Tag Archives: clinical supervision

#WeNurses Twitter Chat re Communication and Compassion

On 21st December 2012 (Cairns time) nurses from the United Kingdom and Australia came together on Twitter using the #WeNurses hashtag. The planned Twitter chat was used to discuss issues raised by the much-publicised death of a nursing colleague – Jacintha Saldanha.

This curated version of the Twitter chat demonstrates nurses using social media in a constructive manner, and responding to the issues surrounding Jacintha’s passing with thoughtfulness and grace. This was in sharp contrast to the shrill, insensitive and ill-informed way the matter was discussed elsewhere on social media and in mainstream media in the UK and Australia.

I’ve used sub-headings in red to structure the chat as per the themes that emerged.

WordCloud created from the full transcript of the #WeNurses Twitter chat

Preliminary Information.
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Setting The Tone.
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Communication and Confidentiality.
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Individualising Communication & Confidentiality.
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WiFi for Hospital Patients.
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Compassion.
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Prank Call.
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Targeted Crisis Support.
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Clinical Supervision (aka Peer Supervision, aka Guided Reflective Practice).
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Supportive Workplaces.
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Preventative/Early-Intervention Resources.
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The 6Cs (Care, Compassion, Competence, Communication, Courage & Commitment).
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Integrating Defusing Emotions into Clinical Practice.
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Finishing-Up: Key Learnings.
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Farewells.
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Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/communication-and-compassion

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End Notes

This archive of Tweets relate directly to two blog posts I wrote at the time. If you’re interested in elaboration re the context at the time, please visit these pages:
Questions of Compassion meta4RN.com/questions-of-compassion
WeNurses: Communication and Compassion meta4RN.com/WeNurses

As always, please use the comments section below for any feedback/questions.

Paul McNamara, 3rd April 2018

Short URL: meta4RN.com/Chat

@WePublicHeath

For the week Monday 27th January to Sunday 2nd February 2014 I was able to use the @WePublicHealth Twitter handle, thanks to the generosity of Melissa Sweet (aka @croakeyblog).


Here’s what happened:

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Explanation

These Tweets were initially compiled using a social media aggregation tool called Storify
storify.com/meta4RN/wepublichealth

Unfortunately, Storify is shutting-down on 16 May 2018 and all content will be deleted.

I’m using my blog as a place to mimic/save the Storify pages I created and value.

End

 

A big shout-out to Melissa Sweet. I am very grateful to Melissa for inviting a mental health nurse to have a stint on @WePublicHealth.

Melissa is a rockstar of public health and health social media in Australia. If you’re not familiar with her work read-up about Melissa here, and “croakey“, the social journalism project of which she is the lead editor, here. More info re @WePublicHealth, the rotated curation Twitter account that Melissa coordinates, here.

As always, please use the comments section below for any feedback/questions.

Paul McNamara, 2nd April 2018

Short URL: meta4RN.com/WePublicHealth

First Thyself

First Thyself – Surviving Emotionally Taxing Work Environments

On 28th April 2017 I’ll be presenting a session at the Ausmed “Breaking Point: Ice & Methamphetamine Conference” in Cairns. More info about the conference here: https://www.ausmed.com.au/course/ice-methamphetamine#overview

The nature of nursing will mean that we are likely to be are exposed to a range of challenges.

Feeling unsafe, witnessing violence, tragedy and dealing with trauma are some examples.

This emotionally taxing environment can result in tension with colleagues, family and friends.

This session will begin day two of the conference by creating an opportunity to discuss the following:

What are the professional implications of working in challenging areas of nursing and healthcare?

How can we maintain unconditional positive regard?

Why self-care matters and how to practice what we preach!

What’s all this then?

“First Thyself” is planned as an interactive session accompanied by visual cues to give the discussion a bit of structure. Consequently, the transcript/dialogue of the presentation can not be included here.  The visual presentation itself doesn’t use powerpoint slides. It uses the prettier (and free!) platform Prezi instead: prezi.com/skmu0lbnmkm5/first-thyself/#

This page serves as a one-stop directory to the online resources used to support the discussion.

I’m recycling and combining a lot of old ideas for the session (there’s that self-plagiarist vs groovy remix of favourite old songs thing again).

Here is the online presentation: Prezi

Here are the resources and references used in the presentation:

Emotional Aftershocks (the story of Fire Extinguisher Guy & Nursing Ring Theory) meta4RN.com/aftershocks

Football, Nursing and Clinical Supervision (re validating protected time for reflection and skill rehearsal) meta4RN.com/footy

Hand Hygiene and Mindful Moments (re insitu self-care strategies) meta4RN.com/hygiene

Lalochezia (getting sweary doesn’t necessarily mean getting abusive) meta4RN.com/lalochezia

Nurse & Midwife Support nmsupport.org.au  phone 1800 667 877
– we have specifically targeted 24/7 confidential support available

Nurses, Midwives, Medical Practitioners, Suicide and Stigma (re the alarming toll of those who undertake emotional labour) meta4RN.com/stigma

Nurturing the Nurturers (the Pit Head Baths and clinical supervision stories) meta4RN.com/nurturers

Spector, P., Zhiqing, Z. & Che, X. (2014) Nurse exposure to physical and nonphysical violence, bullying, and sexual harassment: A quantitative review. International Journal of Nursing Studies. Vol 50(1), pp 72-84. www.sciencedirect.com/science/article/pii/S0020748913000357

Zero Tolerance for Zero Tolerance (a reframing of reducing aggression) meta4RN.com/zero

It’s OK if you forget everything about today’s talk, just don’t forget that there is 24 hour support available via 1800 667 877 or https://nmsupport.org.au

End

Please have a play with the pretty Prezi prezi.com/skmu0lbnmkm5/first-thyself/#

Thanks for visiting. As always your comments are welcome.

Paul McNamara, 30 March 2017

Short URL: meta4RN.com/thyself

 

 

Nurses, Midwives, Medical Practitioners, Suicide and Stigma

Trigger Alert – this blog contains info re suicide which may be unsettling for some people.

Alarming Data

Click to enlarge. To keep the data handy, save the image to your phone.

Click to enlarge. To keep the data handy, save the image to your phone.

A retrospective study into suicide in Australia from 2001 to 2012 uncovered these alarming four findings:

Female Medical Professionals 128% more likely to suicide than females in other occupations
(6.4 per 100,000 vs 2.8 per 100.000)

Female Nurses & Midwives 192% more likely to suicide than females in other occupations
(8.2 per 100,000 vs 2.8 per 100.000)

Male Nurses & Midwives 52% more likely to suicide than males in other occupations
(22.7 per 100,000 vs 14.9 per 100.000)

Male Nurses & Midwives 196% more likely to suicide than their female colleagues
(22.7 per 100,000 vs 8.2 per 100.000)

Data source: Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

Suicide is a complex matter that does not lend itself to easy understanding or simple solutions. However, something we know about health professionals is that they know that there are mental health services and supports. Health professionals know that these services can be accessed by people who who are feeling suicidal. The data suggests that health professionals have an actual or perceived barrier to accessing these existing supports. I wonder what that barrier is.

Stigma?

Could it be that nurses, midwives and medical professionals suicide at a greater rate than the other occupations because of actual or perceived stigma? We have the peculiar privilege of providing care for strangers who are/have been suicidal, but perhaps we aren’t so good at extending that nurturing care to ourselves and each other.

I have a suggestion for health professionals. If you ever come across a colleague who says something derogatory or stigmatising about a person experiencing mental health problems or suicidality, politely show them the data,. Save the chart above to your phone and show them that suicide is a bigger problem for nurses, midwives and female medical professionals than it is for people in other occupations. Say something like, “Suicide is an important issue for our colleagues too. Let’s both care for this patient like we would like to be cared for.”

You’re very welcome to share the chart above or this blog post with your colleagues – the short URL is https://meta4RN.com/stigma

There’s also a PDF version of the chart here: stigma

Hopefully, sometime down the track, the data will result in targeted support for the prevention of suicide by health professionals. However, we need not wait for our political masters, health bureaucracies and professional organisations before we walk-the-walk and talk-the-talk of fighting stigma.

If we see mental health/suicide stigma we should address it on the spot.

In the words of Lieutenant General David Morrison, “The standard you walk past, is the standard you accept.” As the data shows, it is dangerous for nurses, midwives, medical professionals and other health professionals to accept stigma.

alarmingdata

Support

It’s important to acknowledge that talking and thinking about suicide can be distressing. People in Australia can access support via:

Lifeline – 13 11 14

Suicide Call Back Service – 1300 659 467

MindHealthConnect www.mindhealthconnect.org.au

phone_hotline-40Outside of Australia and not sure where to get support? Google usually displays a red telephone icon and your country’s suicide support phone number when searching for a suicide-related topic.

End

That’s it. As always your comments are welcome in the section below.

Paul McNamara, 26th September 2016

The short URL for this page is https://meta4RN.com/stigma

Just in case you missed it above, here’s the original paper citation and link:
Milner, A.J., Maheen, H., Bismark, M.M., & Spittal, M.J. (2016) Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012. Medical Journal of Australia 205 (6): 260-265

The Last 40-Odd Weeks

This blog post has one purpose only.

It is to explain why I have been so uncharacteristically vague, and often distracted, for the last 40-odd weeks.

During that time many dozens of people (most of them uni students, but also friends, family and colleagues) have asked this question: “Are you still teaching at the uni?” My wishy-washy responses have been along these lines:
“Hopefully!”
“I’m not sure.”
or the hilariously inaccurate “Ask me again in a couple of weeks.”

FullSizeRender copy

Let me explain/elaborate by using a timeline:

1995: Started working for the health department full-time [see LinkedIn]

1996: Started working for the uni temporarily/part-time – an arrangement that continues sporadically over the years that follow [see LinkedIn]

May 2015: I’m working at the uni. Casual chat between senior uni colleague and I. Outcome = let’s think about the possibility of a shared position between the uni and the health department. There would be some benefits to both organisations. It’d be a pretty cool gig, I reckon.

June 2015: Senior uni colleague says “let’s do it!”. A meeting is held between senior uni colleague and a senior health department colleague. Verbal agreement established. The uni sends a contract to the health department. The first draft of the role description is drawn up by the uni and sent to the health department. The contract and position description cite an October 2015 start date.

July 2015: I’m back at the health department. I make sure that people who need to know about the new position coming know, and offer to help progress things along if I can. Funding’s an issue, of course, but there should be a way…

August 2015: I make occasional enquiries. Bureaucracies need processes and time. Be patient.

September 2015: More enquiries. It’s all about the paper-trail, funding, signatures. Be patient.

October 2015: My enquiries must be getting a bit too shrill. Emails are not answered. Phone calls are not returned. The intended start-date for the position passes.

November 2015: I’m getting anxious about the delayed start not leaving enough time for 2016 subject preparation. I start pulling on the very few levers that are available to me: someone who knows someone who knows someone will look into it. I rescheduled my December flights: if I happen to get this job I won’t have time to go to Japan in December. The teaching starts in January, and there needs to be subject preparation.

December 2015: The position is advertised. Yay!
My request for consideration of transfer at level so as to expedite the position starting in a timely manner is declined. Bugger.
I send in my application and hope for the best.

8th January 2016: Interviewed for the position. I was phoned after the interview and offered a 3 month secondment into the position. That’s weird. It’s funded for 5 years. I ask to think about it over the weekend.

8th-10th January 2016:  Consult with my wife and trusted friends. Consensus is that if I’m good enough to do the job for 3 months, it’s weird that I’m not good enough to do the job for the term of the contract. I find myself thinking of the refrain from Bob Dylan’s Ballad of a Thin Man:
Because something is happening here
But you don’t know what it is
Do you, Mister Jones?

11th January 2016: “Thank you very much for offering me a 3 month position. However, I applied for a 5 year position. I can only commit to the position if the organisation commits to me.” Nice try Paul. “We’ll let you know when we schedule another interview.”

18th January 2016: The uni teaching period starts. The subject is underway without the position being filled.

2nd February 2016: Interviewed for the position again.

2nd February – 31st March 2016: I hear nothing at all officially. Other people do. It makes its way along the health department grapevine that someone else has been successful. One of those whispers reaches me via a convoluted track. I’m disappointed, of course, but not surprised. Silence is the polar opposite of someone enthusiastically saying, “Congrats! We reckon you’ll be great! When can you start?”

1st April 2016 (no, not joking): An email from noreply@smartjobs.qld.gov.au that says “I wish to advise that on this occasion you have not been successful in obtaining the position.”

So that’s it.

I can drop the vague, unknowing responses to enquiries now. It’s a relief to know. It’s a relief to be able to be open and transparent again. I didn’t get the job that I was hoping for. Yes, of course I am disappointed. However, I am totally accepting of the obvious fact that there was another candidate for the position who is better credentialed, better prepared and/or more meritorious for the role.

Ricky Ponting wouldn’t feel bad if somebody said Don Bradman was a better cricketer than him. Same-same, but different. Not that I’m the Ricky Ponting of mental health nurse education. More like Boof Lehmann, I reckon. 🙂

I am disappointed by how long the whole recruiting process took. The uni sent the contract and position description to the health department in June 2015. It’s taken the health department until April 2016 to fill the position. That’s longer than a human pregnancy.

IMG_7564

Despite being there for the courtship, conception and gestation, I now know it’s not my baby.

The other lesson I’ve taken from this is to cautiously self-monitor my behaviour at work (I’m a mental health nurse in a general hospital ). In clinical supervision we recognise that there are parallel processes: how a nurse treats a patient can be influenced by how the organisation treats the nurse. It is prudent that I be especially intentional and vigilant to treat my patients in a timely manner, and with the kindness and respect they deserve.

The last 40-odd weeks have been odd. Sorry about all my distractibility and wishy-washy responses to questions during that time. I hope this timeline/blog post explains it all.

End

That’s it. Thanks for reading.

Paul McNamara, 3rd April 2016

Short URL: http://meta4RN.com/40weeks

Crisis? What Crisis?

I’m a nurse. Every day at work somebody is in crisis.

Every. Single. Day.

People have life threatening injuries and illnesses. People experience suicidal ideation and sometimes act on those thoughts. People experience delirium, dementia and psychosis – they lose touch with reality. People behave in unexpected and challenging ways.

All of these people are in crisis. They are having the worst day(s) of their life.

When you are part of the clinical team trying to help out these people it’s always useful to acknowledge and clarify the nature of the person’s crisis. It’s surprising what the individual’s perception of the crisis is. I’ve met a person who was desperately unwell – ICU unwell – who’s subjective crisis was that the cat was home alone without anyone to feed it. That was the crisis she wanted me to respond to. I’ve met quite a few people who need urgent medical/surgical interventions, but who perceive their biggest crisis as being unable to smoke a cigarette right now. I’ve had the peculiar privilege of spending time with people who have survived suicide attempts, who have experienced a crisis related to abuse, financial problems, relationship breakdown, and loss of job/role/independence/sense-of-self. An existential crisis in mind, body and spirit.

All of these people are in crisis. It is their crisis.

It is important to ascribe ownership. The nurse/midwife/physician/other clinician is not experiencing the crisis; they are responding to the crisis. We (the clinicians) have not been immunised against crises, but we do have the responsibility to do whatever we can to not get overwhelmed by them. Also, truth of the matter is, I’m not sure how long you would last if you responded to every day at work as an adrenaline-filled, too-busy-to-wee, emotional rollercoaster. That be the road to burnout and breakdown, my friend.

So, what do we do?

We use Jedi Mind Tricks, pithy sayings and clinical supervision. That’s what we do.

Clinical Supervision
I’ve written about clinical supervision before (here and here). Despite the name, it’s not about scrutiny. Clinical supervision is about reflecting on clinical practice with a trusted colleague, and asking simple questions of yourself: what did I do?; what were the outcomes?; how did I feel?; what lessons did I learn?.

The idea of clinical supervision is to acquire and refine clinical skills.

Pithy Sayings
A lot of us use and repeat pithy sayings such as the ED adage: “In the event of a cardiac arrest [or any other patient crisis for that matter], the first pulse you should take is your own.”

If you recognise your own anxiety you’re more capable of managing it. Intentional slow breathing is an excellent intervention for this. You can do it while you’re scanning the patient/file/environment.

Breath. Slowly.

It is not a crisis. A crisis is when there’s a fire, storm-surge, tsunami, earthquake or explosion that requires evacuation of staff and patients. If the hospital is not being evacuated it’s not a crisis. It’s just another day at work.

IMG_1099

Jedi Mind Tricks
The other thing I like to do when feeling anxious is impersonate a calm person. It’s like a Jedi mind trick. “This not the anxious nurse you’re looking for. This is a calm nurse.”

When impersonating a calm person  I conjure-up a person who was a CNC when I was a student nurse at the Royal Adelaide Hospital. Part of the apprenticeship model of nursing education at the time was to give students experience in RN roles. I had been thrown into the Team Leader role on a day when the neuro ward was especially busy. There were emergency admissions, a stack of post-op patients – two of whom were really unwell, a person dying in the side room, and an inexperienced unqualified overwhelmed drongo (me) coordinating the whole thing. We were in trouble. We needed more nurses and a proper team leader.

I sought-out the CNC – a smart-as-a-whip young woman not much older than me (i was quite youngish 25 years ago). The CNC spent all of about 5 minutes with me prioritising the ward’s workflow:

  • “First things first. No need to shower/clean anyone unless they’re incontinent.” There goes about 50% of the morning’s workload in an instant.
  • “Don’t bother with routine 4-hourly obs unless the person looks unwell. Only the post-op patients and the clinically unwell patients need their obs done.” There goes another 10% of the work.
  • “Let’s get Fiona (the most experienced and skilled nurse on the shift) to look after the two dodgy post-op patients and nobody else.” The biggest concern was instantly taken care of.
  • “Bring all the nurses in here (a cramped nurses station overlooking 2 bays of 6 patients each) and tell them the plan. Make sure they all drink water and coordinate their breaks.” Got it. To look after the patients you need to look after the nurses.
  • “After you’ve told the nurses the plan, tell the patients/visitors who aren’t critically unwell the plan. They’ll understand we’re abnormally busy if we tell them.” Open, honest communication? Who’d have thought?
  • “Slow down your breathing. Use your humour. You’ll be fine. Come and grab me if you need.” My racing thoughts slowed. Panic evaporated.

We, nurses and patients alike, had a good shift. All the vital stuff was done. It wasn’t a crisis. It was a day at work.

I haven’t seen that CNC (her name is Lee Madden) since 1992, but I think of her every now and then. Whenever I see a crisis unfolding or see/feel anxiety rising, I wonder, “What would a calm person do?” and conjure an image of Lee floating serenely into the space. I channel Lee’s reassuring smile and clear understanding of priorities, and do my best to behave in the way she modelled to an impressionable overwhelmed student nurse.

Crisis? What crisis? I’m impersonating a calm person.

IMG_1098

End

As always, you’re welcome to leave comments below.

Paul McNamara, 5th September 2015
Short URL: meta4RN.com/crisis

Sample Clinical Supervision Agreement

During the week I co-facilitated three days of workshops about Clinical Supervision with Paul Bailey, Clinical Supervision Program Coordinator, Queensland Centre of Mental Health Learning (QCMHL). As with other workshops I’ve had the pleasure of co-facilitating with Paul, it was an immersive learning experience that inspired, exhausted, and uplifted participants and facilitators alike.

QCMHLAmongst the many factors of the art and craft of clinical supervision discussed at the workshop was the importance of negotiating and documenting a sound Clinical Supervision Agreement. The agreement is what defines the doing of clinical supervision. It acts as an anchor to stop the supervisee, supervisor or the supervision relationship drifting aimlessly.

Examples of clinical supervision templates are available via QCMHL’s Clinical Supervision Resource Centre for Mental Health Services, the Australian College of Mental Health Nurses and elsewhere on the internet.

With the consent of the excellent Clinical Supervisor I have had the privilege and pleasure of working with over the last five years, on this webpage I am adding another version to those examples that already exist. This version is more detailed than most. For a period of time I was employed a couple of days a week as Nursing Professional Leader: Clinical Supervision (more about that on my LinkedIn page). The purpose of the role was to promote and, as much as possible, embed clinical supervision into mental health nursing practice in my local health service.

ACMHNCSAs a way to increase understanding of the process of clinical supervision I wrote an agreement that is.. umm… thorough. Actually, I think the agreement is probably over-inclusive for the needs of most people, especially if they are beginning supervises or supervisors. However, I was in a role that included the responsibility to educate, and encourage and model best practice, so tried to consider most of the factors of a “good” clinical supervision agreement.

I now offer this detailed version to the internets. Please do not consider this to be a template for what a Clinical Supervision Agreement should look like, however it may be useful as a sample for you to use and adapt as you see fit.

Anyway, with no further ado, here it is as a Microsoft Word document:

Sample Clinical Supervision Agreement in WordSampleClinicalSupervisionAgreement

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and, as PDF:

Sample Clinical Supervision Agreement as PDFSampleClinicalSupervisionAgreement

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and, for those who are paranoid careful about following the links above, here is the de-identified content of my Sample Clinical Supervision Agreement:

Clinical Supervision Agreement

  • Supervisee: [name and role/team]
  • Supervisor: [name and role/team]
  • Period of this Agreement:  [start date] to [end date]

The content/structure of this Clinical Supervision Agreement is adapted from Clinical Supervision Guidelines for Mental Health Services (Queensland Health, October 2009, p. 22) & the sample agreements made available in the Queensland Centre of Mental Health Learning (QCMHL) Supervisor’s Toolkit (2009, pp. 14-20).

Objectives

  • Supervisee
    • Restorative
      • To discuss clinical scenarios that I have faced, in a manner that is supportive and constructive.
      • To reflect on my responses to the challenges & issues I face in clinical practice.
      • To reflect on my responses to the challenges & issues I face in providing clinical supervision.
      • To identify counter-transference and prevent it from impairing my ability to work safely.
    • Formative
      • To improve skills and knowledge in delivering clinical services.
      • To improve skills and knowledge in the practice of providing education.
      • To improve skills and knowledge in the art and craft of clinical supervision.
    • Normative
      • To stay orientated to best-practice by checking adherence to Clinical Supervision Guidelines for Mental Health Services (Queensland Health, October 2009).
      • To ensure that my clinical practice & clinical supervision roles are each performed within the boundaries of best practice as determined by the Mental Health Act, Nursing & Midwifery Board of Australia and Queensland Health codes & policies.
  • Supervisor
    • To assist the Supervisee meet their objectives.

Expected Outcomes

  • Supervisee
    • Over the course of this agreement these outcomes will be met:
      • Restorative
        • To have discussed 4 or more clinical scenarios that I have faced, in a manner that is supportive and constructive.
        • To have reflected on my responses to the challenges & issues I face in 4 or more instances of clinical practice.
        • On 4 or more occasions, to have reflected on my responses to the challenges & issues I face in providing clinical supervision.
        • On 4 or more occasions explore counter-transference and the impact it has on my ability to work safely.
      • Formative
        • To have provided quality clinical practice for the majority of clients I have been referred.
        • To recognise occasions when my clinical practice has been below-par, and attempt to redress the underlying cause(s) of this.
        • To have provided quality education sessions.
        • To have provided quality clinical supervision.
      • Normative
        • That my clinical supervision be informed by the best-practice Clinical Supervision Guidelines for Mental Health Services (Queensland Health, October 2009).
        • That my clinical practice & clinical supervision role have been performed within the boundaries of best practice as determined by the Mental Health Act, Queensland Nursing Council policies and Queensland Health codes & policies.
    • Supervisor
      • By reflecting well on the goals Paul and I have agreed upon, he will have improved and consolidated his competency, his capability and his capacity in his mental health nursing role as well as making the transition with greater confidence into his role in clinical supervision. We will measure the progress through our regular reviews within supervision.

Obligations

  • Supervisee
    • Demonstrate the value placed on clinical supervision by quarantining the time set-aside for clinical supervision from other appointments & interruptions.
  • Supervisor
    • To set aside sufficient time before meeting with Supervisee to ready myself for quality reflection with him by disengaging from other commitments.

How will dual roles (eg: workshop co-facilitators, colleagues) be managed

  • Performance & planning issues regarding the work we do together will not be discussed in clinical supervision unless there is mutual consent. This will require inclusion in a pre-agreed session agenda.
  • We have had some experience in managing dual roles on occasions over the last three years; it is expected that the mutual respect we have established will continue to inform how and when boundaries are drawn and shaped.

Structure

  • Frequency
    •  Every month, with a degree of flexibility that allow for the vagaries of each other’s holidays & other work commitments.
  • Duration
    • 50-60 minutes
  • Location
    • Primarily via phone.
    • When we’re both in the same town/area we will endeavour to schedule an opportunistic face-to-face supervision session.
  • Resources
    • Quarantined time & venue, with an absence of interruptions.
    • Access to telephones.
    • Access to emails in the days leading up to sessions.
  • Cancellation
    • The nature of mental health work is such that it is common for a consumer or the workplace to be in crisis.
    • A busy day or busy week is not an adequate reason to cancel clinical supervision; in fact the more common the crisis the greater the indication for clinical supervision.
    • Consequently, for the purposes of this agreement, a crisis that warrants cancellation of a clinical supervision would be of the scale where there is a fire in the workplace requiring evacuation of staff and patients.
    • Given this definition, cancellation of clinical supervision will be a rare event.
  • Preparation
    • Phone number for Supervisee/Supervisor to dial to be confirmed by email.
    • Other preparation (eg: reading journal article, preparing sample reports and documentation) as negotiated.
  • Agenda
    • Supervisee to set a simple agenda & email this to Supervisor a day or two prior to each session.
    • The Supervisor may add to &/or adjust the agenda.
  • Availability between Sessions
    • Usually by email only.
    • Phone availability may be able to be negotiated if it is mutually convenient to do so, but this is expected to be in exceptional circumstances only.
  • Is supervisee currently receiving other supervision?
    • Yes, with a Nursing colleague [named here]
  • If yes, how will different forms of supervision be integrated?
    • The goals of this supervision agreement relate primarily, but not exclusively, to clinical practice and clinical supervision.
    • The goals of the other supervision agreement relate primarily, but not exclusively, to cross-cultural issues and pseudo-team leader tasks.
    • Consequently, it expected that each form of clinical supervision will have areas that overlap a little, but are primarily focused on different components/roles.

Evaluation

  • What is the agreed process for evaluating Clinical Supervision?
    • Each Session
      • Wrap-up discussion at the end of session to include a mutual check between Supervisor and Supervisee whether the goals of supervision are being adequately addressed.
      • If the Supervision relationship itself is causing problems, the Supervisor and/or Supervisee will ensure that this matter is included on the agenda for the next session.
    • Every 12 Months
      • Formal mutual evaluation of supervision will be conducted using this Clinical Supervision Agreement:
        • Are the objectives/outcomes being met?
        • Should the agreement/objectives be modified?
      • and the Supervisor Workbook:
        • EPSI (Evaluation Process within Supervision Inventory)
        • SWAI (Supervisory Working Alliance Inventory)

Review of Supervision Agreement

  • The agreement should be reviewed if the objectives, expected outcomes, obligations, or structure of clinical supervision change.
  • Mutual review a month prior to the end-date of this agreement to allow time for extension or conclusion of the agreement & the supervisory relationship.

Documentation/Records

  • What form will supervision records take?
    • Agendas will be simple emails (see “Structure” above).
    • As per attached “Clinical Supervision Record”, themes of the session will be recorded as numbers & brief comments will be made as required.
    • It is understood that notes regarding supervision will be more extensive and detailed if there are concerns about clinical competence/client safety. This will be done in a transparent manner where both Supervisee and Supervisor will have access to the clinical supervision record.
  • How will these supervision records be used?
    • To assist the Supervisee & Supervisor reflect on their work.
    • As an adjunct to the Clinical Supervision Evaluation process.
    • As a record of Clinical Supervision.
  • Who will have access to them and in what circumstances?
    • Under usual circumstances:
      • Supervisee
      • Supervisor
    • When there are concerns about clinical competence/client safety:
      • Line Management. This will be done in a transparent manner where both Supervisee and Supervisor are fully informed of the rationale.
  • Where will the records be stored?
    • On the Supervisee’s password protected Queensland Health drive/server (as per filepath of this document – see footer).
  • Duration of Storage.
    • 7 years
  • What records will be used/provided for performance purposes (eg. That practice supervision has occurred)?
    • The Clinical Supervision Record (copy attached).

Ethical Issues

  • How will difficulties in supervision be dealt with?
    • Difficulties in supervision initially to be discussed between supervisor and supervisee either at the time an issue arises or at the commencement of the next meeting.
  • What if the supervision relationship completely breaks down?
    • If the supervision relationship breaks down completely a third party will be invited to assist.  If relates to an operational matter should be the team leader or if of a professional matter then utilising a senior staff member.  If all other options explored and unable to resolve then utilise HRM or EAS.
  • What do your professional code and organisational policies outline as ethical conduct in and for supervision?
    • The Queensland Health ‘Clinical Guidelines for Mental Health Services’ (October 2009) serves as our reference tool regarding ethical conduct in. The guidelines describe the principles of choice, flexibility & confidentiality as being central to best practice in Clinical Supervision.
  • In general, which issues raised in supervision will be kept confidential to this relationship
    • Any matter that is personal to the Supervisee or about any patient he discusses, except if there are serious concerns about safety or competency. Pages 25 – 27 of the Queensland Health ‘Clinical Guidelines for Mental Health Services’ (October 2009) describe the circumstances & process for taking matters outside of the Clinical Supervision relationship.
  • Which aspects may be discussed and with whom?
    • It is acknowledged that the Supervisor will develop a unique insight into the Supervisee’s reflective learning and ethical practice. Consequently, the Supervisee may request that the Supervisor act a referee for future performance appraisals and/or employment opportunities. The Supervisee will discuss this with the Supervisee prior to nomination.
  • Content
    • The content of Clinical Supervision will be negotiated in confidence by The Supervisee and Supervisor. It will include a list of the knowledge and skills that the Supervisee would like to develop, and will be regularly reviewed and renegotiated.

Signatures & Date

  • Supervisee:
  • Supervisor:
  • Supervisee’s Line Manager:

That’s It

This is a long, detailed Clinical Supervision Agreement. I do not present it as a template of what everyone should be doing, but as a sample of some of the content that such an agreement could include. I hope I haven’t scared anyone off clinical supervision with the length/detail of this agreement – clinical supervision is too important.

Clinical supervision allows us clinicians safe, regular and purposeful guided reflective practice to keep us and our patients safe – I’ve spoken about this before here and here.

As always, comments/feedback are welcome.

Paul McNamara, 13th September 2014

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