The Literature on Clinical Supervision and Leadership

Subject: Nursing
Pages: 18
Words: 4921
Reading time:
17 min
Study level: College

This paper is aimed at providing a summary of the available literature on clinical supervision (CS) and leadership to serve as a resource manual for nursing supervisors. Clinical supervision is the process officiated by a supervisor to provide necessary support and interventional education to supervisees to upgrade their acquaintance and aptitude. It also ensures that they provide high-quality and safe services in intricate clinical situations (Hyrkas et al, 2006, p. 522).

Blouin, S. A., McDonagh, K.J., Neistadt, M.A., & Helfand, B. (2006). Leading tomorrow’s healthcare organizations: strategies and tactics for effective succession planning. The Journal of Nursing Administration, 36 (6), 325-330.

The article details the limitations in healthcare organizations that are perceived to hinder the process of succession planning and maintenance of the talents in healthcare management (Blouin et al, 2006, p. 325). In addition, it provides guidelines to succession planning particularly for the chief executive officers (CEOs) and other superior leaders. The authors argue that there are many problems facing healthcare organizations’ leadership, particularly an increment in the rate of turnover. The challenge that is identified in this case is that there are no internal talents that can replace the gaps left by the top leaders. Through analysis of a case relating to a healthcare facility in Texas, the authors provide the most appropriate ploys in succession planning (Blouin et al, 2006, p. 327). The authors evaluate the implications of succession planning in terms of organizational continuity. Organizational continuity is important to healthcare organizations because the organizations’ services affect many communities.

The article further provides a summary of the literature available on the scope of succession planning in the context of the healthcare industry and universal businesses. In this case, literature on healthcare leadership provides the most unique problems facing the industry which require urgent intervention. In line with the process of succession planning, the authors provide the merits of programs aimed at developing future leaders in healthcare organizations. The case of Christus Spohn Health Facility studied in this article indicates that when the top leadership is committed to leadership brilliance, they create an organizational culture that enables the junior staff to value and support the top leadership (Blouin et al, 2006, p. 329). Finally, the article provides tactical strategies for implementing the available literature into practice in real-world situations. The ultimate benefit of investing in leadership development is that it aids in attracting young leaders who would wish to work with successive organizations (Blouin et al., 2006, p. 330).

Bradley, G. (2010). Work-induced changes in feelings of mastery. The Journal of Psychology, 144 (2), 97-119.

The author, a researcher at Griffith University provides the findings of the study conducted to test the effectiveness of Karasek and Theorell’s person-work-environment theory (Bradley, 2010, p. 97). The theory states that work experiences such as the ability to control different work situations and demands are directly related to the feelings of mastery displayed by the workers. The theory further states that the feelings of mastery are attained through active and continuous learning. This is in line with other past research studies and theories which indicate that the conditions of any working environment are bound to exact long-lasting effects on the workers. The study was carried out on 657 teachers. It entailed evaluating the effects of job control, active learning, and job demand on mastery in two different case studies, on a duration of eight months (Bradley, 2010, p. 110). The results from the study partially supported the propositions of the theory. It is shown that job control coupled with active learning increases job mastery.

On the other hand, the effect of job demands on mastery is felt when the worker can control the increased job demands in which case job control and job demands play a collective role in increasing mastery. Moreover, the author provides past literature that supports Karasek and Theorell’s theory. Despite the study providing evidence to a model that had not been reviewed or researched on, the author notes some limitations such as the use of a non-experimental plan and dependence on the reports from subjects which may contain some response biases. This calls for future research that should measure independent job demands and abilities related to job control over a wider organizational area and large sample size (Bradley, 2010, p. 116).

De Jonge, J., Le Blanc, M.P., Peeters, M.C.W., Noordam, H. (2008). Emotional job demands and the role of matching job resources: a cross-sectional survey study among health care workers. International Journal of Nursing Studies, 45 (1), 1460-1469.

The article provides the results of a research study conducted by the authors, researchers on the mechanisms behind the effect of poignant job requirements on the welfare and vigor of the healthcare worker. The researchers embarked on this case because the available literature on emotional labor in the context of healthcare systems did not reveal the conditions under which poignant job demands affect the health and welfare of the healthcare worker (De Jonge et al, 2008, p. 1460). The cross-sectional study which employed unnamed questionnaires was aimed at assessing the role of expressive and cognitive work resources in terms of moderating the relationship between the emotional job demands and the welfare and health of the worker. The study involved a sample size of 1259 workers in a healthcare facility in the urban Netherlands.

These workers were then supplied with the questionnaire of which approximately 66% of the subjects which is equivalent to 826 workers returned the answered questionnaires. The analyzed data indicate that the matching or emotional job resources help to balance the effects of emotional job demands which affect the welfare or health of the workers sometimes leading to emotional fatigue. Nevertheless, the emotional job resources and partly the cognitive or non-matching job demands, control the liaison between the job demands and the positive emotional outcomes of a healthcare worker (De Jonge et al., 2008, p. 1466). The authors, researchers concluded that the effect of emotional job resources on the emotional outcomes in the worker is based on the fact that these resources are capable of replacing the exhausted emotional resources that the worker utilizes in meeting the emotional work requirements thereby increasing the chances of the worker displaying positive emotions. Therefore, the provision of emotional job resources to the workers helps in limiting the stressful situations associated with emotional job requirements thereby increasing worker productivity and job contentment (De Jonge et al., 2008, p. 1468).

Fairbrother, G., Jones, A., & Rivas, K. (2009). Development and validation of the Nursing Workplace satisfaction questionnaire (NWSQ). Contemporary Nurse, 34 (1), 10-18.

The authors, one Research Fellow, a Nursing Executive Officer, and a Quality Manager respectively, present a case study conducted in a large Sydney healthcare facility to assess the effectiveness of NWSQ in measuring job satisfaction within the organization (Fairbrother et al., 2009, p. 10). A single-page questionnaire consisting of 14-items was developed through reviewing of the instruments available and group discussions. The importance of the NWSQ over the previous tools of measurement which were perceived to be North-American biased, long, and aimed at measuring factors affecting the whole organization and thus not specific is that it reduced the content into three main sections. These include coherent, inherent, and extrinsic job fulfillment levels of assessment. The tool was developed as a result of the introduction of a new model of nursing care that involved teaming nurses instead of the past model of allocating individual nurses to particular exercises (Fairbrother et al., 2009, p. 12). When the tool was tested using 220 respondents, they all confirmed its validity in the measurement of job satisfaction. Further validation conducted through analysis of 459 internal respondents, confirmed the tool as being even and consistent.

This article further provides the procedure followed in designing the questionnaire which involves evaluation of the available materials, group-based questionnaire design, piloting, investigative factor analysis, and internal evenness analysis (Fairbrother et al., 2009, p. 16). Finally, the effectiveness of the tool in measuring hospital-based or ward-based job satisfaction is pegged on it being precise, short, designed to satisfy the immediate or regional requirements, and its ability to measure three variables of the same factor at once.

Hyrkas, K., Appelqvist-Schmiddlechner, K., & Haatajar, R. (2006). Efficacy of clinical supervision: influence on job satisfaction, burnout, and quality care. Journal of Advanced Nursing, 55 (4), 521-535.

The article provides a study aimed at evaluating the effect of supervisees’ backgrounds, working environments, the infrastructure used in job satisfaction, burnout levels, and the workers’ perceptions on the quality of service and effectiveness of Clinical Supervision (Hyrkas et al., 2006, p. 521). The study involving 799 respondents affiliated with various healthcare facilities in Finland was conducted using various standardized evaluation tools and measures that were to be completed by the subjects. Data collection started in October 2000 and came to an end in February 2001(Hyrkas et al., 2006, p. 526). The analyzed data shows varied statistical significances between different respondents because of the varied backgrounds. However, there was a strong relationship between the infrastructure used in clinical supervision and the outcomes of the study.

The supervisee’s attributes such as age, gender and work-related experiences including the experiences gained in clinical supervision play a key role in the assessment of the efficiency of Clinical supervision. The findings of the assessment of clinical supervision are important predictors of the supervisees’ levels of exhaustion, job contentment, and good nursing practice (Hyrkas et al., 2006, p. 530). As a result, the authors state that the group of nursing professionals with ten years’ job experience, working in shifts or part-time over 24 hours in addition to working in the general nursing care would benefit more from the process of clinical supervision than otherwise. This will also depend on the extent to which educational resources are provided to the supervisors. In addition, the nursing staff must be encouraged to take part in the clinical supervision exercise both as the supervisors and supervisees. This is because clinical supervision influences the quality of nursing care and job satisfaction positively.

Johansson, I., Holm, A., Lindqvist, I., & Severinsson, E. (2006). The value of caring in nursing supervision. Journal of Nursing Management, 14 (1), 644-651.

The authors present the analysis of the supervisors’ views regarding the importance of caring in the process of clinical supervision and their practice about the values they attach to the whole exercise of supervision. The value of caring in clinical practice comes to the forefront when the supervisor encounters the supervisee. The encounter is characterized by hope, confirmation, participation, and trust (Johansson et al., 2006, p. 644). The study was instigated by a lack of relevant literature that describes the ways of ensuring maintenance of quality in nursing supervision. The study was conducted through interviews that were aimed at generating data from the target groups. The questions ranged from the open and associative ones to the main questions on the topic. The researchers had earlier sent invitations to thirteen supervisors but only four were able to form the focus groups (Johansson et al., 2006, p. 649). From the supervisors’ perspective, the value of caring in clinical supervision involves a legitimate meeting between two individuals whereby respect, trust, and acceptance are in existence. The value is made visible through sharing stories related to patients’ experiences and how best to deal with different clinical situations. They also indicate that building the student’s courage is vital towards encouraging the development of professional values. This is displayed through the supervisor’s motivation, bravery, acquaintance, and abilities to apply various questions to orientate the students towards developing an interest in the value of caring. Therefore, the supervisors intend to create a caring environment characterized by support and sharing. It is imperative to promote participation in clinical supervision from the nursing staff because it helps in building the value of caring (Johansson et al., 2006, p. 650).

Lee, W.T. & KO, Y.K. (2010). Effects of self-efficacy, affectivity, and collective efficacy on the nursing performance of hospital nurses. Journal of Advanced Nursing, 66 (4), 839-848.

The authors, an Associate Professor and a full-time lecturer present an account of a study whose aim was to scrutinize the effect of self-efficacy, individual and group-based attributes on the performance of nurses in hospitals (Lee & Ko, 2010, p. 839). The study was conducted to examine the contributions of organizational and individual-based factors to professional performance because the available and earlier studies analyzed the individual-based factors only. The study was conducted from seven Korean provinces on 1996 professional nurses. Self-controlled questionnaires were employed in data collection which took place in 2006. Data analysis was conducted using the Pearson correlation coefficients, multilevel analyses, and descriptive statistics (Lee & Ko, 2010, pp. 842-843). The results indicated that the individual-based factors such as the individual’s employment status, work experience, position held, and self-efficacy showed a strong positive relationship with their performance in nursing practice. On the other hand, the collective or group-based factors such as clinical supervision and active learning helped to reduce errors in performance and the whole nursing practice. Therefore, the top leadership in healthcare management must understand the effects of collective factors on individual performance in nursing practice to develop clinical and performance supervision strategies in hospital settings.

McAlearney, A.S. (2010). Executive leadership development in U.S. health systems. Journal of Healthcare Management, 55 (3), 206-222.

Due to the rapid and constant changes characterizing the top leadership in healthcare management, the author, an Associate professor at The Ohio State University, designed this research study to examine the founding, establishment, content, procedure, costing, and progression of the Executive Leadership Development (ELD) initiative across most healthcare facilities in the United States (McAlearney, 2010, p. 206). The survey employed the quantitative method of data collection in which a questionnaire with 35-items was given out to different CEOs in the healthcare industry. On the other hand, the survey used the qualitative method of data collection whereby key informants in the healthcare industry were interviewed on the existence of any ELD programs in their respective institutions (McAlearney, 2010, p. 210).

The results show that approximately 50% of the respondents across the health facilities in the U.S. indicated that ELD programs were in place at their respective institutions, particularly among the small-scale healthcare organizations. However, in most cases, the programs were reported to be extremely new. The identified drives behind the establishment and progression of such programs include: the programs were valued based on different organizational perceptions of the returns and maintainable budgets associated with them in addition to the fact that the programs enabled the subject institutions to develop and implement their strategic plans and in the development of succession planning. Moreover, some elements of ELD were identified as being behind the development of leadership skills and capabilities in the said organizations. Therefore, it is important to implement the establishment of ELD programs in healthcare organizations to manage the ever-changing healthcare business environments (McAlearney, 2010, p. 220).

McAlearney, A.S. (2008). Using leadership development programs to improve quality and efficiency in healthcare. Journal of Healthcare Management, 55 (5), 319-331.

Many managers in the healthcare industry face the challenge of ensuring that quality and efficiency in service delivery are maintained in their organizations (McAlearney, 2008, p. 319). Resourceful ideas are identified in various leadership development programs but the challenge is linking these theoretical approaches to the real-world practice of most healthcare facilities in the US. In line with this challenge, the author provides the analysis of the data from three research studies, which are aimed at providing ways of incorporating leadership development strategies into the process of ensuring that quality and efficiency are maintained in healthcare organizations (McAlearney, 2008, p. 325). The study involved 200 interviewees drawn from various professions and departmental ranks in the whole healthcare industry including vendors of leadership improvement curriculums. The results indicate that leadership development programs are vital in ensuring quality and efficiency in terms of advancing the competence skills of the workers, enhancing effectiveness in education and other development activities within the organization. This helps in decreasing the turnover cost and other related expenses and helps the organization to concentrate on strategic priorities (McAlearney, 2008, p. 328).

The study provides various approaches that can be employed by the managers in implementing the findings of this survey into real-world practice. However, these being a qualitative study that only concentrates on the opportunities whereby leadership development programs can be employed in improving quality and efficiency, there is the need for further quantitative measurements that provide specific approaches to improve quality and efficiency in healthcare management.

McNally, K. & Lukens, R. (2006). Leadership development: an external-internal coaching partnership. The Journal of nursing administration, 36 (3), 155-161.

In line with the leadership development programs, the authors identify one major strategy in the program, which is professional coaching (McNally & Lukens, 2006, p. 155). The benefits attached to this strategy include: it advances both the individual and the organizational performance levels, it helps the organization to maintain the internal talents in leadership, it promotes succession planning, and it also helps the leaders in healthcare management to meet their specialized and individual ambitions. Moreover, the authors describe the development of professional coaching and the benefits associated with teaming up internal and external professional coaches in a case study involving 64 leaders in healthcare management. Approximately 90% of the participants were able to complete the coaching program which was aimed at promoting the accomplishment of the newly developed practice model in professional coaching in addition to providing the required leadership development skills to the newly appointed leaders to different positions in the healthcare management (McNally & Lukens, 2006, p. 158). To allow for evaluation of the program, the participants were asked to self-report on their understanding and advancements in the program. It is noted that the development and the outcomes of the program rely on the participants’ commitment to the requirements of the program (McNally & Lukens, 2006, p. 160). Overall, the outcomes of the program were in line with previous studies in the same field, which had indicated positive returns from investing in the program. Finally, the article provides various recommendations that can be used by the healthcare leadership in implementing the findings of the study in real-world situations.

O’Neil, E., Morjikian, R.L., Cherner, D., Hirschkorn, C. & West, T. (2008). Developing nursing leaders. The Journal of Nursing Administration, 38 (4), 178-183.

Due to the ever-changing healthcare leadership environments, nurses are required to develop their leadership skills to meet the requirements of the prevailing job demands (O’Neil et al., 2008, p. 178). This target can be achieved through the implementation of leadership development programs that enable the leaders in nursing care to effectively discharge their duties in addition to making excellent personal and collective decisions. The authors of this article provide the results of a study aimed at presenting the exact requirements of the leadership development programs in most healthcare facilities. In line with the requirements of the study, the researchers collected data of two different types. The survey involved a telephone study of 27 participants in the leadership of nursing care to acquire a comprehensible representation of the consumers of the leadership development programs (O’Neil et al., 2008, p. 180). Additionally, the same survey was conducted using questionnaires that were distributed to 54 different chief leaders in different healthcare institutions to find out whether there were any significant differences in the participants’ perceptions of the requirements of the programs.

On the other hand, the second set of data was collected from an environmental scan intended to review the variety of leadership development programs accessible to various nursing chiefs and other experts (O’Neil et al., 2008, p. 180). Moreover, the study provides a range of factors related to the program such as identification of challenges in healthcare facilities, comparison of the internal and external resources for training and leadership development, the cost, quality, and accessibility of the resources in addition to barriers to expanding training and development programs for nurses (O’Neil et al., 2008, p. 181). The study indicates that the participants were content with the existing programs which were identified to be more than 100 from the second set of data. However, disparities were noted in the provision of such programs to different classes of nurses because the results indicate that the programs were provided to inpatient nurses while there were no such services for the community-based and other public nurses. Therefore, there is the need to develop such programs for all categories of nurses to improve their leadership skills and capabilities.

Rubin, M.S. & Stone, R.K. (2010). Adapting the “Managing by walking around” methodology as a leadership strategy to communicate a hospital-wide strategic plan. J Public Health Management Practice, 16 (2), 162-166.

The article examines the case of Metropolitan Hospital Center (MHC) located in New York City, which had undertaken several leadership changes including a newly developed strategic plan intended for the hospital-wide staff members (Rubin & Stone, 2010, p.162). Delivery of information across all units in the hospital proved to be cumbersome because of the large number of staff members in different shifts and the tight schedules which could not allow the workers to attend to external duties. The Managing by Walking Around (MBWA) strategic plan involved Executive WalkRounds Programs and Breakthrough Programs which had been recently implemented successfully by the top management (Rubin & Stone, 2010, p.164). The strategic plan was to be implemented by the hospital management across all hospital units in the two shifts within two weeks. The results of the study indicate that approximately 69% of the hospital staff accessed the services offered during the executive rounds.

Another study aimed at analyzing the level of employee satisfaction with the project involved members of the management teams and the general service employees. The results from the study show that about 88.9% of staff members at the leadership level and 64.5% of staff in casual and general labor were satisfied with the program and they admitted to understanding the contents of the strategic plan after attending the rounds (Rubin & Stone, 2010, p.165). Therefore, there is a need for other healthcare facilities to implement MHC’s strategic planning because the approach undertaken in the current case is relevant to other healthcare institutions. However, the study fails to provide a clear guideline on how the new strategy can be evaluated in a hospital setting. This calls for additional studies to provide effective evaluation strategies.

Reitz, O.E., Anderson, M.A. & Hill, P.D. (2010). Job embeddedness and nurse retention. Nurs Admin Q, 34 (3), 190-200.

In this article, nurse retention defines the relationship between the employer and the employee. On the other hand, job embeddedness is the total of factors that determine the probability of a nurse being retained in the current job (Reitz et al., 2010, p. 190). Previous studies do not provide results assessing the two concepts based on locality (Rural or Urban) or exclusive samples (Registered or Non-registered nurses). The authors, researchers conducted a study aimed at assessing the factors behind nurse retention. The study involved a cross-sectional design employed on registered nurses drawn from rural and urban localities (Reitz et al., 2010, p. 195). The concept of Job Embeddedness was assessed by measuring the scores recorded by a normalized gadget while Nurse Retention relied on the participants’ self-reports based on the reasons behind the stay in their current jobs. The results indicate that the total reaction rate stood at 49.4% of all the participants involving 96.1% females, 87.4% non-Hispanics, and 74.9% married persons.

In addition, the study shows that age and job embeddedness are the major factors behind nurse retention because they represent approximately 26% of the analyzed data given by participants, which is based on the reasons that make them stay in their current jobs (Reitz et al., 2010, p. 198). However, the data analyzed indicate that age contributed to a less extent in nurse retention while Job embeddedness contributed to approximately 24.6% of the data analyzed. Moreover, the study shows that older workers are bound to be retained in their current jobs which makes job embeddedness useful in terms of initiating programs aimed at nurse retention.

Swearingen, S. (2009). A leadership journey: designing a nursing leadership development program. The Journal of Continuing Education in Nursing, 40 (3), 107-112.

Research shows that most nurses and healthcare managers acquire the skills required in the healthcare industry on the job, which makes it impossible for these persons to fully understand the contents of what they are doing (Swearingen, 2009, p. 107). In line with this problem, there is the need to develop leadership development programs, which enable the leaders and nurses in the healthcare industry to attain the necessary skills that meet the job demands besides improving their personal and organizational skills (Swearingen, 2009, p.108). This is because the acquired skills affect job satisfaction, patient satisfaction, and service delivery in addition to the position of the whole organization (Swearingen, 2009, p. 110). The author of this article provides the benefits of developing internal leadership in healthcare organizations, the means of reinforcing the leadership development skills within such organizations, and the most workable strategies of developing the leadership development programs appropriate to specific organizations. The study further provides the appropriate program contents to be incorporated into the leadership development programs besides identifying the internal staff members who can be used to deliver the content to other members (Swearingen, 2009, p. 111). The benefits of leadership development are considered based on staff retention, patient outcomes, and the financial implications. The procedure of designing the program involves program assessment, building the curriculum, teaching, evaluation, and assessment of outcomes (Swearingen, 2009, pp. 107-110). Finally, the author notes that leadership development is dynamic and slow, it is worth taking into account the fact that the outcomes of the program can take a long to be visible.

Vasset, F. et al. (2010). Employees’ perceptions of justice in performance appraisals. Nursing Management, 17 (2), 30-34.

The authors, researchers of this article provide the results of a research study aimed at providing the employees’ opinions of fairness in performance evaluation conducted on nurses and supporting nurses in Norway’s healthcare facilities. The background of the study is hinged on the fact that performance assessment is unpopular among many employees who perceive it as being unfair (Vasset et al., 2010, p. 30). When this happens, it is hard for such employees to attain the motivation perceived to be driven by such programs and there would be no observable behavioral changes (Vasset et al., 2010, p. 30).

Justice can be grouped into three major categories. In this case, they include organizational justice, procedural justice, and interactional justice. The survey involved study forms consisting of 30 items that were sent to various nurses and supporting nurses derived from 25 out of 430 towns in Norway (Vasset et al., 2010, p. 32). The participants were supposed to agree or disagree with the statements given in the survey forms. Out of the 600 forms distributed, 371 forms were completed are returned. The data generated was used to test various theories based on interactional and procedural justice. The study indicates that the employees’ concern relative to procedural justice is based on their capability or powerlessness to make contributions to the assessment program (Vasset et al., 2010, p. 33). The supporting nurses recorded that they received scrupulous criticism from human resource managers when compared to other nurses. This is because the nurses have the same educational ranks as the managers which made them better-placed in identifying mistakes in the assessment program. However, constructive assessment programs identified in many institutions were attributed to good communication and listening skills among the employees (Vasset et al., 2010, p. 33). On the other hand, some respondents indicated that the programs were generally unfair. Therefore, besides assessing all employees in an organization, there is the need to make follow-ups, revise the assessment procedures, and assess employees in small groups rather than individually.

Wolf, G.A., Bradle, J. & Greenhouse, P. (2006). Investment in the future: a 3-level approach for developing the healthcare leaders of tomorrow. The Journal of Nursing Administration, 36 (6), 331-336.

Amidst the ever-changing nursing environments, the fundamentals and foundations of the healthcare industry remain constant all along, that is, they are all aimed at improving the quality and efficiency of service delivery. Changes in job demands, increased patient keenness, nurse shortages, high turnover rates, and advancements in technology provide new challenges to the industry (Wolf et al., 2006, p. 331). The authors of this article provide a leadership development program to be implemented at 3 levels that can congregate the requirements of the above-named challenges. The program was developed at the healthcare leadership development academy at the University Of Pittsburgh Medical Center. The authors provide the procedure of building the program besides the three levels of implementation which include; identification of emerging leaders, assessment of operational leaders, and selection and preparation of strategic leaders (Wolf et al., 2006, p. 334). The graduates of the first two levels indicated that the program was the best in developing professional experiences. Assessment of the financial implications of the program indicated that it can enable the subject organization to save up to $ 500,000 at the end of level three. The progress of the healthcare industry and individual organizations is thus dependent on the development of competent and skilled leaders across all levels in healthcare management (Wolf et al., 2006, p. 335). Therefore, there is the need to develop programs and Healthcare Leadership academies to develop leadership surroundings within healthcare organizations (Wolf et al., 2006, p. 336).