Supervision is defined as including oversight, direction, guidance or support (whether given directly or indirectly). Supervision refers to monitoring, evaluating and directing specific activities of a specific person or group of persons, for a defined period of time and is determined by the registered nurse or midwife dependent upon the nature and complexity of the healthcare task being delegated, the environment and the nature and degree of other support infrastructures in place.
The decision as to the extent of supervision required is based on the registered nurses’ professional judgment and is determined as part of the health and risk management assessment, prior to the decision to delegate care.
There are three types of supervision
Managerial supervision involves the performance appraisal, rostering, staffing mix, orientation, induction, team leadership etc (eg GP/Practice Nurse, eg enrolled nurse as a manager of aged care facility). This may mean that an enrolled nurse holds a management position and have management oversight of registered nurses. In this scenario, the enrolled nurse does not provide professional supervision or clinical supervision.
It is the professional role and function of a registered nurse to provide professional supervision to an enrolled nurse and other registered nurses.
The registered nurse may also preceptor a student, undertaking course for entry to the profession. Accountability for professional supervision is not delegable or transferable.
Clinical supervision is a part of the delegation process. It requires that a registered nurse oversee and assess the clinical practice of another nurse (eg an enrolled nurse or other registered nurse) to determine that nurse’s competence to perform the clinical procedure and the level of ongoing supervision required. Clinical supervision included education, guidance, and support to achieve a required level of competence. It includes directing individuals’ performance, monitoring and evaluating outcomes, including client health outcomes.
There are two clear levels of supervision
These levels are about the proximity of the registered nurse to the enrolled nurse to be able to directly intervene if required.
Direct supervision means that a registered nurse is present and works with the enrolled nurse (or unlicensed healthcare worker) observing and directing his or her activities. The proximity of this supervision is such that immediate intervention is possible if problems occur.
The registered nurse is able to observe and monitor the execution of the enrolled nurse’s activities and retains accountability for the level of supervision required. What is determined to be a reasonable level of supervision will depend on the context, the needs of the consumer and the needs of the person who is being supervised
Indirect supervision means the registered nurse or midwife is not present and supervision is provided by other than direct observation, of an enrolled nurse (or unlicensed healthcare worker) by a registered nurse.
The absence of proximity of the registered nurse or midwife requires processes being in place for the direction, guidance, support and monitoring of the enrolled nurse activities. The registered nurse retains accountability for the level of supervision required. What is determined to be a reasonable level of supervision will depend on the context, the needs of the consumer and the needs of the person who is being supervised