The policy-practice divide Who has clinical supervision in nursing?

The role of the NHS in supporting qualified nurses is important for the development and retention of staff. Although there is a general perception that clinical supervision is beneficial and leads to better outcomes of patient care, most literature focuses on the main functions of the supervisory role, the interactions between supervisee and supervisor, or the supervisory process. There is limited large-scale empirical evidence on nurses' receipt of clinical supervision or their perceived need of its various dimensions. This paper reports findings from a large-scale nationally representative sample of diplomate nurses who qualified between 1997 and 1998. Using Proctor's model, it discusses the experiences of clinical supervision of 1,918 nurses in early career, 18 months after qualification, from the adult, child, learning disability and mental health branches. The findings show that the receipt of clinical supervision varied among the branches. Just over half of learning disability and mental health diplomates were receiving supervision, compared with approximately one-third of diplomates graduating from the adult and child branches. Sizeable proportions of nurses had never had a clinical supervisor in their current job. It is generally agreed that clinical supervision should enable the development of new skills through reflection on practice. However, many supervisees identified that they were not given the opportunity to do this in their supervision sessions. There was a perceived need for more supervision in these and other aspects. These findings are particularly important given the increased expectation of organisational support for staff development under Agenda for Change, a new pay and grading system introduced in 2004 throughout the NHS.