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Take on burnout together

Clinical supervision is effective at reducing stress and improving performance – but it requires full organisational support. 

Healthcare organisations aspire to provide high-quality care to the community. The role staff play in achieving this is critical.

In 1998, the World Health Organization highlighted the need to reduce stress by promoting a safer and healthier work environment. And research from 1988 has shown the most common reason for long-term sick leave amongst nurses is depression caused by exhaustion and burnout, all of which affect care. 

More than 20 years later, exhaustion and burnout are still causes of concern in the healthcare community. With an increasingly complex and demanding work environment, it is important for nurses, as individuals, to be aware of how they feel and how their workload is affecting them. Organisations also need to recognise and investigate strategies to enable staff to work effectively. Such strategies sit alongside ensuring there is an adequate skill mix, along with nursing numbers and broader resources.

One tactic for improving self-care and tackling stress and burnout at an organisational level is clinical supervision.

The term clinical supervision is used to mean different things. The allied health professions, and some parts of the nursing profession, have used clinical supervision for a number of years. In these settings, clinical supervision is generally understood as something that is regular, occurs in protected time, and enables in-depth reflection on clinical practice. The clinical supervisor will be an experienced colleague and the discussions that occur are confidential. The benefits include improved patient care, stress reduction, enhanced skills and increased job satisfaction. Ideally, it should continue throughout a person’s career.

Clinical supervision is integral to nurses being aware of their thoughts, feelings and work. It has been advocated for, particularly in nursing, as having a supportive and educational function. Responding to the increased awareness of the emotional support and self-care required in organisations is just as important as managerial supervision. Yet, it has been difficult to gain recognition of the role that organisations can play in enabling and supporting it appropriately – even though a whole-organisation approach will be most successful.

Whilst organisations may state recognition of the positive contribution clinical supervision can make to the wellbeing of nurses and the broader improvements in patient care, the ability to have regular sessions continues to be a challenge in many organisations. There must be a clear and unambiguous commitment to putting in place the structures to enable effective clinical supervision. These will include the allocation of protected time and funding for education of supervisors. There also needs to be a clear understanding of the differences between, management supervision, clinical oversight and clinical supervision. It is not a replacement for other systems that, on the surface, may appear to have some similarities.

This system allows nurses to improve their practice by helping them reflect, analyse, solve problems and learn for the future. It also makes them aware of how they are feeling about their patients and their work, and how that affects their lives in a wider sense. Reflection allows nurses to be aware of how scenarios make them feel as they happen, instead of having a build-up of difficult scenarios resulting in exhaustion, burnout and, in the worst case, departure from nursing entirely. This reflection also leads to improved patient care outcomes – surely a desirable outcome for any health organisation.

It is about empowerment not control. One of its aims is to increase professional accountability that builds confidence and self-esteem and allows the exploration of practice in a safe and supported environment without fear of punishment. It is also through the use of the reflective practice element that clinical judgement and reasoning within the individual nurse is encouraged to develop. Timely development of these skills in those less experienced is becoming increasingly critical as the older nursing group moves into retirement. These skills do not develop on their own and clinical supervision can be useful to further support and develop these skills in nurses.

This is one of the reasons clinical supervisors cannot have any line management responsibility for the nurses they support. For it to be effective, the people involved need to have a trusting relationship where discussion and exploration of issues can be open and constructive, without any fear of judgement from a managerial perspective.

Direct supervisors and peers, as well as clinical supervisors, need to be aware of their colleagues’ workloads and stress levels so they are able to watch for burnout and exhaustion before they become long-term issues. The combination of an organisational commitment and support, open communication and an increasing awareness from colleagues of peers’ behaviour is important.

Clinical supervision is increasingly being recognised as a key component of contemporary nursing practice, and it is imperative that organisations incorporate it across the career span of nurses. Having the major responsibility of caring for the Australian public means also caring for the carers.

Adjunct professor Debra Thoms is CEO of the Australian College of Nursing. 

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