The establishment and value of peer group clinical supervision: A qualitative study of stakeholders' perspectives.

AIMS: Explore perspectives of steering group members and external clinical supervision facilitators of developing and establishing peer group clinical supervision. BACKGROUND: The climate of healthcare is complex which can lead to staff burnout and challenges to practice. Clinical supervision is suggested as an approach to managing and leadership of such complexities. DESIGN: Qualitative descriptive. METHODS: Focus group interviews with 19 members of the peer group clinical supervision steering groups and individual interviews with five external clinical supervision facilitators from the Western region of Ireland were conducted. Data analysis followed Elo and Kyngäs' content analysis method, involving preparation, organising and reporting, to extract meaning and identify patterns from the qualitative data collected. RESULTS: Developing peer group clinical supervision practice requires, clarity of purpose and function that address the pros and cons of clinical supervision. Organisational leadership is required to support and release staff for peer group clinical supervision and peer group clinical supervisors need to be credible and have a level of expertise in practice. When prepared and supported, the aspects of confidence, leadership, personal development and resilience develop. CONCLUSION: Peer group clinical supervisors need training and ongoing continual professional development for their role, scope of practice and responsibilities. Sustainability rests on staff awareness and familiarity with the purpose and format of peer group clinical supervision and the regularity of sessions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Peer group clinical supervision is a means of supporting improvement of patient care delivery while in parallel supporting personal and professional development of staff, building resilience in the workplace. IMPACT: This study explored the implementation of peer group clinical supervision for staff across nursing and midwifery disciplines. It found that implementing peer group clinical supervision had a positive impact on staff well-being and morality and on patient care delivery. These findings influence healthcare service providers in implementing peer group clinical supervision in a sustainable way enabling nurses to continue working in complex healthcare environments delivering safe person-centred care. REPORTING METHOD: The qualitative reporting guidelines Standards for Reporting Qualitative Research (SRQR) were followed. PATIENT OR PUBLIC CONTRIBUTION: Patient/public involvement was addressed in this study by staff, managers, planners, directors, leaders and educationalists being involved at all stages of the study (concept, design, analysis and reporting).

Operational nursing managers' experiences of clinical supervision at a Johannesburg Hospital.

BACKGROUND:  Clinical supervision is pivotal in supporting nurses in rendering quality, safe patient care. Therefore, it is essential to understand clinical supervision from operational nursing managers' context to define existing challenges and propose suitable recommendations. OBJECTIVES:  This study aimed to explore and describe operational nursing managers' experiences of clinical supervision within the context of an academic hospital in Gauteng province and propose evidence-based practice recommendations to improve patient safety and the quality of clinical supervision. METHOD:  An exploratory, sequential, mixed-method design was used and implemented over two phases to take advantage of the strengths of both the qualitative and quantitative research designs. Unstructured individual interviews were conducted to collect data in phase one, and an adapted Manchester Clinical Supervision Scale (MCSS) questionnaire was used to collect data in phase two. RESULTS:  Operational nursing managers work in stressful conditions and environments with a gross shortage of staff and tools of the trade while being expected to deliver high-quality and safe nursing care. Of the sampled respondents, 36% (n = 17) were dissatisfied with the supervision they received, while 64% (n = 30) were indifferent in the sense that they did not think it was adequate or inadequate. CONCLUSION:  Clinical supervisors should be trained and supported in clinical supervision, with regular workshops on interpersonal relations.Contribution: A clearer understanding of clinical supervision within the hospital context and evidence-based practice recommendations to improve patient safety and the quality of clinical supervision.

Mapping ward managers' core competencies using the Balanced Scorecard model.

BACKGROUND: Nurse ward managers have a crucial role in the effective functioning of hospital wards and in organising the work of the nursing team. The Balanced Scorecard model is a management framework that enables strategy to be translated into action by setting goals that lead to measurable outcomes. Few studies have used the Balanced Scorecard model to map the competencies of healthcare professionals. AIM: To use the Balanced Scorecard model to map the core competencies of nurse ward managers and determine relevant key performance areas (KPAs) and key performance indicators (KPIs). METHOD: This mixed-methods study was conducted in the surgical department of an Italian hospital using a qualitative and quantitative exploratory sequential approach. For the quantitative part, the authors asked a convenience sample of various clinical staff to rate a list of nine competencies in terms of their importance for the work of nurse ward managers. For the qualitative part, two focus group discussions were held with nurse ward managers. FINDINGS: Responses to the questionnaires showed that all nine competencies were important to respondents, with no statistically significant differences between roles. Findings from the focus group discussions broadly confirmed the relevance and importance of the nine competencies. Based on these findings, the authors formulated a strategic map of the nurse ward manager role, with core competencies and associated objectives mapped against the four dimensions of the Balanced Scorecard model. CONCLUSION: A strategic map of the nurse ward manager role informed by the Balanced Scorecard model can help measure nurse ward managers' performance and provide a benchmark for them to improve their competencies.

Impact of Evidence-Based Charge Nurse Education on Charge Nurse Skills and Nurse-Specific Metrics.

OBJECTIVE: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics. BACKGROUND: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience. METHODS: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program. RESULTS: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction. CONCLUSIONS: Interventions targeting frontline leaders positively impact CN performance.

Psychometric Testing of a Structured Assessment Instrument for Non-technical Skills (NANTS-no) for Use in Clinical Supervision of Student Nurse Anesthetists.

BACKGROUND: This study evaluated psychometric properties of a structured behavioral assessment instrument, Nurse Anaesthetists' Non-Technical Skills-Norway (NANTS-no). It estimated whether reliable assessments of nontechnical skills (NTS) could be made after taking part in a workshop. An additional objective was to evaluate the instrument's acceptability and usability. METHODS: An explorative design was used. Nurse anesthetists (n = 46) involved in clinical supervision attended a 6-hour workshop on NTS, then rated NTS in video-recorded simulated scenarios and completed a questionnaire. RESULTS: High reliability and dependability were estimated in this setting. Participants regarded the instrument as useful for clinical supervision of student nurse anesthetists (SNAs). CONCLUSIONS: Findings suggest that NANTS-no may be reliable for performing clinical assessments of SNAs and encouraging critical reflection. However, further research is needed to explore its use in clinical settings.

Factors influencing adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development: An integrative review.

WHAT IS KNOWN ON THE SUBJECT: CS was developed to give healthcare professionals a space to reflect, problem solve and recognise their own practice. It is different from managerial supervision as it is for the benefit of the individual staff member's personal and professional development firstly, but can potentially benefit the quality of care delivered by the organisation. There have been a range of problems associated with inpatient mental health nurses' engagement in CS and in experiencing the benefits of CS. This is concerning for the delivery of high quality care and the recruitment and retention of inpatient mental health nurses. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE: This paper explores and identifies factors influencing adequate and effective CS for inpatient mental health nurses' personal and professional development. It identifies 6 themes incorporating enablers and barriers for inpatient mental health nurses' CS which lead to practice recommendations for improvement. WHAT ARE THE IMPLICATIONS FOR PRACTICE: This paper advocates a needs analysis to improve access to CS for inpatient mental health nurses. This review specifically adds further knowledge relating to inpatient mental health nurses' engagement with CS which the application of the needs analysis could influence. ABSTRACT: Introduction Clinical supervision (CS) has been recognized as a reflective mechanism in inpatient mental health nursing practice; however, it remains unclear what adequate and effective supervision entails for inpatient mental health nurses. Aim To explore factors which influence adequate and effective clinical supervision for inpatient mental health nurses' personal and professional development. Method Whittemore and Knafl's model for ensuring rigour was utilized. This included stages to address problem identification, literature searching, data evaluation, data analysis and presentation. Seven electronic databases were searched with hand searching/Internet searching. Fourteen retrieved articles were selected and appraised using the Mixed Method Appraisal Tool (MMAT). The data extracted from the papers were analysed thematically. Results The review synthesis resulted in identifying six themes: (a) what makes CS effective; (b) reflection; (c) the facilitation of professional identity and knowledge through CS; (d) participation; (e) knowledge and understanding of CS; and (f) the facilitation of personal awareness and coping. Discussion This review adds further knowledge on the identification of effective CS for inpatient mental health nurses as a defined occupational healthcare group. Implications for practice A suggested needs analysis is presented to improve access to CS options with the aim of promoting effective CS and increased engagement.

The learning environment and supportive supervision promote learning and are based on the relationship between students and supervisors - A qualitative study.

During clinical education, teaching and supervision are essential. Teaching is a process intended to facilitate students' learning, and to lead and support the students in discovering knowledge by themselves. But, the understanding of learning is not only to understand the students' learning process but also to understand conditions that influence that process. Therefore the aim of this study was to identify what factors support students learning in the ambulance service from both the students' and supervisors' perspectives. An inductive qualitative study design with four group interviews and content analysis was used. One main theme was identified including the sub-themes; reflection in practice, preparations for clinical education, motivation to learn, mutual trust in students' abilities and contextual factors supporting learning Conclusion: Reflection, preparations, motivation, trust, sense of belonging in a community and the context are essential factors supporting undergraduate nursing students' learning. However, supervisors sometimes had a hard time reflecting, teaching and supporting learning about care and caring science. The lack of knowledge and/or interest about caring science among supervisors needs to be addressed in the ambulance service otherwise it will be difficult to support undergraduate nursing students' learning about caring skills.

Nursing students' perspective on a caring relationship in clinical supervision.

BACKGROUND: Nursing students spend approximately half of their time in clinical practice. It is important that clinical supervisors understand nursing students' path of learning and can support their growth and development during the different and multifaceted learning situations offered in the clinical-practice period. OBJECTIVE: Based on nursing students' perspective and rooted in the didactics of caring science, to examine how a learning and constructive caring relationship between nursing students and supervisors in clinical practice can be formed. DESIGN: Qualitative and quantitative concurrent triangulation design of mixed methods. METHODS: Focus group interviews with Finnish nursing students (n = 21) in the qualitative part of the study. In the quantitative part, a closed questionnaire with closed answers was analysed using descriptive statistics. The analysis process was conducted using inductive content analysis. ETHICAL CONSIDERATIONS: Ethical issues were considered throughout the research process according to ethical principles and scientific guidelines. Informed consent was obtained from the informants, confidentiality regarding the data material was guaranteed and quotations were anonymized. RESULTS: A caring relationship between nursing students and supervisors is based on mutual respect, the ethos of responsibility, motivation, willingness and professionalism. Dignity and a caring ethical approach, where nursing students feel they belong, are recognized, seen and heard enables learning and professional development. It is also significant that the supervisor's actions and reflections are ethically defensible, equal and protect nursing students from suffering and various power relationships in clinical practice. CONCLUSION: A good cooperative relationship and shared responsibility between the nurse education institution, which offers theory and prepares nursing students for the encounter with clinical practice and the healthcare organizations is crucial for enabling a caring relationship in clinical supervision.

Enhancing the quality of clinical supervision in nursing practice.

Clinical supervision has been an aspect of nursing practice in various forms for several years; however, it remains challenging to ensure its widespread implementation across healthcare organisations. There is an increasingly evident need for formalised support in nurses' busy practice settings, so it is important to improve the quality of clinical supervision in healthcare. This will also assist nurses in providing evidence of their continuing professional development as part of revalidation. This article provides an overview of clinical supervision, outlining its features and functions in healthcare practice. It includes three case studies related to group clinical supervision, discussing how this was implemented in each case and the various methods of group-working that were used.

Delineation of the Nursing Supervisor Role: A Pilot Study.

OBJECTIVE: The purpose of this study was to describe a sample of nursing supervisors and their work. BACKGROUND: The role of the nursing supervisor is not well understood. The supervisor population is poorly defined, as are their ideal academic preparation and work activities. METHODS: This study followed the American Nurses Credentialing Center® framework for role delineation studies. A convenience sample of 50 nursing supervisors from New Jersey was recruited to complete an online survey including demographic data and prioritization of work activities. RESULTS: Participants represented a homogeneous and aging workforce with diverse professional preparation. Exploratory factor analysis revealed 6 categories of nurse supervisor work including administrative presence, leadership liaison, patient safety and experience, patient care advocacy, throughput, and external response. Work activities were prioritized. CONCLUSIONS: Nurse supervisors prioritized responding to emergencies above all other responsibilities. This study should be replicated in a nationwide sample of nurse supervisors.

Describing Nurse Manager Role Preparation and Competency: Findings From a National Study.

OBJECTIVE: The aim of this study was to describe the role preparation and competency development of nurse managers. BACKGROUND: Approximately 70 000 nurses are retiring annually. This represents a significant loss of nursing leadership wisdom. Few systematic studies of nurse manager role preparation and competency development have been conducted. METHODS: An electronic survey was completed by a national sample of 647 nurse managers managing 964 patient care units in 54 hospitals. RESULTS: Findings suggest that nurse managers rate themselves as competent for the 1st 6 years as a nurse manager. They begin to reach proficiency by year 7. Experience had the strongest association with nurse manager competence, followed by graduate leadership education. CONCLUSIONS: Nurse executives need to evaluate the bench strength of their nursing leadership talent pool. They need to develop policies and strategies that promote nurse manager competence.

Levels of Innovativeness Among Nurse Leaders in Acute Care Hospitals.

OBJECTIVE: The purposes of the study were to describe levels of innovativeness in nurse executives, clinical directors, and nurse managers in acute care settings in the United States and to compare innovativeness between the groups. BACKGROUND: Nurse leaders must navigate the complex ever-changing landscape of healthcare. New strategies are necessary for managing resources and improving patient outcomes. METHODS: A survey was posted in the American Organization of Nurse Executives newsletter using the Scales for Measurement of Innovativeness to measure innovativeness. The sample included 137 nurse leaders in executive and management positions in acute care settings. RESULTS: The largest percentage of nurse leaders across all leadership roles fell into the innovativeness category of early majority. Of the total sample, only 2 individuals were categorized as innovators, and only 15 as early adopters. Fifty-one individuals were early majority; 49 were in the late majority; and 20 individuals were at the lowest category of innovativeness, that of laggards. Both nurse executives and clinical directors had significantly higher levels of innovativeness compared with nurse managers. Graduate-level education and certification were not associated with higher levels of innovativeness. CONCLUSIONS: Understanding the levels and components of innovativeness may assist nurse leaders to affect change in themselves and their organizations.

Managerial competencies of head nurses: a model and assessment tool.

Head nurses' performance plays an important role in the successful operation of hospitals. Identification and prioritisation of managerial competencies required for these supervisors and evaluation of their performance on this basis are necessary. This study aimed to provide a valid tool for assessing managerial competencies of hospital department head nurses. First, through literature review, Delphi technique and expert panel, a competency model was developed. Then using the analytic hierarchy process, competencies were weighted and prioritised. Finally, based on the model, an instrument was designed to measure the competencies of head nurses. Validity and reliability of the instrument was also checked. The proposed framework included 27 competencies categorised by four main managerial tasks: planning, organising, leadership and control. Findings revealed that the highest priority was given to strategic thinking (0.1221) and the lowest priority was given to evidence-based decision making (0.007). Based on impact score and content validity ratio results, the content validity of all questions has been proved. Furthermore through the use of a content validity index, 11 questions were omitted or modified. The study presents a valid and comprehensive model for assessing managerial competencies of hospital department head nurses in order to take an important step towards improving their performance.

Supervisory relationships in long-term care facilities: A comparative case study of two facilities using complexity science.

AIMS: This study aims to understand the factors that contribute to supervisory nurse performance in long-term care facilities. BACKGROUND: Long-term care facilities have been faced with staffing challenges and increasing resident care needs, resulting in suboptimal quality of care. Nursing leadership has been identified as a key factor in the provision of high-quality care. METHODS: The comparative case study employed a complexity science framework to compare two facilities. The facilities were chosen based on the level of perceived supervisory support staff received from their supervisors, and 10 participants were recruited from each facility at various levels of management and staff (n = 20). Data were collected in 2015 using semi-structured interviews. FINDINGS: The quality and quantity of supervisory relationships was central to shaping the effectiveness of the supervision. Effective supervisory support was characterized by frequent and high-quality supervisor-staff interactions. Effective nurse supervisors acknowledged self-organisation as beneficial, and worked in environments that encouraged fluidity of roles. CONCLUSIONS: The findings suggest that effective nurse supervisors and supervisory support fosters improved work environments and the staff's ability to respond to residents' needs in a timely, effective and compassionate manner. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers who provide effective supervisory support can improve the quality of care provided to their residents.

Validity and reliability of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T), Turkish version1.

OBJECTIVE: A methodological type of study was conducted for the purpose of investigating the validity and reliability of the Turkish version of the Clinical Learning Environment, Supervision and Nurse Teacher (CLES+T) evaluation scale of the clinical learning environment of students, clinical nurses, and educators. METHODS: Sample was comprised of 602 Turkish nursing students with clinical practice experience at the hospital. The CLES+T, developed by Saarikoski, was used for data collection. Language equivalency, internal consistency, item-total correlation, and structure validity were conducted within the scope of the validity and reliability study on the CLES +T scale. RESULTS: It was determined that item-total correlations of four items were lower than 0.30, and those items were removed from the scale as a result of item analysis. The Cronbach's alpha value of the scale was 0.93-0.99; item total point correlations of the scale varied between 0.45 and 0.66; six factors were identified in the CLES+T factor analysis study, with a total variance explained by these six factors of 64%. CONCLUSION: According to the findings of the research, the CLES+T Turkish version was found to be a valid and reliable scale, which can be used to evaluate satisfaction of nursing students with their clinical education in Turkey.

Factors Influencing New RNs' Supervisory Performance in Long-Term Care Facilities.

In long-term care facilities (LTCF), registered nurses (RNs) perform both clinical and supervisory roles as part of a team aiming to provide high-quality care to residents. The residents have several co-morbidities and complex care needs. Unfortunately, new RNs receive minimal preparation in gerontology and supervisory experience during their program, leading to low retention rates and affecting resident outcomes. This qualitative study explored factors that influence supervisory performance of new RNs in LTCF from the perspective of 24 participants from Ontario, Canada. Data were collected through individual interviews, followed by a directed content analysis. Three levels of influences were identified: personal influences, organizational influences, and external influences. Each level presented with sub-elements, further describing the factors that impact the supervisory performance of the new RN. To retain new RNs in LTC, organizations must provide additional gerontological education and mentoring for new RNs to flourish in their supervisory roles.