Policy: C16 Clinical Supervision for Nurses

Transcription

1 Plicy: C16 Clinical Supervisin fr Nurses Versin: C16/06 Ratified by: Trust Management Team Date ratified: 3 rd June 2015 Title f Authr: Deputy Directr f Nursing Title f respnsible Directr Directr f Nursing & Patient Experience Gvernance Cmmittee Trust Partnership Frum Date issued: 4 th June 2015 Review date: May 2018 Target audience: All nursing staff and clinical managers Disclsure Status B Can be disclsed t patients and the public EIA / Sustainability C16 EIA apprved.dc (BL) Sustainable Develpm Other Related Prcedure r Dcuments: West Lndn Mental Health NHS Trust Page 1 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

2 Equality & Diversity statement The Trust strives t ensure its plicies are accessible, apprpriate and inclusive fr all. Therefre all apprpriate plicies will be required t underg an Equality Impact Assessment and will nly be apprved nce this prcess has been cmpleted Sustainable Develpment Statement The Trust aims t ensure its plicies cnsider and minimise the sustainable develpment impacts f its activities. All relevant plicies are therefre required t underg a Sustainable Develpment Impact Assessment t ensure that the financial, envirnmental and scial implicatins have been cnsidered. Plicies will nly be apprved nce this prcess has been cmpleted West Lndn Mental Health NHS Trust Page 2 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

3 C16 Clinical Supervisin fr Nurses Versin Cntrl Sheet Versin Date Title f Authr Status Cmment C16/01 June 2003 New plicy issued C16/02 May 2007 Updated plicy issued C16/03 17 th C16/04 8 th Nvember 2010 February 2011 C16/05 July 2013 February 2014 Deputy Directr f Nursing Deputy Directr f Nursing Deputy Directr f Nursing C16/06 Oct 2014 Deputy Directr f Nursing Revised plicy issued Revised plicy issued Revised plicy Revised Plicy Plicy reviewed. Plicy updated in line with NHSLA. Present t Plicy Review Grup 21 st Octber fr apprval apprved. 17 th January 2011 addendum added/integrated int 6.4 Clinical Supervisin and Child Prtectin. Guidance is added int Appendix 10. Present t Plicy Review Grup 31 st January 2011 fr apprval. Apprved pst PRG by Executive Directr Partial review and update due t full review f prcess by external cnsultants Presented t TMT, apprved, review date Oct 2014 Cmprehensive review fllwing cmpletin f Trust wide Clinical Supervisin develpment prgramme Trustwide cnsultatin ending West Lndn Mental Health NHS Trust Page 3 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

4 Cntents Page 1. Flwchart Intrductin Scpe Definitins and mdels Backgrund Previus internal reviews f WLMHT Clinical Supervisin Plicy fr Nurses Internatinal evidence base fr Clinical Supervisin Duties Systems and Recrding West Lndn Mental Health NHS Trust Prcess Implementatin and Mnitring Supervisin skills develpment: Plicy review Fraud statement Supprting dcuments Glssary f terms References Appendices Appendix 1 Appendix 2 Clinical Supervisin cntract (Line Manager respnsible fr PDR) Clinical Supervisin cntract (Alternative suggested fr use by nn-line Manager - nt respnsible fr PDR) Example Supervisin recrd Appendix 3 Appendix 4 Example Clinical Supervisin agenda band 3 Appendix 5 Example Clinical Supervisin agenda band 5 Appendix 6 Example Clinical Supervisin agenda band 6 Appendix 7 Example Clinical Supervisin agenda band 7 Appendix 8 Appendix 9 Staff supervisin register WLMHT Safeguarding Children-Supervisin Guidelines West Lndn Mental Health NHS Trust Page 4 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

5 1. Flwchart New member f staff (new starter r transfer frm anther ward/team) jins team. Ward/Team manger allcates supervisr with 7 days. Supervisee and supervisr sign cntract and agree date fr mnthly clinical supervisin sessin. Supervisee attends 1:1 clinical supervisin sessin (40-60 minutes duratin). OR Supervisee attends grup (max 8) clinical supervisin sessin (40 60 minutes duratin). Supervisin data cllated by perfrmance team and reprted mnthly t CSU lead nurse, peratinal managers and Trust management team. Clinical supervisin data feedback t Ward/team manager by peratinal manager. Maintenance and imprvement actins agreed. Supervisr recrds attendance and sessin summary via exchange. Date f next sessin agreed and diarised. All supervisees cmplete an annual clinical supervisin evaluatin survey at time f PDR final review Annual evaluatin reprt and recmmendatins prepared by CSU Nursing gvernance frum Mnthly uptake trends and actins reviewed in CSU Nursing gvernance meeting. Uptake and quality assurance reprt received by Trust-wide nursing Gvernance frum Annual clinical supervisin uptake and quality reprt and recmmendatins t QAC, TMT. Subsequently t CSU SMTs and Nursing Gvernance frums fr actin West Lndn Mental Health NHS Trust Page 5 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

6 2. Intrductin 2.1 The West Lndn Mental Health NHS Trust [WLMHT] is ne f the largest and mst diverse mental health services in the United Kingdm. It prvides treatment and care fr arund 20,000 peple each year and serves a lcal ppulatin f abut 700,000 residents. 2.2 WLMHT emplys arund 3000 staff and serves a diverse cmmunity acrss three Lndn brughs. This includes lcal mental health services fr adults, lder peple and children in the Brughs f Ealing, Hammersmith & Fulham and Hunslw. The high secure services at Bradmr Hspital, tgether with the West Lndn Frensic Service, makes the Trust ne f the leading natinal prviders f secure and specialist mental healthcare. 3. Scpe 3.1 The West Lndn Mental Health NHS Trust is cmmitted t the practice f Clinical Supervisin [CS], a frmally structured arrangement t supprt staff in human service agencies, which has a lng and established histry in many health care prfessins. 3.2 The WLMHT has given public expressin t such a cmmitment thrugh this Plicy dcument, which was first issued in June 2003, the cntents f which seek t ensure that each emplyed nurse and healthcare assistant [HCA] has access t, and receives, apprpriate and effective Clinical Supervisin. 3.3 Thrugh regular and frequent Clinical Supervisin, it is expected that these staff grups will be assisted t develp a deeper understanding f their respective rles as reflective and accuntable practitiners. It will help supprt them t develp and maintain cmplex relatinships in a mdern mental health service. 3.4 At the level f individual, Clinical Supervisin will encurage the prcess f lifelng learning and will help in the develpment f the clinical leaders f the future. At the level f the rganisatin, Clinical supervisin will help t identify and address matters f prfessinal interest and cncern t a relevant Trust-wide clinical gvernance agenda. In particular, CS can make a cntributin t the prcess f clinical risk management and t a safe envirnment in which care is delivered. 4. Definitins and mdels 4.1 Operatinal definitins f Clinical Supervisin, tgether with the preferred mdels f practice, framewrks fr implementatin and the strategies fr systematic evaluatin, all vary within and between prfessinal grups and practice settings (Slan and Watsn 2002; Milne 2007). The essential parameters f Clinical Supervisin, hwever, have nw been established. Clinical Supervisin is usually distinguished frm case review, persnal perfrmance review and therapy, West Lndn Mental Health NHS Trust Page 6 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

7 althugh there is little dubt that when Clinical Supervisin is prvided t an efficacius standard it is likely t be therapeutic (Spence 2001). 4.2 Within the WLMHT, it is likely that nurses will becme expsed t examples f five main frms f lcal supervisin; 'clinical supervisin', 'managerial supervisin', 'caselad management', 'reflective practice grups' and 'mdality specific supervisin'. Managerial supervisin is usually facilitated by the line manager and fcusses n perfrmance and assciated tasks; it may prvide supprt and feedback and tends t cnclude with further actins and tasks t be cmpleted within an agreed timescale. Reflective practice grups are usually rganised arund the wrk f the clinical team and are an pprtunity t reflect n specific case wrk and generatin f hypthesis fr imprvement t be tested ut. This frm f supervisin may als examine ways t imprve the system in which individual Supervisees and teams wrk. The 'mdality specific supervisin usually invlves supervisin in a discrete psychlgical therapy, t help ensure the develpment and fidelity f that apprach. Nurses will experience sme r all f these types f supervisin and these tgether with case reviews, clinical incident reviews and case discussins with ther prfessinal clleagues prvide cntinuus pprtunities fr reflectin n practice. The WLMHT Nursing Directrate will wrk with clleagues t identify guidance t recrd these additinal pprtunities fr reflectin in rder t further supprt nurses in practice and in their preparatin fr NMC revalidatin (NMC 2015). 4.3 This Plicy dcument, hwever, relates specifically t Clinical Supervisin fr nurses. Fr the majrity emplyed by WLMHT, CS sessins are currently arranged n a ne-t-ne basis [s-called dyads], in which a Senir Nurse in the management line will assume the rle f Supervisr. The cntent f such CS sessins are distinct frm Perfrmance Develpment Review [PDR], hwever, and the present Plicy readily acknwledges the ptential sensitivity f the current arrangement, which will remain under cnstant review (see The Trust Prcess at sectin 7 belw). 5. Backgrund 5.1 The main histrical threads f the develpment f nursing Clinical Supervisin in Britain are nw well rehearsed in the public literature [White and Winstanley, 2014]. Mst publicatins agree that the main accelerant was caused by findings frm the Allitt Inquiry (1991) and by recmmendatins f the subsequent Clthier West Lndn Mental Health NHS Trust Page 7 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

8 Reprt [Department f Health, 1994). General cncerns were raised abut the standards f supervisin and training fr nurses. 5.2 In the wake f these accunts, Faugier & Butterwrth (1994) argued that Clinical Supervisin shuld be cnsidered a necessary part f the clinical gvernance agenda fr safer nursing care in Britain. This psitin was later publicly endrsed by the United Kingdm Central Cuncil fr Nursing, Midwifery and Health Visiting (UKCC 1996) and later by the Department f Health (2000), Lndn and, by 2002; the successr regulatry authrity [Nursing & Midwifery Cuncil] had issued guidelines n Clinical Supervisin. 5.3 In 2008, the Nursing & Midwifery Cuncil updated its publicly available CS guidelines. In 2012, hwever, the N&MC reviewed its advice sheets and mved t a new structure f prviding a range f regulatry infrmatin t supprt implementatin f standards and guidance. A decisin was taken by the N&MC t remve the infrmatin n Clinical Supervisin which was nt nly because it was ut-dated, but als because it was n lnger regarded apprpriate fr a Regulatr t prvide guidance n an issue that shuld be part f lcal training, develpment and gvernance framewrks. 5.4 Thrughut, the WLMHT has been mindful f several internal Serius Untward Incident and Critical Incident Review inquiries, which reinfrced the need fr gd quality Clinical Supervisin t be included as an imprtant area fr develpment in Clinical Gvernance frward plans and key perfrmance indicatrs. 6. Previus internal reviews f WLMHT Clinical Supervisin Plicy fr Nurses 6.1 Three years after it was intrduced, this Plicy was reviewed in 2006 by a selectin f Senir Nurses wrking within the West Lndn Mental Health NHS Trust. It included a full cnsultatin exercise with all Senir Nurses, via the nursing gvernance structures. It als included feedback frm a series f Fcus Grups held fr Band 5, 6 and 7 nurses in Lcal and Frensic Services, the results f which were built int a revised plicy dcument. In 2010, the plicy was again reviewed by WLMHT Heads f Nursing. Findings revealed that Clinical Supervisin ffered an pprtunity t: examine practice penly, safely and hnestly identify examples f gd practices cnsider future develpment needs help imprve the delivery f nursing care t patients feel prfessinally supprted and minimise any sense f prfessinal islatin West Lndn Mental Health NHS Trust Page 8 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

9 6.2 It was agreed that Clinical Supervisin shuld nt be regarded as a channel fr disciplinary prcedures; nr a rute t make cmplaints; an pprtunity t reprimand pr perfrmance r t criticise ther team members; a time t arrange ff duty and shifts r hurs f wrk, nr 'time ut' t chat abut things in general, r gssip. 6.3 The current plicy revisin is the prduct f a cmprehensive Trust wide Clinical Supervisin Develpment Prgramme cncluded in It recmmended the review f this plicy t reflect cntemprary evidence and best practice. 7. Internatinal evidence base fr Clinical Supervisin 7.1 A number f cntemprary reviews f the internatinal CS utcmes literature have examined the evidence base f Clinical Supervisin (Watkins 2011, White and Winstanley 2011) and a cmmnality f expert pinin has begun t emerge frm the findings, sme f which were highlighted during the WLMHT plicy review prcess referred t at 6.3 abve. Fr example, there is little dubt that effective CS has a causal effect n lwering the stress levels f individual Supervisees, when carefully measured by research instruments with established psychmetric prperties. 7.2 A current research agenda exists t unequivcally establish a causal relatinship between this reductin and [say] staff sick leave and staff retentin rates. There are als grwing indicatins that Clinical Supervisin may als be psitively assciated with an imprvement in the quality f clinical care and, where this can be demnstrated, imprved utcmes fr mental health service users may als be detected( Bambling et al 2006; Bradshaw et al 2007; White and Winstanley, 2010). 7.3 In rder that CS may be successfully implemented and sustained, the best and clearest directins currently available (White and Winstanley 2010) suggest that a number f envirnmental cnditins shuld be met: I. Clinical Supervisin shuld be universally cnsidered part f the cre business f cntemprary prfessinal mental health nursing practice. II. III. IV. Psitive supprt fr Clinical Supervisin shuld be evident at all levels f service management and accepted as a dminant feature f the rganisatinal culture. The mainstream status f Clinical Supervisin shuld be written int all wrkfrce plicies, as a psitive expectatin fr all staff t engage Explicit prtcls shuld be in place t cnfirm the arrangements fr the sustainable implementatin acrss all services [size, 1:1 r 6-8 in grups; frequency, nt less than mnthly; duratin, between minutes; grund rules abut cnfidentiality and s n], tgether with a dedicated West Lndn Mental Health NHS Trust Page 9 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

10 infrmatin management system t cntinuusly mnitr these are given full effect. V. Supervisees shuld retain the ptin t identify an additinal Clinical Supervisr fr mdality specific clinic wrk, where this is practicable. This shuld be an apprpriately trained and experienced practitiner, wh des nt hld peratinal r managerial respnsibility fr the Supervisee VI. VII. VIII. IX. Individuals identified by lcal criteria t becme Supervisrs shuld be apprpriately prepared fr their rle thrugh the prvisin f apprpriate training. Upn appintment, all staff shuld be assisted t becme fully rientated t lcal Clinical Supervisin arrangements, including new registrants and thers transferring int the mental health wrkfrce Managers wh hld individual respnsibility fr the staff rster and budget shuld t be prvided with the supprt necessary t ensure a smth CS peratin, withut deleterius effect n clinical cntact time. A Prgramme f cntinuus evaluatin in discrete clinical lcatins and acrss the entire service shuld be in place t ensure that the quality and efficacy f lcal Clinical Supervisin arrangements are able t be demnstrated and regularly reprted. X. In the face f cmpelling evaluatin utcmes, necessary adjustments shuld be made t maximise ptential benefits arising frm Clinical Supervisin. XI. Suitable administrative recrds (Recrding f sessins, reprting uptake and evaluatin f effectiveness) shuld be maintained. 8. Duties 8.1 Chief Executive The Chief Executive is respnsible fr ensuring that the Trust has plicies in place and cmplies with its legal and regulatry bligatins. 8.2 Accuntable Directr (Executive Directr f Nursing & Patient Experience) The accuntable directr is respnsible fr the develpment f relevant plicies and t ensure they cmply with NHSLA standards and criteria where applicable. They must als cntain all the relevant details and prcesses as per plicy P3. They are als respnsible fr trust wide implementatin and cmpliance with the plicy. West Lndn Mental Health NHS Trust Page 10 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

11 It is the respnsibility f the Executive Directr f Nursing & Patient experience and Deputy Directrs f Nursing t ensure that a cntemprary plicy, apprpriate training and a system f audit is in place fr Clinical Supervisin It is the respnsibility f Service Directrs t implement the Clinical Supervisin Plicy thrugh the cascade mechanisms in each CSU. 8.3 Managers Managers are respnsible fr ensuring plicies are cmmunicated t their teams / staff. They are respnsible fr ensuring staff attend relevant training and adhere t the plicy detail. They are als respnsible fr ensuring plicies applicable t their services are implemented It will be the respnsibility f the ward r team manager t cnfirm that all nurses wh prvide supervisin have the skills t d s 8.4 Plicy Authr Plicy Authr is respnsible fr the develpment r review f a plicy as well as ensuring the implementatin and mnitring is cmmunicated effectively thrughut the Trust via CSU / Directrate leads and that mnitring arrangements are rbust. 8.5 Lcal Plicy Leads Lcal plicy leads are respnsible fr ensuring plicies are cmmunicated and implemented within their CSU / Directrate as well as c-rdinating and systematically filing mnitring reprts. Areas f pr perfrmance shuld be raised at the CSU / Directrate SMT meetings with agreed actins t address. 8.6 Service Directr Service Directrs respnsible fr implementing the plicy and mnitring cmpliance with plicy. 8.7 All Staff It is an expectatin that all staff will engage in supervisin with the aim f learning and imprving practice. 9. Systems and Recrding 9.1 Where recrded: A recrd f every clinical supervisin sessin (1:1 and grup) will be recrded via the exchange 9.2 When recrded: As sn after the clinical supervisin sessin as pssible West Lndn Mental Health NHS Trust Page 11 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

12 9.3 Recrded by wh: The supervisr is respnsible fr recrding that the sessin has taken place. 10. West Lndn Mental Health NHS Trust Prcess 10.1 West Lndn Mental Health NHS Trust expects that individual Clinical Supervisin will be prvided t all nursing emplyee s using a cascade mdel, in which Senir Nurses will supervise junir nurses within their CSU Team/Ward r Department. In the majrity f instances Senir Nurses/Nurse Cnsultant at Band 8b t 8a will supervise the Ward/Team Managers and ther Senir Nurses at Band 7. The Ward/Team Managers will supervise their Clinical Team Leaders [Band 6]; the Team Leaders supervise Band 5 Nurses. Band 5 Nurses (nt underging preceptrship) will be expected t prvide clinical supervisin fr Preceptrship Band 5 Nurses and Healthcare Assistants within each ward and department. Each supervisr will recrd (via the exchange) each supervisin sessin t ensure an apprpriate level f mnitring, a lcal register shuld be maintained by the ward manager (Appendix 8) This arrangement fr the delivery f Clinical Supervisin nt nly recgnises the size and cmplexity f the Trust, but als ffers a structure t enable sme ptins fr the individual, in recgnitin f the need t manage the wrklad effectively. The cascade structure fulfils the Trust s respnsibility t ensure that every member f nursing staff receives Clinical Supervisin within their individual wrk cntext. In sme cases, experienced nurses f the same banding e.g. band 6 may supervise anther inexperienced band 6 nurse with the agreement f the Line Manager f the Supervisee Only in exceptinal circumstances will individuals be allwed t chse their supervisr. Supervisrs will nrmally be assigned by the ward/team Manager within 7 days f a nurse jining the team (New starter r transfer frm anther area) 10.4 If individuals wish t seek supervisin frm an additinal supervisr (internal r external), they will be required t negtiate the develpment f this relatinship thrugh their Line Manager in additin t the Clinical Supervisin arrangements utlined in this dcument In sme instances Clinical Supervisin may be ffered by smene ther than a nurse; hwever, this shuld nly be in additin t supervisin frm a nurse. A nurse may als supervise anther registered prfessinal In additin t ffering individual Clinical Supervisin, every Directrate, Ward, Team r Department where nurses are emplyed shuld cnsider establishing grup clinical supervisin A signed cpy f a Clinical Supervisin cntract shuld be held by bth parties (appendix 1 & 2). West Lndn Mental Health NHS Trust Page 12 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

13 10.8 A recrd f each Clinical Supervisin sessin attendance (1:1 r grup) tgether with a sessin summary is made via the exchange by the clinical supervisr; bth practitiners shuld have access t this recrd. It is the respnsibility f individual supervisees t keep a recrd f their Clinical Supervisin, including tpics discussed and actins agreed Appendices 3 t 7 prvide example templates t supprt the administratin and prcess f clinical supervisin including; supervisin recrd and Clinical Supervisin sessin agendas fr band 3 t band 7 nursing staff Written recrds f supervisry sessins are cnfidential and shuld nly be disclsed with the cnsent f the supervisee. Trust Audits f clinical supervisin uptake will simply ensure that the clinical supervisin sessin has been recrded Every ward/team Manager shuld maintain a staff supervisin register which bth parties sign after every sessin [example template at Appendix 8] t prvide assurance that A requirement t participating in, and (where apprpriate) prvide, Clinical Supervisin will appear in all Jb Descriptins The rati f supervisees held by any ne Supervisr shuld be cnsidered lcally. Ideally, n mre than 6 staff shuld be assigned t each Supervisr Supervisrs must be apprpriately trained fr their rle. Training prgrammes and refresher pprtunities are available within the Trust and these will be revised and extended t reflect this Plicy The Trust s Higher Educatin prviders have incrprated the principles f Clinical Supervisin int pre-and pst-registratin prgrammes Infrmatin resulting frm clinical audit shuld be made available t all staff in a feedback lp, t enhance the quality f Clinical Supervisin sessins, within wards, teams and areas Teams and Wards must be audited (via data prvided by perfrmance departments) by their Service Manager/Senir Clinical Manager r Senir Nurse t ensure all nursing staff have access t, and experience f, Clinical Supervisin. This frms an imprtant and integral part f the nursing gvernance arrangements, as utlined in the WLMHT 'Strategy fr Nursing (Octber 2014) 11. Implementatin and Mnitring 11.1 Strategically, WLMHT prvides a plicy framewrk fr Clinical Supervisin which nurses are expected t fllw. This framewrk is prvided t ensure that all nurses emplyed in the Trust receive frequent and regular Clinical Supervisin. This plicy is agreed thrugh the Trust Clinical Gvernance prcesses and implemented by peratinal managers in each Clinical Service Unit (CSU). West Lndn Mental Health NHS Trust Page 13 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

14 11.2 Operatinal Implementatin It is the respnsibility f the Executive Directr f Nursing & Patient experience and Deputy Directrs f Nursing t ensure that a cntemprary plicy, apprpriate training and a system f audit is in place fr Clinical Supervisin It is the respnsibility f Service Directrs t implement the Clinical Supervisin Plicy thrugh the cascade mechanisms in each CSU The prvisin f Clinical Supervisin is a perfrmance bjective fr nurses at bands 5 8b. Prgress against this bjective will be assessed within annual and peridic persnal develpment reviews [PDRs) It is the duty f Ward managers/clinical Nurse Manager s [r senir nurse in the cmmunity] t ensure that Clinical Supervisin arrangements are in place fr all nursing staff. They are accuntable fr ensuring that mnthly Clinical Supervisin is available fr all staff in their Team/Ward/Department Mnitring f Clinical Supervisin: Standardised templates which are t be used by all thse wh manage WLMHT-emplyed Nurses, are fund as Appendices f this plicy. Each clinical supervisin sessin must be recrded via the Trust exchange platfrm It is the duty f the Service Directr in each CSU t mnitr that the Clinical Supervisin standard has been met. The uptake f Clinical Supervisin fr nurses in each CSU will be audited thrugh perfrmance management prcesses The CSU Directr carries verall respnsibility fr ensuring that the Clinical Supervisin is delivered in the clinical setting and that evidence f this is available t the Deputy Directr f Nursing and Executive Directr f Nursing and Patient Experience The Service Directr(s) in each CSU may delegate the mnitring and reprting f Clinical Supervisin t a senir nurse in the Directrate; hwever, the Service Directr will retain verall respnsibility Ward managers/clinical Nurse Manager s Nurse Managers [r senir nurse in the cmmunity] will hld a register f all Clinical Supervisin held in their ward/team. This recrd shuld include the name f the nurse, the name f their Supervisr, and the date that it tk place. This recrd must be signed by bth parties and kept fr audit purpses Deputy Directrs f Nursing, have a respnsibility t ensure that the clinical supervisin system utlined in this plicy is in place within their CSU. They will prvide assurance t the Trust Nursing Gvernance frum n a minimum f a six mnthly basis using uptake data and audits f clinical supervisin quality. West Lndn Mental Health NHS Trust Page 14 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

15 12. Supervisin skills develpment: 12.1 Clinical supervisin is integral t nursing practice and it is generally accepted that the skill is learnt by experience (i.e. thrugh receiving gd quality clinical supervisin). It is the respnsibility f the mst senirs nurses in the CSU t set the clear standards. It will be the respnsibility f the ward r team manager t cnfirm that all nurses wh prvide supervisin have the skills t d s. Where there is a skills gap an individual skills develpment plan will be put in place, which will include the receipt f high quality clinical supervisin t learn frm. 13. Plicy review 13.1 This Plicy shuld be reviewed annually. The respnsibility fr the review will rest with the Executive Directr f Nursing and Patient Experience, wh will als take the lead rle Any deficits in cmpliance with, and/r departures frm, the Plicy shuld be raised with the Executive Directr f Nursing and Patient Experience, r deputies. 14. Fraud statement 14.1 Nt applicable t all plicies (N/A) 15. Supprting dcuments This plicy shuld be read in cnjunctin with: West Lndn Mental Health NHS Trust Strategy fr Nursing (2014) 16. Glssary f terms CS NMC KSF PDR CSU WM SN Clinical Supervisin Nursing & Midwifery Cuncil Knwledge & Skills Framewrk Perfrmance Develpment Review Clinical Service Unit Ward Managers Senir Nurses West Lndn Mental Health NHS Trust Page 15 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

16 17. References Allitt Inquiry. (1991). Independent inquiry relating t the deaths and injuries n the children s ward at Grantham and Kesteven General Hspital during the perid February t April Bambling, M. et al (2006) Clinical supervisin: Its influence n client-rated wrking alliance and client symptm reductin in the brief treatment f majr depressin. Psychtherapy Research, 16(3), pp Bishp, V. (1994) Clinical Supervisin fr an accuntable prfessin. Nursing Times: 90(39):35-39 Bradshaw. T, Butterwrth. A & Mairs. H. (2007) Des structured clinical supervisin during psychscial interventin educatin enhance utcme fr mental health nurses and the service users they wrk with? J Psychiatr Ment Health Nurs: 14(1):4-12. Department f Health (1994) Independent Inquiry Relating t Deaths and Injuries n the Children s Ward at Grantham and Kesteven General Hspital during the perid February t April 1991 (Clthier Reprt) Lndn: HMSO. Department f Health. (2000). Making a difference: Clinical supervisin in primary care. Lndn, UK: Department f Health. Faugier, J., & Butterwrth, T. (1994). Clinical supervisin: A psitin paper. Manchester, UK: University f Manchester. Milne, D. (2007). An empirical definitin f clinical supervisin. British Jurnal f Clinical Psychlgy, 46, NMC (2008) Clinical Supervisin fr Registered Nurses (April 2008) NMC (2015) The Cde: Prfessinal standards f practice and behaviur fr nurses and midwives. Lndn Slan G, Watsn H (2002) Clinical supervisin mdels fr nursing: structure, research and limitatins. Nursing Standard. 17, 4, Spence, S.H., Wilsn, J., Kavanagh, D., Strng, J., Wrrall, L. (2001). Clinical supervisin in fur mental health prfessins: A review f the evidence. Behaviur Change, 18(3), United Kingdm Central Cuncil fr Nursing, Midwifery and Health Visiting (1996). Psitin statement n clinical supervisin fr nursing and health visiting. Lndn, UK: United Kingdm Central Cuncil fr Nursing, Midwifery and Health Visiting. West Lndn Mental Health NHS Trust Page 16 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

17 Watkins, C. E., Jr. (2011). Des psychtherapy supervisin cntribute t patient utcmes? Cnsidering 30 years f research. The Clinical Supervisr, 30(2), White. E, & Winstanley, J. (2009) Implementatin f Clinical Supervisin: educatinal preparatin and subsequent diary accunts f the practicalities invlved, frm an Australian mental health [crrected] nursing innvatin. Jurnal f Psychiatric mental health nursing (10): White, E., & Winstanley, J. (2010). A randmised cntrlled trial f clinical supervisin: Selected findings frm a nvel Australian attempt t establish the evidence base fr causal relatinships with quality f care and patient utcmes, as an infrmed cntributin t mental health nursing practice develpment. Jurnal f Research in Nursing, 15(2), White, E., & Winstanley, J. (2011). Clinical supervisin fr mental health prfessinals: The evidence base. Scial Wrk and Scial Sciences Review, 14(3), White. E, & Winstanley, J (2014) Clinical Supervisin and the Helping Prfessins: An Interpretatin f Histry. The Clinical Supervisr, 33:1, Appendices Appendix 1 Appendix 2 Appendix 3 Clinical Supervisin cntract (Line Manager respnsible fr PDR) Clinical Supervisin cntract (Alternative suggested fr use by nn-line Manager - nt respnsible fr PDR) Example Supervisin recrd Appendix 4 Example Clinical Supervisin agenda band 3 Appendix 5 Example Clinical Supervisin agenda band 5 Appendix 6 Example Clinical Supervisin agenda band 6 Appendix 7 Example Clinical Supervisin agenda band 7 Appendix 8 Appendix 9 Staff supervisin register WLMHT Safeguarding Children-Supervisin Guidelines West Lndn Mental Health NHS Trust Page 17 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

18 Appendix 1 Clinical Supervisin cntract (Line Manager respnsible fr PDR) Supervisee Name As supervisee and clinical supervisr we agree t the fllwing: T wrk tgether t facilitate reflectin n issues affecting practice, in rder t bth persnally and prfessinally develp a high level f practice expertise. T meet nce per calendar mnth fr minutes. T prtect the time and space fr clinical supervisin, by keeping t agreed appintments and time bundaries. Privacy will be respected and interruptins avided. T keep a recrd f ur supervisin, shwing the time and date f the meeting. This recrd may include ntes, practice bjectives and plans fr future sessins. We understand that there may be circumstances (e.g. CIR, SUI s, disciplinary investigatins) when supervisin recrds may be required and reviewed by Trust and Directrate managers. As a supervisee I agree t: Prepare fr the sessins, fr example by having an agenda and bringing pertinent practice issues t supervisin. Take respnsibility fr making effective use f the time. Be willing t learn, t develp practice skills and be pen t receiving supprt and challenge. As a supervisr I agree t: Keep all infrmatin yu reveal in the clinical supervisin cnfidential, except fr these exceptins: Shuld yu describe any unsafe, unethical r illegal practice that yu are unwilling t g thrugh the apprpriate prcedures t address r yu repeatedly fail t attend sessins. In the event f an exceptin arising I will discuss the issue with yu and if I remain cncerned then I will infrm yu that I will need t discuss this issue with a suitable manager. Offer yu advice, supprt, and supprtive challenge t enable yu t reflect in depth n issues affecting yur practice. Be cmmitted t cntinually develping myself as a practicing prfessinal Use my wn clinical supervisin t supprt and develp my skills as a clinical supervisr and practitiner. West Lndn Mental Health NHS Trust Page 18 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

19 Any ther issues? Frequency f meetings Venue Review date Signed (Supervisee) Signed (Supervisr) Date cntract signed West Lndn Mental Health NHS Trust Page 19 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

20 Appendix 2 Clinical Supervisin cntract (Alternative suggested fr use by nn line Manager - nt respnsible fr PDR) Supervisee: Supervisr: Line Manager: EXPECTATIONS TO BE AGREED The purpse f supervisin sessins: Particular pririty areas t be discussed regularly: Dcumentatin: West Lndn Mental Health NHS Trust Page 20 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

21 Limits f Cnfidentiality: Hw cnflicts/prblems in the supervisin relatinship will be dealt with: Infrmal cntact between sessins: Rle f the Line Manager: Frequency f Sessins: Duratin: Usual Venue: Respnsibility fr Initiating Sessins: Respnsibility fr Agenda Setting and Preparing fr Sessins: Structure f Sessins: Annual Review Date: Signed: Supervisee Signed: Supervisr Signed: Line Manager Date: West Lndn Mental Health NHS Trust Page 21 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

22 Appendix 3 Example Supervisin Recrd Supervisee/Band: Ward/Dept: Supervisr/Band: Date: Agenda Item Discussin ntes Actin pints by whm/when Date f next meeting: Supervisee sign: Supervisr sign: West Lndn Mental Health NHS Trust Page 22 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 June 15

23 Appendix 4 Example Clinical Supervisin agenda Band 3 - Health Care Assistant 1. Supervisees issues 2. Review actins agreed at last meeting and explre current issues in practice 3. NHS KSF Cre dimensins (see pst utline fr apprpriate level required fr this pst) Cmmunicatin Persnal & peple develpment Health, safety & security Service imprvement Quality Equality and diversity 4. Mandatry training/ther training 5. Supervisry respnsibilities 6. Practice Rle Attitude Quality f engagement with service users Recrd keeping (including reprting f incidents) Wrking with thers Safeguarding 7. Date next meeting West Lndn Mental Health NHS Trust Page 23 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

24 Appendix 5 Example Clinical Supervisin Agenda Band 5 - Staff nurse 1. Supervisees issues 2. Review actins agreed at last meeting and explre current issues in practice 3. NHS KSF Cre dimensins (see pst utline fr apprpriate level required fr this pst) Cmmunicatin Persnal & peple develpment Health, safety & security Service imprvement Quality Equality and diversity 4. Mandatry training/ther training 5. Supervisry/preceptr/mentr respnsibilities 6. Practice Rle Primary/assciate nurse, care c-rdinatr Attitude Shift c-rdinatin Quality f engagement with service users Recrd keeping (including incident reprting) Wrking with thers Case lad Assessment/care plans/interventins/evaluatin Risk assessment/risk management/primary preventin/advanced directives. 1:1 weekly meetings with patient CTM/CPA attendance Safeguarding 7. Date next meeting West Lndn Mental Health NHS Trust Page 24 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

25 Appendix 6 Example Clinical Supervisin Agenda Band 6 - Team leader 1. Supervisees issues 2. Review actins agreed at last meeting and explre current issues in practice 3. NHS KSF Cre dimensins (see pst utline fr apprpriate level required fr this pst) Cmmunicatin Persnal & peple develpment Health, safety & security Service imprvement Quality Equality and diversity 4. Mandatry training/ther training 5. Supervisry/preceptr/mentr respnsibilities 6. Practice assure wn and the practice f thers: Rle (Including Primary/assciate nurse, care c-rdinatr) Attitude Quality f engagement with service users Recrd keeping (including incident reprting) Wrking with thers Case lad Assessment/care plans/interventins/evaluatin Risk assessment/risk management/primary preventin/advanced directives. 1:1 weekly meetings with patient CTM/CPA attendance Safeguarding 7. Leadership/management: Visible facilitatin, supprt & guidance Assure practice standards and systems are understd and met Assure clinical systems (e.g. primary nursing, CPA, recrd keeping, reprting, security, supervisin, mandatry training) are maintained. 8. Date next meeting West Lndn Mental Health NHS Trust Page 25 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

26 Appendix 7 Example Clinical Supervisin Agenda Band 7 - Clinical nurse manager 1. Supervisees issues 2. Review actins agreed at last meeting and explre current issues in practice 3. NHS KSF Cre dimensins (see pst utline fr apprpriate level required fr this pst) Cmmunicatin Persnal & peple develpment Health, safety & security Service imprvement Quality Equality and diversity 4. Mandatry training/ther training 5. Supervisry/preceptr/mentr respnsibilities 6. Practice- ensure standards Rle (including care c-rdinatr) Attitude Quality f engagement with service users Recrd keeping (including incident reprting) Wrking with thers Case lad Assessment/care plans/interventins/evaluatin Risk assessment/risk management/primary preventin/advanced directives. 1:1 weekly meetings with patient CTM/CPA attendance Safeguarding 7. Leadership/ward management Facilitatin and supprt Visiblility Ensure practice standards are understd and met Ensure clinical systems (e.g. primary nursing, CPA, recrd keeping, reprting, security, supervisin, mandatry training) are maintained. 8. Date next meeting West Lndn Mental Health NHS Trust Page 26 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

27 Appendix 8 Staff Supervisin Register Team/Ward/Department Mnth Name/band Supervisee sign Supervisr sign Date* West Lndn Mental Health NHS Trust Page 27 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

28 Nte *Recrd the date n which supervisin tk place WM/CNM/Senir nurse signature Date sent t senir/cnsultant nurse West Lndn Mental Health NHS Trust Page 28 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

29 Appendix 9 West Lndn Mental Health Safeguarding Children Supervisin Safeguarding Children Supervisrs fr the WLMHT Safeguarding Children Team must be experienced Safeguarding Children Prfessinals with a Safeguarding Children qualificatin and have attended Safeguarding Children/ Child Prtectin Supervisin training. Supervisrs wh deliver Clinical Supervisin t WLMHT staff must have attended Trust Safeguarding Children Supervisin Training. Supervisee Supervisr WLMHT Named Nurse Designated & Named Nurse Supervisin Grup. WLMHT Named & Lead Dctrs Designated & Named Dctrs Supervisin Grup. WLMHT Safeguarding Children Lead Prfessinals WLMHT Named Nurse r Safeguarding Children Training & Develpment Officer. All ther WLMHT clinical staff Safeguarding Children Supervisin is t be incrprated int all Trust Clinical Supervisin as per Safeguarding Children Supervisin Addendum. Safeguarding Children Supervisin Principles West Lndn Mental Health Trust shuld ensure that there are structures in place fr supervisin which explicitly incrprate safeguarding children and child prtectin issues. West Lndn Mental Health NHS Trust Page 29 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

30 The purpse f including safeguarding children int clinical supervisin agendas is t strengthen the safeguarding and prtectin f children within WLMHT. This is a means f prmting excellence in safeguarding children practice, by supprting staff t practice with cnfidence. Safeguarding children supervisin will prvide a mechanism f supprt and guidance t all staff that have cntact with parents/carers, children including unbrn babies, and patients wh may pse a risk t children. This dcument prvides guidance and a framewrk n acceptable standards fr safeguarding children supervisin within West Lndn Mental Health Trust. Supervisrs and supervisees shuld knw wh the safeguarding children leads and /r named prfessinals are and hw t cntact them. Named and /r lead prfessinals are a valuable surce f advice and supprt when safeguarding cncerns arise. Supervisrs and supervisees must knw the systems that are in place t refer and/ r escalate child prtectin cncerns when they are identified. The impact f adult mental ill-health n children, including risk, shuld always be cnsidered during safeguarding children supervisin. Similarly, when the child is the patient, the risk t the child as well as t ther children must be explred. These issues shuld be rutinely enquired abut and addressed in supervisin/case discussin and frm part f the hlistic apprach t all patient care (adults and children). Supervisin discussin and any agreed utcme plans n specific cases must be dcumented in case ntes and integrated in t the apprpriate RIO pathways. Dcumentatin shuld be cntempraneus and shuld be as agreed between supervisee and supervisr. The team must be infrmed f the plan at the earliest pprtunity if the decisin was nt made at the team meeting. Supervisrs must be up t date with current safeguarding children legislatin, plicy and practice. They must have attended and be up t date with Trust safeguarding children mandatry training, including safeguarding children supervisin training. Supervisrs shuld fully understand their rles, respnsibilities and the scpe f their prfessinal discretin and authrity. Risks assciated with peer supervisin are recgnised and can include cllusin, avidance, delay and lack f prfessinal challenge: it is imprtant that supervisrs and supervisees are aware that such issues may arise during practice and within supervisin itself. Persnal issues and values may impact n safeguarding children practice. Supervisin shuld prvide an pprtunity fr frank discussin when these issues are identified, allwing fr reflectin and prfessinal challenge with a view t an utcme f safer practice and imprved utcmes fr the children and their families. If unsafe practice is identified by the supervisr but is nt acknwledged and addressed by the supervisee, apprpriate actin must be taken. Issues f unreslved unsafe practice shuld be explicitly discussed with the supervisee, if apprpriate t d s, befre taking utside the supervisry relatinship. Any issue that is seen t cmprmise safe practice r is f significant cncern shuld be prgressed thrugh the relevant channels, such as the relevant line manager r Executive lead In certain situatins, e.g., cncerns that a staff West Lndn Mental Health NHS Trust Page 30 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

31 member may pse a risk t children, such cncerns shuld nt rdinarily be discussed with the supervisee but advice sught as a first step. (Detailed guidance n what t d if an allegatin is made against a member f staff is given in appendix 8 f the Safeguarding Children Plicy C18). Safeguarding children cncerns in pregnancy The impact f the patients mental ill health n the unbrn and cncerns abut the patients capacity t safely and adequately parent when the baby is brn needs t be explred. An actin plan shuld be agreed including a decisin as t whether children s scial care shuld be infrmed s that a pre birth planning meeting can be cnvened. General questins fr inclusin in all supervisin Where the patient is an adult. 1. Is the patient a parent r carer r living with r in cntact with children? 2. What are the pssible implicatins, cncerns and impact f the adult s mental illhealth r behaviur n the child? 3. Are there any risks t the children r needs identified? 4. What actins have yu taken r d yu need t take? If risks r cncerns are identified then an actin plan needs t be agreed, implemented and escalated, when required. This shuld be recrded and signed by bth the supervisr and supervisee in the clinical case recrds as a change t the care plan and, if relevant, as a change t the risk management plan. The team must be infrmed f the plan at the earliest pprtunity if the decisin was nt made at the team meeting. When decisins are made nt t take actin r nt t share infrmatin, the issues and risk factrs shuld have been fully explred by the supervisr and supervisee. The decisin must be based n a full and thrugh discussin and analysis f the case, with the best interests f the child always being at the frefrnt f the prcess. The reasns must be fully dcumented. If a child is cnsidered t be suffering r at risk f suffering significant harm then a referral t children s scial care (and in sme instances the plice) must be dne immediately. Where the patient is a child. 1. D yu have any safeguarding cncerns abut the child (r ther children in the husehld/wider family netwrk). 2. Des the child pse a risk t ther children? 3. Des the child s specific circumstance lead t increased cncerns abut vulnerability, e.g., parental mental ill health, parental substance misuse, dmestic vilence, private fstering, unaccmpanied minrs, yung ffenders, children in gangs? 4. What actins have yu taken and what actins need t be taken t imprve the utcme fr the child? West Lndn Mental Health NHS Trust Page 31 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15

32 If risks r cncerns are identified then an actin plan needs t be agreed, implemented and escalated, when required. This shuld be recrded and signed by bth the supervisr and supervisee in the clinical case recrds as a change t the care plan and, if relevant, as a change t the risk management plan. The team must be infrmed f the plan at the earliest pprtunity if the decisin was nt made at the team meeting. When decisins are made nt t take actin r nt t share infrmatin, the issues and risk factrs must have been fully explred by the supervisr and supervisee. The decisin shuld be based n a full and thrugh discussin and analysis f the case, with the best interests f the child always being at the frefrnt f the prcess. The reasns must be fully dcumented. If a child is cnsidered t be suffering r at risk f suffering significant harm then a referral t children s scial care (and in sme instances the plice) must be dne immediately. West Lndn Mental Health NHS Trust Page 32 f 32 Plicy C16 Date f First Issue: June 2003 This is current versin C16/06 May 15