The following information provides an evidence base for clinical supervision:
Rationale, importance and need for clinical supervision
Within nursing practice, clinical supervision is an established feature of day to day routine
(Butterworth, Bell, Jackson., Maida, 2008) and particularly so within mental health and psychiatric
settings (Bland & Rossen 2005; Hines-Martin & Robinson; 2006; West; 2009). Clinical supervision is
widely recognised as standard practice among many of the Allied Health Professionals (AHPs)
(Dawson, Phillips & Leggat . 2012) The importance of clinical supervision is also “widely promoted”
within counselling and psychotherapy practice (Wheeler & Richards 2007). In the context of
professional psychology training, clinical supervision too is deemed highly important and is a major
investment of staff training time (Gonsalvez & Milne 2010).
The following table reflects the wider literature in health care which also presents a rationale for
executing supervision.
Paper
Mills, J.E., Francis, K.L., Bonner, A. (2005).
Mentoring, clinical supervision and
preceptoring: clarifying the conceptual
definitions for Australian rural nurses. A review
of the literature. Rural & Remote Health, 5(3),
410.
Rationale for Supervision
Extremely important in the context of remote
and rural nursing.
Chilvers, R., Ramsey, S (2009). Implementing
a clinical supervision programme for nurses in
a hospice setting. International Journal of
Palliative Nursing. 15(12), 615 - 619.
Important in improving standards of patient
care.
Hines-Martin, V., & Robinson, K. (2006).
Supervision as professional development for
psychiatric mental health nurses. Clinical
Nurse Specialist, 20(6), 293–297. Retrieved
from
http://www.ncbi.nlm.nih.gov/pubmed/17149020
Within psychiatric mental health nursing,
supervision supports clinical competence,
quality care and professional insight. Emphasis
is also placed upon reflection, self-awareness,
and therapeutic use of self.
Spence, S.H., Wilson, J., Kavanagh, D.,
Strong, J., Worrall, L. (2001). Clinical
supervision in four mental health professions:
A review of the evidence. Behaviour Change,
18(3), 135 - 155.
Supervision offers graduates the ability to
maintain their skills in line with current
recommendations. In addition, problem solving
skills, creativity, emotional awareness and
confidence are promoted.
Mastoras, S. M., Andrews, J. J. W. (2011). The
Within psychology and counsellor training,
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supervisee experience of group supervision:
Implications for research and practice. Training
and Education in Professional Psychology,
5(2), 102–111. doi:10.1037/a0023567
supervision is an integral component in the
delivery of services and in the delivery of
continuing professional development.
Bland, A. R., Rossen, E. K. (2005). Clinical
supervision of nurses working with patients
with borderline personality disorder. Issues in
Mental Health Nursing, 26(5), 507–517.
doi:10.1080/01612840590931957
Spence, S.H., Wilson, J., Kavanagh, D.,
Strong, J., Worrall, L. (2001). Clinical
supervision in four mental health professions:
A review of the evidence. Behaviour Change,
18(3), 135 - 155.
Within psychiatric nursing, clinical supervisors
oversee and are responsible for the work of
nurses, as well as providing knowledge and
emotional support.
Sirola-Karvinen, P., & Hyrkäs, K. (2006).
Clinical supervision for nurses in administrative
and leadership positions: a systematic
literature review of the studies focusing on
administrative clinical supervision. Journal of
Nursing Management, 14(8), 601–609.
doi:10.1111/j.1365-2934.2006.00719.x
In clinical supervision for nurses in
administrative and leadership positions, the
focus is placed upon quality management.
Holloway, E. (1995). Clinical Supervision: A
Systems Approach. London: Sage
Publications.
An ongoing relationship that permits the
supervisee to learn professional attitudes, skills
and knowledge in a supportive manner (and
related to the development of the supervisee as
a professional).
Provides the opportunity for nurses to explore
therapeutic techniques, attitudes and ethics,
particularly during testing times.
Bland, A. R., Rossen, E. K. (2005). Clinical
supervision of nurses working with patients
with borderline personality disorder. Issues in
Mental Health Nursing, 26(5), 507–517.
doi:10.1080/01612840590931957
Morgan, M. M., & Sprenkle, D. H. (2007).
Toward a common-factors approach to
supervision. Journal of Marital and Family
Therapy, 33(1), 1–17. doi:10.1111/j.17520606.2007.00001.x
Personal aspects of supervision aims to
promote motivation and may include career
planning, and in coping with stress.
Outlines how supervision could support
supervisee personal growth, self-awareness,
autonomy and confidence.
Farnan, J. M. Petty, L. A., Georgitis, E., Martin, Enhanced attending supervision could improve
S. Chiu, E., Prochaska, M. & Arora, V. M.,
patient and education-related outcomes.
(2012). A Systematic Review: The Effect of
Clinical Supervision on Patient and Residency
Education Outcomes. Academic Medicine, 87(4)
428 – 442.
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The literature also notes that clinical supervision needs to be viewed as a voluntary and collaborative
partnership (Cleary et al.2010), such that it supports perceived feelings of ownership. Other research
has highlighted how clinical supervision can be viewed as a discussion with more experienced
colleagues - that allows for reflection of “clinical experiences in order to recount them and deepen
understanding and/or identify areas for further improvement” (Brunero& Stein-Parbury 2008), (also
similar to the propositions noted by Wheeler & Richards(2007). In looking at the function of
supervision, Milne (2007) suggests the following:



Quality control (including gatekeeping, and safe, ethical practice);
Maintaining and facilitating the supervisees’ competence and capability; and
Helping supervisees’ to work effectively (accepting responsibility, developing own personal
identity, enhancing self-awareness and resilience and lifelong learning skills).
In all, the literature outlines that the clinical supervisory process aims to enhance and support best
clinical skills for improved outcomes for clients and for addressing cases, contexts and careers.
References
Bland, A. R., Rossen, E. K. (2005). Clinical supervision of nurses working with patients with borderline
personality disorder. Issues in Mental Health Nursing, 26(5), 507–517.
doi:10.1080/01612840590931957
Brunero, S., & Stein-Parbury, J. (2008). The effectiveness of clinical supervision in nursing: an
evidenced based literature review. Australian Journal of Advanced Nursing, 25 (3): 86-94.
Butterworth, T., Bell, L., Jackson, C., Majda, P. (2008) Wicked spell or magic bullet? A review of the
clinical supervision literature 2001-2007. Nurse Education Today. 28(3), 264 - 72.
Cleary, M., Horsfall, J., Happell, B. (2010). Establishing clinical supervision in acute mental health
inpatient units: acknowledging the challenges. Issues in Mental Health Nursing, 31(8), 525 - 531.
Gonsalvez, C. J., & Milne, D. L. (2010). Clinical supervisor training in Australia: A review of current
problems and possible solutions. Australian Psychologist, 45(4), 233–242.
doi:10.1080/00050067.2010.512612
Dawson M., Phillips B. and Leggat S (2013) Clinical Supervision for Allied Health Professionals A
systermatic Review Journal of Allied Health 42 2 65-73.
Hines-Martin, V., & Robinson, K. (2006). Supervision as professional development for psychiatric
mental health nurses. Clinical Nurse Specialist, 20(6), 293–297. Retrieved from
http://www.ncbi.nlm.nih.gov/pubmed/17149020
Milne, D. (2007). An empirical definition of clinical supervision. The British journal of clinical
psychology / the British Psychological Society, 46(Pt 4), 437–47. doi:10.1348/014466507X197415
West, B. (2009). Support and Supervision in Nursing: A discourse with the literature. Aberdeen: Hive
Design and Consultancy.
Wheeler, S., Richards, K. (2007). The impact of clinical supervision on counsellors and therapists,
their practice and their clients. A systematic review of the literature. Counselling and Psychotherapy
Research, 7(1), 54–65. doi:10.1080/14733140601185274
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Allied Health Professionals
The following table reflects an overview of the literature in respect of Allied Health Professionals
which also presents a rationale for executing supervision.
Paper
Rationale for Supervision
Dawson M., Phillips B., Leggat S. (2012)
Effective clinical supervision for regional
allied health professionals – the
supervisee’s perspective Australian Health
Review (36) 92-97
Recognises the importance of clinical
supervision to supervisee & within clinical
governance
Sellars J.(2004) Learning from
contemporary practice: and exploration of
clinical supervision in physiotherapy
Learning in Health & Social Care 3 (2) 6482
Identifies the support required to
effectively integrate & sustain clinical
supervision.
Fischer M., Mitshe M., Endler P.,
Mesenholl-Strehler E., Lothaller H & Roth
R. (2013) Burnout in physiotherapists: Use
of clinical supervision and desire for
emotional closeness or distance to clients
(2013) International Journal o Therapy and
Rehabilitation Vol 20 No 11 550-558
Regular supervision or support can help
reduce the risk of burnout - helping staff
to deal better with work stresses
Hall T. and Cox D (2009) Clinical
supervision; an appropriate term for
physiotherapists? Learning in Health and
Social Care 8 4 282-291
Supervision supports practitioners
competence and confidence throughout
their career
Kuipers P., Pager S., Bell K., Hall F and
Kendall M (2013) Do structured
arrangements for multidisciplinary peer
group supervision make a difference for
allied health professional outcomes?
Journal of Multidisciplinary Healthcare 6
391-397
Supervision can have a positive impact
on quality of patient care and help staff
cope with job stress
Morley M and Petty N (2010) Developing an
observed practice programme for
occupational therapists and
physiotherapists: reporting the first phase of
an action research study British Journal of
Occupational Therapy 73 (8) 379-387
Observed practice as a concept in
supervision can assist professional
development and improve clinical
practice
Ostergren J.A. (2011) The first year of
Professional Service in Speech-Language
Outlines how supervision and
supervisors role can support newly
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Pathology: supervisory role, working
relationships, and satisfaction with
supervision Contemporary Issues in
Communication Science and Disorders 38
61-75
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The Benefits of Clinical Supervision
A variety of benefits have been identified from the process and outcomes of clinical supervision.
Briefly these advantages can be summarised under the headings of personal benefits, patient care
benefits and organisational benefits. The benefits under each of these headings will necessarily
overlap with each other.
Benefits recognized for the individual in receipt of clinical supervision include a feeling of being
supported. This may manifest itself in individuals feeling less isolated and experiencing less stress
and burnout (Sloan 2005). On the positive side supervision may also promote increased personal
confidence, self-value and enhance job satisfaction (Cotton 2001). Other than providing support,
supervision has been identified as a tool for personal development. Similarly Kuipers, Pager, Bell,
Hall & Kendall (2013) noted that a formal supervision process in additional to having a positive impact
on the quality of care, helped staff cope with the work stress and increased their level of confidence.
This development may show itself in a number of ways: increased knowledge and awareness of
possible solutions to clinical problems; increased self-awareness; participation in reflective practice
(Winstanley and White 2003).
The benefits that individual clinicians derive from supervision should in turn contribute to improved
patient care. In this respect Cotton (2001) points to the potential for clinical supervision to improve the
quality of patient care through the development of professional practice. Clinicians who had
scheduled opportunities to reflect on their clinical practice noted that this “quality time” supported their
professional development Sellars (2004) . Equally Chilvers and Ramsey (2009) believe that clinical
supervision, by reducing occupational stress, should safeguard the standards of patient care, and
therefore improve the overall delivery of the quality of service.
Finally organisations should also benefit from the outcomes of clinical supervision. A feeling of
personal well-being may result in less sickness absence (Sloan). Similarly supervision have may an
impact on staff turnover and risk management with obvious economic benefits to the organization
(Chilvers and Ramsey).Effective clinical supervision is considered an important component of
clinical governance – supporting improvements in clinical practice through reflection and support of
clinicians (Dawson, Phillips and Leggat (2012).
Interestingly a counterview of the benefits of CS is also presented in the literature. Cleary et al.(2010)
posit that existing practices already offer the claimed benefits of clinical supervision and that too much
emphasis is being placed on it. They cite Nicklin (1995) who argued that good training, management
and pastoral care could achieve similar benefits to that of clinical supervision.
References
Cleary, M., Horsfall, J., Happell, B. (2010). Establishing clinical supervision in acute mental health
inpatient units: acknowledging the challenges. Issues in Mental Health Nursing, 31(8), 525 - 531.
Chilvers, R., Ramsey, S. (2009). Implementing a clinical supervision programme for nurses in a
hospice setting. International Journal of Palliative Nursing. 15(12), 615 - 619.
Cotton, A. (2001). Clinical supervision UK style: good for nurses and nursing? Contemporary Nurse: A
Journal for the Australian Nursing Profession, 11(1), 60 - 70.
Dawson M., Phillips B., Leggat S. (2012) Effective clinical supervision for regional allied health
professionals – the supervisee’s perspective Australian Health Review (36) 92-97
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Kuipers P., Pager S., Bell K., Hall F and Kendall M (2013) Do structured arrangements for
multidisciplinary peer group supervision make a difference for allied health professional outcomes?
Journal of Multidisciplinary Healthcare 6 391-397
Nicklin, P. (1995). Super supervision. Nursing Management, 2(5), 24–25.
Sellars J.(2004) Learning from contemporary practice: and exploration of clinical supervision in
physiotherapy Learning in Health & Social Care 3 (2) 64-82
Sloan, G., Watson H. (2002) Clinical supervision models for nursing: structure, research and
limitations. Nursing Standard, 17(4), 41 - 46.
Sloan, G. (2005). Clinical supervision: beginning the supervisory relationship. British Journal of
Nursing, 14(17), 918 - 923.
Winstanley, J., White, E. (2003). Clinical supervision: models, measures and best practice. Nurse
Researcher, 10 (4), 7 - 38.
Statutory Supervision of Midwifery Practice
The references below describe some of the benefits around statutory supervision of midwifery
Practice:
Brintworth. K., Johnson, G. (2013) Supporting the supervisors Midwives magazine: Issue 4 :: 2013
Kirkham, M. (1998) Evaluation of the Impact of the Supervision of Midwives on Midwifery Practice and
the Quality of Care. London. English National Board for Nursing and Midwifery
Rogers, C., Yearley, C. (2013) National survey of supervision of midwives: time for reflection? British
Journal of Midwifery 21(5): 356-63.
Shaw, A.M., Clarke, D., Long, A.F. (2013) Midwives and supervisors of midwives’ perceptions of
statutory supervision of midwifery within the United Kingdom: a systematic review. Midwifery 29(1):
75-85.
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