SUPERVISION AND MANAGEMENT

INTRODUCTION:

Supervision is one of the important functions in an organization. In every organization there is a provision
for supervision. Supervision means overseeing the employees at work. So in this session we will see in
detail regarding supervision and supervisor roles in managing people.

The term supervisor implies that an individual holds authority over others (National Labor Relations Act
[NLRA], 1935). While nurses supervise others on a daily basis, they do not necessarily hold "authority"
over those they supervise. Therefore, it is important to differentiate between supervision and delegation
(Matthews, 2010). Supervision is more direct and requires directly overseeing the work or performance
of others. Supervision includes checking with individuals throughout the day to see what activities they
completed and what they may still need to finish. When one RN works with another, then supervision is
not needed. This is a collaborative relationship and includes consulting and giving advice when needed.

The following gives an example of supervision:

ANAP has been assigned to take all the vital signs on the unit and give the morning baths to eight
patients. Three hours into the morning, the NAP is far behind in the assignment. At this point, it is
important that the RN discover the reason the NAP has not been able to complete the assignment.
Perhaps one of the clients required more care than expected, or the NAP needed to complete an errand
off the unit. Reevaluation of the assignment may be necessary. Individuals who supervise others also
delegate tasks and activities. Chief nursing officers often delegate tasks to associate directors. This may
include record reviews, unit reports, or client acuities. Certain administrative tasks, such as staff
scheduling, may be delegated to another staff member, such as an associate manager. The delegator
remains accountable for ensuring the activities are completed.

Terminologies:

What is "Management"?

Traditional Interpretation

There are a variety of views about this term. Traditionally, the term "management" refers to the set of
activities, and often the group of people, involved in four general functions, including planning,
organizing, leading and coordinating activities. (Note that the four functions recur throughout the
organization and are highly integrated.)

Another Interpretation

Some writers, teachers and practitioners assert that the above view is rather outmoded and that
management needs to focus more on leadership skills, e.g., establishing vision and goals,
communicating the vision and goals, and guiding others to accomplish them. They also assert that
leadership must be more facilitative, participative and empowering in how visions and goals are
established and carried out. Some people assert that this really isn't a change in the management
functions, rather it's re-emphasizing certain aspects of management.
What Do Managers Do?

Both of the above interpretations acknowledge the major functions of planning, organizing, leading and
coordinating activities -- they put different emphasis and suggest different natures of activities in the
following four major functions.

What is "Supervision"?

There are several interpretations of the term "supervision", but typically supervision is the activity carried
out by supervisors to oversee the productivity and progress of employees who report directly to the
supervisors. For example, first-level supervisors supervise entrylevel employees. Depending on the size
of the organization, middle-managers supervise firstlevel supervisors, chief executives supervise middle-
managers, etc. Supervision is a management activity and supervisors have a management role in the
organization.

DEFINITION

 Supervision is an act of a superior person to see the work of the personnel working under him. or
her.
 Guiding and directing efforts of employees and other resources to accomplish stated work outputs
-Terry and Franklin
 Supervision is a process by which workers are helped by a designated staff member to learn
according to their needs, to make the best use of their knowledge and skills and to improve their
abilities so that they do their Jobs more effectively and with increasing satisfaction to themselves
and the agency. –Williamson
 Supervision is defined as "An art or a process by which designated individual or group of
individuals oversee the work of others and establish controls to improve the work as well as the
worker".

Objectives of supervision

1. Help the staff to do their job skillfully and effectively to give maximum output with minimum resources-
cost effectiveness.

2. Help the staff develop the individual capacity to the fullest extent with a view to channelize the same in
favor of work.

3. Guide and /or assist in meeting predetermined work objectives or targets. Ex in nursing preventive,
promotive, curative and rehabilitative care of the people.

4. Help to promote effectiveness of the subordinates/ staffs. Ensuring that the subordinate staff or
supervise does what he/she supposed to do.

5. Help to motivate subordinates to maintain high morale, i.e. promotion of motivation and morale among
all the nursing staff.

6. Help the members of the team to recognize problems, identify solution and to take action.
7. Help to develop team spirit and promote team work for effective functioning.

8. Help to improve the attitudes of the members towards the work or program i.e. bridging the gap
between the worker‘s personal goal and the organizational goal by providing guidance in the right
direction.

GOALS OF SUPERVISION

 To assist in the problem solving of the matters concerning personal, administrative and operation
of services.
 To develop standards of service and methods of evaluation of a personnel and services.
 To evaluate the services given, personal performance, progress made and to suggest changes
for improving the work effectively and outcome of the personnel.

PURPOSE OF SUPERVISION:

Factors of effective Supervision

Following factors are responsible for effective supervision

• Human relations skills

• Technical and managerial knowledge

• Leadership position

• Improved upward relation

• Relief from nonsupervisory duties

• General and loose supervision

Human relations skills

Supervision is mainly concerned with instructing, guiding and inspiring human beings towards greater
performance. For purpose of direction, the supervisor has to rely on leadership, counseling,
communication and other determinants of human relation.

Technical and managerial knowledge

Guidance implies a complete understanding of all work problems, for which the supervisor should have
good knowledge about technical aspect of job and also the managerial aspects.

Leadership position

The authority of supervisors must be made commensurate with their duty so as to make the job of
supervision a satisfying, rewarding and challenging one. So, the supervisors are to be vested with
necessary authority for enabling them to exercise leadership over the group and influence the
employees.

Improved upward relation

To ensure good quality of supervision, the supervisor‘s upward relations must be well established, which
means to say that supervisors should be regularly allowed to present their views and suggestions to top
executives in regard to the personnel and their work performance, for which, the top management must
pay adequate attention and thought on supervisory jobs to ensure good quality supervisions.

Relief from non supervisory duties

To make the supervisory duties purposeful, the supervisors are to be relieved of many routine activities
that divert their attention from the real job.

General and loose supervision

According to some experience, the general and loose supervision is more productive than close
supervision. Here the leader must allow freedom and initiatives to his followers for pursuing a common
course of action.

Functions of Supervision

Orientation of newly posted staff

Transfers and postings, or new postings of personnel are common in all organization. All new
comers should be informed about their functions, the method that they should use, the personnel
with whom they will work and the community wherein they will work, that needs an
orientation.

Assessment of the workload of individuals and groups

It must be ensured that the workload is within the physical and mental competence of a worker.
Otherwise job should not be assigned to them. A supervisor should not expect from workers a level of
effort that is beyond them.

Arranging for the flow of materials

A supervisor must find out the needs for supplies and equipment and arrange for their supply in good
time.

Coordination of the efforts

A supervisor coordinates the work of his/her workers and agencies and promotes team work.

Promotion of effectiveness of workers

This may be done through performance evaluation and introducing concepts of the staff development.

Promotion of social contact within the work team.

Social contacts help to bring the staff together and increase group cohesiveness. A good supervisor
should provide opportunity.

Helping individuals to cope with their personal problems

Personal problems are likely to come up while dealing with workers. Those may be the supervisors‘
duties but a sympathetic understanding on his part improves the individual morale.

Facilitating the flow of communication

A free flow of communication among members is necessary for team work. Supervisor should encourage
free communication among peer, team members.

Raising the level of motivation

All good work should be given due credit through recognition. Supervisor must provide opportunities for
growth and achievements.

Establishment of control

Supervision is a control measure as well as leadership technique. The supervisor must know is being
done and with what effectiveness. A number of techniques such as observation and record review can
be used for this purpose.

Development of confidence

Supervisors must know the background of workers and try to develop mutual confidence. There is a
need to combine understanding with firmness and to take a personal interest without sacrificing
impartiality or discipline.

Emphasis on achievement
It has been proved that the development of a smooth work routine and the improvement of human
relations without corresponding emphasis on goal achievement are not likely to increase productivity.

Record keeping

The supervisor should maintain good record system.

Principles of Supervision

Supervision should not be overburned to any individual or group.

Supervision causing unreasonable pressure for achievement results in low performance and low
confidence in the supervisor.

Supervise diagnosis, do not overestimate his understanding and memory.

Human behavior with due consideration to human weakness. This should be kept in minds of
supervisors.

Supervisors should create atmosphere of cordiality and mutual trust.

Supervision should be planned and adopted to the changing conditions. It calls for good planning and
organization.

Supervisors must possess sound professional knowledge.

Supervision must be exercised without giving the subordinate a sense that they are being supervised.

Supervision strives to make the unit a good learning situation. It should be a teaching- learning
process.

Supervision should foster the ability of each staff member to think and act for himself/herself.

Supervision should encourage workers‘ participation in decision making.

Supervision needs good communication

Supervision should have strength to influence downwards depends on capacity to influence upwards.

Supervision is a process of cooperation and coordination.

Supervision should create suitable climate for productive work.

Supervision should give autonomy to workers depending from personality, competence and
characteristics.

Supervision should respect the personality of the staff.

Supervision should stimulate the workers/ staff ambitions to grow in effectiveness.

Supervision should focus on continued staff growth and development.

Supervision is responsible for checking and guidance.

 Good leadership is part of good supervision.

Changing concepts of supervision

Today, there is more democracy in supervision. Educators think of supervision either as guidance
or a working together for common goals. The nature and scope of supervision varies with the kind of the
work to be supervised, the type of the people to be supervised, the extent of the supervisor‘s
responsibility and the level of supervision.

Conceptual model of supervision:

Need for supervision

The effectiveness of the workers depends on the supervision they reserve.

Quality of work is directly related to the degree of supervision. High degree supervision improves work,
poor supervision leads to poor work.

Stages and activities of supervisory technique

There are 3 stages

• Stage one: Preparation for supervision

• Stage two: Supervision

• Stage three: Follow up of supervision

Stage one: preparation for supervision

For successful supervision preparation is one of important stage. While getting prepared to supervise the
supervisor should focus on specific issues like efficacy of the services provided to the patient.

- Relevant problems which may arise.

- The performance of individual members of staff.

- The effective utilization and management of limited resources covering 3 M‘s –

 Manpower
 Money
 Material

- Study of documents such as hospital policy, routines, rules guidelines job description etc in detail.

- Identification of the priorities for supervision such as priorities areas, activities and tasks related to
nursing care services in a hospital or in a community which should be supervised. This will make
supervision most effective.

- Preparation of a supervision schedule- it is essential that you prepare checklist for observation in the
wards in the institutional settings and for field visit in the community settings. Prepare a planned
schedule of visits on the basis of the priority needs and content supervision as set out in the checklist.

Stage two: Supervision

After preparation is over the supervisor can begin his supervision work. In this stage the tools which are
to use may include

- Job description

- Task description

- Weekly time table

- Checklist and or rating scale for each task

As a supervisor the following activities are expected to perform in this stage

• Establish contracts

• To know about other members of the team providing comprehensive care to the patient.

• Review the objectives, targets and norms • Review the job description

• Observe the nursing staff‘s motivation

• Observe individual nursing staff carry out his/her tasks- her skills, attitude, utilization of resources.

• Identify the gaps and needs for follow up action based on feedback.

Stage three: follow up of supervision

In this stage the supervisor should make a report on the observation made during supervision which
includes:

 Organizing in-service training programme / CNE programme for the nursing personnel
 Reorganization of time table / duty roster
 Initiating changes in logistic support or supply system.
  Initiating actions for organizing staff welfare activities
 Counseling and guidance regarding career development and professional growth.

Qualities of a good supervisor

According to Halsey a good supervisor must possess the following qualities

Thoroughness

Fairness

Initiative

Tact

Enthusiasm

Emotional control

Others

Personal qualification

Teaching ability

General look

Interpersonal and professional skills

Professional and technical knowledge

Attitude

Styles of supervision

There are two main styles

Task centered: when the supervisor emphasizes the task more than the performer whom she / he
supervises. This type of supervisor probably believe that ends are more important than the means

Employee centered supervisor: such supervisor are people oriented. They believe that a concern for
workers/ staff, their need and welfare is very important. Therefore if the employees are well taken acre
they will be able to work well and be capable of taking on responsibilities. However such a supervisory
style at an extreme can also lead to inefficiency if the subordinates take them as lenient persons.

Other styles of the supervisor

An autocratic or critical supervisor who cannot tolerate any deviation from norms, lack of quality in
work, lack of discipline etc. the decisions are made by themselves.

A benevolent supervisor who is very protective of his/ her subordinates, keep telling them what they
should do and what they should not, thus providing constant direction, such supervisor are usually liked
by the workers but are effective as long as they are physically present as they tend to develop the
subordinates as dependent followers.

Democratic supervisor who believes in a style of ― let us agree on what we are to do‖ in dealing with
the subordinates. Such supervisor provides guidance only when requested by the subordinates. The
subordinates with this type of supervisor tend to develop confidence in their work. They are quite
independent and cooperate with one another and work together. The effectiveness of the style of
supervisor depends on job factors and personal factors.

The job factors include

- The complexity of the job

- The difficulty of the job

- The nature of the job

- The urgency of the task

- Consistency of the task

- Need for creativity or new idea.

The personal factors include

- Skills

- Knowledge

- Expertise and experience

- Attitude

- Independent decision making.

Types of Supervision

Generally there are two types of supervision

Direct supervision

Direct supervision

This is done through face to face talk with the workers. This can be exercised at the ward/ unit level in
the hospital or PHC or subcenter of the community setting. The following are the considerations which
are essential for this type of supervision

 Do not loose temper or abuse

 Use democratic approach and avoid autocratic methods.
 Reprimand if necessary in private and do it promptly.
  Give workers a chance to reply.
 Do not talk too much and too fast.
 Be human in behavior
 Do not take it granted that the worker has understood everything told to him
 Do not give instructions in haphazard way.

Indirect Supervision

It is done with the help of record and reports of the workers and through written instructions or through
some agency between the supervisor and supervisee. This includes

 Ensuring that every worker is carrying out allotted work in accordance with the plan of operation
and with the prescribed methodology and in keeping pace with the time as far as possible.
 Analyzing the monthly progress reports to know the inputs of efforts and the achievements of the
workers and their relations with each other.
 Analyzing what amount of work allotted for the month has been done with reasons for non
performance and providing suitable guidance for the same.
 Providing support and guidance to all workers in implementation of various activities.
 Analyzing the stage of program or job in each sector/ unit and village and to suggest plan for
future months on the above basis.
 Ensuring that the worker is utilizing his/her full capacity in the program. Ex how many hours per
day have been spent in the field or unit/ ward, and what efforts have been done by him/ her
during this time.

Direct supervision Indirect supervision

It is done through face-to-face talk with the It is done with the help of record and reports of the workers
workers. This can be exercise in the ward and through written instruction or through some agency
or unit level in the hospital or PHC or between the supervisor and supervisee. This includes:
subcentre of the community setting. The  Ensuring that every worker is carrying out allotted work
following are essential in direct supervision: in accordance with the plan of operation and with the
 Do not loose temper or abuse. prescribed methodology and in keeping pace with the
 Use democratic approach and avoid time as far as possible.
autocratic methods.  Analyzing the monthly progress reports to know the
 Reprimand if necessary in private input of efforts and achievement of the workers and
and do it properly. their relations with each other.
 Give workers a chance to reply.  Analyzing what amount of work allotted for the month
 Do not talk too much and too fast. has been done with reasons for nonperformance and
providing suitable guidance for the same.
 Be human in behaviour.
 Providing support and guidance to all the workers in the
 Do not take it granted that the worker
implementation of various activities.
has understood everything told to
him.  Analyzing the stage of programme or job in each sector
or unit and village and to suggest plan for future months
 Do not give instruction in a
on the above basis.
haphazard way.
 Ensuring the worker is utilizing his/her full capacity in
the programme. How many hrs per day have been
 spent in the field or unit/ward, and what efforts have
been done by him/her during this time.

Method of supervision

Supervision is a cooperative process that has for its objective the improvement of nursing service. To
achieve these objectives, there are different methods of supervision which include:

1. Technical vs creative supervision

2. Cooperative vs authoritarian supervision

3. Scientific vs intuitive supervision.

Technical vs creative supervision

Technical methods are some of the basic supervisory skills which need to be trained. Group
conferences, group discussions. Creative supervision provides maximum adaptation to the situation. Ex
instead of an orientation period of two weeks for each new staff member, a variable plan in both contents
and time according to the needs of each individual should be formulated.

Cooperative vs Authoritarian supervision

In cooperative supervision there is a full participation of each member of the group in planning, action
and decision whereas in authoritarian supervision responsibility centers entirely on the supervisor, with
the staff following his/her orders. Both are needed according to situation and circumstances.

Scientific vs Intuitive supervision

Scientific supervision relies on objective study and measurement than personal judgment or opinion.
Whereas intuitive supervision needs to maintain the interpersonal relationship. The supervision needs a
sensitive and intuitive reaction to the emotional needs of another person.

Techniques of supervision

o Group conferences
o Individual conference
o Anecdotal records
o Initial conference
o Control of early experience
o Assistance with bed side care
o Reassurance
o Supervision of nursing procedures
o Incidental teaching

Tools for supervision

o Checklist
 o Rating scale
o Nursing rounds
o Nurse‘s reports
o Staff educations
o Problem solving approach

Core skills in management & supervision

1. Problem Solving and Decision Making

2. Planning

3. Effective Delegation

4. Basics of Internal Communications

5. Meeting Management & Managing Yourself

1. Problem Solving and Decision Making

A. Define the problem

Defining complex problems:

Prioritize the problems:

Understand your role in the problem:

B. Look at potential causes for the problem

C. Identify alternatives for approaches to resolve the problem

D. Select an approach to resolve the problem

E. Plan the implementation of the best alternative (this is your action plan)

F. Monitor implementation of the plan

G. Verify if the problem has been resolved or not

2. Planning

a. Goals

Goals are specific accomplishments that must be accomplished in total, or in some combination, in order
to achieve some larger, overall result preferred from the system, for example, the mission of an
organization. (Going back to our reference to systems, goals are outputs from the system.)

b. Strategies or Activities

These are the methods or processes required in total, or in some combination, to achieve the goals.
(Going back to our reference to systems, strategies are processes in the system.)
c. Objectives

Objectives are specific accomplishments that must be accomplished in total, or in some combination, to
achieve the goals in the plan. Objectives are usually "milestones" along the way when implementing the
strategies.

d. Tasks

Particularly in small organizations, people are assigned various tasks required to implement the plan. If
the scope of the plan is very small, tasks and activities are often essentially the same.

e. Resources (and Budgets)

Resources include the people, materials, technologies, money, etc., required to implement the strategies
or processes. The costs of these resources are often depicted in the form of a budget. (Going back to
our reference to systems, resources are input to the system.)

f. Phases in planning

- Reference Overall Singular Purpose ("Mission")

- Take Stock Outside and Inside the System

- Analyze the Situation

- Establish Goals

- Establish Strategies to Reach Goals

- Establish Objectives Along the Way to Achieving Goals

- Associate Responsibilities and Time Lines With Each Objective

- Write and Communicate a Plan Document

- Acknowledge and Celebrate Accomplishment of the Plan

g. Guidelines to Ensure Successful Planning and Implementation

A common failure in many kinds of planning is that the plan is never really implemented. Instead, all
focus is on writing a plan document. Too often, the plan sits collecting dust on a shelf. Therefore, most of
the following guidelines help to ensure that the planning process is carried out completely and is
implemented completely -- or, deviations from the intended plan are recognized and managed
accordingly.

Involve the Right People in the Planning Process

Write Down the Planning Information and Communicate it Widely

Goals and Objectives Should Be SMARTER

Build in Accountability (Regularly Review Who's Doing What and By When?)

 Note Deviations from the Plan and Replan Accordingly

Evaluate Planning Process and the Plan

Recurring Planning Process is at Least as Important as Plan Document

Nature of the Process Should Be Compatible to Nature of Planners

Critical -- But Frequently Missing Step -- Acknowledgement and Celebration of Results

3. Effective Delegation

The hallmark of good supervision is effective delegation. Delegation is when supervisors give
responsibility and authority to subordinates to complete a task, and let the subordinates figure out how
the task can be accomplished. Effective delegation develops people who are ultimately more fulfilled and
productive. Managers become more fulfilled and productive themselves as they learn to count on their
staffs and are freed up to attend to more strategic issues.

Delegation is often very difficult for new supervisors, particularly if they have had to scramble to start the
organization or start a major new product or service themselves. Many managers want to remain
comfortable, making the same decisions they have always made. They believe they can do a better job
themselves. They don't want to risk losing any of their power and stature (ironically, they do lose these if
they don't learn to delegate effectively). Often, they don't want to risk giving authority to subordinates in
case they fail and impair the organization.

The following general steps to accomplish delegation:

-Delegate the whole task to one person

-Select the right person

- Clearly specify your preferred results

-Delegate responsibility and authority -- assign the task, not the method to accomplish it

-Ask the employee to summarize back to you, their impressions of the project and the results you prefer

-Get ongoing non-intrusive feedback about progress on the project

-Maintain open lines of communication

-If you're not satisfied with the progress, don't take the project back.

-Evaluate and reward performance

4. Basics of Internal Communications

Effective communications is the "life's blood" of an organization. Organizations that are highly successful
have strong communications. One of the first signs that an organization is struggling is that
communications have broken down. The following guidelines are very basic in nature, but comprise the
basics for ensuring strong ongoing, internal communications.
 o Have all employees provide weekly written status reports to their supervisors o Hold monthly
meetings with all employees together
o Hold weekly or biweekly meetings with all employees together if the organization is small (e.g.,
under 10 people); otherwise, with all managers together Have supervisors meet with their direct
reports in one-on-one meetings every month

5. Meeting Management & Managing yourself

o Opening Meetings
o Establishing Ground Rules for Meetings
o Time Management
o Evaluations of Meeting Process
o Evaluating the Overall Meeting
o Closing Meetings

Role of New Manager or Supervisor of Often Very Stressful

The experience of a first-time supervisor or manager is often one of the most trying in their career. They
rarely have adequate training for the new management role -- they were promoted because of their
technical expertise, not because of their managerial expertise. They suddenly have a wide range of
policies and other regulations to apply to their subordinates. Work is never "done". They must represent
upper management to their subordinates, and their subordinates to upper management. They're stuck in
the middle. They can feel very alone.

Guidelines to Manage Yourself

Everyone in management has gone through the transition from individual contributor to manager. Each
person finds their own way to "survive". The following guidelines will help you keep your perspective and
your health.

-Monitor your work hours

-Recognize your own signs of stress

-Get a mentor or a coach

-Learn to delegate

-Communicate as much as you can

-Recognize what's important from what's urgent -- fix the system, not the problem -Recognize
accomplishments

A narrative-based approach to supervision: the seven Cs:

One aim of supervision is to help people to find new versions of a situation which has become stuck by
asking questions which invite change. Palazzoli Selvini et al (1980) suggest that supervisors should not
give advice, offer solutions or make interpretations. Educational supervision may, however, require a
more directive approach such as asking questions which help people think from new angles (Tomm,
1988). These techniques, and ways of asking questions, have been formulated into core concepts (the
‗seven Cs‘, adapted from Launer, 2006b), which illustrate how to put supervision into practice.

Conversations

Here the conversation itself is seen as the working tool. Effective conversations do not simply describe
people‘s view of reality, they create new understanding of it through the opportunity for people to rethink
and reconstruct their stories.

Curiosity

Curiosity changes chat into a more substantial conversation in which the story about patients, colleagues
and oneself is developed. Supervisors need to pay close attention to verbal and non-verbal language
used, and their own responses and feelings (such as criticism, boredom or anxiety). It is important to
consciously take a neutral and nonjudgmental stance which allows us become curious about different
positions others might take, including the position of no change.

Contexts

This includes the person‘s networks, his/ her sense of culture, faith, beliefs, community, values, history
and geography and how these may impinge on the conversation. An important context is that of how
power is understood. Who holds the power and how is this seen by others? Who is asking for
supervision and for what purpose? The context helps the conversation come alive.

Complexity

This involves thinking about things in a non-linear way, getting away from fixed ideas of cause and
effect, thinking about the interactions between people and the kind of patterns which develop between
people and events over time to produce a richer description of the story.

Creativity

Creativity means finding a way to create a story or account of reality which makes better sense for
people than the one they are going through. To do this involves using oneself, intuition and sensitivity to
fine-tune the conversation. It also implies the creative process of jointly constructing a new version of the
story.

Caution

This consists of looking for cues from the supervisee to monitor his/her responses. It involves working on
the cusp between affirmation and perturbation in order to challenge appropriately without being
confrontational or too bland. Sometimes it is appropriate to give straightforward advice (although you
need to be aware of its limitations).
Care

Being respectful, considerate and attentive to patients, your supervisee and yourself is important, as is
ensuring that supervision and clinical activities are carried out ethically.

The supervision process

The process of supervision gives an opportunity for supervisees to reconstruct their view of a particular
situation or issue through the supervisor asking questions to try to help them see things from different
perspectives. This is part of an iterative process which might take place within one session or over a
period of time. In order to help people come to their own conclusions and solutions it is often better to
withhold advice until towards the end of the conversation. This does not mean that you should not tell a
supervisee what to do, especially within an urgent clinical setting.

Stage 1: Preparation for supervision

1. A supervisor should focus on specific issue.

• Efficacy of service provided to the

• Relevant problems

• Efficacy problem utilization management of limited resources.

2. Study of document

3. Identification of priorities

4. Preparation of a supervision schedule

Stage 2: supervision

Use tools:

Job description

Task description

Weekly time table

Check list / rating for each work

As a supervisor the following duties has to be performed.

Establish contact

Review the objectives, targets and norms

Review job descriptions

Note actual / potential conflict

Observe the actual performance.

Observe the individual nursing staff carries out his/ her tasks.

Identify the gaps & needs for follow up action based on feedback data attained through the observation.

Stage 3: Follow up of supervision

Unless actions to follow-up the gaps and needs identified during stage are taken, supervision remains
incomplete. Each supervisor must prepare a report on the observations made during supervision. The
follow- up action may include:

 Organizing in-service training programmes/ continuing education programmes for the nursing
personnel.
 Reorganization of time table / work plan/ duty roaster.
 Initiating changes in logistic support or supply system.
 Initiating actions for organizing staff welfare activities.
 Counseling and guidance regarding career development and professional growth.

THE EFFECTIVENESS OF SUPERVISION DEPENDS ON:

1. Human relations skill

2. Technical and Managerial knowledge

3. Leadership position

4. Improved upward relations

5. Relief from non-supervisory duties

6. General and lose supervision

1. Human relations skill:

Supervision is mainly concerned with instructing, guiding and inspiring human beings towards greater
performance. For purpose of direction, the supervisor has to rely on leadership, counseling,
communication and other determinants of human relations

2. Technical and Managerial knowledge:

Guidance implies a complete understanding of all work problems, for which supervisor should have good
knowledge about technical aspect of job and also the managerial aspect

3. Leadership position

The authority of supervisor must be made commensurate with their duty so as to make the job of
supervision a satisfying, rewarding and challenging one

4. Improved upward relations

To ensure god quality of supervisors, the supervisor's should be regularly allowed to present their views
and suggestions to top executive in regard to the personnel and their works performance.
5. Relief from non-supervisory duties

To make the supervisory duties purposeful, the supervisors are to be relieved of many routine activities
that divert their attention from the real job.

6. General and lose supervision

According to some experience, the general and loose supervision is more productive than close
supervision. Here the leader must allow freedom and initiative to his followers for pursuing a common
course of action.

SUPERVISORY RESPONSIBILITIES OF THE COMMUNITY HEALTH NURSE

Supervision is generally termed as an educational process in which a person with better training or more
experience takes the responsibility of training a person with less training or less experience, and in this
educational process the leadership of the supervisor and the growth of the supervised combine to
achieve and maintain progressively the highest level of performance of which the worker is capable.

In the hospital there are senior staff nurses, sisters and nursing superintendents to help and guide the
staff in the execution of their day- to-day responsibilities. Similarly, in the community health field, super-
vision of the nursing personnel is an important function of the community health nurse.

*1 "Nursing personnel look to supervision for stimulation, development, and promotion in service; they
look to supervision for inclusion and "belongingness", opportunity to grow and contribute, recognition,
and security; they look to supervision as a means of preserving their personal and social prestige and
dignity; they look to supervision for the psychological values to which those who dedicate their services
have a right in terms of compensation."

The primary aim of supervision is to help the individual develop her or his capacities to serve to the
fullest extent.

All the nursing staff (Community Health Nurse, health visitor, auxiliary nurse midwife, oriented
community health nurse and dai) are not equally trained; and the preparation of these categories of
nursing personnel is not adequate to the need and scope of the community health set-up of today.

The community health field is expanding rapidly, in the process of which the very concept of community
health has changed from only preventive to preventive and curative medicine. Thus, its administration
demands additional services for which the staff needs constant stimulative guidance.

The community is more and more conscious about its health needs, demanding higher and higher level
of nursing care, and hence the need for maintaining higher standards of nursing technique.

*2 It is gratifying to note, in this connection, that in certain States like Mysore, Gujarat, Maharashtra,
Andhra Pradesh and Kerala, the community health nursing supervisors have also been already ap-
pointed either at the State level or at the regional level or at the district level.
SUPERVISORY RESPONSIBILITIES

(Administration, Planning and Development)

1. Development of policies, standing instructions, manual of procedures in consultation with senior field
staff and medical officer.

2. Periodic appraisal or nursing and midwifery procedures and techniques to determine scientific
soundness and practicability.

3. Periodic appraisal and revision of policies, and regulations of the agency.

4. Study of office routines, record system and registers with a view to establishing simple and effective
method of operation.

5. Assistance with the recruitment and selection of staff, if it is not done at the State level.

6. Liaison between the nursing staff and administration-interpret policy to the staff and interpret needs,
problems and recommendations of the staff to the administrative authorities.

7. Assistance in the development of new programmes and budget based on need.

8. Assistance in overall planning of health programme, particularly to nursing service.

9. Assistance in the providing adequate supplies and equipment for safe and economic nursing
procedures.

10. Assistance in providing safe and secure accommodation for the nursing staff.

11. Assistance in the planning and arranging for staff health programme.

SUPERVISORY RESPONSIBILITIES OF THE NURSE WORKED IN HOSPITAL SETTINGS

As a nurse working in a hospital setting, there are several supervisory responsibilities that you may have,
including:

 Supervising other nurses: As a senior nurse, you may be responsible for supervising other
nurses on your team, including assigning tasks, monitoring performance, providing guidance and
support, and ensuring that patient care is delivered effectively and efficiently.
 Training and mentoring: You may also be responsible for training and mentoring new nurses,
providing them with the knowledge and skills they need to perform their duties effectively and
safely.
 Monitoring patient care: As a supervisor, you will need to monitor patient care and ensure that it
meets the highest standards of quality and safety. This may involve conducting rounds, reviewing
patient charts, and communicating with other healthcare providers to ensure that patients are
receiving the best possible care.
 Ensuring compliance with policies and procedures: You will need to ensure that all nursing staff
are following hospital policies and procedures, including those related to patient care, infection
control, and medication administration.
  Managing resources: You may also be responsible for managing resources such as staff,
supplies, and equipment to ensure that patient care is delivered efficiently and effectively.
 Collaborating with other healthcare professionals: As a supervisor, you will need to collaborate
with other healthcare professionals such as physicians, therapists, and social workers to ensure
that patients receive the best possible care.

Overall, as a nurse supervisor in a hospital setting, you play a critical role in ensuring that patients
receive the highest quality care possible while also supporting and managing the nursing staff under
your supervision.

PROBLEMS OF SUPERVISION

PROBLEMS IN NURSING SERVICE:

There are no perfect nursing service programs/ situations without any problems

1. Shortage of nursing personnel.

2. Individual differences among personnel in interests, capacities and abilities.

3. Lack of information, insight and understanding of changes and developments in the interest of the
continuance and improvement of nursing.

4. Lack of clearly defined assignments, multiple responsibility and lack of planning on the part of those to
whom personnel is responsible

5. Outdated policies, procedures and guides to workmanship which cause them to be disregarded and
unused.

6. Inadequate, unsafe, and defective equipment.

7. Ill health in the part of personnel

8. Undesirable personnel characteristics with special attention to attitudes.

COMMON PROBLEMS IN COMMUNITY HEALTH NURSING SUPERVISION:

1. Problems inherent to budgeting, planning and timing.

2. Personnel problems including problems of poor performance.

3. Grievances

4. Lack of financial resources.

5. Lack administrative support

6. Staff members who are inflexible and resist any type of change 7. Assignment to projects other than
those committed to perform 8. Lack of political support

9. Staff members who do not accept or support the program goals.

10.Conflict within the nursing unit itself.

11.Inability to proceed (for many reasons) because the timing is wrong

12. Inability to hire qualified personnel.

13.Changes in program priorities.

14. Other issues can include anything from car rental, uniform allowance, security of the staff within the
community, need for supplies and equipment, duplication of services provided by another organization.

JOURNAL REFERENCE

Clinical supervisors' perceptions and use of the fundamentals of care framework in supervision
of nursing students

Abstract

Aim: To explore clinical supervisors' perceptions and use of the Fundamentals of Care framework in
supervising nursing students in clinical placement in hospital settings.

Design: A qualitative study using focus group interviews. Reported in accordance with Consolidated
Criteria for Reporting Qualitative Research.

Methods: Twelve clinical nurse supervisors working in medical, surgical or psychiatric wards in hospitals
in Denmark participated in four focus groups conducted from September to November 2020. Data were
analysed using thematic analysis.

Results: Clinical supervisor's perceptions and use of the framework are described in three themes:
structuring students' clinical learning, supporting tool for learning what nursing care is and developing
own supervision practice.

Conclusion: Supervisors perceive the Fundamentals of Care framework positively and use it as a
supporting tool to structure and facilitate students' reflection on what nursing is and requires. They
perceive that having a shared framework across school and clinical setting contributes to a safe and
positive learning environment. Furthermore, using the framework develops their own practice as clinical
supervisors.
 THEORY APPLICATION

The Transformational Leadership Theory, developed by James MacGregor Burns, emphasizes the
importance of leaders inspiring and motivating their followers to achieve a shared vision and goals.
Transformational leaders empower their followers, provide them with the necessary resources and
support, and encourage them to grow and develop both professionally and personally.

In the context of nursing supervision, the Transformational Leadership Theory can be applied by nurse
leaders to motivate and inspire their staff to provide high-quality care, improve patient outcomes, and
achieve organizational goals. Nurse supervisors can use this theory to create a positive work environment
that fosters teamwork, collaboration, and open communication.

By providing mentorship, coaching, and training opportunities, nurse leaders can empower their staff to
take ownership of their work and make meaningful contributions to patient care. This can lead to increased
job satisfaction, improved staff retention, and ultimately better patient outcomes.

Overall, the Transformational Leadership Theory is a useful framework for nurse supervisors to promote
a culture of excellence in nursing service and support the professional development and growth of their
staff.

CONCLUSION

If ‘vision’ implies seeing, the word ‘supervision’ can be read as over-seeing, looking over someone’s
shoulder to check on them, and also ‘super’ in the sense of outstanding or special: helping someone to
extend their professional skills and understanding.Supervision supports professional learning and
development, but also relates to monitoring and improving performance as part of effective clinical
governance and standard setting.In medical education, a distinction is often made between the two
closely related activities of clinical and educational supervision.

Supervision and management is a vital and important role where the supervisor and the subordinates
should have a cordial relation in order to run the organization effectively.
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 Seminar

On

SUPERVISION AND MANAGEMENT

Submitted to: Submitted by:

Mrs. Yamuna T. V Dipa mani Rabha
Tutor M.Sc 2nd year
College of Nursing College of Nursing
JIPMER JIPMER