Chapter 42: Clinical supervision in mental health care
Case Study: Student nurse to staff nurse
Kim is a newly qualified staff nurse who is working on an acute mental health ward and is near to completing her preceptorship programme. She acknowledges that she still has much to learn and is finding the transition from student nurse to staff nurse to be much harder than she had anticipated. Whilst a student nurse she valued the ability to always refer to her mentor or one of the qualified members of staff. Now, despite all good efforts to avoid this, she often finds herself as the only ’regular’ qualified member of staff on shift , the others being agency nurses with limited knowledge of the ward, the protocols and the needs of the service users. You are her supervisor. Today she started her session with ‘I don’t know how much longer I can keep doing this job … it’s all I ever wanted to do. My dad got admitted to one of these wards when I was a little girl, it was awful; all I want to do make sure that no other person or family has the experience that he had. I truly want to make a difference, but I havent got the strength … it’s just too hard.’ She is near to tears. You as a supervisor have the task to help her make the use of the 60 precious minutes that you have with her.
What are your priorities?
Please consider the structure for supervision, provided in Chapter 42:
- Name the issue
For Kim, the priority has got to be to reduce her distress, to help her formulate the issue for clinical supervision. So, assuming that she trusts you and feels safe with you, take the time to let her express herself as much as she needs to, which may mean a tolerance of emotional expression, and then regain her composure.
Then, and only then, ask Kim to name the main issues [it could be a raft of things. DO NOT MAKE ANY ASSUMPTIONS. For example:
- the transition from student to staff nurse.
- working with agency nurses.
- remembering her dad.
- remembering her experience as a child.
- her sense of incapability.
- her exhaustion;.
- concerns re ‘passing’ her preceptorship.
Let her state it. You could be surprised. Let her take control. It is her supervision.]
2. Exploring and clarifying
Once the issue is stated, help Kim to describe it. Use exploratory skills such as probing, summarising and clarifying to help her describe her difficulty. This, in itself, will be meaningful and helpful.
3. Finding a route through
Help Kim to find her own way through using coaching questions to enable her to create SMART1 goals and ways of addressing her struggles with positive and goal-centred activity which is realistic and achievable
4. Round up and record
It’s important to keep an eye on the time. Rounding up takes at least 10 minutes. Don’t underestimate this. Get her to complete her supervision record in the meeting, in bullet point form (this is where an old fashioned exercise book comes into its own!).
1 SMART: Specific, Measureable, Achievable, Realistic, Time limited.