Disquiet in the Development of Clinical Supervision for Professional Development in Nursing Practice: a Literature Review

Abstract

Nursing literature reflects that nurses have been exploring and experiencing the process of clinical supervision for well over a decade. Nurses in the United States (U.S.), United Kingdom (U.K.), Scandinavia, and Australasia have written much over the past fifteen years. While nurses grapple with what clinical supervision is within nursing development and disquiet continues to emerge in the literature. While the process of clinical supervision has been borrowed from the fields of psychotherapy, social work, counselling and mental health nursing, resulting in different forms of implementation, a considerable body of data has been developed illustrating nurses' experience of developing the process within their own varied areas of practice. This literature review will expand on themes that surround this disquiet. These centre on continued confusion and lack of clear definition; whether psychotherapy is implemented under the guise of clinical supervision, who uses it, and the dearth of empirical evaluation of its effectiveness. The lack of significant empirical evidence of its ability to assist practitioners to deliver improved patient/client care continues despite claims of improved professional and personal development, therapeutic relationship, and occupational stress management. These claims come from both supervisees and supervisors. The manner in which clinical supervision is portrayed in nursing in that it is frequently referred to as a support system, rather than one of learning a complex set of communication skills is also highlighted. The continued debate on what model(s) best suit nurses, or whether line management should provide clinical supervision as a means to ensure quality standards and control over nursing practice and optimal patient care is discussed. Whether nursing should stop borrowing from other fields and develop their own model(s) is also a question being raised. Two emerging stances focus on a process that is practice-based as identified by senior staff and management, or one that continues along the lines of what psychotherapy has developed with practitioner-identified developmental needs. These issues raise many questions for further development in nursing, one being are nurses developed enough in their self-awareness to understand what they are to adopt into their practice? Authentic voices from those nurses experienced in the practice of providing and receiving clinical supervision, are shaping therapeutic practice for nurses in the future, and continue to sharpen the debate. Some reference to unpublished data and local practice in the Wellington area, New Zealand, have been included as a stimulus for further incorporation of clinical supervision in local practice development.