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Ongoing Clinical Supervision
they cannot take time away from a busy inpatient unit. These clinicians may prefer
more informal support at least as a starting point to building trust and engaging in
more formal clinical supervision (see Spontaneous Supervision, p. 66). Additionally,
engaging inpatient nursing staff in particular in individual clinical supervision can
be challenging due to unit constraints (see Nursing and Clinical Supervision, p. 75).
Confidentiality is critical to the development of a safe and trustworthy environment.
The clinical supervisor explains that discussions in the sessions are confidential. The
only time this confidentiality is broken is if the clinician has been involved in unsafe
or unethical behaviour with a client. The supervisor must confront such behaviour.
Ideally, the supervisor helps the clinician identify the problem and initiate corrective
action. The supervisor monitors the process (Gilmore, 2001). If supervision has been
mandated, the supervisor is obligated to share information with the manager. (See
When Clinical Supervision is at the Request of the Manager, p. 28). A strong confidential
ethic contributes to a safe environment. Without the establishment of a safe
environment, the clinical supervisor and clinician will be less likely to explore the
more risky aspects of unprofessional practice (Epling & Cassedy, 2001).
A discussion of goals is important to the development of a focus for clinical supervision
sessions (see Beginning of the Relationship and Contracting, p. 23). Clinicians
may come with very specific goals, such as addressing difficulties experienced while
caring for a particular client, a client population or diagnosis, or they may require
assistance in exploring and developing their goals within a framework of clinical
supervision. Frameworks or models of supervision within both nursing (Proctor,
1991) and social work (Kadushin, 1976) frequently include the components of
support, education/learning and administration, and supervision is described as a
reflective process (see Appendix 1, a review of the literature, pp 103). It is important
to note, as Fowler and Chevannes (1998) suggest, that some clinicians may not be
ready to or able to cope with intense examination of themselves and their work. If the
clinician is inexperienced clinically, then a focus on reflection may not be appropriate,
at least not initially. A more directive approach such as a preceptorship may better
meet the clinician’s goals, with clinical supervision being available when the clinician
is more experienced.
The opportunity to off-load in the context of a supportive relationship builds trust
and a foundation for later exploring clinical material in more depth. Caring for
clients living with mental illness and/or addictions is hard work. Listening to clients’
stories and bearing witness to their pain and suffering can take a toll on clinicians
and contribute to burnout and low morale. Novice clinicians may be particularly
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