Policy and Guidelines
Peer Group Supervision
Issued:
Authorised:
Contents
1.0
Introduction
2.0
Purpose and Scope
3.0
General Policy Statement
4.0
Clinical Supervision
4.1 Principles
4.2 Frameworks
5.0
Peer
5.1
5.2
5.3
5.4
6.0
Participant Rights and Responsibilities
6.1 Rights of the Supervisee
6.2 Responsibilities of the Supervisee
7.0
Peer Group
7.1 Rights of the Peer Group
7.2 Responsibilities of the Peer Group
8.0
Peer Group Supervision Management
8.1 Contracts
8.2 Recording and Documentation of Clinical Supervision
Sessions
8.3 Risk Management
8.4 Training Required
8.5 Implementation, Monitoring and Review
Group Supervision
Aims
Process
Suggested Structure
Long distance peer group supervision
Appendices
Appendix
Appendix
Appendix
Appendix
Appendix
I – Professional Supervision Peer Group Contract
II – Peer Supervision Record
III – Nursing Council Competencies
IV – Peer Group Supervision Audit Tool
V – Rural Health Clinical Supervision Risk Profiling Tool
References/Bibliography
2
1.0
Introduction
Clinical supervision supports evidence based, high quality and safe patient care,
by encouraging practitioners to learn from experiences in the work place. It
brings practicing health care staff together to reflect on practice and encourages
the development of professional skills. This enhances the quality of patient care
through the implementation of an evidenced based approach to maintaining
standards of best practice. Much of the benefit of clinical supervision is reliant
upon listening to, recognising and facilitating the supervisee(s) to become selfreflective and ultimately generate their own solutions in defining a positive
outcome-based action plan.
2.0
Purpose and Scope
The aim of this policy is to provide a formalised framework for the development,
and implementation of clinical supervision, underpinned by international and local
guidelines. This policy will apply to all clinical staff employed
within..................................... Clinical supervision is advised for all grades of
clinical staff. This includes the following groups:
 Employed staff who have direct contact with patients/clients
 nurses
 Health care assistants
 Public Health nurses,
 District nurses
 Midwives
 Well child nurses (Tamariki Ora nurses)
 Practice Nurses
 Nurse specialists
 Nurse Practitioners
This policy outlines the process for clinical/professional supervision and the
responsibilities of clinical staff and reinforces the importance and value of clinical
staff having the opportunity to reflect on clinical interactions as a means of
practicing effectively and safely, to improve practice and to identify learning and
development needs.
3.0
General Policy Statement
Clinical supervision will:
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Support and enhance practice for the benefit of patients
Maintain and improve standards of care
Promote evidence based best practice
Provide a practice-focused professional relationship
Promote reflective practice
Be organised, planned and systematic
Be conducted within agreed boundaries
Be evaluated against the contract (Appendix 1), within agreed time
scales.............................................will:
Support all clinical staff with protected time to access clinical
supervision.
Provide training for clinical supervisors and supervisees.
3
Organisational Benefits
There are a number of benefits in providing clinical supervision to staff which
include:
 Supervision can be used as a workforce development strategy or as a
human resource strategy by providing an approach which addresses
factors which impact on the workers ability to function effectively.
 Supervision can help prevent and reduce the effects of stress and burnout
by providing emotional support.
 Supervisees have reported that regular supervision relieves the negative
effects of isolation and improves staff relationships.
 Reviewed literature reports good quality supervision is a key component
of effective staff retention. (VHA, 2008).
4.0
Clinical Supervision
4.1
Principles
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4.2
To
To
To
To
To
To
safeguard standards of practice;
develop the individual personally and professionally;
promote excellence in healthcare;
be practice focused;
empower staff and patients;
facilitate professionally accountable practitioners.
Frameworks
The framework of clinical supervision for clinical staff in ...........................will be
peer group supervision. However, in some circumstances, one-to-one supervision
may be the framework of choice. The choice of framework will depend on both
staff and service needs and will be at the discretion of line managers/professional
leads.
5.0
Peer Group Supervision
In peer group supervision each member takes responsibility for supervising and
being supervised. There is no permanent supervisor who is overall responsible
for the group rather each member takes their turn in taking up the facilitator role
and the supervisee role. Within the initial agreement all participants agree to
participate equally in the roles and responsibilities of both supervisor and
supervisee.
All peer group supervision requires the members to have attended training
through a workshop. Peer group supervision is based on a number of clinical staff
who agree to work together. Groups should be a minimum of 3 to a maximum of
6 clinical staff; they should be from the same discipline, work in the same
team/service area or share a commonality e.g. palliative care.
4
5.1
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Aims
Provide an opportunity for clinical staff to review and clarify clinical issues,
within a safe and challenging environment
Provide clinical staff with evidence of clinical supervision
Promote reflective practice
Identify a forum for staff and service developments
Explore the management of clinical risk
Provide a mechanism for identifying gaps in service and to develop action
plans to address those gaps
Fulfill the principles of clinical supervision
Process of Peer Group Clinical Supervision
Clinical supervision sessions provide a safe, supporting and challenging
environment characterised by trust and confidentiality where set members
work on issues and solve problems through a process of reflection and action.
It also provides a particular structure to a group which, although simple,
radically alters the normal flow of conversation. The supervisee presents the
issue to the group in order to reflect upon and explore ways of addressing the
issue. The group members act as supporters, listening, observing, commenting
and questioning the supervisee with the aim of assisting in the exploration of the
issue and in forming action points. The facilitator enables this interaction to be
most useful to the supervisee through facilitation.
5.2
Suggested Structure for a Peer Supervision Group Session
Facilitator
Always appoint a facilitator for the session whose responsibility is to keep the
group on task, keeping to the structure, agenda, and time keeping (the person
facilitating alters each time to ensure everyone takes turns).
Minutes
Minutes are recorded and a minute recorder is allocated on the roster/facilitation
plan (this alters each time to ensure everyone takes turns), or the facilitator can
record the minutes. Main points of the session are documented and distributed to
each of the supervisees using the record of clinical supervision form this will
provide evidence of attendance at the individual’s annual appraisal and nursing
council competencies.
Check In
Everyone checks in at the beginning, how they have been at work etc before
starting on the agenda.
Peer Supervision
The first person on the roster/facilitation plan presents their dilemma or issue.
Their peers ask reflective questions, give feedback or share knowledge if
requested until the supervisee has been able to reflect on the issue explore
options and come up with some actions. The facilitator ensures that the first
person takes no more than 20 minutes in total. The next person on the roster
then gets a chance to reflect on their issue and the same process is used as
before.
Check Out
The group review the session, what was useful, any changes they want to
suggest or anything else they need to do. The facilitator ensures the next person
due to facilitate according to the facilitation plan/roster knows it’s their turn and
5
the time, date and venue for the next session is confirmed. Those who are due
for supervision next time are asked to remember to bring an issue/dilemma etc
next time.
5.4
Long distance Peer Group Supervision
When group members live in rural or isolated areas peer group supervision can be
conducted via Skype which is an internet program which can be downloaded free
from: http//:www.skype.com/intl/en/ By using a conference call the group
members can speak at little or no cost. It is advisable that prior to the
commencement of Skype sessions that the members have had some contact via
email to share some information. If one member cannot attend physical for a
reason they could attend via Skype instead.
6.0
Participant Rights and Responsibilities
6.1
Rights of the Supervisee
The supervisee can expect the following rights within the supervision process:
 To be treated with respect and as an equal partner in the supervision
relationship
 To confidentiality, with the exception of revealing anything that endangers
patient safety, breaks the law, trust policy or professional codes of conduct
 To protected time to access a minimum of six hourly clinical supervision
sessions a year, equivalent to 6 hours
 To protected space, in private with no interruptions
 To talk openly without fear of reprisal or criticism, about any difficulties,
issues or feelings of vulnerability
6.2
Responsibilities of the Supervisee
The supervisee is expected to undertake the following responsibilities within
the supervision process:
 To attend a minimum of one hours of clinical supervision, six times a year,
equivalent to 6 hours and to provide evidence of this to their line manager
at their annual appraisal.
 To prepare for clinical supervision by identifying ongoing
clinical/professional issues
 To manage their own time and give booked sessions high priority
 To be punctual and attend the full session
 To arrange service cover to enable business continuity
 To be open to and be prepared to challenge with positive intent
 To give feedback to the supervisor regarding their facilitation techniques
e.g. what is helpful, what is least helpful
 To use the protected time to reflect in depth on issues affecting
clinical/professional practice and avoid non-productive conversation
 To set an agenda to meet clinical needs
6
7.0
Peer Group
7.1
Rights of the Peer Group
The peer group can expect the following rights within the supervision process:
 To be treated as equal partners in the clinical supervision relationship
 To break confidentiality relating to anything that endangers patient safety,
breaks the law, trust policy or professional codes of conduct
 To challenge any behaviour or values that the supervisee displays which
raises concerns regarding their practice, development or use of clinical
supervision
 To refuse requests which make inappropriate demands on them within
their supervision group.
 To set personal and professional boundaries on issues to be discussed
 To choose whether or not to work with a group
7.2
Responsibilities of the Peer group
The peer group members are expected to undertake the following responsibilities
within the supervision process:
 To be registered with a relevant body e.g. Nursing Council and at least one
member to have 18 months or more clinical experience.
 To prepare for the supervision session, ensuring the venue is appropriate
with no interruptions.
 To prioritise agreed appointments, and ensure time boundaries, the
supervision contract and agreed confidentiality is met.
 To ensure that management or educational assessment is not part of the
supervision
 To encourage the supervisee to seek specialist advice or help where
necessary
 To challenge any behaviour that the supervisee displays which raises
concerns about their practice, development or use of supervision
8.0
Peer Group Supervision Management
8.1
Contracts
Prior to commencing any supervision session the peer group members must
agree and sign a contract (Appendix 1). The clinical supervision contract should
contain the following:
 The aim of the clinical supervision session is to enable the supervisee to
reflect in depth on issues affecting practice in order to develop personally
and professionally towards achieving, sustaining and developing high
quality best practice
 The frequency, timing and location of the clinical supervision sessions.
 The contract should be personalised and have agreed, planned sessions,
subject to review
 Records must be distributed to each individual to provide evidence at
appraisal and for nursing council competencies
 Agreed timing of reviews and evaluation of the effectiveness of clinical
supervision.
 Preparation for sessions and the responsibility for bringing agenda items
 Details of the development and learning points to be actioned
 Lines of communication
 Agreement on the occasions when confidentiality may need to be broken
7
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8.2
Frequency of contract review
Details of new members or changes in membership
Recording and Documentation of Clinical Supervision
Sessions
The following is recommended:
 Each clinical supervision session should be recorded on the supervision
record sheet (Appendix 2)
 Documentation of the session should be discussed with, agreed by and
signed by all the peer group members. Any differences of opinion should
be clearly noted.
 All actions to be undertaken by the supervisee or other group members
must also be documented.
 Copies of the documentation will be held by the supervisee and in a
central group folder.
 Access to the clinical supervision record by anyone other than the
supervisee would be in exceptional circumstances (i.e. as part of a
disciplinary, legal process or audit).
 The supervisee(s) would in all circumstances be informed that their
records were to be accessed.
 All registered and non-registered staff are required to record attendance at
supervision, and in particular learning and development resulting from it,
as part of their professional portfolio.
8.3
Risk Management
Clinical supervision is a key mechanism supporting clinical governance by
enabling practitioners to examine their practice, their skills, knowledge, attitudes
and values in a safe environment. Effective participation in clinical supervision is
seen as individuals demonstrating accountability and taking responsibility for the
continuous improvement of their practice. Having a structured approach to aid
deeper reflection on clinical practice; lead to improvements in practice and
patient care, and contribute to clinical risk management. The risk assessment
tool in appendix 4 can be used to assess the supervisee’s vulnerability and need
for the support provided by peer group supervision.
8.3
Training Requirements
...............................have a responsibility to provide and resource training needs
and facilitate staff attendance. All staff receiving peer group supervision will be
required to have a basic understanding of:
 The principles of clinical supervision
 The supervision contracting process
 The roles and responsibilities of the supervisee and the peer group
members
 Techniques of reflective practice
 The process of the supervisory relationship
 Ethical and legal issues
 Supervision models and frameworks
 Facilitation skills
 Group supervision
8
8.5
Implementation, Monitoring and Review
.......................... is responsible for ensuring that this document is reviewed
and, if necessary, revised in the light of legislative guidance or organisational
change.
Review shall be at intervals of no greater than 3 years. Any revisions to this
document shall be agreed through ...........................................approval
processes
A copy of this policy will be placed with all other policies on ......................
intranet, internet and Provider Services internet site. All peer group members will
be required to read the policy and sign to state that the policy has been read and
understood. This policy is subject to annual audit of compliance
9
Appendix I
Clinical Supervision Peer Group Contract
As supervisor and supervisee’s we all agree to the following:
Aim
The aim of our sessions together are to enable the peer group members named
below to reflect in depth on issues affecting their practice in order to develop both
personally and professionally towards achieving, sustaining and developing a high
quality of practice.
Meeting
The group will meet once a month at an agreed date and time. The meetings to
be held at lunch time 12 to 1pm, 1pm to 2pm. The peer group members and
supervisor will ensure protected time and space to reflect in depth by sticking to
agreed appointments and time boundaries, being punctual, ensuring privacy and
no interruptions.
Record of Meeting
Records of dates and times of supervision sessions or any notes of the meeting
will be kept by both in the peer group folder and by the supervisee’s and any
copies or use of these records will only be when explicitly agreed by all parties,
for example when used within a supervisee’s portfolio.
Agenda
The supervisee’s will be responsible by preparing for the session and bringing to
the supervision areas of practice they wish to reflect on.
Responsibility
Supervisee
The supervisee’s will take responsibility for making effective use of the time, for
outcomes and any actions needed as a result of the supervision. Also ensuring
each member has the opportunity to participate equally in the supervision
session. The supervisee is willing to be challenged and supported to learn and
make change. As a group the supervisees will keep confidential all information
discussed within the group sessions.
Peer Group Members
We agree to keep all personal information revealed within the supervision session
confidentially except for the following exceptions:
 Unsafe, unethical, or illegal practice is revealed and the supervisee is
unwilling to go through the appropriate organisational procedures to deal
with the situation
 The supervisee consistently fails to turn up for supervision sessions or fails
to use the time constructively.
In the event of an exception occurring the peer group members will:
 Attempt to persuade and support the supervisee involved to deal with the
issues appropriately.
 Check that this has been done
 If it had not been dealt with as a last resort the supervisor will reveal the
relevant information to the appropriate person/organisation.
The peer group members will offer support, catalytic help, supportive challenge
and information or advice to enable the supervisee’s to reflect in depth on issues
affecting their clinical practice. The peer group members will use their own
10
clinical judgment to support challenge and develop their own abilities in working
with the supervisee’s without breaking confidentiality.
The supervision session format, time, venue, effectiveness etc will be reviewed
after 6 months and at further agreed intervals.
Peer Group Members
Name
Signature
Date
11
Appendix II
Peer Supervision Record
Date:
Facilitator:
Supervisee:
Other Group Members:
Cases and Issues
1
2
3
Case History or Identified Problem:
Main Issues Identified:
1.
2.
3.
4.
5.
What’s been tried so far:
12
On reflection what decisions/actions to be taken:
This is a true record of the supervisees practice.
Signed
………………………………………..
Signed
.................................................................
Peer Group Members
Date……………………………….
Peer Group Members
Signed................................................
Signed....................................................
………………………………………..
Supervisee
Date…………………………………
13
Appendix III
New Zealand Nursing Council Competencies
In order to link the nursing practice identified in the peer group supervision with
the nursing council competencies the following can be used to highlight which
area is being demonstrated.
Nursing Council Competencies include:
Professional Responsibility
E.g. Comply with legislation, 1a, nursing practice, 1b delegation, 1c clients rights,
1d ethical principles, 1e, seek guidance on professional, ethical, cultural issues
Safe Environment
e.g. (2a,identify and manage risk, 2b, Implement nursing responses/policies for
risk management, 2c recognise and respond to changes in client health status
including critical events, initiate immediate response).
Professional Development
e.g. (3a, Participate in evaluation of own practice, 3b, use evidence based
practice, 3c, proactive in seeking professional development).
Quality
e.g. (4a, Use quality improvement principles within own practice, 4b, Identify and
participate in quality improvement activities, 4c, implement changes in practice if
necessary).
Health Promotion
e.g. (6a, proactive in health promotion, illness prevention, community
development, 6b, uses goals objectives, cultural safety and evidence based
practice as key elements in planning/presentation of health promotion activity, 6c
use Tikanga Maori concepts relevant to health promotion)
Health Education
e.g. (7a, Ensure education for the client is, consistent, timely, culturally safe and
appropriate for their needs, 7b, use appropriate resources, formal and informal
appropriate for the client group).
Communication
e.g. (8a uses variety of communication skills to establish rapport and trust with
client, 8b, Demonstrate skills in problem solving/and or conflict resolution, 8c,
advocate for the client when requested by the client).
Collaboration and Co-ordination
e.g. (9a Contributes and participates with others in the health care team to meet
NZ health strategies objectives, 9b, Collaborates, consults and provides accurate
information to the client and other health professionals, 9c, Co-ordinates,
maintains and documents timely information to maximise health outcomes for
client.
14
Sphere
Met
Not Met
Not
applicable
Evidence
Professional
Responsibility
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Legislative and
ethical
requirement
Safe environment

Professional
development
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Quality
Professional nursing
practice

Nursing Process

Health promotion

Health Education
Professional
relationships

Communication

Collaboration and
Co-ordination
Identified Education and professional development:
Appendix IV
Peer Group Supervision Audit Tool
Please circle the answer which is most appropriate for you.
I have attended the peer group supervision sessions in the last 6 months
15
100%
75%
50%
25%
0%
The timing of the peer group supervision session suits me
100%
75%
50%
25%
0%
50%
25%
0%
The venue suits me
100%
75%
I find it easy to reflect on issues with my peers within the group
100%
75%
50%
25%
0%
25%
0%
The sessions are run in a structured way
100%
75%
50%
The peer group supervision sessions have positively contributed to my
professional development and nursing practice
100%
75%
50%
25%
0%
I feel more validated and supported in my role since starting peer group
supervision
100%
75%
50%
25%
0%
Please take the time to briefly comment (positive and negative) on the peer
group supervision you are receiving with any ideas you may have for ways to
improve it.
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Appendix V
Rural Health Clinical Supervision Risk Profiling Tool
Dimension
Level of experience or competence
generally
Low Risk = 1
Senior Practitioner –
Highly experienced
practitioner with ongoing
continuing education
Regional Centre
(Greater access to a pool
of peer and senior
professionals,
infrastructure etc)
Moderate Risk = 2
Established or
competent practitioner
in general clinical areas
High Risk= 3
New Graduate at entry
level competency in
general clinical areas
Rural Location
(More limited access to
a pool of peer and
senior professionals,
infrastructure etc)
Professional Isolation
High opportunity for
formal and informal
discipline-specific
supervision. E.g. larger
department
Discipline Clinical Supervision culture
Higher levels of CS
education, training,
perceptions and
expectations.
e.g. Social work and
Psychology
Formal agreement,
Training and funding
support for CS.
Strong processes, clear
roles, flexible modes of
delivery
Little to no involvement in
areas of practice which
Moderate opportunity
for formal and informal
discipline-specific
supervision. E.g.
Multidisciplinary team
(only) or Virtual dept
Moderate levels of CS
education, training,
perceptions and
expectations.
Very Remote or Remote
Location
(poor access to a pool of
peer and senior
professionals,
infrastructure etc)
Low opportunity for
formal and informal
discipline-specific
supervision. E.g. Sole
Practitioner
Geographic remoteness
Level of organisational support
Exposure to areas of work with
inherent clinical, professional or
Adhoc, Training and
funding support for CS.
Less defined processes,
unclear roles, less
flexible modes of
delivery
Work in areas of
moderate risk (e.g.
Lower levels of CS
education, training,
perceptions and
expectations.
No formal agreement
Poor access to trained
supervisors
Poor access to IT,
communications and
other infrastructure
High level of involvement
in areas of practice which
Score
personal risk
present high clinical or
personal risk (physical or
psychological)
Level of experience/competence
within a specialty
Senior Professional with
both training and
experience within
specialty
Overall Risk:
7-11 = Low Risk
12-16= Moderate Risk
17-21 = High risk
NSW Institute of Rural Clinical Services and Teaching. (2008
Home visits) or
moderate level of
involvement in areas of
practice which present
high clinical or personal
risk (physical or
psychological)
Competent practitioner,
with specialist training
and/or experience
present high clinical or
personal risk (physical or
psychological)
E.g. Mental Health,
Novel Practitioner within
specialty, may be
experienced generalist
with recent shift into
more complex role
Total
2
References/Bibliography
Bond, M., & Holland, S. (1998). Skills of clinical supervision for nurses: a
practical guide for supervisees, clinical supervisors, and managers.
Buckingham, Philadelphia : Open University Press.
Department of Health. (UK) (1993) A Vision for the Future: The Nursing,
Midwifery and Health Visiting Contribution to Health and Health Care. London:
The Stationery Office
NSW Institute of Rural Clinical Services and Teaching. (2008). A Report: Clinical
Supervision for Allied Health Professionals in Rural NSW: Accessed from
www.ircst.health.nsw.gov.au on 06/12/2010
NZNO. (2005). NZNO Position Statement for: Professional and Clinical
Supervision: Accessed from www.nzno.org.nz on 06/12/2010
Victorian Healthcare Association. (2008). Clinical Supervision and Leadership in
Community Health Literature Review. Accessed from
http://www.vha.org.au/uploads/Clinical%20Supervision_Background%20_Final_.
pdf on 07/12/2010