Setting Up Peer Group Supervision Presented by Gytha Lancaster New Zealand Institute of Rural Health

Background Rural nurses wanting to know about supervision Lack of available trained supervisors Nurses requesting supervision How to provide supervision for rural nurses

Hurdles and barriers Hidden Misconception and mistrust: what is supervision, whose it for and why have it? Attitude: What’s in it for me? Actual Cost: Who pays? Time: Work time or family time? Distance: Can’t travel, no one near to talk to Lack of trained supervisors:

Setting up Peer group supervision and Overcoming barriers Allaying fears, misconceptions, and changing attitudes Cost and time Structure Supervision skills workshops

Misconception and mistrust Supervision is just another way for management to oversee your practice There’s nothing wrong with my practice so I don’t need it Its only for people who have been told to have it by nursing council because of poor practice It’s the same as having a mentor

Differences between preceptoring, mentoring and supervision Preceptorship Mentoring Supervision A preceptor is more experienced in a particular area of nursing and works with a less experienced nurses while they learn the necessary skills for their new role Mentoring is a long term relationship to meet a developmental need to help develop full potential and benefits all partners (Suzanne Faure as quoted by the New Zealand Mentoring and Coaching Centre,2010) Supervision is a process where the supervisee is given the opportunity to have in depth reflection on their practice in order to achieve, sustain and creatively develop a high quality of practice.

What’s in it for me and why should I have it Focuses on issues of education and development of skills by reflecting on experience in practice. Supports personal well being Encourages self development Creates awareness of how stresses and distress in working practice affects individuals. Helps maintain boundaries, stability and emotional distance. Focuses on accountability and quality of care practiced by the supervisee.

Encourages awareness of blind spots and prejudices and ensures the highest professional standards are upheld. Ensures that policies, practices and procedures are followed Increases practitioner’s confidence in their practice. Reduces staff turn over Reflections from the supervision may be used within the portfolio for nursing council competency and peers can confirm practice. A protected environment. Maintains and safeguards standards of practice

How to overcome misconceptions and mistrust

Cost and Time Peer group supervision reduces cost Supervision skills workshops provided by NZIRH for rural nurses within certain DHB areas Supervision proposal/guideline demonstrates benefits to employers 1to 1 &1/2 hours per month (at a time negotiated by group) Time: most want supervision in working day: times: before starting work, lunch time or other

Guidelines Guidelines for successful peer supervision: Set clear boundaries e.g. no gossip, discussion of stories after the session, no post mortems Clear ground rule over confidentiality Have a contract Keep to the process or structure Always have someone as the facilitator When getting feedback, listen, reflect, check whether it is accurate or relevant and take what is useful and leave the rest. Focus on the person who is getting the supervision Its ok to make mistakes and learn from them, you don’t always have to look competent Prioritise the sessions and put a high value on it Respect each other, yourself and your patients/clients

Distance solutions Teleconference SKYPE: either group or single person to attend a group. Small charge for groups free for single, free download http://www.skype.com/intl/en/prices If travelling: central location, or take turns May need to have mixed professions e.g. Nurse, social worker, doctor, Occupational therapist

Structure Facilitator ensures group members keep on track

Structure Peer group members: 3 to 5 Group contract/ground rules Facilitator: Always appoint a facilitator for the session whose responsibility is to keep the group on task, keeping to the structure, agenda, and time keeping. (The person facilitating alters each time to ensure everyone takes turns) Minutes: Minutes to be recorded, one person is allocated on the roster/facilitation plan (this alters each time to ensure everyone takes turns) to record the session. Members bring issues Audit: 6 to 12 monthly audit of process to ensure achieving goals

Format to explore issues Identify the issue or what’s happening now Use clarifying questions to get to exactly what’s happening and the current reality. Identify key issues and strengths. Describe how you would like it to be different Use the questions to build a picture of how they would like it to be Using open ended questions enable them to develop specific goals or what they want to happen Find out what is stopping them from achieving this right now.

Explore Options 4. Actions to be taken Use open ended questions to generate options beginning with ideas from the supervisee Explore different avenues or actions they could take If they appear to be out of ideas offer suggestions carefully or give examples of similar experiences (only if required) Make sure options address the key issues 4. Actions to be taken Ensure they make specific commitments to actions to be taken with a time frame to accomplish them Identify any foreseeable obstacles or problems and identify plans to overcome these Wrap up and close the session

Supervision skills workshops, what they entail 1 day workshop (certificate of attendance) Interactive, role play, enjoyable Explore definitions of supervision Function of supervision What to bring to supervision Skills, active/reflective listening, asking open questions Format to use to explore issues Feedback: good and when not useful Sharing information, what’s wrong with advice Ethics and responsibilities Suggested structure Set of examples of contracts, proposal/guideline and other forms supplied for adaptation.

Conclusion Education re supervision to reduce barriers SKYPE or teleconference, or central meeting place Supervision proposal/guidelines to get employer buy in Protected valued time for supervision sessions Formal structure of Peer group sessions Regular audit to ensure Peer group supervision achieving goals