Policy for Clinical Supervision / Professional Support - Halton and St ...

Policy for Clinical Supervision / Professional Support 

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Document Owner: 

Board approved: 

Policy Indexed 

Controlled Document No 

Version Number 1 

Status: 

Clinical Policy 

All areas of the Trust 

All Trust staff 

Clinical Staff 

Professional Development Manager 

Approved by Integrated Governance 

Committee June 2007 

ClinPol4 

HSHPCT/ClinPol4 

Statutory and legal requirements 

Implementation Lead 

Implementation Process 

Healthcare Commission Standards for 

Better Health 

Department of Health (1998) A first 

class quality service in the NHS 

Professional Development Manager 

Policy to be circulated to all staff, 

Clinical Governance Workstream to 

monitor training programme and 

awareness sessions across the Trust. 

Register of supervision sessions 

monitored 

The Trust is committed to an environment that promotes equality and embraces 

diversity both within our workforce and in service delivery. This document 

should be implemented with due regard to this commitment. 

Issue Date: March 2007 Author: Prof. Dev. Manager Page 1 of 22 

Review Date: March 2009 Lead Director: Director of Workforce

CONTENTS PAGE 

Introduction 3 

What is Clinical Supervision 3 

Link between Clinical Governance and Clinical Supervision 5 

Why is Supervision Necessary? 5 

Trust responsibilities for Clinical Supervision 6 

Characteristics/Qualities of a Clinical Supervisor 6 

The Supervisor’s Role 6 

The Supervisee’s Role 7 

Models of Clinical Supervision 7 

Arrangements of Clinical Supervision in: 

Community Nursing 7 

Child Protection 8 

Midwifery 9 

Therapy & Dental Services 10 

Supervision Contract 10 

Register of Attendance 11 

Monitoring the Process 11 

References 12 

Appendices 13-22 



1. Introduction 

Clinical Supervision is the term used to describe a formal process of 

professional support which should be seen as a means of encouraging selfassessment 

and analytical and reflective skills. 

Clinical Supervision can both empower and support those in practice, but only if 

it is developed by clinical staff and implemented through them, as the process 

relies on those who are actively working in practice and have current 

experience. 

Clinical Supervision involves a tripartite partnership between the Supervisor, 

Supervisee and the organisation. If any one of these fails to participate in, or 

actively sabotages Clinical Supervision, the supervisory process cannot be fully 

effective or demonstrably beneficial. 

There are benefits in Clinical Supervision to both the individual practitioner and 

the organisation. It is a means whereby professional knowledge may be 

expanded and an understanding developed of individual client needs. The 

process facilitates the evaluation of the Practitioner’s interaction with the client 

and the rest of the Team to ensure that the best quality of care is provided. 

This policy has been developed to provide a strong framework around which 

the practice of Clinical Supervision can be enhanced within the Trust. It is 

hoped that they will support a variety of models of clinical supervision that have 

developed in accordance with local circumstances and staff development needs. 

This policy includes the basic principals of Clinical Supervision but are not 

intended to prepare an individual to take on either the role of Supervisor or 

Supervisee. A programme of a two-day workshop for supervisors and basic 

awareness training for supervisees is available to support the implementation of 

Clinical Supervision within all services. 

2. What is Clinical Supervision 

The NHS Management Executive defined Clinical Supervision in 1993 as: - 

“… a formal process of professional support and learning which enables 

individual practitioners to develop knowledge and competence, assume 

responsibility for their own practice and enhance consumer protection 

and safety of care in complex situations.” 

Bond and Holland (1998) describe it as: - 



‘Regular, protected time for facilitated, in-depth reflection on clinical 

practice aimed to enable the supervisee to achieve, sustain and 

creatively develop a high quality of practice through the means of 

focused support and development’ 

Clinical Supervision is a collaborative dynamic process including the components 

of teaching and mentorship, which goes beyond a pastoral, nurturing role and 

positively works towards ‘enabling’ the supervisee to: 

• Have time to engage in critical self-examination and reflection on 

practice. 

• Become more self aware 

• Identify practice issues and to consider approaches to practice based on 

evidence. 

• Consider the recipients of the service in terms of their perceptions of 

what is happening in their lives and in response to interventions. 

• Be challenged in a safe environment 

• Have the opportunity to consider their training and development needs. 

Clinical Supervision can be offered in terms of three different functions. Within 

any one supervision session the relationship can focus on just one of these 

functions or be a mixture of two or three different functions. 

• Formative (Educational) 

• Normative (Managerial) 

• Restorative (Supportive) 

• FORMATIVE – is about developing the skills, and understanding the general 

abilities of the supervisee. Developing an awareness of why and how 

interventions are used and exploring alternative strategies, ensuring that 

practice is evidence based. 

• RESTORATIVE – is a way of responding to supervisees as a consequence of 

them as individuals, working with people who have complex needs. 

Supervisees should be encouraged to reflect on ways in which they have 

been affected, and they may, as a result, relate differently to other people. 

• NORMATIVE – is related to the qualitative aspect of the work the supervisee 

undertakes. The qualitative aspect of supervision is concerned with issues 

related to equity and fairness to the people we work with, the organisation 

we work for and relate to. Normative or managerial supervision is not about 

making judgements on people and their work, but about highlighting areas 

for improvement and change of which the supervisee may not be fully 

aware. 

Proctor, B (1986) ‘Supervision: A Co-operative Exercise in Accountability’ 



3. Link Between Clinical Governance and Clinical Supervision 

Clinical Governance can be defined as: 

‘A framework through which NHS Organisations are accountable for 

continuously improving the quality of their services and safeguarding 

high standards of care by creating an environment in which clinical 

excellence will flourish’. (DoH 1998). Clinical Governance is also the 

means ‘by which organisations ensure the provision of quality clinical 

care by making individuals accountable for setting, maintaining and 

monitoring performance standards’. (DoH North Thames Regional Office 

1998). 

Clinical Governance places the responsibility for the quality of care on 

organisations and on individuals within organisations. 

Recent research evidence demonstrates (Butterworth T et al 1997) that Clinical 

Supervision has an important role to play in the Clinical Governance agenda. 

By focusing on clinical work and skills development, through the effective use of 

Clinical Supervision, there is a well-developed system in place which supports 

some of the central requirements of Clinical Governance. 

Participating in clinical supervision in an active way is a clear demonstration of 

an individual exercising their responsibility under Clinical Governance. Clinical 

Supervision should properly be seen as taking its place in a wider framework of 

activities that are designed to manage, enhance and monitor the delivery of 

high quality clinical services. 

4. Why is Supervision Necessary? 

To: 

• Review, reflect and receive guidance on casework. 

• Protect the patient / client. 

• Ensure competent practice and monitor and safeguard standards. 

• Identify, develop and share practice skills. 

• Review and reflect on clinical issues. 

• Reflect on critical incidents. 

• Decrease feelings of isolation and distress. Increase feelings of 

responsibility and commitment to improve client / patient care. 

• Keep a perspective on professional boundaries and to ensure that the 

boundaries in the practitioner / patient relationship are understood. 

• Express emotional or painful work- related feelings. 

• Ensure legal and ethical standards are maintained. 



4.1 Trust Responsibilities for Clinical Supervision 

Training and Support: 

• Appropriate experienced Practitioners will be offered training to undertake 

the role of Clinical Supervisors. 

• Supervisors will receive Clinical Supervision themselves, either one to one or 

in a small group. 

• Formal support networks for Clinical Supervisors will be developed within 

each service. 

• The Trust acknowledges that Supervisors need a willingness and 

commitment to fulfil the role. 

• Time will be allocated to attend Clinical Supervision meetings. 

4.2 Characteristics / Qualities of a Clinical Supervisor 

Clinical Supervisors will be experienced practitioners with clinical credibility who 

are able to demonstrate: - 

• Knowledge and application of reflective practice skills. 

• Professional maturity i.e. willingness, openness and confidence to challenge 

practice issues. 

• Understand the issues concerned with personal accountability and 

responsibility. 

• Good interpersonal skills. 

• A sound knowledge base in relevant practice field. 

4.3 The Supervisors Role is to: 

• Ensure protected time for each Supervisee to lay out issues in his / her own 

way. 

• Help Supervisees explore and clarify thinking, feeling and beliefs which 

underlie their practice. 

• Enable Supervisees to identify and discuss critical incidents and / or stressinducing 

aspects of their professional work. 

• Share experience, information and skills appropriately. 

• Challenge practice which he / she perceives unethical, unwise or 

incompetent. 

• Challenge personal and professional blind spots which he / she may perceive 

in individuals or the group. 

• Be aware of the organisational contracts with he / she and the Supervisees 

may have with the employer and client in terms of Supervision. 

• Facilitate professional development. 



4.4 The Supervisees Role is to: 

• Identify practice issues with which he / she needs help and to ask for time 

to deal with these. 

• Become increasingly able to share these issues freely. 

• Contribute to reflective discussion. 

• Become more aware of the organisational contracts he /she is in with clients 

and the Supervisor or supervision group. 

• Respond to feedback from his / her Supervisor in a structured and 

professional manner. 

• Participate in the process of ‘shared responsibility’. 

4.5 Models of Clinical Supervision 

There are a variety ways of organising Clinical Supervision: - 

• One to one supervision with a supervisor from your own discipline 

• One to one supervision with a supervisor from a different discipline 

• Group supervision (shared supervision by teams). Group supervision can be 

uni-professional or multi-professional. The ratio of supervisor: supervisee is 

recommended 1:4/5. It is also recommended that if the group is larger, then 

consider the use of 2 supervisors or splitting the group. 

• Network supervision – a group of practitioners with similar expertise and 

interests who do not work together on a day-day basis 

(Butterworth, T. 1995) 

5. THE ARRANGEMENTS FOR CLINICAL SUPERVISION IN: 

5.1 COMMUNITY NURSING. 

(District Nursing, Health Visiting, Practice Nurses and School Health Nurses, 

Family Planning Nurses and Nurse Clinicians) and specialisms i.e. MacMillan, 

Heart Failure. 

MODEL. 

The preferred model for Clinical Supervision in Community Nursing is group 

supervision. This can be undertaken as a multi-professional group or uniprofessional 

based on local circumstances and staff needs. Where there may be 

only one post or two within an area of practice, special arrangements need to 

be made on how to access clinical supervision. This may be linking into a multiprofessional 

group or seeking supervision outside of the Trust. One-one 

supervision is available for staff to access should the need arise. This model is 

beneficial to newly qualified/employed practitioners. It can be a continuum to 

preceptor ship. 



FREQUENCE. 

Recommendations from the evaluation study (Porter, I. 1998) were 4-6 times 

per year and hence supervision sessions need to take place. 

• Minimum 3 monthly 

• Maximum 2 monthly 

Each supervision session should be between 1-2 hours in length with agreed 

start and finish times. 

The Nurse manager from each of the services will arrange bi-annual meetings 

with the Clinical Supervisors within their service. The purpose of these 

meetings will be to identify: 

• Issues relating to the management of supervision, i.e nonattendance, 

lack of time, group size, group dynamics. 

• Areas where Clinical Supervision is not happening and the 

reasons for it. 

• Training needs of Clinical Supervisors. 

• Tangible benefits of clinical supervision to be fed through 

Clinical Governance Committee 

It is the responsibility of the Nurse Managers for ensuring that new starters are 

linked into clinical supervision. Supervisors will facilitate this process and will be 

available to support supervisors who are experiencing particular difficulties with 

the role of “supervisor”. 

It is the responsibility of the Nurse Managers to keep a record of all staff within 

their service and how they access clinical supervision. It should be mandatory 

for all nursing staff to attend clinical supervision. 

5.2 CHILD PROTECTION. 

Supervision of Health Visitors / School Health Nurses in Child Protection will 

take place with one of the Child Protection professionals from the Halton / St 

Helens office as appropriate and will aim to give Health Visitors / School Health 

Nurses the opportunity to discuss freely and openly cases about which they 

have particular concerns. 

Child Protection Clinical Supervision will be on a one-to-one basis and will be 

planned individually with each Health Visitor / School Health Nurse. 

Supervision merges with training and will include information giving and 

guidance. Newly qualified and newly appointed staff will be introduced to local 

policies and procedures and the continuing training needs of practitioners will 

be assessed. 



Other professionals and agencies will have access to the senior Nurse Child 

Protection for advice and information. 

5.3 STATUTORY SUPERVISION OF MIDWIVES 

Supervision of Midwives and midwifery practice is a statutory responsibility 

established in the first Midwives Act 1902. 

It is written into the Midwives Rules and Standards (NMC 2004). 

Supervisors of Midwives 

• Protect the public – are advocates of high standards of care for 

mothers and babies 

• Support midwives in their practice – a mechanism of support and 

guidance to every practising midwife 

• Investigate and address issues of poor practice – through training, 

updating, mentorship and support, while seeking to achieve a 

positive learning experience for midwives. 

Organised through the Strategic Health Authorities, supervision is region-led by 

the Local Supervising Authority (LSA) through the LSA Midwifery Officer, and a 

team of Link Supervisors of Midwives. 

There is a yearly inspection of midwifery practice locally by the LSA Officer, 

when she meets midwives and service users, and measures local practice to 

ensure achievement of agreed standards set by the LSA. 

Prospective Supervisors must be experienced clinical midwives with a minimum 

of 3 years experience as a practising midwife. 

Requirements of Supervision 

The maximum recommended ratio of midwives to Supervisor is 15 to 1. An 

annual Supervisory audit meeting takes place between each midwife and her 

Supervisor which includes checks on: - 

• Drugs 

• Diaries 

• NMC Guidance booklets 

• Record Keeping 

• Personal Delivery Register 

Discussion also takes place around: - 

• A reflective practice incident – all midwives are encouraged to use 

reflection as a learning tool 

• Any issues that midwives feel affects practice 



• Training and updating evidence is reviewed and advice given 

• A plan for further development for the forthcoming year is 

encouraged and agreed between midwife and Supervisor 

Locally, midwives have an opportunity annually to choose which Supervisor 

they are allocated to 

There is a 24 hour Supervisor on-call rota, so that midwives can contact a 

Supervisor for advice and support any time of the day or night. 

5.4 THERAPY & DENTAL SERVICES. 

Each Service has an agreed structure for implementing Clinical Supervision. 

Group and one to one sessions are the models used. Frequency ranges from: 

Minimum 

Maximum 

3 monthly 

1 monthly 

Supervisors will be either peers or a senior grade clinically to the supervisee. All 

Clinical Supervisors will have undertaken the relevant training. The managers 

will have the responsibility to ensure that supervision takes place. 

Arrangements for Supervision for Supervisors and other most senior clinicians 

will be arranged outside the Trust, if no appropriate peers are available within 

the organisation. This may occur in specialist services. 

Bi-annually supervisors will meet with therapy and dental managers to feed the 

outcomes of clinical supervision into the management agenda. This will form 

the basis of a report outlining the impact of Clinical Supervision and the 

changes in practice occurring as a result. 

6. SUPERVISION CONTRACT (Appendix One). 

It is important to have a clear working arrangement for every supervision 

relationship, and every supervision relationship must have its own contract. 

The Supervision Contract should be agreed and signed by both the supervisees 

and supervisor. 

The Supervision Contract should include the following: 

1. Name of Supervisor and Supervisee 

2. Frequency, length and venue of supervision sessions; if possible, plan the 

supervision sessions for the forth-coming year. 

3. Confidentiality clause. The limits of confidentiality must be specified in the 

contract. The group need to be aware of when confidentiality will be broken 

and for what reasons. The confidentiality clause to be used in all supervisory 

contracts is: 



“All issues discussed will be in confidence, unless there is anything 

disclosed that affects the well being of the supervisee or are detrimental 

to patients, professional practice, the Team or the organisation.” 

4. Documentation of issues discussed within the supervision session. There will 

be a requirement for evidence to support the evaluation process of clinical 

supervision. Supervisors will be expected to keep agenda / action notes of 

the topics covered and the outcome. This information will be able to support 

the monitoring and audit process. 

5. The supervision contract should have a date agreed and a review date. 

7. REGISTER OF ATTENDANCE (Appendix two) 

A register of attendance must be kept by the supervisor. A copy of the register 

should be sent to the identified manager for the service, who is supporting 

clinical supervisors. Reason for non-attendance by supervisees must be 

recorded. 

Whilst is appreciated that supervisees will not be able to attend all sessions, 

Clinical Supervision is not considered as an option and non-attendance or 

difficulties with the supervisory relationship should be brought to the attention 

of management. 

Supervisors should be supported by management in emphasising the 

importance of any “contractual/charter” agreement to those practitioners who 

are non-attendees or afford Clinical Supervision a low priority. 

8. MONITORING THE PROCESS. 

A database which contains the details of all clinical supervisors, their 

supervisees, frequency of sessions and attendees will be maintained by the 

manager of the Service. This will necessitate the return of a copy of the 

supervision register being forwarded to their manager. This would enable the 

Trust to audit the uptake of clinical Supervision across the organisation. A 

central database will be kept in clinical governance with a list of supervisors. It 

is the managers responsibility to inform clinical governance of changes to the 

list. 

Clinical Supervisors will be responsible for producing a brief report on the 

process and outcomes of their clinical supervision sessions. A series of “tools” 

have been developed to support this process (Appendix Three). The “tools” can 

be used to maintain the focus of Clinical Supervision for the supervisees and by 

the Clinical Supervisor to facilitate clinical issues being raised at supervision. 

The clinical supervisors report back sheet should be sent back to the clinical 

supervisor’s manager every six months and a copy sent to the professional lead 

within the Trust. 



An annual report with an overview of the outcomes of Clinical Supervision will 

be made available to the Clinical Governance Committee. 



REFERENCES FOR CLINICAL SUPERVISION 

Butterworth T (1994) Preparing to take on clinical supervision. Nursing 

Standard 8(52): 32-34. 

Butterworth T (1996) Primary attempts at research-based evaluation of clinical 

supervision. Nursing Times Research. 1(2): 96-101. 

Band M Holland S (1998) Skills of Clinical Supervision for Nurses Open 

University Press. 

Department of Health (1998) A first class service quality in the new NHS. HMSO 

London. 

NMC (2002) Midwives Rules and Standards 

Proctor B (1986) Supervision - A Co-operative Exercise in Accountability. 

Wright H (1989) Group Work perspectives and practices. 



Appendix One 

HALTON AND ST. HELENS PCT 

SUPERVISION CONTRACT 

Group Supervisor 

Designation: 

Supervisees: 

Designation: 

Date for review of the Contract 

Agreed Venue: 

Frequency of Supervision: 

Length of Session: 

Record Keeping: 

Type of record to be kept, who will keep 

them and how the record will be used. 

Confidentiality Clause: 



The content of supervision over a period of time is expected to embrace the 

following issues: 

i. Workload/caseload management/discussion of 

individual cases 

ii 

iii 

iv) 

Supervisory role, which a Supervisee may undertake 

where appropriate 

Their service contribution to meeting health care 

standards and improving care of patients 

Individual/personal development (offering 

practical/emotional support where required) 

v) Training issues 

vi) 

vii) 

viii) 

ix) 

Interpersonal and Team Issues 

Policy and Practice issues 

Information giving and clarification 

Any other matters requiring attention. 

Supervision will be conducted in professional manner and in line with this 

contract. Information and data will be used to provide quality indicators 

and/or evaluate the Structure / Process / Outcome of Clinical Supervision. 

The confidentiality of individuals will always be preserved, unless it is within 

the confidentiality clause. 

SIGNATURES: SUPERVISOR: ………………………………….. 

SUPERVISEES: 

………………………………….. 

………………………………….. 

………………………………….. 

………………………………….. 

DATE: 

………………………………….. 



Appendix Two 


SUPERVISION REGISTER 

Clinical Supervisor 

Date: 

Time: 

Venue: 

Supervisees Attended: 

Supervisees Apologies 

Reason for Non-attendance 

Please return to: Linda Spooner, Professional Development Manager, 

Victoria House. 



Appendix Three 


REFLECTIVE PRACTICE 

USE OF A CRITICAL INCIDENT 

Description of the event. 

Why was the event important to you and how do you feel about it? 

On reflection: 

1. What was satisfactory? 

2. What was most troubling? 

3. What might you have done differently? 

4. What was the outcome of reflecting upon this in supervision? 

What were the agreed actions with your supervisor? 


Review Date: March 2009 Lead Director: Director of Workforce 

Appendix Three



CASE DISCUSSION 

Select a patient / client on your caseload who you would like the 

opportunity to discuss as supervision. It may be a case that is causing you 

some concern. Patient personal details should not included. 

Briefly describe the package of care (i.e. diagnosis, family dynamics, care 

package, other agency involvement) 

What is troubling you with regard to this case? 

Reflect upon the package of care in relation to: 

1. Strengths 

2. Weaknesses 

3. Opportunities 

4. Threats 

Share this reflection at supervision. 







EVIDENCE BASED PRACTICE 

Describe an area of your practice. 

From a risk management perspective would you consider it to be: 

High Medium Low 

From the literature that you have read, would you consider this area of 

practice to be evidence based? 

If yes – give evidence and supporting evidence. 

If no – what is the evidence related to this area of practice? 

Give references and supporting evidence. 

What was the outcome of this discussion at supervision? 






TRAINING AND DEVELOPMENT 

Briefly describe a study day or training event you have attended. 

What was the purpose for undertaking this training or development? 

What were your initial feelings about the training event? 

How do you think you will implement your new knowledge into practice? 

Upon reflection within your supervision group, what was the outcome and 

agreed actions? 


CLINICAL SUPERVISION 

Appendix Four 



NOTES FROM GROUP / INDIVIDUAL SESSION 

DATE: 

ISSUES DISCUSSED 

ACTION TO BE TAKEN / BY WHOM 


Appendix Five 

CLINICAL SUPERVISORS REPORT BACK SHEET 



SUPERVISOR:……………………………………………………………… 

SUPERVISEES:……………………………………………………………. 

………………………………………………………………………………… 

………………………………………………………………………………… 

PERIOD……………………………..NUMBER OF SESSIONS:………… 

Topic/Subject brought to 

Supervision 

Outcome following Supervision 

Topic/subject brought to Supervision 

Outcome following Supervision 



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