Supervision

1
Supervision

• Frank Ursell
• Chief Executive Officer
• Registered Nursing Home Association

2
Overview

• NMS 36 Requirements
• Expectations of the CSCI
• Some Principles of Supervision
• But, what does it really mean ?
• Putting it in Practice
• Recording the Supervision

3
NMS 36 - OUTCOMEStaff are appropriately
supervised

• NMS 36.2
• Care staff receive formal supervision at least
  6 times a year.
• NMS 36.3 Supervision covers
• all aspects of practice
• philosophy of care in the home
• career development needs.

4
NMS 36 - OUTCOMEStaff are appropriately
supervised

• NMS 36.4
• All other staff are supervised as part of the
  normal management process on a continuous basis.
• NMS 36.5
• Volunteers receive training, supervision and
  support appropriate to their role and do not
  replace paid staff

5
Categories of Staff

• The National Minimum Standards place a
  requirement for Supervision on three distinct
  groups of staff
• All Care Staff care assistants and nurses
• All other staff domestics, cooks, even
  outdoor staff such as gardeners
• All volunteers note use of words (who) do
  not replace paid staff

6
CSCI Expectation 36.2

• The term Formal would imply a structured and
  dedicated time set aside for the member of staff
  to receive support and supervision from their
  supervisor.
• This would include recording the supervision
  and judgement-making about an individuals
  performance

7
CSCI Expectation - 36.2

• Supervision could take different forms
• Individual one to one meeting with staff
• A group supervision session
• Perhaps observation of professional practice and
  a report and a record of the outcome

8
CSCI Expectation 36.3

• A record should be kept to evidence that
  supervision is taking place and should include
  areas mentioned in Standard 36.3
• All aspects of practice
• Philosophy of care in the home
• Career development

9
CSCI Expectation 36.4

• All professionals need an element of support
  and supervision including mangers and owners.
• However, it may be difficult for an owner /
  manager to access appropriate supervision
  particularly if they are a small private company

10
CSCI Expectation 36.4

• It may be helpful for them to access a mentor or
  another professional for support and supervision
  in relation to professional practice
• There is the possibility of owners / managers
  utilising their peers for such support and
  linking themselves with professional
  organisations such as the Registered Nursing Home
  Association as one example.
• It may also be helpful to access an internet site
  with information regarding management and
  supervision, www.managementhelp,org

11
So, What does it really mean ?

• This is an area where we are experiencing
• Poor Inspection Scores / Reports
• Many Questions to Head Office
• Need to look behind the legislation
• What is the mischief which the NMS seeks to
  remedy
• How do we make it work ?

12
Looking behind the Legislation

• The mischief which is addressed is the fact
  that the vast majority of care provided in care
  homes is provided by an untrained workforce
• Mid to Long Term solution is NVQ II trained
  staff, regulated by the GSCC
• Short Term view is Supervision where
  supervision has a meaning other than control
  or direct

13
NMS for Younger Adults (18 65)

• Uses different words used for this standard -
  Supervision and Support
• Staff receive the support and supervision they
  need to carry out their jobs (36.1)
• Translation of the Homes Philosophy and Aims
  into work with individuals (36.4)
• Monitoring of work with individual service
  users (36.4)
• Support and professional guidance (36.4)

14
Applying this Approach

• Supervision is meant to be an opportunity of
  on-going dialogue, on a one to one basis, which
  supports formal training
• Gives an opportunity to explain / discuss all
  aspects of the principles, objectives, policies
  and procedures of the home
• Intended to encourage a continuing learning
  environment within the home

15
Applying this Approach

• A continuous interaction between senior and
  junior staff which draws upon and reflects the
  homes written procedures and day to day
  practice
• Can include instant feedback, or end of shift
  meeting, which meets the criteria as well as a
  formal session but record it !
• Time and place has a part to play in what
  makes a dialogue supervision

16
Some Principles of Supervision

• Clinical supervision is available for all
  registered nursing staff and for all care
  assistants employed at the home.
• The content of supervision sessions will be
  confidential, recorded only by the supervisee,
  but disclosure of information which contravenes
  the NMC or GSCC Codes of Conduct will be
  recorded by the supervisor and acted upon

17
Some Principles of Supervision

• Clinical supervision should not be used to
  assess performance or competence.
• Clinical supervision is distinct from
  managerial processes, even when staff have
  clinical supervision with their line manager

18
Some Principles of Supervision

• Staff and supervisors will have training in
  the process of supervision.
• The process of clinical supervision should
  always be practitioner led and practice focused.

19
Some Principles of Supervision

• All care staff should have a nominated
  supervisor, whose name should be entered in
  their personal development file.
• Staff should be given a say as to who their
  supervisor will be.
• All care and nursing staff should have at
  least one formal supervision session of at
  least one hour duration every two months.

20
Some Principles of Supervision

• Supervision time should be planned, protected
  and uninterrupted.
• Sessions should be held in private and should
  be entirely confidential.
• Supervision time should be taken while on
  duty, but at a time that is convenient to other
  staff on duty and to service users
• There should be agreement between supervisor
  and supervisee about how they will conduct their
  supervision sessions.

21
Who should be supervisors ?

• Each supervisor should not have more than
  three staff under supervision at any one time.
• Supervisors need to have clinical expertise,
  excellent interpersonal skills and a
  facilitative attitude to others.
• New supervisors will be selected by the home
  management

22
Some interrelations with Supervision

• Communication systems
• Quality control
• Grievance and disciplinary processes
• Homes general atmosphere
• Process and style of management

23
Some Key Questions to Address

• How can supervision be related to day to day
  comments on practice ?
• Does a good supervisor hand out praise or
  allocate criticism ?
• Should supervision be about the person or the
  task ?
• How do supervision and appraisal fit together
  ?
• Is supervision an individual or group process?

24
Some Dos and Donts

• Dont say
• Its too expensive on time / resources
• I have a hands on approach and speak to people as
  and when I need to
• We do things differently here
• Do
• Recognise that the CSCI are looking for it
• Seize the opportunity of supporting staff
• Find a way to make it work
• Record every activity which meets the criteria

25
Some Practical Examples

• Take two or three points from the Statement of
  Purpose / Service User Guide as discussion
  points (remember not to lecture)
• Use some open questions what do you think
  we mean by the words patient centred care ?
• Use the opportunity to discuss death and
  dying when a patient in the home is in the later
  stages of life
• Both praise and criticism can also be the cause
  of a period of supervision

26
Whats Important ?

• To the staff member ongoing support,
  instruction and improvement
• To the home owner a more motivated, informed
  member of staff
• To the Patient the likelihood of receiving a
  better service
• To the CSCI writing it down !!!

27
Recording you Supervision

• The NMS is specific 6 times per year
  remember, if it isnt written down it didnt
  happen
• Find a way convenient to you, but which can be
  easily used to demonstrate to the CSCI that
  supervision has taken place
• It can involve more than one person at a time
  consider showing who else was involved
• Be particular careful to record the impromptu
  sessions which also count.

28
Conclusion

• This item has been included on the programme
  because of poor scores and many questions from
  members
• It remains an easy process for Inspectors to
  check
• It is, perhaps, inappropriately called
  supervision it is about supporting an
  untrained and unqualified work force CPD in
  practice
• It will remain a priority until the workforce
  becomes fully trained and registered with the
  GSCC