Monthly Archives: January 2013

What has social media been saying about clinical supervision this week?

At the beginning of December 2012 an “online newspaper” was created using a tool called – the weekly publication is called “The Clinical Supervision Digest“. The aim of the publication is to answer the question, “What has social media been saying about clinical supervision this week?” With that question answered, perhaps we can quickly, easily stay up to date with new information regarding clinical supervision.

The content of “The Clinical Supervision Digest” is automagically curated by bots that crawl through Twitter, Google+ and Facebook searching for the term “clinical supervision”. A little playfully, but also respectfully, I’ve also added “Brigid Proctor” as a Twitter search term as of 19/01/13. Using the technology, the search results are collated, formated, and then released every Thursday morning (Cairns, Australia time).

CSscreengrabThis style of publication certainly doesn’t have the same sort of cachet as a peer-reviewed journal or traditional paper-based publication, but it does have some advantages. Along with flushing-out newly released research articles about clinical supervision, it also uncovers opinion pieces, blogs,  online conversations, conference news and course information. In this, the information age, we don’t necessarily want to limit ourselves to academic papers alone – social media is a wonderfully effective way to share new findings quickly and broadly.

My perception is that the quality of the searches/the online newspaper has been getting better over the last six weeks. I assume (hope) that we who are using the newspaper are “teaching’ the bots (aka web crawlers) what we’re interested in. That is, I think (hope) that the bots see which articles we click the most each week, and have been modifying the search and collation functions to give us more of the same. If so, there is a delicious irony that a algorithm in a piece of software can inform and enhance the very human, very interpersonal activity of clinical supervision.

I wonder what our ancestors in clinical supervision would make of this; will robot-like web crawlers effectively become another part of the lineage of clinical supervision?

Maybe. Maybe not.

Either way, if you’re interested in staying up-to-date with information about clinical supervision, please consider subscribing to The Clinical Supervision Digest via this page. Subscription is free, and if you find the weekly updates useless or intrusive it’s quick and easy to unsubscribe.

Paul McNamara, 21st January 2013

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Post Script (aka my Lance Armstrong moment)

This post is an obvious companion piece to a previous post: What is social media saying about perinatal and infant mental health this week?

Yes, self-plagiarising is alive and well in tropical FNQ.

Social Media for Nurses: my ten step, slightly-ranty, version

9780826195883There’s been a new book released called Social Media for Nurses: Educating Practitioners and Patients in a Networked World. I have not read the book, so for all I know it’s the most enlightening piece of literature in the world, but finding-out about its existence did get me wondering – do nurses really need to read a 284 page book on using social media?

Asking such a question = running the risk of seeming like some ranting, permissive, anti-academia, anti-intellectual hack.

I am permissive, and can be a bit ranty and hack-like at times, but am neither anti-academia nor anti-intellectual. I just think a book talking about social media for nurses is less valuable than nurses acquiring first-hand experience observing and using social media.

Now I’ll take a big breath and argue my case.

See One. Do One. Teach One.

I remember as a first year student nurse giving an IM injection for the first time. Preparation included some didactic teaching about the process and physiology of asepsis, locating the appropriate injection site, and rationale for IM injections. We also had interactive tutorials about some of the do’s and don’ts of IM injections. Then we student nurses were directed to review the relevant policies and procedures in our training hospital. The final part of classroom-based teaching was when we had a chance to rehearse the physical skill/dexterity of giving an IM injection – using oranges, of all things.

This is how student nurse vodka-orange parties get started.

Anyway, all of that was useful background learning for the clinical environment. In most hospital wards administering medication via IM injection is an unremarkable, routine nursing task. Experienced nurses are usually very adept at the skills involved in IM injection preparation, administration and documentation. Generally speaking, it is only the novices (ie: patients unfamiliar with being unwell and new student nurses) who find IM injections intimidating. Student nurses move from novice to beginning practitioner in nursing skills through experiential education, which is often referred to as “See One, Do One, Teach One”.

So, as a capstone to the classroom education, as a student nurse I assisted and observed more experienced nurse colleagues give IM injections. Having picked-up a few extra tips and tricks, I then took the confidence-requiring, confidence-acquiring step of administering IM injections under close supervision by a senior nurse. Incidentally, I gave my first IM injection to a lady who had Portugese as her first language – on giving the injection she said something like, “Obrigado Paulo. Isso foi o mais suave procedimento indolor, que eu já encontrei. Você é uma enfermeira maravilhosa.”*

The final part of embedding the skill of giving IM injections is when I went from being the mentored to the mentor. If you ever want to learn something really well, you could do worse than aim to teach it really well.

If there is a 284 page book on giving IM injections I have not read it. If I did read it, it still would not have overcome the very necessary part of experiential learning – the “See One, Do One, Teach One.” part.

And so it is with social media.SoMeFlowchart

Social Media for Nurses in Ten Tweets

Yesterday, after I found-out about the book, I wondered out-loud (via Twitter, that is) about social media for nurses. Ten consecutive tweets were sent using the hashtags #SocialMediaForNurses and #see1do1teach1 – the Tweets are collated on Storify. The Tweet that started the thought train is also included – umm… that makes eleven tweets, but anyway…

Look, I’m not an expert in anything much, least of all social media. Even Mark Zuckerberg would need to be a bit cautious about calling himself a social media expert – Facebook did not exist before February 2004. Twitter didn’t exist before March 2006. We are all relatively new to social media, so only the brave amongst us claim the title “social media expert”. “Expert” usually implies both depth of knowledge and length of expertise; given the relative recency of social media, the former is in short supply, and the latter is all-but unavailable.

So, with that disclaimer in mind, here is my take on social media for nurses in ten tweets (with occasional elaboration):

1Additional Info. Learn by watching other nurses using social media in a professional capacity.

Not sure where to get started? You could do much worse than following nominees for 2012 Social Media Nurse of the Year, they each have their Twitter handles listed here. The nurse who created Social Media Nurse of the Year disqualified himself from being nominated. Be sure to follow Ian Miller via his impactednurse social media portfolio: Twitter, Facebook or Blog.

Another way to get involved is via Google+ – check-out a community there called Nurse+



3Additional Info. This includes all the usual stuff about patient confidentiality too.




Additional Info. Learning by mistakes will be part of learning social media. I’ll probably fall for taking troll-bait again when discussing something I feel strongly about, but my troll-radar is more refined than it used to be.


Additional Info. Those that do name their employer often add the disclaimer “views my own”. I am not sure why this is so. It is usually assumed that people are representing their own views, not their employer’s, when chatting via phone or email, so I’m not really sure why it would be considered different on Twitter/social media.

Anyway, just to clarify: although I was once an altar boy in a Catholic church, the views I express on social media do not represent the views of God, Jesus, The Pope, or other members of the Catholic clergy or congregation. Same goes for previous, current and future employers.


Additional Info. There might be exceptions to this rule if there is something positive, fun and noteworthy to Tweet about, eg: “Here is a photo of the prize-winning Christmas decorations on the Paeds ward” (no patients in photo).


Additional Info. Maybe this is true. As with bland hospital food, take this with a large pinch of salt. 😉


Additional Info. This is probably the best single bit of advice I can give. The risks of social media are commonly overstated by those who are not using it, feel threatened by it, or are trying to make a living out of it. For the rest of us, nurses or not, it’s a fun way to find and share information and interact with interesting people from all over the world.

What have I missed? What advice would you give to a SoMe newbie? Please feel free to add your suggestions in the comments section below.

Paul McNamara, 20th January 2013

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Author’s note

The lady who I administered my first IM injection to really was Portuguese, and she did say something in Portuguese after I gave the injection. However, judging from her grimace, I doubt very much that she said anything like the completely fabricated sentence in quotation marks above.

Nurturing the Nurturers

Lately I’ve been thinking a lot about how we nurture those who nurture: nurses and midwives especially. It’s a subject that has popped-up in a couple of journal articles, on social media (including my recent blog), and in conversations at work.

Before we think about nurturing nurses, let’s think about miners.

Believe it or not, the mining industry with its big burly blokey image has some valuable lessons in nurturing for us namby-pamby health industry types.

Pit Head Baths + Pit Head Time

Back about 100 years ago Welsh coal miners said to their bosses, “We work hard in your mines all day. We get sweaty and covered head to toe with coal dust from your coal mines. Then we go home and use our time, our bath, our laundry to get cleaned up. It’s a mess of your making, shouldn’t the daily cleanup be your expense?”

Then, as now, the mining industry bosses threw their collective hands in the air and said, “No! We can’t afford to do that! Your excessive demands will send us broke!”

So the miners went on strike.

And stayed on strike until, eventually, the mining companies installed pit head baths so miners could get cleaned-up and changed in the boss’s time, using the boss’s resources. It’s called “Pit Head Time”: it’s enshrined in award conditions for miners and pit head baths are just part of the infrastructure of mines.

Todd and Brandt clocking-off.

Todd and Brandt clocking-off.

Remember the Beaconsfield miners emerging clean and shiny after a fortnight underground? They clocked-off AFTER getting cleaned and changed. The infrastructure is in place – somewhere between the working part of the mine and the clocking-on/off area is a shower and change room – the pit head baths. The miners clock-off by moving their tag from the red “underground”  section of the board to the “safe” green area of the board. That’s how pit head time works – you clock-off after you’ve cleaned-up.

"Care for the Caretaker" generously shared by Kath Evans via Twitter:

“Care for the Caretaker” generously shared by Kath Evans via Twitter:

So what?

Nurses don’t usually get covered in coal dust.

Nurses do emotional labour.

Nurses get covered head to toe in the emotional experiences of people who are, very often, having the worst, most traumatic, day(s) in their life.

Shouldn’t nurses get cleaned-up on the boss’s time too?

Clinical Supervision

Clinical Supervision is the name given to the process of cleaning-up after doing emotional labour.

Clinical Supervision is a slightly clumsy name for it, because the word “supervision” implies scrutiny. Nurses are a bit thingy about scrutiny. Nursing was born in the church and raised by the military – it has shameful history of bombastic, bullying, bellowing scrutiny. Nursing and feminism (ie: the gender equality movement) have fought hard to overcome the worst of some very bad power imbalances. That’s why it’s understandable that some nurses are cautious about volunteering for something called “Clinical Supervision” without understanding it fully.

Clinical Supervision does go by some nom de plumes: “Supported Reflective Practice” and “Guided Reflective Practice” being the most common alternatives I’ve come across. Whatever the nomenclature, they each generally attend to the same task – assisting and supporting the clinician to reflect on their work, with the intent of keeping them and their practice safe.

ProctorCSBrigid Proctor is considered one of the rock stars of Clinical Supervision, mostly because she had the capacity to simply articulate the primary functions of Clinical Supervision.

The Formative Function of Clinical Supervision (learning) attends to developing skills, abilities and understandings through reflecting on clinical practice. We don’t know what we don’t know; sometimes it is only through reflecting on our work with a trusted colleague that we get a glimpse of some of our blind spots.

The Normative Function of Clinical Supervision (accountability) is concerned with maintaining the effectiveness and safety of the clinician. Sometimes we need a trusted colleague to prompt us to revisit clinical practice guidelines, policies, procedures and legislation as a way to make sure we’re working within expected norms in everyday practice.

The Restorative Function of Clinical Supervision (support) addresses the inevitable emotional response to the privilege, the frustrations, the joys, and the stresses of working in a caring, nurturing role. Sometimes it is only through discussing our work with a trusted colleague that we recognise the emotional effects of our work, and learn how to manage our reflex responses.

It is the restorative function of clinical supervision that I value the most. By (metaphorically) cleaning-up the dust and grime I get covered in doing emotional labour, I feel that I am being nurtured, sustained. By being nurtured in the workplace not only do I avoid spending my entire wage at Dan Murphy’s bottle shop as a maladaptive coping strategy, but it also equips me with the capacity to nurture others. some workplaces (mine included) there have been attempts made to make Clinical Supervision part of the infrastructure, just like the showers and change rooms the Beaconsfield miners used. If you’re interested in an example of what the infrastructure for assisting clean-up after emotional labour looks like, take a look at the Queensland Health (2009) Clinical Supervision Guidelines for Mental Health Services [PDF].

I know that many of my Nurse and Midwife colleagues don’t have this infrastructure available to them, and I can’t understand why. If it’s good enough for miners to have pit head baths and pit head time, surely it’s good enough for Nurses and Midwives to have Clinical Supervision.

Shouldn’t we be nurturing the nurturers?

Paul McNamara, 15th January 2013

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That Was Bloody Stressful! What’s Next?

It was 1998 when the decision was made to use comic sans and screen beans in this staff resource... the idea was to make a heavy subject accessible. Please don't judge me.

It was 1998 when the decision was made to use comic sans and screen beans in this staff resource… the idea was to make a heavy subject accessible. Please don’t judge me.

Gather around children, Uncle Paul has a story to tell…

No! Don’t run away! It’ll be quick, I promise!

Back in the late 1990s I was working as a Nurse Educator in Community Health – it was good to get back in touch with general nursing after a few years in mental health. One of the things that popped-up at the time was that some staff (both clinical and non-clinical) were getting pretty stressed-out at work, usually because of work-related stuff. My boss at the time was keen to tap-into my background in mental health to see if it was something we could address as an organisation.

Some of the nurses, indigenous health workers, admin officers and cleaners I chatted to at the time made it clear that they didn’t want to show their vulnerabilities to clients, colleagues or management for fear of being thought of as weak or unable to cope. Staff asked for information and support that could be accessed discretely, without it being necessary to disclose anything to anyone at work.

One nurse put it succinctly: “This place is bloody stressful. There’s no avoiding it. We know we’ll cop stress, we just don’t know what to do about it; about what comes next.”

That’s how the staff resource, That Was Bloody Stressful! What’s Next? was born. Since 1998 it has been on the workplace intranet. We told people how to find it, “Just search for ‘bloody stressful’ on QHEPS”, and asked that they pass the tip on to workmates. It has sometimes been used with general hospital patients too – feedback is that some patients find it validating to know that staff can relate, in part at least, to their experience of having a stress reaction after a traumatic event.

Over recent years information about the organisation’s employee assistance program has become much more visible and easy to access on the intranet; so much so that a dinky, amateurish, screen-bean & comic-sans laden little PDF with 10-year-old references probably isn’t really necessary anymore. Nevertheless, we made the decision a couple of months ago to keep it available because each month a dozen people or more search the organisation’s intranet using these key words: bloody stressful.

Here is what they find: BloodyStressful

Perhaps you’re wondering why, in 2013, I have decided to liberate this shabby-looking resource from the intranet to share with the internet. Well, nurses experiencing secondary traumatisation popped up as a topic in a Twitterchat last month, in a Google+ community a week ago, and again on Twitter this morning.

Nurses do emotional labour. Maybe we should pool our thoughts and resources about how best to manage the effects of this.

Paul McNamara, 4th January 2013

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Update: 7th April 2017

So as to include the recently launched Nurse & Midwife Support info, I’ve updated the “That Was Bloody Stressful! What’s Next?” PDF.

Access the 2017 version here: BloodyStressful2017

As an added bonus, the headline font has now been changed away from Comic Sans.