Clinical supervision for novice millennial nurses in the perinatal setting: The need for generational sensitivity

doi:10.4236/ojn.2013.35050

Paper Menu >>

Journal Menu >>

Open Journal of Nursing, 2013, 3, 373-378 OJN

http://dx.doi.org/10.4236/ojn.2013.35050 Published Online September 2013 (http://www.scirp.org/journal/ojn/)

Clinical supervision for novice millennial nurses in the

perinatal setting: The need for generational sensitivity

Jo Watson1,2, G. J. Macdonald2, Donna Brown1,2

1Sunnybrook Health Sciences Centre, Toronto, Canada

2Lawren ce S Bloomberg Faculty of Nursi n g, University of T o ronto, Toronto, C anada

Email: jo.watso[email protected]

Received 18 May 2013; revised 19 June 2013; accepted 10 July 2013

permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

This paper reports on a qualitative research study

that examined the experience of expert and novice

nurses participating in a new, reflective program of

“clinical supervision”, intending to facilitate the tran-

sition of new graduate nurses into the workforce.

Three patterns emerged during the constructivist

inquiry: readiness to reflect, valuing of clinical super-

vision, and sustainability of the clinical supervision

model. The researchers suggest generational sensitiv-

ity as a key perspective to consider when developing

engaging workplace strategies for millennial nurses.

The article offers recommendations for the imple-

mentation of clinical supervision and would be of in-

terest to nurse leaders in a clinical setting.

Keywords: New Graduate Nurses; Clinical Supervision;

Generational Sensitivity; Constructivist Inquiry

1. INTRODUCTION

Novice nurses face real challenges when entering the

workplace. They are particularly vulnerable to high

levels of burnout, increased levels of depersonalization,

and lower levels of personal accomplishment than more

experienced nurses [1,2]. Difficulties for these new

members of the profession lead to rising attrition rates

and possible marginalization [3,4]. New programs and

approaches are needed that engage novice nurses in the

profession by helping them transition into the workplace.

During this transition, novice nurses could benefit from a

system of support that fosters reflective practice.

1.1. Review of the Literature

Born between 1980 and 2000, most current graduates

belong to Generation Y and are known as millennials [5].

Millennial nurses expect quick access to their leaders and

want prompt, frequent feedback [6]. Unlike previous

generations, millennials are drawn to work that they

perceive to be meaningful and to work environments that

support a work-life balance [7,8]. Having grown up

learning and working in groups, they favour teamwork,

collaboration, interdependence and networking [9].

The difficulties that new nursing graduates experience

are well described in the literature [2,7]. Novice nurses

find the first months of work the most difficult. They are

acutely aware of missing their clinical instructor and may

even contemplate leaving the profession [2]. New

graduates have long been labeled as inadequately pre-

pared to transition easily into the workplace [10]. This is

not surprising since the new graduate’s experience is

recognized as a time of significant professional adjust-

ment [7].

Recommendations have been made to develop work-

place strategies focused on easing new graduates’ tran-

sition into professional practice [3,7]. One potential

support identified for new nurses is participation in the

practice of clinical supervision (CS) following orien-

tation. Clinical supervision, an approach used for

decades in the United Kingdom, is a “formal process of

professional support and learning, which enables prac-

titioners to develop knowledge and competence and

assume responsibility for their own practice” [1], pre-

viously cited in the London Department of Health 1993

[11]. This approach to supporting staff has been linked to

the provision of quality care, role socialization, and

acculturation [7].

A key element of clinical supervision is the in-

volvement of experienced or expert nurses who provide

support and guidance to novice nurses and promote

reflective practice. Expert nurses work to create a safe

environment, share their wisdom explicitly, facilitate

reflection and provide effective feedback [12]. Novice

nurses participating in clinical supervision are expected

to identify key concerns in practice, remain open to

OPEN ACCESS

J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378

374

feedback, and engage in reflection [12]. Clinical super-

vision takes place after a formal orientation has been

successfully completed. It is not meant to be a type of

preceptorship and does not include shared shifts or

hands-on clinical sup port.

Suggested benefits of participating in clinical super-

vision include increased confidence, decreased isolation

and burnout, increased feelings of support, decreased

sick time, as well as improved listening, problem solving

and coping skills [13-18]. The value of clinical super-

vision has been specifically highlighted for novice nurses

in [19, 20]. These benefits suggest clinical supervision is

an ideal approach to foster the engagement of novice

nurses in reflective professional practice. Yet, uptake of

this initiative has been inco nsisten t and no t all reports are

positive. Concerns raised in the literature regarding

clinical supervision include resistance, fear and suspicion,

as well as the lack of organizational and policy support

[21-25].

While there is no clear consensus on how clinical

supervision is best implemented in clinical practice, the

value of clinical supervision for novice nurses has been

established [14]. Clinical supervision is an initiative

worthy of consideration as a means of professional

development for Canadian nurses and as a strategy to

support novice nurses during their transition into the

profession. There are no reports of clinical supervision

being implemented in Canadian practice settings or,

more specifically, evaluated in perinatal units.

1.2. Study Introduction, Guiding Questions

The purpose of this study was to explore the experience

of novice and expert nurses during their participation in a

program of clinical supervision, introduced into a Ca-

nadian, perinatal setting. The research question guiding

the study was: What is the nature of the experience of

novice nurses and expert nurses who participate in a

program of clinical supervision during the first year of

the novice nurses’ clinical practice?

The goal of the CS program was to support and

engage novice nurses during their transition into the

profession in their first year of practice.The CS program

was introduced in a letter sent out to novice nurses, who

had completed their formal orientation. Novice nurses

were asked to review written material and guidelines

about CS before the meeting. Participants were paid for

their time at their regular hourly rate. The letter also

invited the nurses to a one-hour group session to

introduce the research study.

The Clinical Supervision program consisted of three

meetings, between paired novice/expert nurses. These

meetings followed the formal orientation and were

completed within the first year of the novice nurses’

employment. Meetings were unstructured and allowed

the novice nurses to reflect upon any successes, concerns

or questions they may have had about their professional

life. The initial meeting took place within three months

of the end of orientation. Subsequent meetings between

expert nurses and novice nurses were held within the

next nine months. This meeting schedule resulted in

novice/expert nurse dyads planning to meet a total of

three times during their first year of practice.

Ten novice nurses were invited to participate in the

study. These ten nurses were practising in the perinatal

setting, had successfully completed their formal

orientation program, and were beginning their mandated

clinical supervision program. In this program, each

novice nurse was paired with an expert nurse. Three

expert nurses, who were providing individual clinical

supervision to one or more of the cohort of ten novice

nurses, were also invited to participate in the study. The

three mid-career, expert nurses worked in advanced

practice nursing roles in the perinatal setting.

Three novice nurses and the three expert nurses

volunteered to participate in the study. The novice nurses

were identified with the millennial age cohort while the

expert nurses were identified with the baby boomer age

cohort. The expert nurses did not know the identity or

number of the novice nurses who were research

participants. The novice nurses were not aware of the

identity or number of expert nurses who participated in

the re search study.

2. STUDY DESIGN AND METHODS

Separate focus groups, one for novice nurses and one for

expert nurses, took place after the program of clinical

supervision was completed. Data was collected through

two focus groups that provided the opportunity to explore

the research question with the novice and expert nurses.

Focus groups are a methodology particularly well suited

for use with small gr oups of vulnerable participants who

may find the interaction with peers empowering [26].

Separate sessions were held, one with the novice nurses

and one with the expert nurses. Similar open ended

questions guided both focus group discussions. The

groups were facilitated by the same doctorally-prepared

nurse who was experienced in focus group methodology

and aware of the importance of encouraging dialogue

between participants [26]. Three novice nurses and three

expert nurses attended their respective focus group. At

each focus group, open-ended interviews were audio-

taped and the tapes were transcribed. The novice nurse

focus group preceded the expert nurse focus group. This

supported the facilitator’s ability to probe the expert

nurses in areas that the novice nurses had discussed, such

as the suggestion to have a group based CS model rather

J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378 375

than the novice/expert model. Approval to conduct the

study was received from the hospital’s research ethics

board.

This study took place at a tertiary perinatal unit in a

large, urban teaching centre where 4000 births take place

annually. This setting was the workplace of two of the

investigators. Participants included nursing staff from the

Birthing Unit and the Mother-Baby Unit. New staff had

completed a formal orientation process that consisted of

ten to 12 weeks of clinical preceptoring and in-class

learning. At the time of this study, there was no ongoing

support for staff after the formal orientation ended.

The CS study used a constructiv ist analysis that led to

the identification of patterns from the qualitative data

collected in the two focus groups. In a constructivist

analysis overall patterns emerge and are named as the

data is examined, without prior selection of theoretical

perspectives [27]. The two lead investigators reviewed

the transcripts in hard copy word documents and

completed the analysis, using co lour coding. Initially the

data for the novice nurses and expert nurses was

analyzed separately. However, the early patterns from

each of these two participant groups were directly related,

and led to the researchers merging the findings. Three

main study patterns emerged, incorporating data from

both the novice nurses and expert nurses. Further

analysis revealed three smaller themes in the first pattern.

Initial study findings, both patterns and themes, were

reviewed with the expert nurses to ensure face validity.

Their feedback was incorporated into the ongoing

analysis. The expert nurses confirmed the patterns and

themes were valid from their perspective. The novice

nurses were not involved in this valid ation process.

3. STUDY FINDINGS

During the constructivist data analysis three main

patterns emerged: Readiness to Reflect, Valuing of Clin-

ical Supervision, and Sustainability of Clinical Super-

vision. Three themes identified within the readiness to

reflect pattern were timing, uncertainty and resistance.

Separate themes were not identified in the other two

patterns.

3.1. Pattern One: Readiness to Reflect

The response of novice nurses and expert nurses revealed

a limited readiness to reflect on the part of the novice

nurses. They reported being “surprised by the idea of

clinical supervision”. One stated, “I think we were kind

of feeling why is this going to help us?” The expert

nurses noted that the novice nurses weren’t ready to

reflect on their practice and wanted instead to focus on

solidifying their clinical skills. As one expert nurse stated,

“I didn’t feel them [the novice nurses] necessarily

hesitating to bring things up, but just genuinely didn’t

really feel like they had a lot of difficult situations to

bring up.”

Timing. Novice Nurses expected to be given time to

prepare and to have meetings during scheduled shifts,

rather than during additional paid hours, one stated, “[I]

don’t want to do nursing after hours.” Although they

were paid to attend meetings, they did not want to spend

their personal time on CS. Expert nurses found it difficult

to book meeting times with the novice nurses. Novice

nurses needed to be approached several times before a

meeting time could be confirmed. As one expert nurse

stated, “There was a bit of avoidance”.

Uncertainty. The novice nurses were uncertain about

the intention of CS and were apprehensive about what to

expect, “I don’t know what you call it, worried, I guess”,

“…surprised at the idea of clinical supervision, con-

cerned”, while another nurse felt uncertain and “…didn’t

know how to prepare…”

Resistance. Resistance to engaging in the clinical

supervision program was evident in the dialogue of the

novice nurses. Novice nurses spoke in terms of

involuntary relationships, “Seeing that we are going to be

locked up together” and commented that meetings were

difficult to organize, “It was difficult to get together”.

One novice nurse questioned the usefulness of the model

of clinical supervision, “And I guess I came in there

feeling like it wasn’t all that useful because we sit there

and talk about the same things we talk about all the

time.” The novice nurses resisted engaging in an activity

they didn’t value and were expected to participate in.

Expert nurses identified novice nurses’ resistance and

avoidance. Shift work and concerns regarding con-

fidentiality were reasons cited for this resistance.

Expert nurses struggled to establish a relationship with

the novice nurses. Novice nurses remained confused

about the goal of clinical supervision, wondering why the

expert nurses did not come to the practice setting to work

with the novice nurses on their scheduled shifts. The

novice nurses were focused on doing, while the clinical

supervision model encouraged them to reflect upon their

practice with an expert nurse outside of the clinical

setting. Both the novice and expert nurses recognized

that the novice nurses did not seem ready initially to

engage in a reflective process such as clinical super-

vision.

3.2. Pattern Two: Valuing of Clinical

Supervision

Valuing of Clinical Supervision had both positive and

negative dimensions. Despite the challenges introducing

clinical supervision in this setting, there were indications

that both groups found some value in the relationships

they developed. One novice nurse stated, “I just had a

J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378

376

run-in with [someone] ...and we talked about that. My

expert nurse also had an experience. It was nice that she

had similar stories.” Expert nurses identified that some

novice nurses were having a hard time eliciting support

on their units, and so having the opportunity to talk to the

expert nurse was a valuable resource. One expert nurse

stated, “I think it is valuable because I think that first

year of a new grad can make or break their decision to

stay in nursing.” Two quotes from the expert nurses

speak to the value of the CS program to facilitate the

development of supportive relationships, “So in the later

sessions I did find they were probably a little more

confident in bringing those kinds of things forward” and

“I have continued on with the people that we have hired

and I find it’s a great benefit.”

However, there were questions from both groups

regarding the value of clinical supervision. In the novice

group, commen ts from two of the n ovice nurses included:

“I didn’t find that we really had enough clinical stuff to

fill the whole time”, “I felt like we were just chatting”,

“[I] didn’t have much to talk about at meetings. One

novice nurse stated, “I felt floored and confused because

I didn’t know what it was about so was interested in

knowing how that would help me in my practice.”

Overall, the valuing of clinical supervision by the

novice nurses was low. Expert nurses felt that the novice

nurses didn’t see the purpose of the meetings and

described that some were difficult to sit through because

the novice nurse had nothing to discuss. Meetings felt

uncomfortable, “I found my first session quite contrived”.

Expert nurses reported that initially trust was lacking , “It

was just I remember there wasn’t that trust there”, but

once trust developed, novice nurses looked to the expert

nurses for reassurance and clarifi c at i on .

3.3. Pattern Three: Sustainability of Clinical

Supervision

Novice nurses offered suggestions to foster the sus-

tainability of the clinical supervision model. One novice

nurse indicated she would like to see the expert nurse

more often. Another talked about increasing choice re-

garding who would provide clinical supervision, “Choos-

ing [a] preceptor works much better. Maybe [we

could]… pick expert nurses for clinical supervision, not

be assigned”. Other suggestions included having the

sessions begin earlier and take place more often.

Expert nurses suggested improvements in the ap-

proach to CS that could make future relationships

sustainable. One expert nurse wondered if it would have

been beneficial to have expert nurses who were

colleagues in the un it rather than someone in an advance

practice nurse role. Expert nurses and one novice nurse

suggested a group approach to clinical supervision might

be more effective. Both novice and expert nurses shared

suggestions on how to improve the model of clinical

supervision that addressed the challenges they had

experienced.

4. DISCUSSION

The findings of this study highlight the experiences of

novice and expert nurses participating in a program of

clinical supervision at the end of their orientation to a

perinatal unit. Valuing of clinical supervision was a

dynamic pattern, with the expert nurses placing a higher

value on the potential of clinical supervision while the

novice nurses critiqued the reality of clinical supervision.

Novice nurses described a lack of readiness to

participate, uncertainty and resistance. The expert nurses

also identified these responses in the novice nurses.

Elements in the design of a CS program, specifically

timing, frequency of meetings, and choice of expert

participants, if designed well, could better foster novice

nurses’ engagement. Expert nurses thought highly of the

opportunity to offer this support to new staff, in contrast

to the novice nurses who questioned its purpose. All

participants made recommendations to improve imple-

mentation of the program in orderfor clinical supervision

to continue. Our findings suggest that the novice and

expert nurses recognized that clinical supervision n eeded

to be tailored to meet the needs of the novice millennial

nurses to increase overall engagement.

5. IMPLICATIONS FOR PRACTICE

AND RESEARCH

The findings of this study lead to recommendations for

other centres considering CS as a model of support for

novice nursing staff. In retrospect, it is clear that specific

elements of our model impacted how CS was received in

our setting. The lack of clarity regarding the purpose of

CS, and the timing and frequency of meetings were

barriers to the novice nurses’ readiness to reflect and

value clinical supervision.

Timing and frequency of meetings were also problem-

atic. CS meetings were scheduled outside of work hours

and novice nurses participating in this study were

resistant to this. Other studies have also reported nurses’

ambivalence about participating in programs of clinical

supervision [21,23]. While clinical supervision sessions

should occur often enough that the learners’ needs are

met, timing and frequency of meetings should be taken

into consideration to support millennial nurses’ values

and assumptions about workplace culture and work-life

balance. We recommend that timing of sessions should

be built into the novice nurses’ schedules so that there is

not an expectation for them to participate outside of

scheduled shifts.

Nurses participating in earlier CS studies did not make

J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378 377

their participation a priority. Instead, they described

using other approaches to receive emotional support

from peers [20]. Similarly in this study, the novice nurses

indicated that they created their own support system

within the workplace. Yet, having only an informal

support system is potentially problematic since reliance

solely on informal peer discussions does not ensure

reflection on practice or the development of responsi-

bility for their own practice. Pairing novice nurses and

experienced nurses who did not interact regularly was

also a weakness in this design. Overcoming resistance

would require engaging novice nurses in the develo-

pment of a model that ensures timely feedback. Other

authors have suggested a shift away from a novice/expert

nurse dyads towards peer group-based clinical supervi-

sion [4,21,28]. This approach might have more appeal to

millennial nurses and engage them more actively in

reflection.

For centres considering CS as a way to support novice

nurses, we encourage close attention be paid to the needs

and expectations of millennial learners and suggest the

term generational sensitivity, modeled after the accepted

notion of cultural sensitivity, be used. Generational

sensitivity regarding this group of novice nurses would

include a model where the novice nurse selects the ex-

perienced nurse to wo rk with, rather than being assigned

an expert nurse, and small group cohort meetings rather

than meeting one-on-one. Studies that reported positive

outcomes related to the implementation of clinical

supervision were designed with orientation sessions that

were conducted away from the workplace and novice

staff were given the option to select their own supervisor

[29, 30]. Novice nurses may not have felt at ease meeting

with the expert nurses or may not have met often enough

to establish a supportive relationship. There is growing

evidence that providing support to new graduate nurses

is valuable especially if that support is provided by

experienced nurses close at hand [2,31].

Millennial novice nurses may purposefully seek out

supports that are closer in experience to the novice nurse,

rather than the expert nurses. If generation is an

important motivator, novice nurses may choose an

experienced nurse who is closer in age to them rather

than the most expert nurse in the setting. Such a model

may work effectively if the experienced nurses have

timely access to the support of the expert nurses. A CS

model where experienced nurses support reflective

practice in new graduates, while expert nurses then

support experienced nurses, may be more effective.

While CS was well supported in this study in terms of

budget and staffing, this was not enough to ensure the

program’s success. We recommend modification to the

design of this model of support based on our learning

and evaluation pr ior to full implantation in other settings.

We also recommend further evaluation of clinical

supervision in settings where the modifications sug-

gested for practice have been implemented.

6. STRENGTHS AND LIMITATIONS

While Clinical Supervision is well integrated into

professional practice in the United Kingdom, this is the

first time CS has been evaluated in Canada or in a

perinatal setting. This study included a small sample size

and findings cannot be generalized but may be of value

to settings who have similar models of clinical super-

vision.

7. CONCLUSION

There is now a body of literature describing the

challenges and difficulties that new graduate nurses

experience [1,2,32]. This study highlights some chal-

lenges when clinical supervision was introduced in a

Canadian perinatal setting. Recommendations for deve-

loping a program of clinical supervision for novice

nurses include using experienced colleagues rather than

expert nurses, ensuring that the timing of sessions is

immediate and during scheduled working hours, and

giving novice nurses the opportunity to identify a ex-

perienced nurse in their practice setting, rather than

having one assigned. An informal, flexible approach to

new nursing gradu ates, based on generational sen sitivity,

is suggested to provide the support needed to engage

novice nurses and promote reflection in the first year of

professional practice.

REFERENCES

[1] Edwards, D., Burnard, P., Hannigan, B., Cooper, L.,

Adams, J., Juggessur, T., Fothergill, A. and Coyle, D.

(2006) Clinical supervision and burnout: The influence of

clinical supervision for community health nurses. Journal

of Clinical Nursing, 15, 1007-1015.

doi:10.1111/j.1365-2702.2006.01370.x

[2] Rhéaume, A., Clement, L., LeBel, N. and Robichaud, K.

(2011) Workplace experiences of new graduate nurses.

Canadian Journal of Nursing Leadership, 24, 80-98.

[3] Cho, S.-H., Lee, L.Y., Mark, B.A. and Yun, S.-C. (2012)

Turnover of new graduate nurses in their first job using

survival analysis. Journal of Nursing Scholarship, 44, 63-

70. doi:10.1111/j.1547-5069.2011.01428.x

[4] Duchscher, J.E.B. and Cowin, L. (2004) The experience

of marginalization in new nursing graduates. Nursing

Outlook, 52, 289-296. doi:10.1016/j.outlook.2004.06.007

[5] Weston, M. (2006) Integrating generational perspectives

in nursing. OJIN: The Online Journal of Issues in Nurs-

ing, 11, Manuscript 1.

http://www.nursingworld.org/MainMenuCategories/ANA

Marketplace/ANAPeriodicals/OJIN/TableofContents/Vol

ume112006/No2May06/tpc30_116073.aspx

J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378

378

OPEN ACCESS

[6] Sujansky, J. (2004) Leading a multi-generational work-

force. Occupational Health & Safety, 73, 16-18.

http://search.proquest.com/docview/221000173?accounti

d=47688

[7] Duchscher, J.E.B. and Cowin, L. (2004) Multigenera-

tional nurses in the workplace. Journal of Nursing Ad-

ministration, 34, 493-501.

doi:10.1097/00005110-200411000-00005

[8] Cole, G., Lucas, L. and Smith, R. (2002) The debut of

Generation Y in the American workforce. Journal of

Business Administration, 1, 1-10.

[9] Alch, M. (2000) Get ready for the net generation. Train-

ing & Development, 54, 32-34.

[10] Kramer, M. (1974) Reality shock: Why nurses leave

nursing. American Journal of Nursing, 75, 891.

doi:10.1097/00000446-197505000-00041

[11] Department of Health (1993) A vision for the future: The

nursing, midwifery and health visiting contribution to

health and health care. NHS Management Executive: Sta-

tionery Office, London.

[12] Butterworth, T. (1995) Clinical supervision in nursing,

midwifery and health visiting: Development, contracts,

and monitoring. The University of Manchester, Man-

chester, 1-2.

http://www.nursing.manchester.ac.uk/research/officialrep

orts/ClinicalSupervision2.pdf

[13] Butterworth, T., Carson, J., White, E., Jeacock, J.,

Clements, A. and Bishop, V. (1997) It is Good to talk: An

evaluation of clinical supervision and mentorship in Eng-

land and Scotland. University of Manchester, Manches-

ter.

[14] Butterworth, T., Bell, L., Jackson, C. and Pajnkihar, M.

(2008) Wicked spell or magic bullet? A review of the

clinical supervision literature 2001-2007. Nurse Educa-

tion Today, 28, 264-272. doi:10.1016/j.nedt.2007.05.004

[15] Bedward, J. and Daniels, H.R.J. (2005) Collaborative

solutions: Clinical supervision and teacher support teams

reducing professional isolation through effective peer sup-

port. Learning in Health and Social Care, 4, 53-66.

doi:10.1111/j.1473-6861.2005.00090.x

[16] Hyrkas, K. and Punonwn-Ilmonen, M. (2001) The effects

of clinical supervision on the quality of care: Examining

the results of team supervision. Journal of Advanced

Nursing, 33, 492-502.

doi.org/10.1046/j.1365-2648.2001.01685.x

[17] Jones, A. (2001) Some experiences of professional prac-

tice and beneficial changes derived from clinical supervi-

sion by community MacMillan Nurses. European Journal

of Cancer Care, 10, 21-30.

doi:10.1046/j.1365-2354.2001.00209.x

[18] Marrow, C.E., Holyoake, K., Hamer, D. and Kenrick, C.

(2002) Clinical supervision using video conferencing

technology: A reflective account. Journal of Nursing Ma-

nagement, 10, 275-282.

doi:10.1046/j.1365-2834.2002.00313.x

[19] Teasdale, K., Brocklehurst, N. and Thom, N. (2001)

Clinical supervision and support for nurses: An evalua-

tion study. Nursing and Health Care Management, 33,

216-224. doi:10.1046/j.1365-2648.2001.01656.x

[20] Haggman-Laitila, A., Eriksson, E., Ritta, M., Kirsi, S. and

Leena, R. (2007) Nursing students in clinical practice—

Developing a model for clinical supervision. Nursing

Education in Practice, 7, 381-391.

doi:10.1016/j.nepr.2006.11.011

[21] Buus, N.S., Angel, M., Traynor, M. and Gonge, H. (2011)

Psychiatric nursing staff members’ reflections on partici-

pating in group-based clinical supervision: A semistruc-

tured interview study. International Journal of Mental

Health Nursing, 20, 95-101.

doi:10.1111/j.1447-0349.2010.00709.x

[22] Cottrell, S. (2002) Suspicion, resistance, tokenism and

mutiny: Problematic dynamics relevant to the implemen-

tation of clinical supervision in nursing. Journal of Psy-

chiatric and Mental Health Nursing, 9, 667-671.

doi:10.1046/j.1365-2850.2002.00517.x

[23] Jones, A. (2006) Clinical supervision: What do we know

and what do we need to know? A review and commen-

tary. Journal of Nursing Management, 14, 577-585.

doi:10.1111/j.1365-2934.2006.00716.x

[24] Lynch, L. and Happell, B. (2008) Implementation of

clinical supervision in action: Part 2: Implementation and

beyond. International Journal of Mental Health Nursing,

17, 65-72. doi:10.1111/j.1447-0349.2007.00512.x

[25] Lynch, L. and Happell, B. (2008) Implementation of

clinical supervision in action: Part 3: The development of

a model. International Journal of Mental Health Nursing,

17, 73-82. doi:10.1111/j.1447-0349.2007.00513.x

[26] Ivanoff, S.D. and Hultburg, J. (2006) Understanding the

multiple realities of everyday life: Basic assumptions in

focus-group methodology. Scandinavian Journal of Oc-

cupational Therapy, 13, 125-132.

doi:10.1080/11038120600691082

[27] Lincoln, Y.S. (1990) The making of a constructivist: A

remembrance of transformations past. In Guba, E.G., Ed.,

The Paradigm Dialog, SA GE Publications, Newbury Park,

67-87.

[28] Lakeman, R. and Glasgow, C. (2009) Introducing peer-

group clinical supervision: An action research report. In-

ternational Journal of Mental Health Nursing, 18, 204-

210. d oi:10.1111/j.1447-0349.2009.00602.x

[29] Edwards, D., Cooper, L., Burnard, P., Hanningan, B.,

Adams, B.J., Fothergill, A. and Coyle, D. (2005) Factors

influencing the effectiveness of clinical supervision. Jour-

nal of Psychiatric and Mental Health Nursing, 12, 405-

414. d oi:10.1111/j.1365-2850.2005.00851.x

[30] Whitestanley, J. and White, E. (2003) Clinical supervi-

sion: Models, measures and best Practice. Nurse Re-

searcher, 10, 7-37.

[31] Benner, P., Sutphen, M., Leonard, V. and Day, L. (2010)

Educating nurses: A call f or radic al transfor mation . Jo ssey -

Ba s s, S an Francis co.

[32] Maddalena, V., Kearney, A.J. and Adams, L. (2012) Qua-

lity of life of novice nurses. Journal for Nurses in Staff

Development, 28, 74-79.

doi:10.1097/NND.0b013e31824b41a1