NI Public Health Agency – Local Supervising
Authority
(LSA Code: 77)
Regional Record
for Supervision of Midwives
Review of Practice
Date of Review
Trust
Maternity Unit
Version2 Review Document for Supervision of Midwifery Practice 2011
For Review 2014
Contents
Page
Section 1




Demographic Details
Employment Details
PREP Requirements
Recommended Resource Material
Section 2
3
3
3
4
Training & Development Record
 Mandatory Training & Development Record
5
 Pre – Supervision Review – Midwife’s Record
5
 Professional Development - Reflection and Update NIPEC (2005) 6
Guide to Reflection
Section 3
 Midwifery competency framework
7
Section 4
 Supervision Review
9
This document has been produced for the Local Supervising Authority Midwifery
Officer (Public Health Agency) by the Northern Ireland Practice and Education
Council for Nursing and Midwifery (NIPEC). We would like to acknowledge the
contribution of the work of the steering and stakeholder groups in the
development of this documentation.
2
To be completed by Midwife prior to Supervision Review
(Your Supervisor will cross check with your ITP and LSA database)
Section 1
Name of Midwife:
Name of SoM:
Address:
Tel (SoM):
Email (SoM):
Contact Numbers:
Email:
Prep Requirements
Date of last Notification of Practice Form
35hrs of learning activity relevant to midwifery practice(in the last 3 years)
Yes
No
450hrs of midwifery clinical practice /professional engagement (in the last 3 years)
Yes
Is your personal professional portfolio updated:
Yes
Yes
No /
Discussed :
No
No
Current Employment
Full time
Part Time (Hrs)
Area of Practice:
Other Employment (eg- Bank/Agency):
For Supervisor of Midwives(Please ensure you have entered midwife’s details on to the LSA Database)
Complete
Yes
No
Date
Record of other Supervisor/Supervisee Contacts
Date
Outcome or action plan required
Reason for contact
Review date (if required)
Record of other Supervisor/Supervisee Contacts
Date
Outcome or action plan required
Reason for contact
Review date (if required)
3
Recommended Resource Material
Please demonstrate to your supervisor how to access the following:
NMC Professional Standards/Guidelines – www.nmc-uk.org
Do you have the latest copies of?
 NMC The Code: Standards of conduct performance and ethics for
nurses and midwives
Yes
No

NMC Midwives Rules and Standards
Yes
No

LSAMO Forum (UK) with NMC Modern Supervision in Action
Yes
No

NMC Record Keeping Guidance
Yes
No

NMC Standards for medicines management
Yes
No

NMC Support for Parents: How supervision and supervisors of midwives
can help you
Yes
No

NMC Social Networking
Yes
No
USEFUL WEBSITES
Centre for Maternal and Child Enquiries – www.cmace.orq.uk
Department of Health & Social Services & Public Safety - www.dhsspsni.org
LSA Midwifery Officers National Forum (UK) – www.midwife.org.uk
PHA (the LSA) & Supervision of Midwives in Northern Ireland – www.nipec.hscni.net
National Institute for Health and Clinical Excellence – www.nice.org.uk
NI Practice & Education Council for Nurses & Midwives www.nipec.hscni.net - links to
www.nipec.hscni.net/supervisionofmidwives/
Regulation Quality Improvement Authority – www.rqia.org.uk
Other Suggested Reading from Supervisor
(e.g Independent Reviews, Reports or Public Enquiries)
1.
2.
3.
4
Section 2
Training & Development Record
Mandatory
Obstetric
Emergencies
(including Adult
Frequency
Reflection (Comments) on Learning
Activity
Title:
Date Completed
/ Hours
/
Resuscitation)
Fetal Monitoring:
Title:
/
Neonatal
Resuscitation:
Title:
/
Safeguarding
Children:
Title:
/
Antenatal
Screening:
Title:
/
Breastfeeding:
Title:
/
Title:
/
Haemovigilence:
5
Additional Training & Development Record
(which may include conferences, in service training, experiences & reflection)
To assist you in this section please refer to the NIPEC Development Framework at
www.nipecdf.org
This is a useful website as it explains the different types of learning activities and learning
styles
Learning Activity:
Date Completed
Reflection (Comments) on above Learning Activity
Learning Activity:
Date Completed
Reflection (Comments) on above Learning Activity
Learning Activity:
Date Completed
Reflection (Comments) on above Learning Activity
-
See guidance for explanation or visit www.nipec.hscni.net
6
Section 3
Pre – Supervision Review – Midwife’s Record
Using NIPEC’s development framework - guide to reflection - what aspect of your
practice in the last year were positive/challenging experiences?
Summary of experience/engagement in midwifery in the last year (example – areas of work)
Positive
Challenging
Identify Event:
Identify Event:
Describe Event:
Describe Event:
Analyse Event:
Analyse Event:
Learning from Event:
Learning from Event:
List any aspects of these events that you would like to discuss with your supervisor of midwives
7
Self Assessment of Competence to Practice
The term COMPETENCE refers to the overarching set of knowledge, skills and attitudes required to
practise safely and effectively without supervision (NMC 2010). Using the Midwifery Competency
framework in the guidance booklet, self assess your competency against your current area of practice.
Antenatal
Tick your area/areas of
practice in last 12 months
Are you confident in your
knowledge and skills in
your current area/areas of
practice?
Record topics of your
current practice area (i.e
last 12 months) that you
have little knowledge, need
training or skills that
require updating
Intranatal
Postnatal
Community
Neonatal
Clinic
Inpatient
Yes
No
Comments
1.
2.
3.
4.
If you are employed by virtue of your midwifery qualification (NMC Midwives rules & standards; Rule 2)
e.g. in some other capacity such as managerial, education, or senior midwifery posts for example in
HSC Trust, Higher Educational Institute, Department Health Social Services, Public Health Agency,
Regulatory Body or a Practice and Educational organisation, please comment here on your knowledge
and skills to effectively work and engage with Midwifery.
Comments
8
Section 4
Midwifery Supervision Review Summary
(SoM may wish to photocopy/save these next two pages)
Review of action points from previous review
Issues / topics for discussion at review
Review of midwifery skills that require updating through Learning Needs
Assess (Discuss knowledge and
skills of midwife)
Plan (what are the learning
opportunities)
Evaluate (agree a process for
evaluating the learning
/development activity)
Review results of audit of record keeping practice (where applicable i.e. clinical practice)
Review results of audit of controlled drugs (where applicable i.e. clinical practice)
9
Agreed action plan for supervisee with timescales
Action
Timescale
Agreed action plan for supervisor with timescale
Action
Timescale
Issues of challenge/disagreement
Resolution:
Evaluation of review
Date of next review
Signature of Midwife
Signature of SoM
Date
Date
10
Public Health Agency
County Hall
182 Galgorm Road
Ballymena
BT42 1QB
www.publichealth.hscni.net
Version2 Review Document for Supervision of Midwifery Practice 2011