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Clinical supervision is claimed to benefit nurses' wellbeing, professional development and practice. However, evaluations highlight implementation challenges, and universal uptake among nurses is uncommon, which limits benefits and the quality of evaluations. This paper reports outcomes of a government policy initiative to implement clinical supervision in Victoria, Australia, with survey data generated through a program logic evaluation.
To explore nurses' perceptions of the implementation of clinical supervision, specifically addressing training adequacy, participation rates, organisational support, cultural growth and relational capacity development.
A cross-sectional survey of nursing supervisees was conducted within a program of research investigating the governmental implementation of clinical supervision.
A survey of 366 participating nurses across four separate organisations addressed the following outcome evaluation questions, arising from program logic objectives: Are nurses currently engaged in clinical supervision? What is the relationship between clinical supervision implementation and: (1) nurses' preparation for clinical supervision, (2) their experience of the organisation valuing clinical supervision and (3) valuing nurses' own wellbeing and (4) nurses' perception of their own growth in relational practice?
The findings affirm the clinical supervision implementation program by showing positive associations for the intended outcomes. Nurses reported: they had sufficient training in clinical supervision; their workplaces were experienced as supportive of clinical supervision and nurturing of the participants; and they had growth in relational ability. Each positive finding was significantly stronger for the sub-sample (65%) of study participants who were currently engaged in clinical supervision compared to those who were not.
The study foregrounds the contribution of program logic, within a multifaceted initiative and including a strong authorising environment, to the implementation of clinical supervision.
Implementation of clinical supervision across services can be enabled by values-congruent strategies, including high-level authorising, stakeholder objective setting, training and coalition of change agents.
This paper addresses the gap between numerous local intervention studies of clinical supervision for nurses and the lack of empirical studies informing system-wide implementation approaches. Our survey investigating implementation outcomes shows that nurses experience of the implementation was aligned to program objectives: participating nurses considered themselves effectively trained for clinical supervision and supported by the organisation, with a positive impact on their own practice. This study can assist organisations in considering large-scale implementation of clinical supervision, with a future focus on levels of uptake and impact on practice.
We have adhered to relevant EQUATOR guidelines for survey method (i.e., the CROSS checklist).
Mental Health Consumer and Carer Advisors within the Office of the Chief Mental Health Nurse, Department of Health and Human Services, Victoria, contributed to the establishment of the research evaluation objectives and related survey items. They contributed perspectives via initial project design meetings and further feedback informing the final version of the program logic.
The aim of this review is to identify and map the evidence available on the factors that influence the implementation of clinical supervision for nurses.
The scoping review was conducted and reported following the JBI methodology for scoping reviews.
Searches were conducted on MEDLINE, PsycINFO, and CINAHL databases on 28 March 2023.
A total of 1398 studies were imported into Covidence for screening. Researchers screened the papers according to the inclusion criteria. Empirical studies in English focusing on the implementation of clinical supervision for nurses were included, without year restrictions. Data from 16 studies were extracted and organized according to the constructs within the Consolidated Framework for Implementation Research (CFIR) domains: intervention characteristics, outer setting, inner setting, characteristics of individuals, and process.
When compared with the CFIR constructs, it was found that the influence of the outer setting on implementation was less explored in the literature. Most of the reviewed data highlighted recurring factors, particularly logistical challenges of nursing work such as shift work and lack of control over work time. Organizational culture and managerial support were also identified as significant factors in the implementation. Another significant challenge in implementation was the variety in clinical supervision's design, purpose, and application, despite sharing the same label, leading to questions about whether studies are implementing the same practice.
Policy documents should clearly define both the design and purpose of clinical supervision, beyond just its conceptual definition. Greater emphasis on equitable implementation of clinical supervision is necessary to prevent perpetuating existing inequalities. We conclude that implementation of such complex interventions is not linear, and the implementation strategies need to align with expected implementation challenges.
The advantage of using the implementation framework lies not only in observing what exists as a form of evidence but also in identifying what is underdeveloped. Healthcare services and policy developers can utilize our review to recognize and address potential challenges in introducing, modifying, scaling up, or sustaining their clinical supervision implementation.
No patient or public contribution.
To describe the characteristics and perceived effectiveness of clinical supervision mental health nurses are receiving and further explore any statistical correlations between the perceived effectiveness and satisfaction with the supervisee, supervisor and supervision characteristics.
A cross-sectional survey.
An online survey was distributed to nurses working in public mental health services in Victoria, Australia. A universal recruitment approach was used, and 422 nurses participated in the survey. Of these, 220 nurses who are participating in clinical supervision were eligible for the MCSS-26 survey.
A licensed MCSS-26 questionnaire.
Mental health nurses in the studied environment were likely to receive individual supervision from a senior mental health nurse, with the most common frequency being monthly for 31–60 min, and half receiving it within their workplace location. Half of the participants chose their own supervisor. Our findings indicate that nurses who engage in clinical supervision outside of their immediate workplace and receive individual supervision from a nurse of the same grade perceive higher effectiveness. We also found that clinical nurses may find it most difficult to engage in effective clinical supervision due to time constraints.
This study uniquely contributes to the current clinical supervision literature by reporting the uptake and detailed characteristics of supervision, a facet often overlooked in existing research.
This study reported the characteristics of the supervision, supervisor and the supervisee that are associated with the effective clinical supervision. These insights can lead to tailored implementation strategies that consider the specific roles and settings of nurses.
CROSS (Sharma et al. 2021).
No patient or public contribution.
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