Service Leadership: The Role of Supervision in Advanced Nursing Practice

Significant attention in research and education has been paid to the importance of leadership in nursing, especially for the developing role of the Advanced Practice Registered Nurse (APRN) / Nurse Practitioner (NP) (Metzger & Rivers, 2014; Severinsson, Johansson & Lindquist, 2014; Dale et al., 2013; Taylor, 2013; Queiros, 2014). Supervision as one aspect of leadership has been linked primarily with managerial responsibilities and mentorship for new nurses (Moked & Crach-Zahavy, 2016).  Efforts have been made to capture and quantify both the harmful sequelae of unsupportive supervisory relationships on staff and positive behaviors among managers and supervisors (Kuehnl, Rehfuess, von Elm, Nowak & Glaser, 2014; Dingley, Daugherty, Derieg & Persing, 2008). There is little clarification however on the conscious implementation of specific supervisory skills, practices and approaches toward the ongoing leadership development for APRNs / NPs as well as for all nurses (Kuehnl, Rehfuess, von Elm, Nowak & Glaser, 2014; Metzger & Rivers, 2014).  There is also a gap in the literature regarding the utility of supervision in the reduction of negative outcomes of stress and improvement of both health related and leadership behaviors (Kuehnl, Rehfuess, von Elm, Nowak & Glaser, 2014). Lack of opportunities for leadership development through supervision may contribute to feelings of disempowerment and job dissatisfaction, whereas positive outcomes of skilled clinical supervision within the nursing profession may be an antidote to burnout and to feelings of powerlessness as well as fuel motivation and engagement (Metzger & Rivers, 2014; Severinsson, Johansson & Lindquist, 2014). Both supervisors and supervisees need time for reflection to internalize the desired knowledge, skills and attitudes consistent with best practice especially in light of the multi-layered pressures associated with productivity, outcomes, and sustainability. (Kuehnl, Rehfuess, von Elm, Nowak & Glaser, 2014; Queiros, 2014). Effective communication is a core skill in setting the tone for a safe, supportive and empowering work environment and is vital to risk reduction of poor outcomes in patient care. It makes intuitive sense that as the roles of APRN/NP expand and deepen, an objective way to measure professional outcomes is needed. APRNs/NPs have a unique opportunity to participate in the development and modeling of leaderhip behaviors through skilled supervision as well as to define, distill and disseminate the essence of their dynamic roles (Dale et al., 2013). The arena of clinical social work is rich with applicable models for developing leadership qualities and skills (Kanter & Vogt, 2012; Pack, 2009; Long, Harding, Payne & Collins, 2014). There are many parallels that can be drawn upon and applied to a meaningful use of skilled supervision to support and promote leadership potential, empowerment and professionalism (Kanter & Vogt, 2012; Pack, 2009).

References

Dale, J. C., Drews, B., Dimmitt, P., Hildebrandt, E., Hittle, K., & Tielsch-Goddard, A. (2013). Novice to expert: The evolution of an advanced practice evaluation tool. Journal of Pediatric Health Care, 27, 195-201                       

Dingley C, Daugherty K, Derieg MK, et al. Improving Patient Safety Through Provider Communication Strategy Enhancements. In: Henriksen K, Battles JB, Keyes MA, et al.,editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality  (US); 2008 Aug. Available from: http://www.ncbi.nlm.nih.gov/books /NBK43663/

Grabbe, L. (2015). Attachment-informed care in a primary care setting. Journal for Nurse Practitioners, 11(3), 321-327 7p. doi:10.1016/j.nurpra.2014.12.014

Horvat L, Horey D, Romios P, Kis-Rigo J. Cultural competence education for health professionals. Cochrane Database of Systematic Reviews 2014, Issue 5. Art. No.: CD009405. DOI: 10.1002/14651858.CD009405.pub2.

Kanter & Vogt (2012). On “Being” and “Doing”: Supervising Clinical Social Workers in Case-Management Practice, Smith College Studies in Social Work, 82:2-3, 251-275, DOI:10.1080/00377317.2012.693029

Kuehnl A, Rehfuess E, von Elm E, Nowak D, Glaser J. Human resource management training of supervisors for improving health and well-being of employees (Protocol). Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD010905. DOI: 10.1002/14651858.CD010905.

Long, C. G., Harding, S., Payne, K., & Collins, L. (2014). Nursing and health-care assistant experience of supervision in a medium secure psychiatric service for women: Implications for service development. Journal of Psychiatric & Mental Health Nursing, 21(2), 154-162 9p. doi:10.1111/jpm.12066

Maplethorpe, F., Dixon, J., & Rush, B. (2014). Participation in clinical supervision (PACS): An evaluation of student nurse clinical supervision facilitated by mental health service users. Nurse Education in Practice, 14(2), 183-187 5p. doi:10.1016/j.nepr.2013.07.010

Metzger, R., & Rivers, C. (2014). Advanced practice nursing organizational leadership model. Journal for Nurse Practitioners, 10(5), 337-343 7p. doi:10.1016/j.nurpra.2014.02.015

Moked, Z. & Drach-Zahavy (2015). Clinical supervision and nursing students’ professional competence: Support-seeking behavior and the attachment styles of students and mentors. Journal of Advanced Nursing, 72(2), 316-327.

Pack, M. (2009). Clinical supervision: an interdisciplinary review of literature with implications for reflective practice in social work, Reflective Practice, 10:5, 657-668, DOI: 10.1080/14623940903290729

Queirós, P. J. P. (2015). The knowledge of expert nurses and the practical-reflective rationality. Investigacion & Educacion En Enfermeria, 33(1), 83-91 9p. doi:10.1590/S0120-53072015000100010

Severinsson, E., Johansson, I., & Lindquist, I. (2014). Effects of process-oriented group supervision - a comparison of three groups of student nurses. Journal of Nursing Management, 22(4), 443-451 9p. doi:10.1111/j.1365-2834.2012.01463.x