RCN position on clinical supervision

Published: 31 October 2022

Abstract: RCN position on clinical supervision

Introduction

The Royal College of Nursing is the voice of nursing across the UK and the largest professional union of nursing staff in the world. Our membership comprises over 450,000 registered nurses, midwives, health visitors, nursing students, nursing support workers and nurse cadets.

RCN members work in a variety of hospital and community settings in the NHS and the independent sector. The RCN promotes patient and nursing interests on a wide range of issues by working closely with the Government, the UK parliaments and other national and European political institutions, trade unions, professional bodies and voluntary organisations.

This statement outlines the RCN’s current position on clinical supervision as a means of reflective practice and potential conduit for the critical advancement of a contemporary nursing and midwifery workforce. This member-led position statement was produced as a collaboration between the RCN’s Forum Chairs Committee, Professional Nursing Committee and Nursing Department.

Background

At the start of the pandemic, it was quickly identified that workforce pressures experienced by health and care staff were increasing. Stress and burnout have been a significant and unacceptable issue for nursing¹.

Clinical supervision has gained prominence as a source of psychological and emotional support for nurses, midwives and nursing support workers, with some initiative programmes using a restorative style of supervision².

On close examination, questions were raised about the wider purpose of clinical supervision, beyond its well-known restorative function. A member-led literature review set out to explore this issue, the first RCN joint-professional forums project of its kind³.

The literature challenges views about what is widely accepted as the perceived benefits of clinical supervision. Our knowledge about the advantages of clinical supervision has not led to successful practice integration for all nurses across the UK.

It is clear that there is no single unifying perspective on what clinical supervision truly means, what its purpose is and how it should be implemented in nursing. It’s often subsumed by other competing priorities deemed to be more important.

The RCN is committed to enabling nurses, as a graduate workforce, to critically reflect on, in and for action relating to nursing practice⁴. It is through the lens of reflective practice that the RCN currently positions itself within the clinical supervision debate.

Reflective practice is already a characteristic of the safety-critical work that nurses provide to the public. It is a central component of Nursing and Midwifery Council revalidation⁵. It’s also a means for defining safe and effective staffing, while helping to illustrate the ever-evolving nature of ‘contemporary nursing’. However, time for clinical supervision is often not included in job planning and determining nursing establishments.

The idea of reflective practice has become synonymous with clinical supervision. A joint position statement, authored by a number of esteemed nursing charities, has called for regulators, employers, commissioners, and policy makers to ensure time is protected for reflective practice in nursing and midwifery⁶.

The Nursing and Midwifery Council refers to supervision as part of employers’ responsibilities⁷ and within their standards of proficiency for registered nurses⁸.

The literature review⁹ demonstrates that the reflective practice approach to clinical supervision has not become embedded in the identity of registered and non-registered nursing, nor is it consistently, equitably or effectively operationalised in day-to-day practice, organisational design and care delivery.

RCN position

The RCN supports the progression of an evidence-based narrative surrounding clinical supervision, through national policy and the development of learning resources.

The RCN has referred to clinical supervision throughout the Nursing Workforce Standards; the Principles for return to services; and the ‘One Voice’ position statement on the wellbeing of the health and care workforce.

The RCN recognises an urgent need to establish a shared purpose and understanding of clinical supervision. As clinical supervision continues to be promoted and expanded across every field of practice, it is imperative that nurses take a united position on clinical supervision, positioning ourselves as leaders and change-makers in the development of our professional practice¹⁰.

The RCN recognises member’s divergent views around the purpose and scope of clinical supervision may be grounded in a theory to practice gap. Further exploration of the role of clinical supervision in the development of nursing leadership in practice, research and education would be beneficial.

Next steps for the RCN

The College believes that registered nurses, midwives, nursing associates, nursing support workers and students, must be enabled to build their knowledge, skills and thinking abilities to ensure continuous improvement in the provision of care, leadership, research and education.

The purpose and scope of clinical supervision extends beyond its restorative function. The normative (managerial aspects of the learning and practice) and formative (developing self-awareness through self-reflection to advance the professional education of knowledge and skills) are core elements of clinical supervision.

We must take note that the term ‘supervision’ is often used alongside performance management, often influencing our interpretation of ‘clinical supervision’ and willingness to engage with it.

On behalf of nursing and in collaboration with other professional ambassador organisations, the RCN will set out to lead, efforts to address the barriers that prevent the successful integration and adoption of clinical supervision as a fundamental attribute of professional practice.

The RCN is further committed to disentangle the prevailing assumptions and divergent views underpinning the purpose and scope of clinical supervision. We must separate our perceived value of clinical supervision from the reality of people’s experiences of its use and implementation in practice.

The RCN must determine the most clinically and educationally appropriate way to secure nursing’s access to life-long learning and professional development. The role of clinical supervision as a form of reflective practice is essential to the development of nurses and nursing careers in clinical, research, education and leadership. Clinical supervision models of delivery should be objectively reviewed and revaluated if its function is to act as a conduit towards achieving this goal.

The profession’s collective vision for clinical supervision within nursing and midwifery must be strategically embedded within everything we do in practice and education.