Liverpool primary care trusts (PCTs).

Background

Individual, personal and professional accountability is inherent in the nurses, midwives and health visitors Nursing and Midwifery Council (NMC) Code of Professional Conduct. The public will be protected through agreed standards, which ensures safe practice, high levels of competence and performance through professional self-regulation. Professional self-regulation is a clinical governance requirement and assists in ensuring continuous quality improvement. Clinical supervision is a way to support professional self-regulation.

Principles underpinning this policy

This policy has been developed alongside a clinical supervision implementation plan and not in isolation. For successful implementation and development of clinical supervision in Liverpool PCTs, the elements of both documents should be applied
The PCT will aim to ensure clinical supervisors are available within each nursing discipline. As the ultimate responsibility for clinical governance rests with the Chief Executive of the organisation, therefore, the formal contract between supervisor and supervisee must relate to the policies and procedures of the organisation in which professional clinical supervision is taking place. Therefore, any external supervision would need to be subject to the same quality standards to protect the public and would only be with the knowledge and approval of the service lead. This arrangement would be in relation to exceptional clinical circumstances necessitating the need for external supervision
North, Central and South Liverpool PCTs believe that clinical supervision is not ‘optional’ but a right for all grades of nursing staff regardless of seniority or role
Clinical supervision for nurses in North, Central and South Liverpool PCTs will therefore be implemented as a mandatory requirement for all nurses within the Clinical Governance Framework of the PCTs
Designated supervisors will undertake the supervisory role. Supervisors must have at least 2 years post-registration experience, have undertaken competence-based training and be receiving clinical supervision themselves
Supervisors and supervisees have different and distinct roles and responsibilities. The expectations and responsibilities are outlined in more detail in Appendix 1
A contract of supervision must be made by the supervisor and supervisee. This should be reviewed at least annually, and re-negotiated in full with each change of supervisor (Appendix 2)
Both supervisee and supervisor can request for the contract to be cancelled. This is envisaged if either the relationship is irretrievable or following a review the relationship has come to a natural ending, necessitating a change of supervisor/ee
Supervision will take place as and when necessary. It is recommended in the extensive literature that is available on the subject that all qualified nursing staff receive 1 hour’s clinical supervision every 6–8 weeks. As a standard in the PCTs the minimum is every 3 months – this will be subject to review. The timeframe may need to be flexible if being arranged for group supervision as this will take longer than 1 hour. The details of frequency should be negotiated by the supervisor and supervisee and be recorded in the contract
As clinical supervision is part of public and peer accountability, standards of Caldicott and confidentiality apply to the process. Therefore, the venue chosen should either be PCT or GP premises. Public areas should not be used for clinical supervision
It is vital that both supervisor and supervisee have a clear understanding of the true meaning of confidentiality
Sessions must be strictly confidential at all times under normal circumstances. The limits of confidentiality must be specified in the contract, see Appendix 2
On very rare occasions, for instance:
-where something illegal occurs or is shared with supervisor
-breaches of the NMC’s Code of Professional Conduct
-infringement of PCT policies and procedures
‘The supervisor is obliged to ensure the supervisee’s manager is informed. It is important that both parties understand this fact and in most cases the supervisee should be encouraged and given an opportunity to inform their manager themselves, as in any adult-to-adult relationship, before the supervisor feels obliged to. In some circumstances the supervisor will be legally obliged to write a written statement regarding any breaches of the NMC Code of Professional Conduct. Remember, this is only in rare situations and is the same responsibility any registered nurse has in respect of public safety and the NMC’s Code of Professional Conduct’.
In the event of a breakdown in the supervisory relationship either on the grounds of disagreement or discrimination cannot be resolved, then the supervisor and/or supervisee’s line manager should be consulted. Such a disagreement is not a reason for not receiving clinical supervision. It is incumbent on both supervisor and supervisee to act to resolve the problem as soon as possible
It is imperative that all supervisors receive supervision themselves. This should cover both their general clinical role in addition to their supervisory role
Clinical supervision and performance and development reviews are complementary but distinct processes – they should be separate processes.

The model

Models of supervision
Clinical supervision in North, Central and South Liverpool PCTs will be primarily offered on a one-on-one basis by a supervisor of either the same or different nursing discipline. However, in many circumstances, group supervision may be the model of choice either in addition to or instead of one-on-one supervision. This choice should be made in consultation with nurse managers, quality nurse leads, supervisors and supervisees, and in the knowledge that the processes are different and each has their own strengths and weaknesses. Where group supervision is the chosen model, supervisors are expected to undertake additional training in group work skills over and above the preparation for one-on-one supervision.

Content of sessions

Supervision sessions could include discussions on a wide range of work-related topics including:

any matters the supervisee/staff member wishes to include
matters arising from previous sessions
time to reflect on your experience of and feelings about your work
reviewing your work through discussion, reports and detailed case discussion including critical incidents/ near misses
continuous professional development
setting your professional goals and action plans
feedback on the supervision/peer review process itself
case study discussions.

Recording of clinical supervision

Each clinical supervision session should be recorded by the supervisor on the supervision record (see Appendix 2)
The record is a PCT document and should be held by the supervisor at their base in a locked drawer or cabinet
The record of the session should be discussed with, seen by and signed by the supervisee. Any differences of opinion should be clearly noted as such
All actions to be undertaken by supervisee or supervisor should be noted
Access to the clinical supervision record by anyone other than the supervisor would be in exceptional circumstances (ie only as part of a disciplinary, Commission for Health Improvement (CHI) inspection, legal process or audit). The supervisee would in all circumstances be informed that their records were to be accessed in this way
All registered nurses and other professionals, where appropriate, are encouraged to record attendance at supervision, and in particular learning and change resulting from it as part of their professional portfolio.Evidence of professional development will be required by the NMC as part of the renewal of registration process. Effective clinical supervision and reflective practice should form a key part of this

Change of or termination of employment

If a member of staff changes jobs within North, Central and South Liverpool PCTs, wherever possible they should remain with the same supervisor. If this is untenable, the supervisee should negotiate with their manager a change of supervisor appropriate and feasible with the new role
Where a change of supervisor is indicated the supervision record should be sent to the new supervisor after the final supervision review session and with the supervisee’s knowledge
If a member of staff leaves then their supervision record will be filed by the supervisor into a brown envelope, marked ‘Confidential supervision records’. This should be filed alongside the staff member’s personal file. The same rules of confidentiality apply

Appendix 1

Reasonable expectations and responsibilities of supervisors and supervisees

Supervisee expectations:

to understand and have access to Liverpool PCT’s clinical supervision policy and implementation plan
to receive supervision in-line with the policy and implementation plan
to have a named supervisor who is trained and behaves in a manner which reflects the training
to have training for the role of supervisee
to choose the model of clinical supervision (eg one-to-one or group) and who will be your clinical supervisor
to have a mutually agreed written supervisory contract
protected time for the clinical supervision sessions:
-support to be able to be released from your clinical responsibilities in order to attend
-have the clinical supervisor give your sessions priority and stick punctually to appointments
-appropriate length of ‘air time’
to receive effective and sensitive supervision which is conducted in an environment of mutual trust and respect
to be encouraged to contribute actively to the agenda and session
to be treated in an anti-discriminatory manner
to be fully involved in all decisions on the development of action plans
to give and receive constructive feedback
to be treated as an adult and a professional
to be allowed to have own opinions, to disagree, to learn from mistakes, to be unsure or not to know
to be actively listened to by the supervisor
to have their experience and contribution acknowledged
no interruptions unless in the event of an emergency
to understand and have confidence in the limits of confidentiality
to negotiate a change of supervisor if this is appropriate
to share responsibility for making supervision work
to accept the mandate to be supervised/and be accountable
to participate in negotiating a supervision contract
to attend supervision appointments on time
to come to supervision prepared for the session and to actively participate
to be open and share information
to aim to meet the PCT’s legal, ethical and professional standards
to seek and use guidance and knowledge
to promote anti-oppressive practice and behaviour
to implement agreements and action plans
to inform supervisor if plans cannot be implemented
to promote best interest of clients
to accept appropriate responsibility for own performance
to be active in the pursuit of own development
to be clear and honest in seeking assistance
to be responsible for own learning
to give and accept constructive feedback
to use time effectively
to participate in problem-solving
to reflect, think through and explore options
to maintain confidentiality
to identify issues in themselves or their supervisors which may impede communication with particular emphasis or power, gender and cultural issues
to maintain confidentiality
to have a span of control and workload which is achievable within the expectation of the trust
for supervision to be given appropriate priority by supervisees
for supervisees to actively prepare for sessions and to acknowledge issues to be dealt with in supervision
for training in the skills and expectations of supervision for themselves and their supervisees, and for
training in accordance with their training-needs analysis
for all relevant information to be shared regarding case discussions in an open and objective way
full participation by supervisees in all negotiations and agreements surrounding supervision
to have an agreed method whereby difficulties in communication are acknowledged and raised
access to case files, plans and recording as appropriate
to be supervised in turn
not to be expected to know everything but to refer to others for specialist advice as appropriate
for staff to respect confidentiality of their own supervision with peers
to receive constructive feedback on their performance, from their supervisees as well as their supervisor
to have an identified channel to communicate work-based issues into organisations change
to negotiate a change of supervisor for a particular supervisee if this is appropriate.

Superviser responsibilities:

to ensure staff are aware of what they can expect and their responsibilities as supervisees and to whom they are accountable
to organise and arrange supervision according to PCT policy and implementation plan
to ensure supervision is given appropriate priority among other tasks
to coordinate all key activities relating to supervision (the negotiation of contract, agenda review and progress chasing)
to prepare adequately for supervision
to ensure that discrimination does not take place within supervision and to acknowledge and deal with any items which impede effective communication
to identify shortfalls in their own performance and deal with these in their own supervision
to regularly review plans and recordings
to ensure that supervision sessions, especially outcomes and agreed tasks are adequately and clearly recorded
to accept joint responsibility for decisions reached in supervision
to clarify limits of and respect confidentiality of supervision between supervisee and superviser
to report appropriately those issues identified in supervision both individual and organisational, to their own supervisor as appropriate
to discuss the allocation of work and monitor workload of individuals and the group.

Appendix 2

Contract

Name of supervisee:
Designation:
Name of supervisor:
Designation:
Frequency of sessions:
Duration of sessions:
Agreed venue/s:
Date contract agreed:

Ground rules for both parties:

supervision is confidential both verbally and when written, except for explicit exceptions (ie breaching the NMC’s Professional Code of Conduct, trust, health and safety policies, operational policies and equal opportunity policies)
both supervisee and supervisor can request for the contract to be cancelled. This is envisaged if either the relationship is irretrievable or following a review the relationship has come to a natural ending, necessitating a change of supervisor/ee
it is recommended that all qualified nursing staff receive 1 hour clinical supervision every 6–8 weeks. As a standard in the PCTs the minimum is every 3 months, this will be subject to review. The timeframe may need to be flexible if being arranged as group supervision as this will take longer than 1 hour participation in clinical supervision is expected of every qualified health professional in the PCT, a minimum of 1 hour every 3 months
timekeeping and avoiding the cancellation of sessions is a priority
shared responsibility for ensuring the highest standards are maintained
willingness to explore and reflect on skills, knowledge and issues affecting clinical practice
the completing of relevant documentation at the end of each session must be a priority
the process of supervision must be reviewed and evaluated regularly
supervision sessions could include discussions on a wide range of work-related topics including:
- any matters the supervisee/staff member wishes to include
-matters arising from previous sessions
-time to reflect on your experience of and feelings about your work
-reviewing your work through discussion, reports and detailed case discussion including critical incidents/near misses
-continuing professional development
-setting your professional goals and action plans
-feedback on the supervision/peer review process itself
-case study discussions
-caseload management
-clinical effectiveness
-team issues
each clinical supervision session should be recorded by the supervisor on the supervision record (Appendix 3)
-the record is a PCT document and, as such, will be held by the supervisor at their base in a locked drawer or cabinet
-the record of the session will be discussed with, seen by and signed by the supervisee
-any differences of opinion will be clearly noted as such
-all actions to be undertaken by supervisee or supervisor will be noted
-access to the clinical supervision record by anyone other than the supervisor would be in exceptional circumstances (ie only as part of a disciplinary, CHI inspection, legal process or audit). The supervisee would in all circumstances be informed that their records were to be accessed in this way
-all registered nurses are encouraged to record attendance at supervision, and in particular learning and change resulting from it as part of their professional portfolio.

Appendix 3

Clinical supervision documentation

To be completed and kept securely within PCT premises by the clinical supervisor

Date:

Time:

Venue:

Supervisor:

Supervisee:

Issues/actions raised at last session if relevant:

Main areas of discussion at this session for supervisee:

Summary of issues brought to this session by supervisee:

(Supervisee’s actions) required for next session:

To be completed after each clinical supervision session by supervisee

Supervisor’s name:

Tel:

Date of session:

Venue:

Date of last session:

Service in which supervisor works:

Topic area(s) discussed:

Comments:

Critical incident analysis	☐
Time management	☐
Professional working relationships	☐
Ethical issues	☐
Evidence-based practice	☐
Standards, policies and procedures	☐
Resources	☐
Care planning	☐
Other	☐
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