Supervision Policy 2015

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Clinical Supervision

(Nursing, Allied Health Professionals and Support Workers)

Reference/Number POL/COR/0167
Version: 2.0
Ratified by: Policy Approval Committee
Ratification Date: 20/01/2015
Approval Committee Nursing Executive Committee
Date Approved: 29/12/2014
Date Issued: 03/03/2015
Executive Owner: Philippa Davies, Director of Nursing and
Patient Experience
Name of Author(s) and Job Title(s): Ash Purran
Clinical Development Manager
Target Audience: All nursing and AHP clinicians and
support staff
Review date: 03/03/2015
Procedural document linked to/Tagged: Tick as appropriate
9
Regulatory
Compliance
Organisation- 9
wide
Directorate
Service
Shared
document
Keywords Supervision

Clinical Supervision (Nursing, Allied Health Professionals and Support Workers)


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Dissemination and Implementation

Responsible person for coordinating


dissemination and implementation

Methods of Intranet Other Email to key


dissemination Stakeholders
(Delete as
appropriate) Yes Yes No

Consultation

List of those consulted Heads of nursing, senior nursing staff,


AHP leads, Senior Pharmacist, Senior
Dentist

Period of consultation Start and finish dates


(Sept 14 – Nov 14)

Version Control Summary

Version Description of change Author Date


No
Version 1.0 Pre ICO version
Version 2.0 Renewal, guidance, change of Ash Purran
practice, transfer to new template
Acknowledgement:
Rosalind Murphy

Contents
Clinical Supervision (Nursing, Allied Health Professionals and Support Workers)
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1.0 INTRODUCTION ............................................................................................. 4

2.0 PURPOSE ....................................................................................................... 4

3.0 SCOPE ............................................................................................................ 5

4.0 DEFINITIONS .................................................................................................. 6

5.0 DUTIES (Roles and Responsibilities) ............................................................. 7

6.0 POLICY SPECIFIC CONTENT ........................................................................ 8

7.0 DEVELOPMENT AND TRAINING.................................................................. 10

8.0 MONITORING COMPLIANCE and EFFECTIVENESS ..................................... 11

9.0 ASSOCIATED DOCUMENTS ........................................................................ 12

10.0 REFERENCES ............................................................................................. 133

11.0 APPENDICES ............................................................................................. 144

12.0 EQUALITY IMPACT ANALYSIS .................................................................. 191

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1.0 INTRODUCTION
This policy has been designed to ensure that all non medical clinical and support staff has
access to individual supervision. This policy applies to all Whittington Health staff that has
a remit to provide or support clinical care in order to support the development of a high
quality service to our clients.

Supervision is a formal process of professional support and advice, which allows you to
develop your practice, reasoning skills and knowledge and to reflect on your work in order
to problem solve, learn from experience and improve competence. It forms part of the
wider health and social care agenda, concerning quality, accountability and efficacy of
practice.

Clinical supervision together with managerial supervision will provide an overarching


framework of support for staff in order for them to provide a high quality service to clients
and to meet strategic objectives.

It is important to remember that supervision is part of your working week and should take
high priority. Supervision is a two-way process that is for the benefit of all staff, patients
and clients, your department, directorate and the organisation, so it is each professional’s
responsibility to use it to the full.

2.0 PURPOSE

Clinical supervision is a key component of practice and clinical governance, ensuring that
staffs are supported to provide the best possible care.

Models of Supervision
There are a number of approaches to supervision, most commonly one to one sessions
with someone from the same discipline. Other approaches include group supervision
among staff of the same discipline; network supervision between staff of similar expertise
but not from the same organisation or ad hoc supervision with a specialist recruited for a
short term specific need. It is beyond the scope of this document to detail the models
further. Section 9 provides a suggested reading list if more detail is required.

The ICO’s standard form of clinical supervision will be that it is undertaken as part of the
individual’s regular one to one meetings with his/her line manager, but will be distinct from
the managerial issues discussed at the one to one. Progress within supervision should be
noted as part of the annual appraisal process.

If a member of staff is the only practitioner in his/her field and identifies a need to seek
clinical supervision elsewhere this should be discussed and agreed with the Head of
Department and line manger.

Managers may choose to provide group supervision for staff if this is more appropriate to
the roles and/or the service.
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Clinical supervision can:

• Enhance patient/client care


• Safeguard standards of practice
• Support and encourage staff to increase confidence and alleviate stress and anxiety
• Assist staff to reflect on their practice in a constructive way to increase understanding
and self-awareness
• Help staff identify solutions to practice problems
• Promote an understanding of accountability for practice
• Identify training and education needs
• Provide a forum for discussion and exchange of ideas
• Support the professional and career development of staff and, should be used by staff
as means of improving clinical practice

3.0 SCOPE

Supervision is a formal process of professional support, which allows the individual to


develop practice reasoning skills and knowledge and to reflect on his/her work in order to
problem solve, learn from experience and improve competence. It forms part of the wider
health and social care agenda, concerning quality, accountability and efficacy of practice.
Clinical supervision together with managerial supervision will provide an overarching
framework of support for staff in order for them to provide a high quality service to clients
and to meet strategic objectives.

Supervision within Whittington Health should cover clinical practice in the broad sense e.g.
including clinical skills, effective communication and documentation, the dynamics of your
interaction with others, supportive challenge and reflective learning and should inform your
appraisal and personal development plan.

Supervision may include the following:

• Using the practice experience of the supervisor to develop the practice of the
supervisee.
• Maintaining levels of practice and organisation of workload, to ensure that staff are
working at the correct level for their experience.
• To clarify roles and responsibilities.
• To explore the quality and quantity of practice, and to address issues of performance,
measuring outcomes and evaluation of treatment/care.
• To facilitate opportunities for reflection on practice and offer links to other clinicians with
relevant expertise.
• To identify areas for development and training linked to practice
• To ensure that the skills and role of the individual are developed within the
requirements of the service.

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• Practice supervision can happen in a group setting, e.g. team meetings, if this is
deemed to be more beneficial or achievable in some settings. Individuals should still
have one to one meetings with their line manager to discuss managerial issues and
should still receive one to one meetings with a preceptor if part of a preceptorship
scheme.

Managerial Supervision

Managerial supervision time will be used to inform staff of strategic and service wide
priorities and the local objectives designed to meet them. Managers will outline the
individual’s role in meeting strategic and local objectives and may address any day to day
service delivery issues that are preventing delivery of the service. This form of supervision
provides support and guidance for staff in achieving their objectives to the required standard.
It will also be an opportunity to clarify the responsibilities and accountability of the staff
member’s role.

4.0 DEFINITIONS (Professional Body Definitions)


The NMC define clinical supervision as:

‘A practice focused professional relationship that enables a clinician to reflect on their


practice with the support of a skilled supervisor. Through reflection the clinician can further
develop their skills, knowledge and enhance their understanding of their own practice’ NMC
(2004)

The Chartered Society of Physiotherapists offers the following definition:

‘Clinical supervision can be seen as a collaborative process between two or more


practitioners of the same or different professions. This process should encourage the
development of professional skills and enhanced quality of patient care through the
implementation of an evidence-based approach to maintaining standards in practice. These
standards are maintained through discussion around specific patient incidents or
interventions using elements of reflection to inform the discussion’. The Chartered Society of
Physiotherapist’s 2005.

The College of Occupational Therapists (COT) has defined supervision as:

‘A process that should be interactive and used as a means of ensuring that supervisees are
able to do their job effectively and are assisted in their own professional and personal
development.’ ‘Statement on Supervision in Occupational Therapy’ 1997.Clear guidance on
implementation is also provided in the Professional Standards for Occupational Therapists,
2007.

The Royal College of Speech and Language Therapy (RCSLT)

RCSLT recognises supervision as an important factor in delivering a high quality speech and
language therapy service. The college identifies it as a means to support the practitioner to
discuss their work regularly with someone who more experienced. The goal of supervision

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being to promote critical reflective practice; develop understanding of the interactive
processes and the dynamics of the therapeutic relationship; reinforce and offer feedback on
effective clinical skills and provide supportive challenge in a safe environment. RCSLT,
2006,

5.0 DUTIES (Roles and Responsibilities)


The Executive Lead

The Executive Lead for clinical supervision is the Director of Nursing and Patient Experience
who is responsible for ensuring staffs are supported to undertake clinical supervision and
that there is a policy in place to guide staff in its implementation.

Service Managers

Service managers are responsible for ensuring that teams outline the model and frequency
of supervision they intend to employ, and for ensuring that managers support its
implementation.

Ward or Team Managers

Team managers are responsible for ensuring that their staffs participate in supervision on a
regular basis. If the service consistently cannot accommodate supervision the ward/team
manager should escalate the problem immediately and seek a resolution.

Clinical Supervisors

A clinical or practice supervisor is the recognised, and generally registered, practitioner


that has responsibility for ensuring the competence of; the development of and the
acquisition of skills of staff in their team or service. The supervisor will in turn have a
supervisee that he/she will meet on a regular basis. When supervising a member of their
own team supervisors should remember to primarily allow the supervisee to select topics
for discussion, the supervisors will lead discussions during the 1:1 meetings.

Supervisors

The supervisor is responsible for undertaking regular clinical supervision sessions with
each of his/her supervisees, and completing a clinical supervision agreement which
outlines the purpose, See Appendix 3. Once dates for supervision have been agreed the
supervisor should ensure that these are honoured unless exceptional circumstances
prevail. If a supervision session has been cancelled it is the responsibility of both parties to
agree a new date. The supervisor will encourage and enable the supervisee to discuss
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clinically related topics that are affecting the supervisees work; agree action points with
supervisee and monitor progress with agreed actions. Notes will be held by both parties
but will remain confidential unless an issue discussed needs to be addressed outside of
the meeting.

Supervisee

The supervisee is responsible for undertaking regular clinical supervision sessions with
each of his/her supervisors, and completing a supervision agreement which outlines the
purpose, See Appendix 3. Once dates for supervision have been agreed the supervisee
should ensure that these are honoured unless exceptional circumstances prevail. If a
supervision session has been cancelled it is the responsibility of both parties to agree a
new date. The supervisor will encourage and enable the supervisee to discuss clinically
related topics that are affecting the supervisees work; agree action points with supervisee
and monitor progress with agreed actions. Notes will be held by both parties but will remain
confidential unless an issue discussed needs to be addressed outside of the meeting.

6.0 POLICY SPECIFIC CONTENT:

Standards of Supervision

It is essential that a good quality supervisory system is in place within Whittington Health.
All grades of staff must have supervision sessions by whichever model is deemed most
appropriate. Ideally this will be delivered monthly where possible (more frequently for new
or junior staff) but managers may agree an alternative time frame for part time staff or as
capacity allows.

• All staff must have supervision with an appropriately experienced member of staff.
Guidance on the respective role of the practice supervisor is available in Appendix 4.
• Supervisors must have a clear line of accountability for reporting any behaviour which
they deem to be unprofessional, unethical or potentially harmful.
• Supervision sessions must be linked with the ICO’s appraisal system, and
aims/objectives should be regularly discussed, monitored and encouraged.
• A third person, who can be called on should difficulties arise, must be identified.
• Standards and aims of supervision must be discussed in the first session.
• An agreement should be drawn up, agreed and signed both by supervisor and
supervisee.
• Each supervisor must ensure that they have read the Supervision Policy and are fully
aware of its contents and feel competent to supervise others.
• A written record of the agreement and Personal Development Record (PDR) forms will
be kept in the individual’s personal file.

Structuring a Supervision Session

Clinical supervision is a supportive and enabling process, which may be broken down into
three components to cover all aspects of your work.
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• Reflection on previous actions
• Clinical practice
• Development and Training

The emphasis throughout all supervision is to provide support for the supervisee, but at the
same time, encourage the individual to develop or build on existing skills, in order to
manage/explore situations differently in the future. It may include the following:

• Providing general support by listening


• Enabling staff to deal with everyday difficult situations.
• Develop reflection skills and promoting improved standards of care.
• Discussions on caseload, individual and specific, or general condition management.
• Support through change and help managing change.
• Encouraging development of new/existing skills and the ability to self -assess.
• Enabling individuals to use mistakes in a positive way.
• Encouraging the use of alternative strategies

Each component may be addressed in each supervision session, to a lesser or greater


degree. Emphasis may be more heavily placed on one area depending on the individual
and the circumstances however, over the course of the year, it is expected that each of the
components will be addressed to ensure a balanced approach to supervision.

Review of Actions

The supervisee should report progress with previous actions, if not progress has been
made further actions should be set. If a supervisee consistently fails to make progress with
actions the supervisor may choose to escalate this to managerial supervision.

Clinical Practice

Our Practice work is the key component of our professions. We use our Practice expertise
and knowledge for the benefit of our client group and need to ensure that supervision of
work happens regularly. It needs to include:

• Using the Practice experience of the supervisor to develop the practice of the
supervisee.
• Maintaining levels of practical work and organisation of workload, to ensure that staffs
are working at the correct level for their experience, and that their work has the right
amount of practice input.
• To audit quality and quantity of practice, and to address issues of measuring outcomes
and evaluation of treatment.
• To identify areas for development and training in the practice area, ensuring good
practice.

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Supervision agreement

Agreements should be drawn up between supervisor and supervisee at the beginning of the
first session. A written copy of the agreement should be kept in the personal file of the
supervisee and by the supervisor. See Appendix 2.

The agreement is used to provide a framework for supervision sessions. The agreement
should include the following information:

• Who will carry out supervision?

• Where will supervision take place? (Consider the environment - try to avoid
interruptions).

• When will supervision take place? Date and time (it is important that times are
adhered to). This may need to be planned during the supervision itself for the
following session.

• How supervision will be used; identifying components and aims and objectives.

• Confidentiality - Decide on what information should be kept where and who


information may be discussed with. Most supervisors will themselves have
supervision and may want to discuss and gain support from their supervisor in
managing particular situations, or get advice about appropriate training
opportunities. Circumstances where the supervisor would have a duty to reveal
information from supervision should also be discussed.

• Identify a named third person, who information may be shared with, and who can
be called upon, should difficulties arise that cannot be dealt with. This may be the
supervisor’s supervisor or Head of Department.

• Written records - These should be made on the supervision record sheet, and a
decision made as to where they will be kept. Both should agree to sign these and
any other relevant documents. A format for recording sessions is attached or the
form used in NMUH can be used.

• It is the responsibility of each person to bring items for the agenda and these
should be agreed at the beginning of the session.

• Responsibility for the session should be equally shared. It is a two-way process.

• Changes to the agreement may need to take place. It should be decided how these
changes should be made.

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7.0 DEVELOPMENT AND TRAINING

This component is an extension of the others. This links with the ICO’s Appraisal system,
and is inbuilt to ensure that development does take place as discussed with the supervisor
and hence the individual does have the opportunity to develop competencies and develop
skills in identified areas. Specific training needs may be identified, but the development
process should be on-going. It may include the following:

• Encourage professional development by exploring basic and specialist skills.


• Identify training needs\areas of development essential to your working practice.
• Help develop awareness of personal skills\characteristics and the effect on others -
clients, consumers, colleagues, and identify strategies for improvement and to enable
personal growth.
• Developing an action plan with clear aims and objectives, to provide direction.

N.B. All applications for training courses should tie in with individual personal development
plans or objectives, should be discussed with and supported by the supervisor/ line
manage.

8.0 MONITORING COMPLIANCE and EFFECTIVENESS: -

Effectiveness

The effectiveness of this policy will be monitored both directly by line managers and via
annual audit conducted by the practice development team.

Key Performance Indicators

The key policy performance indicators:

• Annual audit of clinical supervision will demonstrate whether standards have been
achieved or whether supervision is supporting improvement in clinical practice. Audit
results will be given to all professional leads and service managers.

• Service held outline of supervision

• Staff and supervisor held agreements

• Supervision records maintained and held by supervisee and supervisor

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Monitoring Compliance and Effectiveness Tool

What key area(s) Who will lead on this What tools / methods How often is the need to Responsible Committee
need(s) monitoring on aspect of monitoring? will be used to monitor monitor each area? for scrutiny and
this document? report and review the arrangements for
identified areas? How often is the need to feedback.
produce a report?

How often is the need to


share the report?

Element/s to be monitored Lead Tool Frequency Reporting and feedback


arrangements

Development and Training of Clinical Development Evaluation forms from each Yearly Nursing Executive
Clinical Supervisors and Manager, Practice training session and audits Committee
Supervisees Development Team and
AHPs Professional Lead

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9.0 ASSOCIATED DOCUMENTS:

Title Intranet hyperlink

Induction Policy for all staff http://whittnet/document.ashx?id=5481

Appraisal Guidance http://whittnet/default.asp?c=16365

10.0 REFERENCES:

Code of Ethics & Professional Conduct. College of Occupational Therapists.

London. 2010. (http://www.cot.co.uk/standards-ethics/standards-ethics)

Driscoll, J. (2000) Practising Clinical Supervision: A Reflective Approach Bailliere


Tindall (in association with the Royal College of Nursing), Elsevier, Edinburgh, UK,
(Chapter 6: Essential skills for supervisees pages 79-100).

Hawkins, P. Shohet, R. (2002) Supervision in the Helping Professions Open


University Press, Buckingham UK, (Chapter 3: Getting the support and
supervision you need pages 16-35).

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11.0 APPENDICES: -
.
Appendix 1 - Equality Impact Assessment Tool

Yes/No Comments
1. Does the policy/guidance affect one group
less or more favourably than another on the
basis of:

• Race No

• Ethnic origins (including gypsies and travellers) No

• Nationality No

• Gender No

• Culture No

• Religion or belief
No
• Sexual orientation including lesbian, gay and
bisexual people No

• Age No
• Disability - learning disabilities, physical
disability, sensory impairment and mental health No
problems
2. Is there any evidence that some groups are
affected differently? No
3. If you have identified potential discrimination,
are any exceptions valid, legal and/or
justifiable?
4. Is the impact of the policy/guidance likely to
be negative? No
5. If so can the impact be avoided? N/A
6. What alternatives are there to achieving the
policy/guidance without the impact?
7. Can we reduce the impact by taking different
action?

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Appendix 2:

Clinical Supervision Agreement

Supervisee(s) name(s):

Supervisor name:

Frequency of sessions: Length of sessions (approx)

We (supervisee & supervisor) agree the following:

• The aim of supervision is to enable the supervisee to reflect in depth on issues


affecting practice or professional development in order to deliver and sustain a high
quality, effective and safe service.

• The time and place for supervision meetings will be protected by ensuring privacy,
time boundaries, punctuality and no interruptions. Sessions will only be cancelled
with good cause and subsequently an alternative date arranged as soon as possible.

• The sessions will be guided by an agenda agreed by all parties

• The content of supervision will be confidential and will not be discussed outside the
session unless agreed by all parties, with the exception of unsafe, unethical or illegal
practice being revealed.

• All supervision documentation will be completed as required by the Clinical


Supervision Policy and local protocols.

As a supervisee I agree to:

• Take responsibility for making effective use of the time made available for supervision
by preparing appropriately for sessions and completing actions arising from
supervision within the agreed timescale.

• Be willing to acknowledge both my strengths and limitations and be prepared to


discuss my practice honestly within my supervision sessions

As a supervisor I agree to:

• Respect the openness and honesty of the supervisee(s) and offer support,
constructive feedback, information and facilitation as appropriate, enabling them to
reflect upon their practice.

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• Keep all personal information revealed in supervision confidential, except where a
supervisee reveals unsafe, unethical or illegal practice.

• Take responsibility for structuring supervision sessions appropriately and completing


any required actions arising from supervision within the agreed timescale.

Signed: (Supervisor) Date:

Supervisee(s) Date:

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Appendix 3:

Clinical Supervision Record Sheet Template

Supervisee(s) Name(s):

Supervisor Name:
Date:

Type of supervision (1:1, group etc):


Length of session (approx):

Positives Outcomes since Previous Meeting:

Agenda:
1. 6.
2. 7.
3. 8.
4. 9.
5 10.

Key points discussed Outcomes


(including agreed actions and timescales)

We confirm that this record is an accurate summary of the key points discussed and the
outcomes/action agreed

Signed: _______________________Supervisee________________________Supervisor

Date & venue of next meeting:……………………………………………


A separate copy to be retained by both supervisor and supervisee(s)

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Appendix 4: Roles and responsibilities of Managers and Professional Leads

Care Group/Team Manager Professional Head

Responsibility for setting team and Support and advisory role


individual objectives, and monitoring Jointly set objectives for the professional
progress against these. lead within the care group.

Day to day operational management, Clinical advice as required.


including leave and sickness absence. Negotiate effective workload management
system and what is an appropriate role in
Manage and monitor the workloads of team.
individuals and teams,
Ensure appropriate and good quality
Supervision of staff- professional clinical practice supervision.
Monthly unless formally varied
Ensure professional development needs
Responsible for ensuring PDRs and are adequately reflected within PDPs and
PDPs take place, as well as any three- training plans. Advise ways to develop
way meetings. professional skills e.g. shadowing,
appropriate training.
Authorisation of time and funding for
training. Approve appropriateness of profession-
specific training and requests for funding for
profession specific training.
Performance Management/ Grievance
and Disciplinary /Investigations and Advice re clinical / professional issues and
complaints. standards of practice/codes of conduct.
Ensure appropriate professional input.
Facilitate having students on clinical
placement Ensure appropriate staff training for this e.g.
fieldwork educator training
Responsibility for Health and Safety,
including risk assessment and Professional training needs linked to
management Health and Safety identified and addressed.
Advice on clinical risk.
Ensure audit and other clinical
governance activity takes place. Profession specific audit/research activity.

Develop and monitor quality standards, Ensure necessary clinical protocols are in
ensure protocols in place. place and that care protocols match
professional standards for best practice.

Registration checks for nurses. Registration checks for AHP/Health Care


Scientists.
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11.0 EQUALITY IMPACT ANALYSIS:

Whittington Health – Equality Impact Analysis Form

All the headings must be included in the Equality Analysis Repor. Access guidance via this
link: http://whittnet/default.asp?c=9308

1. Name of Policy or Service

2. Assessment Officer

3. Officer responsible for policy implementation

4. Completion Date of Equality Analysis (In this format;12/May/2013)

5. Description and aims of policy/service

6. Initial Screening

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An initial analysis has been carried out to explore whether the XXXXX is likely to

have a detrimental impact in terms of people included in one or more of the following

equality categories:

• Race
• Disability
• Gender
• Age
• Sexual orientation
• Religion and belief
• Gender Reassignment
• Marriage and civil partnership
• Pregnancy and maternity

7. Outcome of initial screening

8. Monitoring and review/evaluation

9. Publication of document; …… (Intranet or other)

Clinical Supervision (Nursing, Allied Health Professionals and Support Workers)


POL/COR/0167 Version 2.0 January 2015
This is an online document. Hard copies and downloaded versions are valid only on the day printed or
downloaded. It is the responsibility of staff to verify current status from the Intranet.
PRINT DATE -

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