Gina's* experience of indirect supervision

Trust is such an important word and is integral to our profession, from clinicians to the governing bodies who guide and regulate our profession. As professionals working in a healthcare environment, trust helps us build therapeutic and professional relationships with our patients, their families, work colleagues, managers, and stakeholders. Such a little word which has so much meaning and importance, as it influences how we think, our understandings, our behaviours, and our reputations. 

What happens when you trust the cultural practices in your workplace rather than the Standards of Practice, Codes of Conduct, and policies for your profession? This lesson was the turning point for Gina* a registered nurse who had just completed a Transition to Practice Program earlier in the year. Gina was working a night shift with a very experienced Nurse in Charge who directed how the work would be completed with the expectation that you did not question the practice. The culture of the unit supported this practice.

As a result, observations, and documentation of clients were not completed in line with the policy, which put clients at risk. A notification was subsequently made to Aphra regarding a significant departure from professional standards and conditions were placed on Gina’s registration. One of the conditions imposed required indirect supervision, with monthly reports written about Gina’s performance against the standards for practice for a registered nurse. Indirect supervision means a supervisor works in the same facility or organisation as the supervised person but does not constantly observe their activities. 

Gina found this period in her career to be very stressful, and hard. It is not easy to go back to your workplace with conditions which restrict your practice. To learn to trust your colleagues and explain the reasons for your conditions. The doubts, the feelings of guilt and shame can be difficult to overcome. Questions such as who I trust, how do I navigate who or what to base my trust on, or can I even trust myself seemed daunting. This is where indirect supervision helped Gina to move forward and develop her professional practice.

Gina met with her supervisor regularly to reflect on her practice. Each time they got together they would look at the Standards of Practice and the Code of Conduct to inform their reflection on Gina’s practice. This gave Gina the opportunity to gain a better understanding of the Standards for practice and Code of Conduct for a registered nurse which had positive benefits to her practice and her clients. Her supervisor also found benefits as the process became a mutual journey, learning about the more complex issue of trust and what we base our trust on.

Gina learned that the Standards of Practice and Code of Conduct are more than just a written word or oath, they are foundational principles which guide critical thinking and influence our behaviours. So how did this affect her practice? Gina found this gave her the confidence to make better decisions, which included learning to speak up when the cultural practice is not in line with your own principles or the policies that guide practice. Gina gained a reputation on the unit of being the “Queen of documentation” with staff approaching her to learn how to document correctly.

Gina earned the respect and trust of her colleagues, and managers and other health professionals trusted her opinions. This was evident by the glowing references she received from the senior nursing professionals who managed Gina. 

Gina is now in a senior position herself with no conditions on her registration. She recently reflected how her journey to where she is now in her career was difficult, frustrating, confronting, and hard work, but she also found the conditions placed on her registration helped to support her and gave her the opportunity to grow in her practice as a nurse, to be the nurse she envisioned when she was a student.

The Standards for practice, Code of Conduct and Code of Ethics can be found via the Nursing and Midwifery Board websiteopen_in_new. 

*name has been changed to maintain confidentiality