Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Finding a Way Forward: A Literature Review on the Current Debates around Clinical Supervision

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Finding a Way Forward: A Literature Review on the Current Debates around Clinical Supervision

Article excerpt

The clinical healthcare environment is increas- ingly complex and changing. Health profes- sionals contend with limited resources, workforce shortages, high demand for clinical services, along with increased acuity and complexity of patients (Health Workforce Australia, 2010). In this chal- lenging environment it has been argued that clin- ical supervision may buffer the tensions around what is expected and what is achievable in relation to such issues as person-centred care, implemen- tation of clinical practice guidelines and utilisa- tion of research in an increasingly evidence-based healthcare environment (Australian Resource Centre for Healthcare Innovations [ARCHI], 2012; Butterworth, Bell, Jackson, & Pajnkihar, 2008; McCormack & McCance, 2006). Such diverse expectation of clinical supervision has led to a lack of consensus about role and benefits of clinical supervision.

This paper employs a critical interpretive approach to explore the current debates, chal- lenges and possible ways of moving beyond the current criticisms and limitations of the clinical supervision literature. As the debate stands, there are two major themes that arise as criticisms in the literature. The first relates to the complex nature of clinical supervision as an intervention. As a result of the complexity and diversity of the contexts in which it is implemented, the literature reports confusion about the role and structure of clinical supervision; a diffuse unlinked evidence base; challenges measuring the effectiveness of clinical supervision and difficulty in implement- ing clinical supervision in practice.

The second major theme relates to resistances that arise from within healthcare organisations. Resistance to clinical supervision is perpetuated by organisational culture within healthcare that is suspicious of change. In this context time, staffing and budgets are used as an excuse by organisa- tional management to maintain current practices (White & Winstanley, 2009).

Attempts to establish clinical supervision in practice are being limited by the current debates. These debates have essentially over- looked the role that clinical supervision can have in strengthening teams through group critical reflection on practice. Whilst nurses and nursing research are the focus of this paper, the benefits of clinical supervision should not be limited to their applications within nursing. The confu- sion and conjecture about clinical supervision for nurses resonates across most healthcare disci- plines (Farnan et al., 2012; MacDonald & Ellis, 2012; Spence, Wilson, Kavanagh, Strong, & Worrall, 2001).

The authors content that if clinical supervi- sion is to achieve patient-centred care and inno- vation of practice; it first needs to be legitimised as real work. This will involve genuine sup- port from nurses, management and healthcare organisations. In looking forward the authors explore multidisciplinary clinical supervision as a potential framework for supporting practice innovation through collaboration, participa- tion and critical engagement across health care teams. This paper will outline the potential role of supervision as a forum for learning to enhance and build interprofessional collabora- tive practice.


The purpose of the review was to scope the cur- rent field, identify the main debates and existing evidence around clinical supervision with a view to develop an understanding of current practices that will inform a larger project (Dixon-Woods, Cavers, et al., 2006; Mays, Pope, & Popay, 2005). The project is a post-graduate Thesis that exam- ines if and how clinical supervision may facilitate change in practice within the context of a ran- domised control trial designed to reduce anxiety and depression through the implementation of a psychosocial intervention for adults with can- cer (Turner et al., 2011). The review questions developed iteratively as an understanding of the field was developed (Dixon-Woods, Cavers, et al. …

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