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HELEN SHAW-BROWN discusses how peer group supervision can offer support, shared learning and professional development for nurses in management and leadership roles.

Are you constantly being challenged by the demands of your professional role as a nurse leader? Do you work in a specialist field, an isolated rural setting or a management position?

Among your many other requirements, are you accountable for maintaining standards, improving client care and meeting organisational goals and targets 1,2?

Some research suggests working at this level may be a precursor to increased stress, burnout and job dissatisfaction 3.

Now imagine that amidst your busy calendar of monthly meetings another type of meeting exists, with people who have identical or similar roles and often share the same or comparable issues with you. This meeting is purely for the purpose of mutual support. This support consists of shared learning, problem-solving, and reflecting on practice issues and the achievement of individual successes. The people at this meeting are your peers, with whom you may choose to set up a peer supervision group.

What is peer group supervision?

Els van Ooijen’s 2013 book Clinical Supervision Made Easy describes peer group supervision as a group where “there is no permanent supervisor; group members may either share overall responsibility or take turns at being facilitator” 4.

An ideal group has three to six members 5. With no defined leader, all group members are trained as both supervisor and supervisee prior to forming a peer supervision group 6. The facilitator for each session ensures that each supervisee has an equal amount of time to reflect on the practice issue they have chosen to take to supervision 7.

All members are presumed to have sufficient skill and resources within themselves as a group to make meaning of their experiences. This supported process enables group members to discover different ways of working 7,8.

What are the benefits?

Current research on peer group supervision is limited. A recent New Zealand article, written by Dianne Harker and her three fellow supervision group members, highlights the benefits of peer group supervision. Reduced stress, improved management of work-related situations and development of knowledge are all identified as outcomes. Improvements in skills and competence, plus the opportunity to discuss career choices and progression, are also identified outcomes of their well-structured, educational and positive peer group supervision sessions 7.

A 2009 article by Lakeman and Glasgow looked at an action research project evaluating the development and implementation of peer group supervision for 10 psychiatric nurses in Trinidad. Outcomes for the participants included feelings of greater satisfaction with their work, shared learning, increased positivity and collegial support 8. A further benefit noted in both articles was the cost and time effectiveness of group supervision, compared with individual supervision.

The success of these two groups may be attributed to the commitment of the group members. Their tenacity in sticking to the boundaries set when the groups were first developed, together with following a structured process, paid dividends 7,8.

What are the challenges?

People’s perceptions of the term ‘supervision’ are often a challenge when first introducing any form of professional or clinical supervision.

For some the term conjures up feelings or memories of oversight and control. Instead professional or clinical supervision is a supportive and educative process that helps nurses to improve practice 9.

Other difficulties can be a fear of intimidation, breeches of confidentiality and general anxiety around the safety of the process 1,3. If a group does not follow a structured process, there can be a strong tendency for the group to break into a negative, grumbling mindset rather than trying to create a positive, supported learning environment 7,8.

The reduced amount of time given to individual issues can be a source of dissatisfaction for some. Also, the supervisee may not be skilled in the process, unsure of what to bring to supervision and what feedback they want from the group. This can affect the functioning and dynamics of the group 9.

Bond and Holland, in their 2010 guide to clinical supervision, advise that sharing practice issues in a group situation is fraught with uncertainty, as the risk of disclosure is thought to be higher than one-on-one supervision 9. Lakeman and Glasgow also point out that a supportive group may be reluctant to challenge colleagues (which limits the critical analysis of practice) as they want to protect the group’s cohesiveness 8. Recommendations from the Trinidad pilot project included utilising a trained supervisor during the development of the group to help with the management of group dynamics and build facilitation skills.

Another factor impacting on groups is inconsistent attendance. Fluctuating group numbers often arise because of the difficult task of organising and coordinating time away from people’s busy work environments 1,9. However, if a robust implementation process is followed, with ongoing evaluation, these difficulties can be averted 7.

How is effective peer group supervision implemented?

An excellent starting point is to recognise that peer group supervision can offer many benefits to nurses in leadership and management roles. The greater challenge is to implement peer group supervision that is effective and sustainable. Outlined below are some selections from the literature, and the New Zealand Institute of Rural Health Policy and Guidelines, regarding peer group supervision and the implementation process:

Promotion of professional and clinical supervision for role development: Education through workshops, discussion groups and/or articles is essential in creating an understanding of professional and clinical supervision 7,8. Support at all levels: According to English researchers Davis and Burke, support on all levels is essential for allocation of resources to peer supervision 1. Time, funding for training and staff coverage are all required to enable peer group supervision to be integrated into everyday practice.

Training in peer group supervision: Harker’s peer group and Lakeman and Glasgow used a single one-day workshop to establish their groups 7,8. There may be a need for additional training depending on the experience of group members. The presence of a trained supervisor was advantageous in the initial stages of the group development 7. In Lakeman and Glasgow’s second pilot project, on evaluation, it was recommended that the group started with a trained supervisor 8.

Guidelines and working agreement: A working agreement to guide the process and function of the group is essential for effective and sustainable peer group supervision. Detailed information can be found in the New Zealand Institute of Rural Health Policy and Guidelines on Peer Group Supervision 5. In addition, van Ooijen’s book provides quality information on setting up peer group supervision4.

Regular dedicated time and a safe environment: To gain benefits from peer group supervision, a strong commitment to attend sessions on a regular basis and in a dedicated space is paramount. Regular time to reflect on issues and experiences creates cohesiveness, trust and safety within the group. Access to appropriate technology, such as Skype, is helpful for nurses working in isolation. Freedom from interruptions enables the session to be productive for all 8,9.

Session structure: According to the Harker article and Lakeman and Glasgow, effective peer group supervision works best with a formalised structure 7,8. The local nursing group used seven tools designed by the New Zealand Coaching and Mentoring Centre. In both cases, the facilitator was responsible for guiding the process, thereby assisting supervisees to meet their initial supervision goal.

Give it a go

Peer group supervision presents a unique opportunity for managers and nurses in leadership roles for personal and professional development through shared learning and peer support. Harker and colleagues in their 2015 article say: “Our experience has been that effective peer supervision groups provide a rich learning environment and increase professional effectiveness. We would urge other nurses to start peer supervision groups.” 7.