Clinical supervision is one of a number of processes that aims to enhance professional practice through the facilitation of professional and personal development ultimately leading to the provision of improved, safer and more efficient clinical care.

Whilst the value of informal supervision is recognised, this initiative details the implementation of formal clinical supervision for Nursing staff in line with current Best Practice Guidance and national drivers.

This initiative is based within the only high secure in-patient forensic facility in Scotland, providing high secure care for patients, from both Scotland and Northern Ireland, who have been referred from other services, such as local hospitals, courts or prisons. There are approx 230 nursing staff working in a variety of roles across this extremely challenging environment.

A phased programme of integration was implemented to ensure that clinical supervision is offered to all nursing staff in The State Hospital by the end of 2009. Annual targets detailed in the local delivery plan (LDP) were end of year 1 – 33%. year 2 – 64% and year 3 – 100%.

A 2 day training programme for potential supervisors was devised, where there are currently 67 trained clinical supervisors. The model of ‘reflective practice’ was agreed and formed the basis of an "eclectic model" that meets the needs of staff working in this challenging environment.

A Clinical Supervision Policy For Nursing was ratified by the Hospital Management Team and stipulates 1 hour of supervision every 8 weeks as a minimum standard. Supervisors supervision is mandatory, and takes place a minimum of every 12 weeks.

A system of performance management has been devised incorporating excel spreadsheets and access databases. All this information feeds directly into the organisations balanced score card and local delivery plan targets

The greatest challenges are changing cultures, achieving "buy in" and maintaining organisational committment year on year. Very specific challenges unique to this environment include very fixed staff / patient ratios that have to be maintained, resulting in high replacement costs.

Good advice is "Concentrate on the positives, it's all too easy to forget what you have achieved".

We have already been approached by other Health Boards with interest in the model we have developed, the training we offer our supervisors and the performance management infastructure we have implemented. We are always willing to share our experience with others as we wouldn't have been able to get where we are without the collaboration of colleagues across Scotland.

Most importantly, this initialtive has been built upon a model that has been developed to meet the needs of our nurses at the State Hospital. The service is led by nurses, for nurses and concentrates on facilitated reflection and support in your role as a nurse.

Contact:
Ian.Rodger@tsh.scot.nhs.uk
Jim.Fry@tsh.scot.nhs.uk

from June 1st 2010:
ianrodger@nhs.net
jamesfry@nhs.net