Clinical Supervision Handbook - CAMH Knowledge Exchange ...

ather than staff being able to talk about particular clients over an extended period
of time. One way of attending to this, particularly given the “revolving door” nature
of hospital admissions, is to provide time to discuss clients who are re-admitted as
an opportunity to learn from their previous stays. This underlines the importance of
the clinical supervisor being flexible and available to address the issues that can arise
on an inpatient unit spontaneously on a day-to-day basis. This is further discussed
in Spontaneous Clinical Supervision: Clinical Supervisor as Lighthouse, p. 66.
Nurses on inpatient units have 24-hour responsibility for their clients and no separate
office space. On one unit they described feeling as though they are in a fish bowl,
constantly being observed and accessible to clients in a way that other professionals
are not. This makes boundary setting with clients more challenging. Nurses may feel
powerless because they feel they have less control over their environment.
Nurses usually see clients when the clients are in crisis. They are less likely than other
members of the team to see clients at other stages in their lives such as when they are
functioning in the community. Nurses attend to a broad range of clients’ needs that
include physical as well as emotional needs, and are involved in tasks such as providing
medication, restraining clients, caring for wounds and establishing a therapeutic
relationship. This places nurses within the client’s personal space in ways that are
quite different from other disciplines. This is an important difference for the clinical
supervisor to consider.
PREPARATION
Nursing and Clinical Supervision
Since nursing staff may not be familiar with the process of clinical supervision, clinical
supervisors should provide education up front about what clinical supervision is and
is not in order to develop a “safe” environment where nurses are willing to disclose
their practice challenges. The preparation includes:
• acknowledging their unique position on the team and how that affects their
client interactions
• differentiating between the procedural activities that are the focus of
administrative supervision
• explaining the differences between therapy and clinical supervision to reinforce
the respect for appropriate boundaries between the clinical supervisor and
the nurse.
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