Clinical supervision educator, clinical supervisor and mental health nurse Julie Sharrock credits the reflective collaborative practice of clinical supervision as the reason she has been able to maintain a successful clinical career over almost four decades.
“If I had no place to wash off the emotional grind, the emotional challenges and the cognitive and ethical challenges I was facing on a day-to-day basis as a nurse, if I didn’t have that avenue, and not just as a mental health nurse but also working in the general hospital as well, where I was working with patients with extraordinarily challenging health conditions, if I didn’t have that place to go and talk about my work in order to work out how to deal with it I wouldn’t have survived.”
Sharrock says clinical supervision, adopted in various forms by nurses, social workers, psychologists and psychiatrists all over the world, is often misunderstood.
“They [nurses and midwives] hear the word clinical supervision and they think ‘Oh god it’s going to be someone looking over my shoulder and critiquing me’ but supervision is a bird’s-eye view of your practice. So together with your supervisor you look over your work together and it’s a collaborative exercise where you review and improve practice.”
Sharrock says clinical supervision has been around a long time and is one of the cornerstones of psychotherapy training.
“It’s fair to say it’s been more embedded in psychotherapy and counselling training than anything else,” she explains.
“It’s also very confused with professional supervision where you have health professionals such as counsellors, psychotherapists, psychologists and social workers having supervision as part of their entry into the profession as a gatekeeping function.”
Sharrock points to the Australian Clinical Supervision Association (ACSA), which held its inaugural conference at the ANMF (Vic Branch) in May last year, appropriately distinguishing the two terms by defining clinical supervision as a relationship where health professionals such as nurses and midwives choose their supervisor and there is an equal relationship without the power to let one into the profession.
Clinical supervision is not about teaching nurses and midwives how to carry out a complex dressing or deliver a baby, she says, but rather a critical reflection on what may have unfolded during the course of a shift, such as a baby dying and dealing with the parents in the aftermath.
“It’s basically a professional relationship that’s got trust at its core and that’s why it can’t be someone with power over you,” Sharrock says.
“It’s talking about clinical skill development in that more interpersonal arena with the people you provide service for.”
Sharrock strongly believes all nurses and midwives should have the opportunity to receive clinical supervision.
Significantly, the Australian College of Midwives (ACM), the Australian College of Nursing (ACN), and the Australian College of Mental Health Nurses (ACHMN) are about to launch a joint national position statement on clinical supervision, which Sharrock led.
“Clinical Supervision is a formally structured professional arrangement between a supervisor and one or more supervisees. It is a purposely constructed regular meeting that provides for critical reflection on the work issues brought to that space by the supervisee(s). It is a confidential relationship within the ethical and legal parameters of practice. Clinical Supervision facilitates development of reflective practice and the professional skills of the supervisee(s) through increased awareness and understanding of the complex human and ethical issues within their workplace,” the Draft Statement reads.
Sharrock is hopeful the unified position statement can lead to clinical supervision being embedded in early education.
“The best practice is that all nurses and midwives should have an understanding of clinical supervision and what we’re saying in the position statement is that we want nurses and midwives to be introduced to this as a professional support strategy in their undergraduate training so that they have an idea of this, along with a number of other support strategies such as preceptorship, mentorship, employee assistance programs, basically other self-care strategies that should be introduced into their undergraduate training so they know how to support themselves into the profession and into the future.”
Sharrock stresses introducing clinical supervision more widely would require widespread support.
“To implement clinical supervision successfully in health systems we need to have organisational support for it,” she says.
“We need to have support for people to attend training, to become supervisors and to attend their supervision. All supervisors should have regular supervision as well with access to refresher training because at the moment in Australia we have no regulation or accreditation courses and we have no process across the nation so that organisations have an accredited process for supervisors and we also don’t have a standard that a supervisor has to meet in order to call themselves a supervisor.”
Ultimately, Sharrock is adamant good effective clinical supervision can provide enormous benefits to nurses and midwives and ensure they continue to develop and thrive in their practice.