Advanced practice and clinical supervision: An exploration of perceived facilitators and barriers in practice

Abstract

Aim and Objectives:The aim of this study was to investigate current advanced practice Masters students' experience of clinical supervision, to explore how clinical supervision works in practice and to identify students' perceptions of the facilitators and barriers to clinical supervision in their workplace.Background: Advanced practitioners, and in particular nurses, play a pivotal role in delivering health care across acute and primary care settings. These non-medical professionals fulfil a rapidly expanding proportion of roles traditionally undertaken by medically qualified staff within the National Health Service in the United Kingdom and often lead specialist clinics and services. To prepare for the advanced practice role, individuals are required to undertake a Master's in advanced practice to develop the required skills and knowledge and work in clinical practice with a clinical assessor/ supervisor to demonstrate competence and performance.Design: A mixed method study using an online descriptive cross-sectional survey and qualitative data were collected via focus groups and has been reported using the Good Reporting of a Mixed Methods Study checklist.Results: A total of 79 students completed the online survey (from 145 AP students), a response rate of 55%. Most respondents were nurses (n = 73) with 49 (62%) in a formal advanced practice trainee role, and the majority believed their clinical supervisor had a good understanding of advanced practice and the advanced practice role.Two focus groups were held with 16 participants in total. Thematic analysis revealed five themes: (a) perceived level and amount of support from clinical supervisors, (b) skill level of clinical supervisors, (c) physicians and their perceptions on supervising, Advanced practitioners (d) clinical supervisors' preparation for the role and (e) transition from trainee to qualified advanced practitioner. Conclusion:The survey revealed that advanced practitioner students perceived that clinical supervisors and workplace colleagues had a good understanding of the advanced practice role with good levels of support in practice. A more coherent approach is required for clinical supervision and an implementation framework that can be formally evaluated.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Using simulation-based education to foster competency and confidence in advanced practitioners

“…At best, this can introduce unwarranted variation into the care delivered to patients, and, at worst, this can compromise patient safety. [8][9][10] Simply put, if there is lack of clarity about what advanced practitioners are and what they can or cannot do, then some people in this role may inadvertently deliver care that is below the best practice in that domain, leading to patient harm. This applies to other key aspects of advanced practice, such as patient assessment, diagnosis, and prescribing, which impact patient safety.…”

“…One objective of health professional education is to form autonomous advanced practitioners who make decisions independently within their specialist area of practice (eg, emergency care). [8][9][10] This creates some challenges in defining the unique contribution of advanced practitioners in relation to their scope of practice, but also serves as a grounding principle in relation to SBE. Learning is fostered through direct practice in SBE, as well as socially mediated or situated processes, such as role modeling by a facilitator, interactions with others, and direct or indirect support from instructional faculty, mainly through language.…”

“…The challenge of reaching a global consensus on the definition of advanced practice has implications for patient safety, such as variation in care or suboptimal care arising from nurse or midwife advance practitioners’ inability to function at the appropriate level. The ambiguity in the definition of advanced practice and the concomitant scope of practice may result in some individuals practicing and delivering care in which they lack the necessary competence, confidence, and/or supervision, such as central venous catheter insertion 8–11 . In such a scenario, an individual may ostensibly be an advanced practitioner but functioning outside of their scope of practice.…”

“…In such a scenario, an individual may ostensibly be an advanced practitioner but functioning outside of their scope of practice. At best, this can introduce unwarranted variation into the care delivered to patients, and, at worst, this can compromise patient safety 8–10 …”

“…One objective of health professional education is to form autonomous advanced practitioners who make decisions independently within their specialist area of practice (eg, emergency care) 8–10 . This creates some challenges in defining the unique contribution of advanced practitioners in relation to their scope of practice, but also serves as a grounding principle in relation to SBE.…”