Wales mandates preceptorship and clinical supervision for nurses
The chief nursing officer (CNO) in Wales has mandated preceptorship and restorative clinical supervision for all nurses in the country.
Sue Tranka has told NHS health boards and trusts in Wales that they must make sure they have “career spanning” support in place for their nurses.
“Historically, access to and quality of preceptorship and supervision have been inconsistent”
Gemma Stacey
This includes providing a preceptorship programme for newly registered nurses and access to restorative clinical supervision for nurses throughout their career starting from student.
Ms Tranka has set out her expectations in a new national position statement and connected preceptorship standards and clinical supervision principles, published at the end of March.
In it, she said: “The recent years of unprecedented pressure and strain on the NHS workforce have outlined the need for nationally consistent direction around career spanning support for staff to be factored into our long-term workforce policy.”
She said preceptorship and restorative clinical supervision were “concepts that are proven, well evaluated and highly valued”.
Plans for the new policy were reported by Nursing Times last year.
It comes as, over the last two years, Nursing Times has been campaigning for improved preceptorship for newly registered nurses across the UK, in partnership with the union Unison and charity the Florence Nightingale Foundation.
A recent survey we conducted found that only 50% of respondents in Wales said preceptorship was on offer at their workplace.
In her new position statement, Ms Tranka acknowledged that access to good quality preceptorship in the country was patchy.
She said: “There is evident variation in adoption of preceptorship both across and within Welsh organisations.”
Ms Tranka’s new all-Wales preceptorship standards – which follow the publication of a national preceptorship framework for England in October 2022 – stress that preceptorship is “mandated across NHS Wales and organisations must be preceptee-ready”.
They state that preceptees need to be supernumerary for the first month of employment and embark on a preceptorship programme that lasts up to 18 months.
In addition, they say that preceptors – registered staff who support newly registered nurses through their preceptorship – need “allocated time” to fulfill this role as well as paid time off for training.
Similarly, the all-Wales clinical supervision principles state that “access to restorative clinical supervision is mandated”.
They say that organisations need to provide protected time for nurses to access and provide restoration clinical supervision in all settings.
As a minimum standard, every nurse should take part in restorative clinical supervision four times a year, with each session lasting at least 1.5 hours.
“A restorative model of clinical supervision will be delivered flexibly via group, one to one, face to face or online, based on the needs of the supervisee,” add the principles.
Newly registered nurses should be provided with restorative clinical supervision through preceptorship programmes, the principles state.
Meanwhile, in terms of students, Ms Tranka said universities needed to embed the preceptorship and clinical supervision principles within their nursing programmes.
As part of this, she said student nurses should also be able to access clinical supervision while on work placements.
In her policy document, Wales CNO Sue Tranka defines preceptorship and restorative clinical supervision as follows:
“Preceptorship is a period to guide and support all newly registered nurses to make the successful transition from student to accountable, independent, knowledgeable and skilled practitioner.
“Restorative clinical supervision is a process of professional support, reflection and learning that contributes to individual development and improved person-centred care. In terms of the restorative element, this component provides the supervisee with a supportive, safe, and trusted environment, to reflect on personal reactions and feelings and facilitate the identification of creative solutions.”
The new policy on preceptorship and clinical supervision will be implemented in a phased way and Ms Tranka said governance would rest “exclusively with employers”.
Going forward, employers will be expected to formally evaluate their preceptorship and clinical supervision models at least annually and provide a report to the NHS executive.
While the policy only relates to nurses employed by NHS Wales, Ms Tranka said the approach could be used as a “benchmark for good practice” by other health and social care employers and be applied to other professions.
A Welsh Government spokesperson said: “We are committed to providing the NHS with the well supported workforce it needs, and the NHS workforce is at record levels.
“Recent years of extraordinary pressure on the NHS workforce has shown the need for career-spanning support to be factored into our long-term workforce policy, for registered nurses.
“Last month, the chief nursing officer for Wales published a position statement, mandating restorative clinical supervision across the Welsh NHS whilst also enhancing the provision of preceptorship to support the registered nursing workforce throughout their careers.”
“Long term investment must be prioritised to change the clinical supervision culture in nursing in Wales”
Michelle Moseley
Michelle Moseley, education and lifelong learning adviser for the Royal College of Nursing (RCN) in Wales, said her organisation welcomed the new position statement.
“Newly registered nurses need emotional support whilst integrating into new roles and practice areas,” she said.
“Restorative clinical supervision practice needs to be embedded at undergraduate level with ongoing exposure to restorative clinical supervision through preceptorship programmes and into their nursing careers.”
Ms Moseley, who supported the development of the new all-Wales preceptorship and restorative clinical supervision standards, said she wanted to see the policy position usher in a new “culture of wellbeing and support” in workplaces.
However, she stressed: “Long term investment must be prioritised to change the clinical supervision culture in nursing in Wales, if we expect safe and effective care to be paramount.”
Gemma Stacey
Professor Gemma Stacey, deputy chief executive of the Florence Nightingale Foundation, who has worked with Nursing Times to campaign for better preceptorship, also welcomed the new policy.
She said: “We are delighted to see the CNO Wales strongly championing high quality preceptorship for newly qualified nurses and restorative clinical supervision for nurses across their whole career span.
“We know from our work with the Nursing Times and Unison exploring preceptorship experiences that, while good progress is being made, too many are still not getting the right support at the right time.”
She described the new Wales policy as a “significant step forward in embedding development, support, and reflective practice as a fundamental right for the nursing and midwifery professions, rather than an exception”.
“Historically, access to and quality of preceptorship and supervision have been inconsistent, often dependent on the dedication of individual champions or subject to fluctuating waves of popularity,” said Professor Stacey.
“By standardising and prioritising these essential support mechanisms, Wales is setting a powerful example for other governments to follow.”
However, she stressed that “robust evaluation and monitoring” would be key in the success of the new approach.
Meanwhile, Unison Wales head of health Tanya Bull said: “It’s good to see a set of standards providing consistency across all health boards.
“Allocated hours and paid time off for new recruits and clinical supervisors to attend training is vital, but it needs proper funding.”
Ms Bull added that it was “crucial” that internationally educated nurses reaped the benefits of the new policy too.
