PROFESSIONAL

Restorative clinical supervision:

a chance for change but are we ready?
Rebecca Featherbe

reflection and personal development, the aim of the PNA role

ABSTRACT is to offer clinical, educational and wellbeing support to
In the wake of the COVID-19 pandemic, nurses are experiencing increasing colleagues and underpin quality improvement and service
stress, burnout and mental health problems. The Advocating and Educating development (NHS England, 2021a; RCN, 2023).
for Quality ImProvement (A-EQUIP) model of clinical supervision aims to The accompanying PNA training programme, launched in
support staff wellbeing, promote positive work cultures and improve patient March 2021, was designed to equip nurses with the knowledge
care. Although a growing body of empirical evidence supports the positive and skills to undertake the PNA role through the provision of
impact of clinical supervision, several individual and organisational barriers accredited master’s level continuing professional development
may impede the implementation of A-EQUIP in practice. Organisational culture, modules and the creation of a national PNA qualification (NHS
staffing and workforce pressures all affect employees’ ability to engage with England, 2021a; RCN, 2023).
supervision, and organisations and clinical leaders must consciously work to
sustain lasting change. Scope and aims
This article discusses the development of the A-EQUIP model
Key words: Restorative clinical supervision ■ Professional nurse advocate for nurses, both within the historic context and in light of the
■ A-EQUIP ■ Organisational culture ■ Implementation barriers impact of the COVID-19 pandemic. It also focuses on the
restorative function through appraisal of current evidence and

T
aims to:
he Advocating and Educating for Quality ■ Evaluate the current state of professional wellbeing and the
ImProvement (A-EQUIP) model was developed drivers for the development of A-EQUIP
in response to a statutory change in midwifery ■ Critically analyse available literature on the effects of
supervision. This was brought about after clinical supervision
investigations into failings in care at an NHS trust ■ Investigate the sustainability of the model in the context of
led to concerns being raised about the ability of supervisors of individual and organisational barriers
midwives to reconcile the inherent conflict of interest, given ■ Make a series of recommendations to support the successful
they had both regulatory and supportive roles (Parliamentary implementation of A-EQUIP in practice.
and Health Service Ombudsman, 2013; Kirkup, 2015). The
model and accompanying professional midwifery advocate role Drivers for change
were implemented in England in 2017 following In the wake of highly publicised failings in NHS care and
recommendations that these conflicting functions were separated subsequent criticisms of work cultures characterised by low staff
to ensure midwives were still able to access support despite the morale, poor leadership, dysfunctional working relationships
removal of statutory supervision (Baird et al, 2015; NHS and a lack of compassion (Francis, 2013; Dixon-Woods et al,
England, 2017; Rouse, 2019). The model was subsequently 2014; Kirkup, 2015), The NHS Long Term Plan and NHS People
adapted for nursing and the professional nurse advocate (PNA) Plan 2020/21 laid down clear expectations for organisations to
role was established in 2021 (NHS England, 2021a). ensure that staff are able to work within compassionate cultures
This new leadership and advocacy role was intended to drive and are supported in managing the increasingly diverse demands
the implementation of A-EQUIP in practice to provide support of patient care (NHS England, 2019; 2020; West et al, 2020).
for nurses and to improve patient care (NHS England, 2021a; Historically, the health and care sector has been associated
Royal College of Nursing (RCN), 2023).Through the delivery with high levels of stress, absenteeism and staff turnover (West
of restorative clinical supervision and a focus on promoting et al, 2020) with high vacancy rates (Beech et al, 2019; West
et al, 2020), decreasing staff morale (Borneo et al, 2020), and
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greater levels of sickness absence and work-related stress than

Rebecca Featherbe, Practice Educator, Torbay and South Devon other sectors (Office for National Statistics, 2018; Health and
NHS Foundation Trust, Torquay, rebeccafeatherbe@nhs.net Safety Executive (HSE), 2022) (Box 1).
Accepted for publication: May 2023 High staff turnover and poor retention are prevalent in
nursing (Kinman et al, 2020) and the situation may worsen,

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Box 1. Workplace pressure and its consequences

and moral distress (Hossain and Clatty, 2021), which are linked
to mounting work pressures (NHS England, 2022; NMC, 2022)
■ Nearly half (48.1%) of nurses and midwives find work and to disillusionment over care standards during the pandemic
emotionally exhausting
(NMC, 2019; Hossain and Clatty, 2021; Kinman et al, 2020).
■ The biggest cause of reported sickness absence among
nurses and health visitors (17.3%) is psychiatric conditions, This emotional toll has been linked to greater cynicism and
which include anxiety, stress and depression disengagement among staff (Chana et al, 2015) and has been
■ Nine out of 10 Royal College of Nursing members report shown to have a negative impact on care quality (West and
feeling concerned about the wellbeing of other nurses Dawson, 2012; Kinman et al, 2020).
■ The proportion of NHS staff who feel valued by their
Much of the research into burnout in nursing is correlational
organisation is at its lowest for 5 years
and does not take confounding factors into account when
Sources: Borneo et al, 2020; National Audit Office, 2020; NHS Digital, determining causality (Chana et al, 2015; Kinman et al, 2020).
2020; NHS England, 2022
In reality, the levels and severity of burnout are likely to be
higher than those reported because emotionally exhausted staff
Box 2. Brexit and staffing levels are less likely to take part in surveys and many will have left
■ Before the Brexit referendum in June 2016, approximately 5% the profession, leading to a potential bias towards more resilient
of UK nurses originated from the European Economic Area staff taking part in studies (Kinman et al, 2020).
(EEA) Nationally, nurses frequently report feeling undervalued (Elliot
■ In the 2 years after confirmation of Brexit, more EEA nurses
and Wallbank, 2013; Clayton-Hathaway et al, 2020; NHS England,
left the NHS than joined. More than one in three of those
leaving the Nursing and Midwifery Council register in 2022 2022; NMC, 2022), and workplace culture was the fourth most
cited Brexit as a reason cited reason for leaving the NMC register last year (NMC, 2022).
■ An additional 5000–10 000 nurse shortfall was predicted to Frequent organisational change and a lack of visible leadership
occur by the end of the Brexit transition in 2021 contribute to staff feeling unsupported and powerless (Dixon-
■ Retirement is the most frequently given reason for leaving the
Woods et al, 2014; Clayton-Hathaway et al, 2020). Staff surveys
register and an estimated one-third of the current UK nursing
workforce is likely to retire by 2026 report increasing levels of emotional exhaustion among nurses
and decreasing levels of satisfaction with the care provided within
Sources: Dolton et al, 2018; Beech et al, 2019; Nursing and Midwifery
Council, 2019; 2022; Clayton-Hathaway et al, 2020; Walker, 2021
their organisations (NHS England, 2022).
Many professionals are unable to talk about their work with
family and colleagues because of confidentiality, which increases
given the increasingly ageing population (Clayton-Hathaway feelings of isolation and restricts the use of usual social support
et al, 2020), the recent additional staff losses related to Brexit mechanisms (Wallbank and Hatton, 2011; Wallbank, 2013a).
(Dolton et al, 2018) and the effects of COVID-19-related Thus, it is increasingly important for nurses to have access to
changes in work patterns, all of which have impacted nurses’ appropriate workplace support, such as clinical supervision, and
intentions to leave the profession (Mahachi, 2020; Nursing to work within cultures that ensure that they feel safe, valued
and Midwifery Council (NMC), 2022) (Box 2). and heard (Dixon-Woods et al, 2014; Kinman et al, 2020; NHS
The toll of emotional labour in health care and the consequent England, 2020).
risk of emotional exhaustion and burnout was recognised even
before the pandemic (Chana et al, 2015; Health Education A-EQUIP model of supervision
England (HEE), 2019), with higher levels of anxiety and depression The A-EQUIP model (NHS England, 2017) is based on
seen in nurses than among the general UK population (HSE), Proctor’s (1986) model of supervision, which has been used
2022). This has only increased since COVID-19 (HSE, 2022), extensively in health care (Ross, 2019), including health visiting
with rising levels of poor mental health (Kinman et al, 2020) (Pettit and Stephen, 2015) (Figure 1).

Clinical supervision

Restorative function: Gives attention Formative function: Focuses on Normative function: Helps ensure
to the emotional needs of the health developing skills, understanding that the professional standards and
visitor, how they have been affected and ability, by reflecting on and professional/organisational roles
by work with clients, and how to deal exploring the work of the person are met; is the gate-keeping or
with them constructively being supervised quality-control function
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Figure 1. Proctor’s model of supervision (1986) (adapted by Pettit and Stephen, 2015)

516 British Journal of Nursing, 2023, Vol 32, No 11

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The development of a new supervision model followed

Science Photo Library

widespread stakeholder engagement resulting in the addition
of a further function (Figure 2) (NHS England, 2017) to address Normative:
the previously highlighted need for a continuous focus on monitoring,
improvement (Francis, 2013; Kirkup, 2015). The model, along evaluation and
with the role of the PNA, aims to support staff, promote positive quality control
work cultures and improve patient care (NHS England, 2021a).
The link between clinical supervision and increased staff
wellbeing has been demonstrated in multiple studies (Wallbank,
2013b; Macdonald, 2019; Kinman et al, 2020). Provision of
supervision has been correlated with a reduced risk of burnout
(MacLaren et al, 2016; Kinman et al, 2020), increased resilience
(Macdonald, 2019) and increased compassion satisfaction among
Formative: Restorative:
staff (Wallbank, 2013b). Staff exposed to supervision have education and clinical
reported positive effects on their working relationships (Mahachi, development supervision
2020) and group supervision has been shown to support
teamworking and conflict resolution (Wallbank, 2013b). Most
of these studies, however, have been limited by the use of very
small samples (Wallbank, 2013b; MacLaren et al, 2016), purely
qualitative data collection (Mahachi, 2020) and methodology
that cannot be replicated in further studies (Wallbank, 2013b).
Systematic reviews of the literature (Duhoux et al, 2017;
Cutcliffe et al, 2018; Martin et al, 2021) have raised criticisms Personal
action for
of the available evidence because of a lack of consensus over quality
intervention methods (Duhoux et al, 2017), difficulty in improvement
evaluating organisational impact (Martin et al, 2021) and
overdependence on self-reported outcome measures (Kinman
et al, 2020). Several pre-post intervention studies (Wallbank
Figure 2. The A-EQUIP model of supervision (adapted from NHS England, 2021a)
and Hatton, 2011;Wallbank and Woods, 2012;Wallbank, 2013b)
have been criticised for potential bias in their participant
recruitment (Duhoux et al, 2017), and much of the research consistency of delivery and to provide greater reassurance of
fails to consider the implication of confounding factors on their effectiveness (NHS England, 2017; 2021a).
findings (Duhoux et al, 2017; Martin et al, 2021). Overall, there is convincing evidence within the available
Many of the available studies have been undertaken in specific literature that well-implemented restorative clinical supervision
staff groupings (Wallbank and Woods, 2012; Elliot and Wallbank, improves staff wellbeing, through increasing resilience and
2013; Martin et al, 2021) or around specific elements of practice reducing stress (Wallbank, 2013a; Macdonald, 2019; Rouse,
(Wallbank and Hatton, 2011; Wallbank, 2013a).These have 2019). It also improves morale and facilitates positive work
raised concerns about the overall generalisability of the findings cultures by enhancing communication, teamworking and
(Duhoux et al, 2017; Martin et al, 2021; O’Neill et al, 2022) conflict resolution skills (Wallbank, 2013b; Pettit and Stephen,
because of the heterogenous nature of nursing roles (Kinman 2015; Mahachi, 2020; Martin et al, 2021).
et al, 2020) and the lack of evidence relating to some areas of
practice, including primary care (Duhoux et al, 2017) and child Futureproofing and sustainability
health (O’Neill et al, 2022). A deficit of studies with control The success of clinical supervision depends much on the way
groups (Duhoux et al, 2017; Martin et al, 2021) and concerns it is implemented and the level of organisational support for
surrounding potential publication bias also feature (Duhoux et its use (Dixon-Woods et al, 2014; Martin et al, 2021).
al, 2017; Kinman et al, 2020). Implementing sustained change in large organisations is never
Despite this, there is a growing body of empirical evidence easy (Bridges and Bridges, 2017) and the effectiveness of
to support the positive impact of clinical supervision, and the A-EQUIP in practice may be influenced by a number of
qualitative evidence, which is almost universally affirmative, is individual and organisational barriers (Box 3).
significant (Cutcliffe et al, 2018). Much of the doubt regarding Having protected time is key to effective supervision (Rouse,
effectiveness expressed within the literature hangs on the lack 2019; Martin et al, 2021) although self-care is often not seen
of consensus regarding what supervision entails (Wallbank and as a priority (Elliot and Wallbank, 2013). Non-clinical work is
© 2023 MA Healthcare Ltd

Woods, 2012; Cutcliffe et al, 2018; O’Neill et al, 2022) and generally perceived as less important than patient care (Martin
concerns about inadequate implementation (Duhoux et al, and Snowden, 2020) and, for some professionals, participation
2017; Martin et al, 2021).The use of the A-EQUIP model and in supervision has been seen as an additional burden on already-
the development of the PNA role underpin the restorative stretched staff (Elliot and Wallbank, 2013). Increased pressures
nature of supervision within a clear framework to ensure and reduced staffing are likely to exacerbate this (Martin and

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Box 3. Barriers to clinical supervision

Conclusion
The provision of compassionate and effective patient care
Individual barriers depends on the health and wellbeing of the professionals
■ Lack of time to access supervision
delivering it (Chana et al, 2015; West et al, 2020).
■ Not knowing what supervision is or how to access it
■ Mistrust in the organisation/suspicion over why it is being
There is clear evidence that NHS staff, including nurses, are
offered experiencing increasing stress, burnout and mental health
■ Guilt over time away from patient care problems (Chana et al, 2015; Kinman et al, 2020; HSE, 2022;
■ Restricted availability because of shift pattern/unsocial NHS England, 2022), with the subsequent risk of reduced
working hours
efficacy and poorer, less compassionate patient care (West and
■ Professional nurse advocate (PNA) is the line manager, works
in the same area or holds a senior leadership role Dawson, 2012; Kinman et al, 2020).
Staff wellbeing is linked to better patient experience,
Organisational barriers
■ Lack of physical space or suitable locations
increased compassion, fewer errors, lower patient mortality
■ Lack of supportive leadership rates (King’s Fund, 2012;West and Dawson, 2012; Dixon-Woods
■ Poor organisational culture et al, 2014; HEE, 2019), lower absence rates, increased morale
■ Low staffing levels/lack of cover to free staff and reduced staff turnover (King’s Fund, 2012; Davenport, 2013;
■ Pressures of the PNA substantive role, particularly where the
Halter et al, 2017). There is an evident need for a framework
PNA has key organisational responsibilities
to provide staff with the emotional and practical support they
Elliot and Wallbank, 2013; Rouse, 2019; Martin and Snowden, 2020; need (Kinman et al, 2020; NHS England, 2020;West et al, 2020).
Martin et al, 2021; O’Neill et al, 2022
The A-EQUIP model and the role of the PNA offer such
a framework (NHS England, 2017; 2021a) and, through the
delivery of restorative clinical supervision, the model supports
Snowden, 2020), and staff who feel overwhelmed may improved patient care (HEE, 2019; Kinman et al, 2020),
experience increased anxiety about even beneficial workplace increased staff wellbeing and better work environments and
changes (Elliot and Wallbank, 2013; Bridges and Bridges, 2017). cultures (Kinman et al, 2020; Martin et al, 2021).
Organisational culture and leadership style play a massive
part in how well change becomes embedded (Wallbank, 2013c; Recommendations
Mahachi, 2020; Martin et al, 2021). Feelings of involvement The widespread employer-led implementation of the A-EQUIP
and shared control among professionals make successful change model for nurses was integrated in the NHS standard contract
more likely (Wallbank, 2013c; Bridges and Bridges, 2017), and service development and improvement plan from April 2022
organisational cultures that value teamwork, collaboration and (NHS England, 2021a). Based on the evidence discussed above,
reciprocity between leaders and staff are more likely to be able and within the context of the organisational and individual
to sustain lasting transformations (Wallbank and Woods, 2012; barriers to supervision highlighted, the author makes the
Wallbank, 2013c; Bridges and Bridges, 2017; Leclerc et al, 2021). following recommendations to support the embedding of
To be effective, leaders need to be able to manage their own A-EQUIP in practice:
stresses (Wallbank, 2013c) and to role model the practice of ■ All nurses should have access to regular restorative clinical
self-care to other professionals (Bridges and Bridges, 2017; supervision with a qualified PNA
Leclerc et al, 2021), enabling staff to feel permitted to make ■ Protected time must be given to staff to access PNAs, who
supervision an integral part of their role and not a diversion should be enabled to provide supervision without feeling
from what they ‘should’ be doing (Elliot and Wallbank, 2013). compromised in their substantive role, such as feeling they
Trust and communication are vital (Dixon-Woods et al, 2014; have to work extra hours to make up for the time spent on
Bridges and Bridges, 2017; Leclerc et al, 2021), with one study supervision or catch up on other work
reporting that staff were not engaging with supervision because ■ Clinical leaders should:
they were suspicious about the organisation’s reasons for – Be proactive with their own wellbeing and the role
providing it (Elliot and Wallbank, 2013). modelling of self-care behaviours such as clinical
The substantive role of the PNA, their place in an supervision
organisation’s hierarchy and any pre-existing relationships with – Be more explicit in giving staff approval to participate in
supervisees can all impact the effectiveness of the supervision regular supervision as part of their professional development
relationship and potentially create staff engagement barriers – Promote transparency and honesty with their teams in
(Cutcliffe et al, 2018; Rouse, 2019; O’Neill et al, 2022). Having order to build trust and open communication
sufficient PNAs within an organisation to allow choice of ■ Organisations need to:
supervisor as well as flexibility in style and timing of sessions – Ensure that all staff are aware of what restorative clinical
is therefore crucial to successful implementation (Wallbank and supervision is, what the offer is within their organisation
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Hatton, 2011; Wallbank, 2013b; Rouse, 2019). The ability of and how to access it
individual PNAs to access their own peer support and – Ensure that they have sufficient numbers of qualified PNAs
supervision and the effect of their additional supervision to support supervision and allow nurses the choice to
function on their other roles and responsibilities are also likely access a supervisor who is not their line manager or
to impact on long-term sustainability (Ashmore et al, 2012). someone they do not feel comfortable with

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– Be more proactive in engaging with staff at all levels and

encouraging shared decision-making and collaborative KEY POINTS
working.
To achieve sustained improvements, organisations need to ■ The professional nurse advocate (PNA) role and the delivery of restorative
consciously strive to foster cultures that are inclusive and where clinical supervision within the A-EQUIP model provide a framework through
staff at all levels feel involved in the decisions that affect them which staff can access practical and emotional support
(Wallbank, 2013c; Dixon-Woods et al, 2014). Ongoing ■ The effectiveness of clinical supervision depends much on organisational
evaluation of the model in practice should be undertaken and, cultures and it is more likely to be successful where teamwork and
where appropriate, further strategies developed to support its collaboration are valued
continuing use in practice (NHS England, 2018; Macdonald, ■ Organisational support is crucial and employers must ensure that they
2019). have sufficient PNAs and allow enough protected time for supervision
Further research to provide more quantitative data is needed ■ Practitioners at all levels often view non-clinical work as less of a priority
to strengthen the existing empirical evidence base to support and clinical leaders need to role model self-care, enabling staff to feel they
the use of A-EQUIP (Cutcliffe et al, 2018; Martin et al, 2021); can make supervision integral to their role and professional development
however, with a shift away from a reliance on positivist methods
in research generally (Cutcliffe et al, 2018) and calls for data
that offer deeper context to the supervision experience 2018;27(5):1344‑1363. https://doi.org/10.1111/inm.12443
(Maclaren et al, 2016), mixed-methods approaches with both Davenport D. The basics of clinical supervision. Nursing in Practice, 21 June
qualitative and quantitative elements may be preferable for 2013. https://tinyurl.com/463v55ry (accessed 25 May 2023)
Dixon-Woods M, Baker R, Charles K et al. Culture and behaviour in
future studies (Cutcliffe et al, 2018). the English National Health Service: overview of lessons from a large
Much of the available research focuses on patient, organisation multimethod study. BMJ Qual Saf. 2014;23(2):106–115. https://doi.
org/10.1136/bmjqs-2013-001947
and supervisee outcomes (Wallbank, 2013b; Kinman et al, 2020; Dolton P, Nguyen D, Castellanos M, Rolfe H; National Institute of Economic
Martin and Snowden, 2020; Martin et al, 2021) and, while there and Social Research. Brexit and the health and social care workforce in the
is some evidence to suggest that clinical supervision is a positive UK. 2018. https://tinyurl.com/mtkcpweh (accessed 31 May 2023)
Duhoux A, Menear M, Charron M, Lavoie-Tremblay M, Alderson M.
experience for supervisors (Ashmore et al, 2012; RCN, 2023), Interventions to promote or improve the mental health of primary care
the PNAs’ perspective of the role and their own supervision nurses: a systematic review. J Nurs Manag. 2017;25(8):597-607. https://
doi.org/10.1111/jonm.12511
and support needs are not well understood. Further studies to Elliott V, Wallbank S. Giving something for me: working with health visitors’
explore the views of supervisors and the impact on PNAs of experiences of restorative supervision. Journal of Health Visiting.
2013;1(7):406–410. https://doi.org/10.12968/johv.2013.1.7.406
delivering supervision are needed (O’Neill et al, 2022), and Francis R. Report of the Mid Staffordshire NHS Foundation Trust public
ongoing evaluation of the provision of supervision for PNAs inquiry. 2013. https://tinyurl.com/469ppfch (accessed 31 May 2023)
should be undertaken. Halter M, Boiko O, Pelone F, Beighton C, Harris R, Gale J, Gourlay S,
Drennan V. The determinants and consequences of adult nursing staff
It should also be noted that factors such as staffing and pay, turnover: a systematic review of systematic reviews. BMC Health Serv Res.
which fall outside the scope of this article, have a considerable 2017;17(1):824. https://doi.org/10.1186/s12913-017-2707-0
Health Education England. NHS staff and learners’ mental wellbeing
impact on employees (Beech et al, 2019; Borneo et al, 2020) commission. 2019. https://tinyurl.com/5f8ecdsb (accessed 31 May 2023)
and that systematic change is needed to make a truly meaningful Health and Safety Executive. Human health and social work activities statistics
difference to the health and wellbeing of nurses. BJN in Great Britain, 2022. https://www.hse.gov.uk/statistics/industry/health.
pdf (accessed 25 May 2023)
Hossain F, Clatty A. Self-care strategies in response to nurses’ moral injury
Declaration of interest: none during COVID-19 pandemic. Nurs Ethics. 2021;28(1):23–32. https://doi.
org/10.1177/0969733020961825
King’s Fund. Leadership and engagement for improvement in the NHS:
Ashmore R, Carver N, Clibbens N, Sheldon J. Lecturers’ accounts of Together we can. 2012. https://tinyurl.com/5n6uw5pa (accessed 31 May
facilitating clinical supervision groups within a pre-registration mental 2023)
health nursing curriculum. Nurse Educ Today. 2012;32(3):224–228. Kinman G, Teoh K, Harriss A; Society of Occupational Medicine and RCN
https://doi.org/10.1016/j.nedt.2011.04.010 Foundation. The mental health and wellbeing of nurses and midwives in
Baird B, Murray R, Seale B, Foot C, Perry C; for The King’s Fund. Midwifery the United Kingdom. 2020. https://tinyurl.com/3p9dm47p (accessed 25
regulation in the United Kingdom. Report commissioned by the Nursing May 2023)
and Midwifery Council. 2015. https://tinyurl.com/ycxyajmz (accessed Kirkup B. The report of the Morecambe Bay investigation. 2015.
25 May 2023) https://tinyurl.com/ycmajuhd (accessed 2 November 2020)
Beech J, Bottery S, Charlesworth A et al; Health Foundation, King’s Fund and Leclerc L, Kennedy K, Campis S. Human-centred leadership in health care:
Nuffield Trust. Closing the gap: key areas for action on the health and care a contemporary nursing leadership theory generated via constructivist
workforce. 2019. https://tinyurl.com/5873pwy6 (accessed 25 May 2023) grounded theory. J Nurs Manag. 2021;29(2):294–306. https://doi.
Borneo A, Dalrymple A, Hadden C et al; Royal College of Nursing. Building org/10.1111/jonm.13154
a better future for nursing: RCN members have their say. 2020. https:// Macdonald B. Restorative clinical supervision: a reflection. Br J Midwifery.
tinyurl.com/mpz3uvme (accessed 25 May 2023) 2019;27(4):258–264. https://doi.org/10.12968/bjom.2019.27.4.258
Bridges W, Bridges S. Managing transitions; making the most of change. MacLaren J, Stenhouse R, Ritchie D. Mental health nurses’ experiences
4th edn. London: Nicholas Brealey Publishing; 2017 of managing work-related emotions through supervision. J Adv Nurs.
Chana N, Kennedy P, Chessell ZJ. Nursing staffs’ emotional well-being and 2016;72(10):2423–2434. https://doi.org/10.1111/jan.12995
caring behaviours. J Clin Nurs. 2015;24(19-20):2835–2848. https://doi. Mahachi LC. The role of professional advocate in endoscopy: The A-Equip
© 2023 MA Healthcare Ltd

org/10.1111/jocn.12891 model. Gastrointestinal Nursing. 2020; 18(suppl 8):S18-S24. https://doi.

Clayton-Hathway K, Humbert AL, Griffiths H, Schutz S, McIlroy R; Oxford org/10.12968/gasn.2020.18.Sup8.S18
Brookes University and Royal College of Nursing. Gender and nursing as Martin P, Snowdon D. Can clinical supervision bolster clinical skills and well-
a profession: valuing nurses and paying them their worth. 2020. https:// being through challenging times? J Adv Nurs. 2020;76(11):2781–2782.
tinyurl.com/2p8azfja (accessed 31 May 2023) https://doi.org/10.1111/jan.14483
Cutcliffe JR, Sloan G, Bashaw M. A systematic review of clinical Martin P, Lizarondo L, Kumar S, Snowdon D. Impact of clinical supervision
supervision evaluation studies in nursing. Int J Ment Health Nurs. on healthcare organisational outcomes: a mixed methods systematic

British Journal of Nursing, 2023, Vol 32, No 11519

PROFESSIONAL

review. LoS One. 2021;16(11):e0260156–e0260156. https://doi. and regulation: recommendations for change. 2013. https://tinyurl.
org/10.1371/journal.pone.0260156 com/4v8rrd56 (accessed 25 May 2023)
National Audit Office. The NHS nursing workforce. HC 109 (session Pettit A, Stephen R; Institute of Health Visiting, Health Education England
2019‑2021). 2020. https://tinyurl.com/yc38yexu (accessed 25 May 2023) and Department of Health. Supporting health visitors and fostering
NHS Digital. NHS sickness absence rates April 2020, provisional statistics. 22 resilience. Literature review. 2015
October 2020. https://tinyurl.com/4m8ehxte (accessed 25 May 2023) Ross P. Clinical supervision in nursing. Nursing Education Network.
NHS England. A-EQUIP: a model of clinical midwifery supervision. 2017. 20 February 2019. https://tinyurl.com/2crns48f (accessed 31 May 2023)
https://tinyurl.com/mrx6njyx (accessed 31 May 2023) Royal College of Nursing. Professional nurse advocate standards for
NHS England. Advocating for Education and Quality ImProvement education and training programmes and modules. 2023. https://tinyurl.
(A-EQUIP), England’s model of midwifery supervision—‘One year On’. com/52wnt2fu (accessed 25 May 2023)
2018. https://tinyurl.com/3hef5k3h (accessed 28 May 2023) Rouse S. The role of the PMA and barriers to the successful implementation
NHS England. The NHS long term plan. 2019. https://www.longtermplan. of restorative clinical supervision. Br J Midwifery. 2019;27(6):381–386.
nhs.uk (accessed 25 May 2023) https://doi.org/10.12968/bjom.2019.27.6.381
NHS England. We are the NHS: people plan 2020/21—action for us all. 2020. Walker N. Brexit timeline: events leading to the UK’s exit from the European
https://tinyurl.com/3yc8fchr (accessed 25 May 2023)
Union. Briefing report. House of Commons Library; 6 January 2021.
NHS England. Professional nurse advocate A-EQUIP model: a model of
https://tinyurl.com/y3c5f6xf (accessed 31 May 2023)
clinical supervision for nurses. 2021a. https://tinyurl.com/5d8kfdv9
Wallbank S. Recognising stressors and using restorative supervision to
(accessed 28 May 2023)
NHS England. Professional nurse advocate: role and responsibilities checklist. support a healthier maternity workforce: a retrospective, cross-sectional,
2021b. https://tinyurl.com/ms9fvwfd (accessed 28 May 2023) questionnaire survey. Evidence Based Midwifery. 2013a;11(1):4–9. https://
NHS England. NHS staff survey 2021: national results briefing. London: tinyurl.com/y78f6axr (accessed 26 May 2023)
Survey Coordination Centre; 2022. https://tinyurl.com/4kr2fc58 (accessed Wallbank S. Maintaining professional resilience through group restorative
28 May 2023) supervision. Community Pract. 2013b;86(8):26–28
Nursing and Midwifery Council. Leavers’ survey 2019: why do people leave Wallbank S. Reflecting on leadership in health visiting and the restorative
the NMC register? 2019. https://tinyurl.com/2w463j7k (accessed model of supervision. Journal of Health Visiting. 2013c;1(3):173-176.
25 May 2023) https://doi.org/10.12968/johv.2013.1.3.97598
Nursing and Midwifery Council. Leavers’ survey 2022: why do people leave Wallbank S, Hatton S. Reducing burnout and stress: the effectiveness of clinical
the NMC register? 2022. https://tinyurl.com/3ek8fkef (accessed supervision. Community Pract. 2011;84(7):31–35
25 May 2023) Wallbank S, Woods G. A healthier health visiting workforce: findings
Office for National Statistics. Sickness absence falls to the lowest rate on from the restorative supervision programme. Community Pract.
record. 30 July 2018. https://tinyurl.com/ytufb7bv (accessed 25 May 2023) 2012;85(11):20–23
O’Neill A, Edvardsson K, Hooker L. Clinical supervision practice by West M, Dawson J. Employee engagement and NHS performance. The King’s
community-based child and family health nurses: A mixed-method Fund; 2012. https://tinyurl.com/yy5zsxfa (accessed 31 May 2023)
systematic review. J Adv Nurs. 2022;78(6):1588–1600. https://doi. West M, Bailey S, Williams E; King’s Fund. The courage of compassion
org/10.1111/jan.15191 supporting nurses and midwives to deliver high quality care. 2020. https://
Parliamentary and Health Service Ombudsman. Midwifery supervision tinyurl.com/3uv5edsn (accessed 31 May 2023)

CPD reflective questions

■ How does your own and your colleagues’ wellbeing impact on the care that your team delivers?
■ What strategies can you employ to support your own or your colleagues’ wellbeing? How can you role model self-care for your team?
■ How does the culture in your organisation impact on your own or your colleagues’ ability to access restorative clinical supervision? Are
there any barriers in your workplace?
■ What could you o r your manager do to support engagement with restorative clinical supervision in your team?

Research Skills for Nurses and Midwives

This book aims to provide nurses and midwives with a sound theoretical knowledge base for
understanding, critically appraising and undertaking research in all areas of health service provision.
A comprehensive insight is provided into philosophies, methodologies and methods relevant to health
care, using examples from both professions. It covers the main sources of research and evidence which
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nurses and midwives use to develop their practice.

Not only does the book encourage nurses and midwives to develop their research and evidence skills,
by the time the reader has completed it, they will have the knowledge and skills to conduct their own
small scale research projects.
© 2023 MA Healthcare Ltd

ISBN-13: 978-1-85642-503-2; 210 x 148 mm; paperback; 150 pages; publication 2013; £19.99

Order your copies by visiting or call our Hotline

www.quaybooks.co.uk +44 (0) 333 800 1900*

520 British Journal of Nursing, 2023, Vol 32, No 11

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