Concerns and challenges during supervision

If concerns are raised during supervision 

Supervisors should have a good understanding of how to appropriately escalate any concerns identified during sessions. While maintaining confidentiality is an essential part of the supervisee: supervisor relationship, exceptions may be required.   For example, where there are concerns identified about a practitioner’s conduct, competence, physical or mental health. The supervisor may need to disclose information from a supervision session to an appropriate person, such as a line manager.    

Issues relating to performance or capability should be addressed as soon as they become apparent through providing formal feedback and additional support. This can be more challenging in instances where the individual lacks insight into their performance or capability deficit. Whilst issues such as this are more appropriate to be addressed within management supervision, the overlap between practice, management and restorative supervision requires the practice supervisor to recognise where issues may require escalation.

The circumstances under which confidentiality may be broken, and the process which will subsequently be followed, should be clearly detailed in the supervision agreement.

Challenges in accessing supervision 

The benefits of accessing good quality supervision opportunities are clear and it is therefore hoped that employers recognise the importance of supporting staff to undertake supervision. Using job planning to build protected time into every role can also facilitate effective and responsible supervision. If individuals continue to struggle to access supervision, scenarios and possible solutions are presented.

Challenge 1. My department is short staffed and so I feel that there are too many other things that come first.  

If you are working for an organisation, they have a responsibility to provide the opportunity for supervision, such as scheduling this into a job plan, but this is ultimately an individual practitioner’s choice. Practice supervision is an essential type of CPD that enhances service user and practitioner safety and wellbeing. As such, every effort should be made to ensure that supervision sessions are not cancelled. Job planning¹ can help, particularly where services have vacancies, as it allows you to present an accurate picture of capacity to undertake clinical activity. Job planning gives clinicians ‘permission’ to ensure that clinical activity is not prioritised over other essential professional activities – such as supervision and CPD.  Practitioners should not feel guilty about taking time away from clinical activity. Prioritising your own wellbeing and professional development greatly improves the quality of the service you can deliver.    

Challenge 2. I am the only dietitian in my service / department / organisation / clinical speciality / I am self-employed.

As supervision is an individual practitioner’s responsibility, the dietitian working in isolation must agree with their employer how this will be accessed. Ideally this agreement occurs prior to commencing employment but if not, then agreement can be reached during management supervision sessions. Appropriate channels may include exploring access through an arrangement with a local organisation, through BDA specialist interest groups or appropriately trained private practitioners. For those working in services providing regulated activities – such as NHS organisations or private companies delivering NHS care - the employer has a responsibility to ensure that staff are appropriately trained and have access to supervision (see Your employer’s responsibility). For self-employed dietitians, the practitioner may need to self-fund supervision and this cost may need to be built into fees.

Challenge 3. I work in primary care and only get supervision from someone outside my profession.

Supervision does not need to be provided by someone from your own profession*, although the supervisor must understand the profession and/or role. They must be aware of the scope of that role and identify the limitation to the supervision they can provide (see Training for supervisors). This is likely to be more appropriate for experienced dietitians and there will still be benefit in using your professional specific networks for informal supervision opportunities should you be presented with unusual dietetic cases.

*Within mental health settings, such as eating disorders and CAMHS, the quality standards² recommend that supervision is delivered by someone from the same profession with appropriate clinical experience and qualifications. As such, the BDA position is that dietitians working in these environments should receive practice supervision by a suitably experienced dietitian.

Challenge 4. I don’t work well with my supervisor.

It is likely to take a while to develop a strong working relationship with your supervisor, however, if after a period, the relationship isn’t working then it may be time to switch supervisors. Supervision works better when the supervisee has been able to select their own supervisor. This scenario highlights the importance of having a clear supervision agreement in place which is regularly reviewed so that it is evident to both parties when the relationship isn’t a success.

Challenge 5. My department doesn’t have a supervision structure in place.

Discuss with your colleagues as it is likely that they have also recognised that they are missing out by not having access to practice supervision. Approach your manager to explain why practice supervision is required for yourself and the department.