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 individual’s 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 Home’s 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 home’s 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 • Home’s 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 Do’s and Don’ts • Don’t 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. What’s 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 isn’t written down it didn’t 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