Practice nurses' sources of clinical support: observations from a citywide survey

Abstract

Objectives: The survey aimed to identify present sources, and perceived adequacy, of clinical support amongst local practice nurses.Design: Telephone survey and focus group.Setting: Practice Nurses employed in a General Practice setting supported by reimbursement from the Manchester Health Authority.Participants: Telephone survey—75 practice nurses, ten data collectors. Focus group—6 Practice Nurses, Primary Care Nurse Advisor and a Researcher.Main outcome measures: Survey results aimed to identify frequency of and sources of clinical support amongst all local practice nurses and their understanding of the term Clinical Supervision. Focus group explored fine detail and ‘puzzlements’ arising from survey.Findings:General practitioners are the main source of clinical support for practice nurses. The practice nurses preferred an informal approach to clinical support with the nurse remaining in control of the process, seeking support when needed. All respondents expressed strong concerns that the professional autonomy that they associate with practice nursing should be protected. Most practice nurses seemed unaware of the growth and development elements of clinical supervision. One third of respondents were very vociferous and saw clinical supervision as a threat, the word ‘supervision’ being interpreted as introducing hierarchical management by stealth.Conclusions: There is support that Clinical Supervision has the potential to develop nurses' clinical effectiveness and contribute to clinical governance. It also appears that practice nurses, who work in comparative professional isolation from other nurses, have much to gain personally and professionally from the supportive elements of this initiative. However, this study highlights values and organizational issues that must be considered before implementing this initiative in this particular nursing group.