In search of a national approach to professional supervision for mental health and addiction nurses: The New Zealand experience

Brian G McKenna
Senior Lecturer, Centre for Mental Health Research, Policy and Service Development, University of Auckland; Nurse Advisor, Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, New Zealand

Katey Thom
Centre for Mental Health Research Policy and Service Development University of Auckland Auckland, New Zealand

Fiona Howard
Senior Tutor, Department of Psychology, University of Auckland, Auckland, New Zealand

Val Williams
Nurse Consultant, Waitemata District Health Board Auckland, New Zealand

PP: 267 - 276

Abstract

A competent nursing workforce is crucial for the recovery of mental health and addiction service users. Professional supervision is central to facilitating this competency. This article reports on research that scoped the current provision of professional supervision and explored possibilities for developing a standardised national approach to professional supervision for mental health and addiction nurses in New Zealand. The study involved telephone and mail surveys with nurse leaders and current supervisors from District Health Boards and Non-Government Organisations. The findings indicated that the majority of those canvassed were supportive of a nationally endorsed approach. Standardisation was seen as a means of assisting in the monitoring and quality refinement of the content and provision of professional supervision, and the training of supervisors. It was also recommended that to be successful, a national approach must incorporate partnerships with significant stakeholders in the sector, including service users and Maori.

Keywords

nursing, mental health nursing, professional supervision, clinical supervision

Article Text

Professional supervision can be described as "...a formal process that provides professional support to enable practitioners to develop their knowledge and competence, be responsible for their own practice and promote service users' health outcomes and safety" (Hamer et al 2006: 22). The term professional supervision, however, is often used interchangeably with clinical supervision, which has lead to confusion in the literature. Clinical supervision focuses on clinical practice, yet nurses may be involved in academic, management, and leadership roles.  Thus, we favour the aforementioned term of professional supervision in order to project the value of supervision beyond clinically specific roles (Hamer et al 2006). 

Although the aims of professional supervision are complex, Kadushan (1992 cited in Herkt (2005)) usefully provides a three category simplification. This includes the "administrative function" of professional supervision, which assists the supervisee to align him/herself with the institutional framework in which care takes place.  The goal of this function is to assist the nurse to relate their practice to managerial requirements, including policy and professional standards of practice (Severinsson 2001). Secondly, the "educative function" aims to develop and refine the supervisee's knowledge, skills and professional understanding. Lastly, the "supportive function" relates to the development of the "attitudes and feelings that will enable [the supervisee] to work effectively" (Herkt 2005: 21).

Professional supervision commenced in New Zealand in the 1980's with the prevalence of an administrative model involving a didactic directive process primarily undertaken by managers as supervisors.  The focus was largely on determining performance and was criticised for its lack of regard for the supervisee's professional growth. In the late 1980s a psychotherapeutic model providing primarily supportive supervision was embraced (Consedine 2000).  More recently a range of models have been used that are reflective of an international trend to balance administrative, educative and supportive supervisory functions (McKenna et al 2008).

In New Zealand, where Maori (the indigenous people) feature highly in mental health and addictions morbidity statistics (Oakley Browne 2006), there is recognition of the need to address the ability to work with Maori in mainstream supervision processes. Further, there is recognition of the importance of addressing cultural supervision specifically for health professionals who are Maori.  The purpose of this latter supervision, by Maori for Maori, is to build knowledge of Maori cultural values, attitudes, and behaviours; provide a supportive context to manage complex cultural issues; and to ensure safe practice and culturally appropriate behaviour (Howard Burns and Waitoki 2007; Walsh-Tapiata and Webster 2004).

Similarly, where practitioners of other non-dominant ethnic groups are working in mainstream organisations, cultural supervision is recommended where there is a matching of the supervisee and the supervisor's ethnic group. For example, models of cultural supervision for Pacific Island mental health professionals in New Zealand are in place (Mafile'o and Su'a-Hawkins 2005).

Although New Zealand's mental health and addiction services have a commitment to delivering recovery focused care in partnership with service users, there appears to be no reference to service user involvement in any of the models currently utilised in New Zealand or mention in existing literature. This is in despite the Mental Health Commission's vision of future service delivery in New Zealand in which "the expertise, experience and insights of service users will be valued throughout the mental health and addictions service" (Mental Health Commission 2007:  18).

Regardless of the burgeoning number of models of professional supervision currently used in New Zealand, there is little research that comprehensively evaluates their effectiveness. Anecdotal evidence suggests that there is variability and inconsistencies in the provision of professional supervision for nurses across the New Zealand mental health and addictions sector (Hamer et al 2006). 

International literature, however, has indicated that when models of professional supervision have been implemented supervision increases nurses' feelings of support and personal wellbeing; enables reflection on knowledge and practice creating an awareness of solutions to clinical problems; and increases staff morale and satisfaction leading to a decrease in staff turnover/absenteeism (Cleary & Freeman 2006; Winstanley and White 2003).

Despite these assumed benefits, pragmatic implementation is required for professional supervision to be successful. Several barriers to the implementation of professional supervision currently exist. These include: the availability and quality of supervisors; lack of databases/access to knowledge of available qualified supervisors; irregular supervision with no formal contracts or policy direction; financial constraints limiting availability of primarily supervisors external to the service; and power dynamics between supervisor and supervisee which create tension in the supervision relationship (Cleary & Freeman 2006; Hamer et al 2006; Arvidsson Lofgren and Fridlund 2001).

The research reported in this article adds to the literature with its specific focus on the current approaches to professional supervision for mental health and addiction nurses across New Zealand. Specifically, it aimed to generate information on the number of nurses receiving professional supervision, the number of trained supervisors and their credentials, and the models of professional supervision currently being used. The research also investigated ways of improving professional supervision, the place of service user and cultural input into the supervision programmes, and the plausibility of developing a standardised national approach for professional supervision and the training of supervisors.

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