Clinical supervision Skills for Nurses and Allied Health Professionals: the 4S Model

Summary: This 4-stage model has been developed through working with about 16 Trusts in the Greater Manchester (UK) area since 2004. This is a non-managerial, solution focused approach. It is suitable for use by any helping professional. Many teams and departments are now practising supervision effectively for the first time.

4S stands for Structure; Skills; Support; Sustainability.

Stage 1 — Structure

It is essential that senior members of a Trust or organisation support a proposed clinical supervision scheme, ensure protected time, and agree a policy. Managers and team leaders need to agree on a structure, in order to establish a clear framework for the scheme. This includes considering choices and dilemmas such as:

  1. Optional or mandatory
  2. Group or 1:1 or both
  3. Unidisciplinary or across boundaries
  4. Evaluation
  5. Documentation — policy and contracts
  6. Logistics
  7. Resource allocation
  8. Timescale and action plan

Stage 2 — Skills

A 2-day course for volunteer clinical supervisors, using a collaborative solution focused approach which utilises innate strengths and resources. Participants learn how to facilitate supervisees' own abilities and decision-making, help supervisees look at how they want to progress and develop in their work, and use practical steps towards their goals. Potential supervisors also explore boundary issues such as confidentiality. One-to-one skills are mastered first; group work is more complex and comes later if desired.

Stage 3 — Support

It is essential to provide ongoing support for clinical supervisors. Regular groups, perhaps quarterly, offer sharing of good practice, dilemmas and top-up training as required, and will keep practice fresh. Supervisors should have their own confidential supervision. Ideally, there should be at least one person in the system who is able to advise from a position of experience in both the solution focused approach and supervision, and can take responsibility for the whole scheme.

Stage 4 — Sustainability

Any scheme should plan for sustainability. Over the first few years supervisors will practice and hone their skills. Supervisees will absorb those skills from their supervisors. Later, experienced supervisors will be able to teach new potential supervisors. The organisation may also wish to have a yearly skills top-up day. Ongoing audit/evaluation will also give the organisation further corroboration and guidance.

I'm able to consult with and guide Trusts and other organisations step by step through the 4S process if required. I can provide template documents (eg contract) and help managers to set up an effective and lasting clinical supervision scheme for staff. Contact me for costs and more information.