Can clinical supervision sustain our workforce in the current healthcare landscape? Findings from a Queensland study of allied health professionals

Characteristics of Clinical Supervision for Mental Health Nurses: A Survey Study Using the MCSS-26

AIM(S)

To describe the characteristics and perceived effectiveness of clinical supervision mental health nurses are receiving and further explore any statistical correlations between the perceived effectiveness and satisfaction with the supervisee, supervisor and supervision characteristics.

DESIGN

A cross-sectional survey.

METHODS

An online survey was distributed to nurses working in public mental health services in Victoria, Australia. A universal recruitment approach was used, and 422 nurses participated in the survey. Of these, 220 nurses who are participating in clinical supervision were eligible for the MCSS-26 survey.

DATA SOURCE

A licensed MCSS-26 questionnaire.

RESULTS

Mental health nurses in the studied environment were likely to receive individual supervision from a senior mental health nurse, with the most common frequency being monthly for 31-60 min, and half receiving it within their workplace location. Half of the participants chose their own supervisor. Our findings indicate that nurses who engage in clinical supervision outside of their immediate workplace and receive individual supervision from a nurse of the same grade perceive higher effectiveness. We also found that clinical nurses may find it most difficult to engage in effective clinical supervision due to time constraints.

CONCLUSION

This study uniquely contributes to the current clinical supervision literature by reporting the uptake and detailed characteristics of supervision, a facet often overlooked in existing research.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

This study reported the characteristics of the supervision, supervisor and the supervisee that are associated with the effective clinical supervision. These insights can lead to tailored implementation strategies that consider the specific roles and settings of nurses.

REPORTING METHOD

CROSS (Sharma et al. 2021).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives

AIMS

Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision.

BACKGROUND

The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities.

DESIGN

Qualitative descriptive.

METHODS

Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected.

RESULTS

Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop.

CONCLUSION

Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace.

IMPACT

This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care.

REPORTING METHOD

The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed.

PATIENT OR PUBLIC CONTRIBUTION

Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Comparing Presence and Absence of Initial In-Person Contact and Written Feedback in RE&CBT E-Supervision

This pilot study aims to analyze the effects of the presence and absence of initial in-person contact and written feedback in RE&CBT e-supervision, comparing it on the Supervisory Working Alliance Inventory, the Supervisor Satisfaction Questionnaire, and the Trainee Disclosure Scale. During a period of six months, five supervisees performed ten e-supervision divided into two groups, a control group that did only the initial meetings in-person and an experimental group in which two supervisees completed whole process online. Additionally, in the first five e-supervision, the supervisor reviewed an entire session with written feedback with an additional meeting for each group. In the last five e-supervision, the supervisor only partially reviewed client sessions during supervision. After ten e-supervision, an individual post-interview was conducted with each participant. This study's primary statistical method for calculating and combining effect sizes was Tarlow Baseline Corrected Tau and Open Meta Analyst software. Both groups scored above average on the first two scales, but the disclosure scale had highly irregular and inconsistent patterns. The combined qualitative and quantitative results suggest that novice therapists generally prefer to have their entire sessions reviewed with written feedback and that a single in-person contact is unlikely to influence e-supervision satisfaction and working alliance. Given that there are no adequately validated e-supervision models, this pilot study used a pilot model named Supported Model of Electronic Supervision (SMeS). This model showed potential, but it needs further testing on a larger sample with more clearly operationalized steps. This study experimentally supports the effectiveness of RE&CBT supervision for the first time.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10942-023-00505-2.

The Supervisees' Perspectives Concerning the Clinical Supervision of Radiologic Sciences Students at Clinical Sites: Implications and Future Directions

INTRODUCTION

Clinical supervision (CS) is essential to practice-based learning in radiology. The assessment of the effectiveness of CS is essential to ensure the success of the process and to provide high-quality patient care.

PURPOSE

This study aimed to evaluate the CS of both Diagnostic Radiography (DR) and Nuclear Medicine (NM) technology students studying at Kuwait University.

METHODS

The Manchester Clinical Supervision Scale-26 (MCSS-26©) was distributed electronically to 90 third and fourth year students from Radiologic Sciences department. Ethical approval was obtained from the Health Sciences Centre (HSC) Ethical Committee and all the participants provided electronic informed consent. Data are presented as mean ± SD.

RESULTS

Seventy responses were collected from DR and NM (response rate 78%, DR: n= 51, NM: n=19). Overall, the mean CS score from the MCSS was 67.7±11.3, n=70. CS in NM scored more effective than that in DR with a p=0.037 (72.3±10.1, 66.0±11.3, respectively).

CONCLUSION

The effectiveness of CS has been evaluated in third and fourth year students across the two divisions of RS the department at Kuwait University. This study showed that students value the impact of CS in their professional role and 70% reported being satisfied with the overall CS experience. Limited studies are available that focuses on students' perceptions about clinical supervision; therefore, more studies are needed to evaluate the effectiveness of CS among RS students. Implications for interprofessional education are presented.

Enhancing the quality of allied health clinical supervision in a regional setting: An action research study

OBJECTIVE

To explore and describe strategies to enhance the implementation of an organisational clinical supervision framework and subsequently inform the development of a model of implementation of clinical supervision for allied health professionals in a regional health care setting.

SETTING

A large regional health service in Victoria, providing hospital, rehabilitation, community, mental health and aged care services.

PARTICIPANTS

Allied health managers employed at the health service were members of an action research group.

DESIGN

This longitudinal study used an action research approach. The action research group informed the repeated cycles of planning, action and reflection. Data from recorded action research meetings were analysed using content analysis.

RESULTS

The action research group met 11 times over a 5-year period informing four action research cycles. Six main themes relating to factors that enhanced the quality of clinical supervision emerged from the analysis of the action research group data: purpose and value of clinical supervision; clinical supervision characteristics; differences between disciplines; framework development; training and support and implementation of clinical supervision.

CONCLUSION

The findings from this comprehensive longitudinal study provide evidence-based approaches to the implementation of allied health clinical supervision. The action research approach used ensures that the strategies described are realistic and sustainable. A model has been developed to inform the implementation of clinical supervision for allied health.

Is there a role for professional supervision in supporting the professional and personal wellbeing of the sonographic workforce? A literature review

OBJECTIVES

The sonographer workforce in the UK is under pressure due to chronic staff shortages and increased service demands. The Health and Care Professions Council and the Society of Radiographers both advocate for the use of professional supervision to support wellbeing and development, however the use of professional supervision is not widespread within the sonographer workforce. The aim of this literature review was to explore the evidence around the use of professional supervision and how this could support sonographer wellbeing.

KEY FINDINGS

Professional supervision was found to be of importance for providing emotional support which can lead to increased job satisfaction, lower levels of burnout and subsequently impact on retention of the workforce. Professional supervision supported personal development and therefore increased quality of patient care, allowing professionals to discuss evidence-based care, policies and practice development through reflection. Whilst important for emotional and professional support, this review found that there are conflicting pressures which can impact the effectiveness of supervision including the supervisory relationship itself and time and organisational pressures. Demands on the workforce made a significant impact on the availability of quality clinical supervision.

CONCLUSION

Professional supervision has an important role in supporting the sonography workforce and enable increased wellbeing and emotional support. There are clear benefits to undertaking professional supervision to support the workforce however there are competing demands which may affect the effectiveness of professional supervision.

IMPLICATIONS FOR PRACTICE

There is limited international research on the use of professional supervision in the radiographer and sonographer workforce. There are clear benefits for supporting professional wellbeing and development under a structured professional supervision framework however within the United Kingdom there is a significant gap in the literature where further research is required.

Rebooting effective clinical supervision practices to support healthcare workers through and following the COVID-19 pandemic

The importance of clinical supervision, a professional support and clinical governance mechanism, to patients, healthcare workers and organizations has been well documented. Clinical supervision has been shown to support healthcare workers during challenging times, by reducing burnout, enhancing mental health and wellbeing at work, and improving job satisfaction. However, clinical supervision participation and effectiveness are pre-requisites for realising these benefits. During times of stress and increased workloads (e.g. during the Coronavirus pandemic), healthcare workers tend to prioritise clinical duties and responsibilities over clinical supervision. Effective supervision practices can be restored, and healthcare workers can be better supported in their roles during and in the post-pandemic period only if healthcare workers, policy makers, healthcare organizations, clinical supervision trainers and researchers join forces. This paper sheds light on this important topic and offers a number of practical recommendations to reboot effective clinical supervision practices at the point of care.

Effectiveness of allied health clinical supervision following the implementation of an organisational framework

Background

Clinical supervision makes an important contribution to high quality patient care and professional wellbeing for the allied health workforce. However, there is limited research examining the longitudinal implementation of clinical supervision for allied health. The aim of this study was to determine the effectiveness of clinical supervision for allied health at a regional health service and clinicians’ perceptions of the implementation of an organisational clinical supervision framework.

Methods

A cross-sectional study was conducted as a phase of an overarching participatory action research study. The Manchester Clinical Supervision Scale (MCSS-26) tool was used to measure clinical supervision effectiveness with additional open-ended questions included to explore the implementation of the clinical supervision framework. MCSS-26 findings were compared with an initial administration of the MCSS-26 5 years earlier. MCSS-26 data (total scores, summed domain and sub-scale scores) were analysed descriptively and reported as mean and standard deviation values. Differences between groups were analysed with independent-samples t-test (t) and one-way between groups ANOVA.

Results

There were 125 responses to the survey (response rate 50%). The total MCSS-26 score was 78.5 (S.D. 14.5). The total MCSS-26 score was unchanged compared with the initial administration. There was a statistically significant difference in clinical supervision effectiveness between speech pathology and physiotherapy (F = 2.9, p = 0.03) and higher MCSS-26 scores for participants whose clinical supervisor was a senior clinician and those who chose their clinical supervisor. Seventy percent of participants perceived that the organisation’s clinical supervision framework was useful and provided structure and consistent expectations for clinical supervision.

Conclusions

Clinical supervision was effective for allied health in this regional setting and clinical supervision effectiveness was maintained over a 5 year period. The implementation of an organisational clinical supervision framework may have a positive effect on clinical supervision for some professions.

Enablers and barriers to effective clinical supervision in the workplace: a rapid evidence review

OBJECTIVES

We aimed to review the international literature to understand the enablers of and barriers to effective clinical supervision in the workplace and identify the benefits of effective clinical supervision.

DESIGN

A rapid evidence review.

DATA SOURCES

Five databases (CINAHL, OVID Embase, OVID Medline, OVID PsycInfo and ProQuest) were searched to ensure inclusion and breadth of healthcare professionals.

ELIGIBILITY CRITERIA

Studies identifying enablers and barriers to effective clinical supervision across healthcare professionals in a Western context between 1 January 2009 and 12 March 2019.

DATA EXTRACTION AND SYNTHESIS

An extraction framework with a detailed inclusion/exclusion criteria to ensure rigour was used to extract data. Data were analysed using a thematic qualitative synthesis. These themes were used to answer the research objectives.

RESULTS

The search identified 15 922 papers, reduced to 809 papers following the removal of duplicates and papers outside the inclusion criteria, with 135 papers being included in the full review. Enablers identified included regular supervision, occurs within protected time, in a private space and delivered flexibly. Additional enablers included supervisees being offered a choice of supervisor; supervision based on mutual trust and a positive relationship; a cultural understanding between supervisor and supervisee; a shared understanding of the purpose of supervision, based on individual needs, focused on enhancing knowledge and skills; training and feedback being provided for supervisors; and use of a mixed supervisor model, delivered by several supervisors, or by those trained to manage the overlapping (and potentially conflicting) needs of the individual and the service. Barriers included a lack of time, space and trust. A lack of shared understanding to the purpose of the supervision, and a lack of ongoing support and engagement from leadership and organisations were also found to be barriers to effective clinical supervision.

CONCLUSIONS

This review identified several enablers of and barriers to effective clinical supervision and the subsequent benefits of effective clinical supervision in a healthcare setting.

Effective clinical supervision of allied health professionals: a mixed methods study

BACKGROUND

Clinical supervision is recommended for allied health professionals for the purpose of supporting them in their professional role, continued professional development and ensuring patient safety and high quality care. The aim of this mixed methods study was to explore allied health professionals' perceptions about the aspects of clinical supervision that can facilitate effective clinical supervision.

METHODS

Individual semi-structured interviews were conducted on a purposive sample of 38 allied health professionals working in a metropolitan public hospital. Qualitative analysis was completed using an interpretive description approach. To enable triangulation of qualitative data, a quantitative descriptive survey of clinical supervision effectiveness was also conducted using the Manchester Clinical Supervision Scale (MCSS-26).

RESULTS

Three main themes emerged from qualitative analysis: Allied health professionals reported that clinical supervision was most effective when their professional development was the focus of clinical supervision; the supervisor possessed the skills and attributes required to facilitate a constructive supervisory relationship; and the organisation provided an environment that facilitated this relationship together with their own professional development. Three subthemes also emerged within each of the main themes: the importance of the supervisory relationship; prioritisation of clinical supervision relative to other professional duties; and flexibility of supervision models, processes and approaches to clinical supervision. The mean MCSS-26 score was 79.2 (95%CI 73.7 to 84.3) with scores ranging from 44 to 100. MCSS-26 results converged with the qualitative findings with participants reporting an overall positive experience with clinical supervision.

CONCLUSIONS

The factors identified by allied health professionals that influenced the effectiveness of their clinical supervision were mostly consistent among the professions. However, allied health professionals reported using models of clinical supervision that best suited their profession's role and learning style. This highlighted the need for flexible approaches to allied health clinical supervision that should be reflected in clinical supervision policies and guidelines. Many of the identified factors that influence the effectiveness of clinical supervision of allied health professionals can be influenced by health organisations.

Supervision contracts for mental health professionals: a systematic review and exploration of the potential relevance to psychiatry training in Australia and New Zealand

OBJECTIVE

The use of formal supervision contracts has been strongly advocated across non-medical mental health professions. However, the use of such agreements is not a feature of the RANZCP Competency-Based Fellowship Program. This paper critically examines the evidence to support the use of formal supervision contracts.

METHOD

A systematic review of empirical studies relating to the outcomes of supervision contracts was completed. Included records were subject to quality appraisal.

RESULTS

Two studies met the inclusion criteria; both were assessed to be of poor quality. One study found improved supervision effectiveness associated with the use of supervision contracts, and the other found no significant differences associated with formal contracting.

CONCLUSION

Despite strong advocacy, limited empirical evidence was found to support the value of formal supervision contracts across mental health professions. PROSPERO registration - PROSPERO 2018 CRD42018104142.

Debriefing about the challenges of working in a remote area: A qualitative study of Australian allied health professionals' perspectives on clinical supervision

Background

The benefits of clinical supervision are more pronounced for health professionals in rural and remote areas. Most clinical supervision studies to date have occurred in metropolitan centres and have used the survey methodology to capture participant experiences. There is a lack of qualitative research that captures participants’ lived experiences with clinical supervision at the frontline.

Methods

Participants were recruited from rural and remote sites of two Australian states using a purposive maximum variation sampling strategy. Data were collected through individual, semi-structured interviews with participants. Data were analysed using content analysis and themes were developed. Sixteen participants from six professions completed the interviews.

Results

Eight themes were developed including the content of supervision, context of supervision, value of supervision, increased need for professional support and unique characteristics of rural and remote clinical supervision.

Conclusions

This study has highlighted the value of clinical supervision for the rural and remote health professional workforce. Furthermore, it has shed light on the unique characteristics of clinical supervision in this population. This information can be used by organisations and health professionals to ensure clinical supervision partnerships are effective thereby enhancing rural and remote workforce recruitment and retention.

Factors that contribute to high-quality clinical supervision of the rural allied health workforce: lessons from the coalface

Objective The aim of this study was to identify the factors contributing to high-quality clinical supervision of the allied health workforce in rural and remote settings. Methods This quantitative study was part of a broader project that used a mixed-methods sequential explanatory design. Participants were 159 allied health professionals from two Australian states. Quantitative data were collected using an online customised survey and the Manchester Clinical Supervision Scale (MCSS-26). Data were analysed using regression analyses. Results Supervisee’s work setting and choice of supervisor were found to have a positive and significant influence on clinical supervision quality. Supervisee profession and time in work role were found to have a negative and significant influence on the quality of clinical supervision. Conclusions High-quality clinical supervision is essential to achieve quality and safety of health care, as well as to support the health workforce. Information on high-quality clinical supervision identified in this study can be applied to clinical supervision practices in rural and remote settings, and to professional support policies and training to enhance the quality of supervision. What is known about the topic? There is mounting evidence on the benefits of clinical supervision to health professionals, organisations and patients. Clinical supervision enhances recruitment and retention of the health workforce. However, there are still gaps regarding the factors that contribute to high-quality clinical supervision, especially for rural and remote health professionals. What does this paper add? This study, the first of its kind, recruited rural and remote health professionals from seven allied health disciplines across two Australian states. It investigated the factors that influence high-quality clinical supervision in this under-resourced group. This paper outlines specific factors that contribute to clinical supervision quality for rural and remote allied health professionals. What are the implications for practitioners? Effective and high-quality clinical supervision of the rural and remote allied health workforce can enhance recruitment and retention in those areas. Healthcare organisations can facilitate effective clinical supervision delivery by using the evidence gathered in this study in clinical supervision policy, training and practice.

Physiotherapists' perceptions of workplace competency: a mixed-methods observational study

Objectives Workplace-based competency is increasingly considered fundamental to patient safety and quality healthcare. The aim of the present study was to identify and describe physiotherapists' perceptions of workplace competency. Methods The present study was a mixed-methods cross-sectional observational study. Thematic and descriptive analysis of qualitative and survey data were undertaken. Forty-six physiotherapists employed at a metropolitan acute public hospital participated in interviews or focus groups; a subgroup of 31 participants also completed an online survey. Results Five main themes were identified: (1) despite the availability of workplace learning opportunities and supports, less-experienced staff reported limited confidence; (2) assessment and feedback around workplace competency was limited, predominantly informal and unstructured, with less than half of the cohort (42%) agreeing feedback received was useful for improving their workplace skills; (3) practicing within individual scope is an important aspect of workplace competency as a physiotherapist; (4) most (81%) agreed it was important for them to self-determine their learning and development goals, and they relied primarily on informal discussion to achieve these goals; and, (5) physiotherapists felt motivated regarding workplace learning, with 97% interested in developing their workplace skills however, nearly half (45%) did not feel they had sufficient time to do so. Conclusions The perceptions of physiotherapists working in a metropolitan acute public hospital are reflected in five themes. These themes elucidate how workplace competency is supported, maintained and developed among physiotherapists in this setting. These themes also highlight key challenges of workplace learning faced by this cohort of physiotherapists and allude to methods that may assist with improving feedback mechanisms and knowledge acquisition. What is known about this topic? Studies investigating employee perceptions around workplace competency, knowledge, skills and learning are found across a range of industries. Workplace-based competency is increasingly considered fundamental to patient safety and quality health care. There is little known about physiotherapists' perceptions of workplace competency. What does this paper add? This study has identified and described themes around physiotherapists' perceptions of their workplace knowledge and skills. What are the implications for practitioners? The themes identified provide support for the development, implementation and evaluation of a workplace-based competency framework for physiotherapists.