Project Overview
This information here provides:
- The background to development of the Reflective Supervision Framework
- Key messages underpinning Reflective Supervision
- Elements of Reflective Supervision
- The Framework for Reflective Supervision
- A range of tools and resources to assist nurses and midwives when participating in Reflective Supervision
The Central Nursing and Midwifery Advisory Committee (CNMAC) on 10 June 2016 agreed to take forward work to explore the potential of the development of a Nursing and Midwifery Supervision Framework for Northern Ireland that could be positioned under one policy directive. The work recognised that nursing and midwifery are two separate professions along with legislative changes to the Nursing and Midwifery Order 2001 order which removed the statutory supervision of Midwives on 31 March 2017.
Reporting to a Programme Board three task and finish groups for nursing, midwifery and safeguarding children, with individual objectives related to their area of supervision were set up to ensure that the unique circumstances and requirements across nursing and midwifery areas of practice were recognised.
The model of safeguarding supervision was recognised as being different, as it was primarily about safeguarding the interests of the child, yet similarly underpinned with the standards and processes for nursing and midwifery supervision. The Groups facilitated work to scope existing arrangements, considered the implications of revalidation and made recommendations for the future within an overarching Reflective Supervision Framework. The Reflective Supervision Framework was co-produced based on the work and evidence provided through the three sub groups.
Using the Reflective Supervision Framework will:
- Enable registrants to reflect on personal, professional and practice (service provision) topics to support improved safety, quality and person-centred practice (Figure 1 in the Framework)
- Not be confused with performance management or with the client focused elements of safeguarding supervision
- Outline a clear distinction between appraisal as an employee, revalidation as a registrant and reflective supervision as a professional
- Ensure that the reflective supervision session is attributed as a professional reflective discussion that can be counted as part of revalidation processes
- Have protected time set aside and be confidential to the participants unless a concern is raised that requires escalation
- Be defined within a context of lifelong learning and professional development (Figure 3 in the Framework)
- Allow supervisors and supervisees take part in Reflective Supervisors understanding the elements of Reflective Supervision and understanding their role and responsibilities in maximising the effectiveness of the experience. Registrants may choose an appropriate element based on the focus of the supervision session.
The following elements of Reflective Supervision align with Proctor’s Supervision Model (Proctor 2010) and emphasise how each element has a separate purpose and can be used separately or interchangeably depending on the purpose of the Reflective Supervision session.
Definition
Reflective Supervision is defined as a participative process of supportive reflection that enables individual nurses and midwives to develop personally and professionally to improve the quality, safety and person- centeredness of their practice
Lived Experience
Reflective Supervision should:
- support nurses and midwives to reflect on their skills and their contribution to the environment where they work
- help registrants understand how much they are valued, discuss career aspirations and identify learning needs to develop their practice and fulfil their potential
- be defined within a context of lifelong learning and professional development (Figure 3)
- be used as part of the revalidation process for nurses and midwives
Purpose
Purpose:
- To enable supervisors and supervisees to prepare for and acknowledge their role within the reflective supervision process
- To provide a guideline for organisations to ensure effective implementation
- To guide the development of education programmes for reflective supervision focusing on agreed best practice
- To provide service users and the public with a contemporary description of the standards for reflective supervision
Who:
- A Supervisor of Nurses or Midwives must be a NMC Registered Nurse or Registered Midwife
- A Supervisor should have a minimum of three years experience as Registered Nurse or Registered Midwife
- Supervisors must as a minimum have undertaken a Supervisor Preparation Programme
- A supervisee is a NMC Registered Nurse or Registered Midwife. They should participate in two formal Reflective Supervision sessions per year
- The Supervisee should choose an appropriate Supervisor from the organisation’s list and agree this with their line manager
Ratio:
- The number of reflective supervision sessions that an individual supervisor makes available in a financial year is 1:16 supervisor: reflective supervision sessions annually
- This number relates to sessions not people, for example, if a supervisor has three people who need supervised four times per year they should only provide four more ‘sessions’ for reflective supervision to others
- Where a group session is provided – described in guidance as up to two hours – this will count as two sessions where one session is defined as spanning approximately one hour in length of time
- Where a supervisor works part time hours an agreed pro-rata ratio will be established with his/her line manager
Frequency:
- For each registrant there should be a minimum of two opportunities per year for reflective supervision in individual or in group in format (can be a mixture of both)
- The mode and/or frequency of reflective supervision will change depending on circumstances (Figure 4)
Click here for the guidance relating to frequency of Reflective Supervision based on escalation of risk in practice, which also includes the type of reflective supervision accessed, confidentiality, appropriate choice of environment, responsibilities, boundaries and the agreement of ground rules between the parties.
Confidentiality:
- Confidentiality is pivotal to the success of supervision and respectful, trusting relationships should be maintained
- Supervisors and supervisees should adhere to the responsibilities articulated within the framework acknowledging trust and expectations
Click here for the guidance which also includes appropriate choice of environment, responsibilities, boundaries and the agreement of ground rules between the parties
Organisational Infrastructure:
- Value and priority should be placed on the process of reflective supervision by the organisation at Board level through an organisational Responsible Officer who is a nurse or midwife
- Each organisation should have a structure identified to support organisational accountability, aligning with existing governance and escalation processes to include raising and escalating concerns
- For the purpose of HSC Trusts the Responsible Officer will be the Executive Director of Nursing or in other organisations a nurse or midwife who is of a similar level of seniority
Processes
Along with the standards of Supervision a number of processes support Reflective Supervision.
These are outlined below:
Escalating Concerns:
- If an issue of concern in relation to practice is divulged by a supervisee the issue identified should be dealt with supportively via appropriate organisational and/or regulatory procedures
- Aspects of confidentiality may be waived where an issue is identified that compromises patient safety, quality or experience
Click here to view examples of issues for escalation.
Record of Reflective Supervision:
- Supervisors will be required to keep only a record of the number of sessions provided by them annually to each supervisee, with the exception of any records required relating to issues of concern for escalation
- Supervisees should keep a written reflective account of each reflective supervision session stored within their electronic or hard copy professional portfolio, adhering to good practice guidelines for record keeping. The forms for this activity will be proposed as those relating to the revalidation documentation templates provided by the NMC
- The extant practice for record keeping for safeguarding supervision remains unchanged and has been defined separately to this framework in the revised policy document
Storage of Records:
- The records of service users may be used for the purposes of supervision activity but should only be accessed where necessary to enable learning and development for nurses and midwives
- Participants involved in the reflective supervision process must adhere to the Records Management Policy within their organisation and any reflective account should adhere to the guidance provided by the NMC following Bawa-Garba v The General Medical Council & Ors [2018] EWCA Civ 1879
- The organisation’s records management policies, standards, procedures and principles of Good Management Good Records (GMGR) guide responsibilities in relation to storage of records
- Records should be paperless where at all possible
Click on the links below to view the relevant guidance:
Nursing and Midwifery Council. (2019). Revalidation. London: NMC. https://www.nmc.org.uk/globalassets/sitedocuments/revalidation/how-to-revalidate-booklet.pdf pp 16 – 17.
Department of Health (2014). Good Management Good Records. DOH.
https://www.health-ni.gov.uk/articles/introduction-good-management-good-records
Monitoring and Evaluation
Reflective supervision is promoted and valued as an activity underpinning safe and effective practice. In this context monitoring and evaluation of activity is required to provide assurances of accountability for the organisation and to justify the use of the resources required to promote and sustain delivery of the framework.
- Supervisors should record the number of sessions they provide on a quarterly basis and present to line managers for collation
- Quantity and quality of Reflective Supervision sessions may be included in organisational performance indicators for nursing and midwifery workforce
- Evaluation and monitoring should align with Governance processes and Quality Improvement Frameworks
- Feedback should be collected from staff (after session, surveys, questionnaires, social media groups)
- Practice support methods should be reviewed and evaluated annually
Outcomes
Due to the complexity and diversity of contexts in which Reflective Supervision is implemented there are limitations in the literature related to attributable outcomes.
Despite this there is evidence to suggest that Supervision is a professionally enriching activity providing peer support, greater job satisfaction and promoting professional accountability.
As part of implementation, the following outcomes have been selected to study a link between the process and impact on practice . There has been agreement regionally that this provides an opportunity to use an Outcomes Based Approach (OBA) which asks three questions to identify the most important performance measures:
- How much did we do? (number of people are availing of Reflective Supervision)
- How well did we do it?
- Is anyone better off? (for example heightened peer support, increased job satisfaction and wellbeing, feeling more valued)
Resources
Documents
| Title | Date added | Download |
|---|---|---|
| Reflective-Supervision-Regional-Safeguarding-Supervision-Policy-and-Standards-for-Nursing-and-Midwifery | 07-03-2025 | DownloadPreview |