Sarah Batt-Williams | ORCHID http://orcid.org/0000-0001-8713-6944 Bsc (Hons) RVN MSc Vet Ed. FHEA | Centre for Veterinary Nursing, The Royal Veterinary College, Hatfield, UK

Evie Yon | ORCHID https://orcid.org/0000-0001-9573-1524 BSc (Hons) PG Cert VE FHEA RVN | Centre for Veterinary Nursing, The Royal Veterinary College, Hatfield, UK

ABSTRACT

The aim of this study is to investigate the experiences of clinical supervisors and their perceptions of their role. This communication explores the data relating to confidence as a clinical supervisor. A survey was distributed via Facebook, the BVNA and emails to Training Practices. The study gained ethical approval from the SSREB committee at the Royal Veterinary College URN SR2020-022. Overall participants were confident as clinical supervisors. Increased confidence scores were found to be associated with interest in becoming a clinical supervisor (p = 0.05), prior education-focused qualifications.

p = < 0.001), time spent as a supervisor (p = < 0.001) and the support provided by the practice (p = < 0.001) and teaching institution (p = 0.016). Areas that demonstrated lower confidence were areas the teaching institutions should provide support for. This study provides a baseline understanding which is of interest to employers, education providers, clinical supervisors and veterinary nursing students. 

Key words clinical supervisor, clinical supervision, clinical coach, student veterinary nurse, veterinary education, role satisfaction, confidence, training

Introduction

This is the second communication in a three-part series on the experience of clinical supervisors and the perceptions in their role exploring the descriptive data collated on self-reported confidence of clinical coaches and factors that affect this.  

In exploring self-reported confidence in the range of tasks expected of a clinical supervisor, a picture will be built around whether supervisors feel prepared and able to lead a student in their clinical progression and assess them fairly, accepting or declining competence. There is no data to suggest how confident veterinary clinical supervisors are in any parts of their role and if, therefore, further support is required. However, Holt et al. (2021) explored the preparedness of clinical coaches following clinical coach training and 45.5% felt that this had not prepared them well. 

Methods

The methods are described fully in Part 1 of this study. This study utilised Jisc survey software, containing 29 questions, distributed to clinical supervisors (RVNs and veterinary surgeons) by social media and emails to RCVS Training Practices.

The study was granted ethical approval from the SSREB committee at the Royal Veterinary College URN SR2020-022.

DATA ANALYSIS

Data collected were analysed in IBM® SPSS Statistics®. All numerical data were not normal in distribution and therefore non-parametric statistical analysis methods were utilised (Chi Square test, Kruskal-Wallis, Mann Whitney U test and Spearman’s correlation co-efficient). Hypothesis testing was reported in reference to p ≤ 0.05.  

Objectives

1. To determine how confident participants feel as a clinical supervisor

2. To determine which factors may affect confidence as a clinical supervisor

Hypotheses

There will be an association between reported levels of confidence as a clinical supervisor and:

• Those who sought to become a clinical supervisor

• Those who have been a clinical supervisor for longer  

• Those who have been qualified for longer prior to taking on students

• Those who have undertaken further training before becoming a clinical supervisor

• Those who have undertaken further training after becoming a clinical supervisor

• The length of time the participant has been a clinical supervisor

• Feeling supported as a supervisor by the practice

• Feeling supported as a supervisor by the training provider

Results

DESCRIPTIVE DATA

Confidence as a clinical supervisor

Participants were asked to rank their feelings towards nine tasks that they may complete, ranging from not confident at all (1) to very confident (5). This question was analysed as an individual confidence score and in relation to the task itself. The median confidence score was 41 (range 23–45) and the skill that participants felt most confident in was demonstrating nursing tasks (total score 1314). This was followed by accepting competency (total score 1293), providing constructive feedback (total score 1256), and declining competency (total score 1254). Participants were least confident in supporting personal issues (total score 1151), addressing professional issues (total score 1153), and reporting student issues to the teaching provider (total score 1163).  

STATISTICAL ANALYSIS

The self-reported confidence scale was analysed further against prior interest, qualifications, time spent as a supervisor, and feeling supported within the role. The data for these variables were described in Part 1.

Prior interest

The relationship between prior interest in becoming a clinical supervisor and self-reported confidence score was analysed. The variations within the groups are described in Figure 1 and these variations were statistically significant p = 0.05. Post hoc tests demonstrated that those who are very keen to become clinical supervisors have a statistically significant greater level of confidence compared to those who are keen (p = 0.01), indifferent (p = 0.002) or would have preferred not to have become a clinical supervisor (p = 0.015).  

Prior qualifications

The median confidence score for those who had not undertaken prior qualifications in education was 40 (range 23–45). The median for those who had undertaken educational qualifications prior to becoming a clinical supervisor was 42 (range 28–45). This was a statistically significant difference p = < 0.001, with those undertaking prior educational qualifications being more likely to report higher levels of confidence.

Post qualifications

The median confidence score for those who had not undertaken prior qualifications in education was 40 (range 23–45). The median for those who had undertaken educational qualifications after becoming a clinical supervisor was 44 (range 28–45). This was not a statistically significant difference p = 0.212, therefore it is unlikely that those who have undertaken further qualifications in education after becoming a clinical supervisor will have higher confidence scores.  

Months as a clinical supervisor

For analysis of this variable, years were converted into months. There was a weak positive correlation (0.27) between the number of months a participant had been a clinical supervisor and their self-reported confidence score. This association was statistically significant, p < 0.001, demonstrating tha
t there is an association with time spent as a clinical supervisor and confidence as a clinical supervisor.

Months spent qualified before becoming a clinical supervisor

Again, for analysis of this variable, years were converted into months. There was a weak positive correlation (p = 0.035) between the number of months spent qualified before becoming a clinical supervisor and their self-reported confidence score. This association was not statistically significant, p = 0.56, demonstrating that there is not likely to be an association between the number of months spent qualified before becoming a clinical supervisor and self-reported confidence score.

Feeling supported by the practice

The variations within groups for feeling supported by the practice are described in Figure 2, with 1 describing supervisors that did not feel supported at all and 5 being fully supported, as per Figure 3. This variation was statistically significant p = <0.001, with the difference occurring between those who felt ‘fully’ supported by the practice and all other variables as per Table 1.

Feeling supported by the training provider

The variations within groups for feeling supported by the training provider are described in Figure 3, again, with 1 describing supervisors that did not feel supported at all and 5 being fully supported. These differences were statistically significant, p = 0.016, with significance occurring between confidence scores and those feeling fully supported by the training provider (5) compared to those who feel ‘generally unsupported‘ (2) p = 0.01, ‘somewhat supported’ (3) p = 0.003, and ‘generally supported’ (4) p = 0.022.

Discussion

Overall, high levels of confidence were reported by clinical supervisors which is encouraging. Those who were very keen to become a clinical supervisor reported statistically significant higher levels of confidence than those who were keen, indifferent, or would have preferred not to have become clinical supervisors. While practices may not have the staffing to be selective over who becomes a clinical supervisor, it is the individual’s decision whether they do indeed undertake the training. With the high attrition rates within the veterinary profession, discussed in Part 3 of this study, it is in the best interest of employers that their employees are content and confident in all aspects of the role.

Participants were most confident in the skills that are commonly undertaken, demonstrating skills, accepting SVN competency and providing feedback. However, participants were least confident with supporting personal issues, addressing professional issues, and reporting student issues to the college and university. Despite these being within the themes of the perceived role of the clinical supervisor, these are not roles that the clinical supervisor would be expected to undertake solely, and support from the training provider would be offered. Enhanced communication from the training provider regarding the remit of the clinical supervisor may be beneficial, detailing referral processes for such student issues. While it is yet to be ascertained if this confidence, or a lack of it, affects student outcomes, it is important to address the feelings of those conducting the role and ensure they know the extent to which they should be supporting their SVNs. 

Feeling supported as a clinical supervisor by the practice and teaching institution was positively associated with higher confidence scores. Again, while confidence has not been correlated with student outcomes, having the confidence to demonstrate tasks, appropriately assess them, declining competence when necessary, or referring SVNs back to the teaching institution, as required, is an essential safety net for the profession. 

Developmental factors, time and further training were additionally assessed in relation to confidence. A weak positive correlation occurred between the time spent as a qualified veterinary professional prior to becoming a clinical supervisor and confidence score. However, this was not statistically significant. The RCVS state that professionals should be clinically mature before embarking on clinical supervision (RCVS 2017). What this means to the individual is left open and while the handbook states that newly qualified nurses are not appropriate clinical supervisors, there is no formal restriction on this. This creates flexibility for discretionary appointments based upon the individual and their pre registration experience. 

In some healthcare settings, greater initial support in the early years of being a clinical supervisor is provided through a buddy system. An example of this is reported by Webb and Shakespeare (2008), whereby students reported higher levels of satisfaction when a newly trained mentor was supported by a more experienced mentor. The students benefitted from the teaching and clinical experience the latter provided but also the understanding of the training programme and documentation from the former. While this model sounds ideal, its feasibility in practice may prevent it. It would, however, be something for practices and veterinary groups to consider where possible. 

Further or more regular contact with newly qualified clinical supervisors may also be an option, mimicking the support provided for human-centred nursing supervisors. The NMC states that those who have a long history of supporting students may not require additional training, whereas less experienced nurses may, and this is provided for them (NMC, 2018). 

Further training was also explored in respect to whether this increased confidence scores. Those who had previously undertaken qualifications reported statistically significant higher levels of confidence. However, no relationship was found between confidence and undertaking further qualifications after becoming a clinical supervisor. The sample size for the latter was small and therefore statistically significant differences may not have been detected. Similarly small numbers of further education training were noted by Holt et al. (2021). Further research into the individual training routes and the effect on individual clinical supervisors and their students’ outcomes should be undertaken to explore this relationship further. This would also be recommended for those having undertaken prior qualifications due to the proportion of respondents reporting they had previously undertaken the A1 qualification, the clinical supervision training prior to the change to the NPL (RCVS, 2011). Therefore, this increase in confidence may not be due to specific training, but rather the increased length in service which, as discussed, was found to demonstrate a weak positive correlation within this study. 

A full summary and conclusion will be presented in Part 3, with limitations detailed. However, the overall theme from this section is that clinical supervisors are confident in most areas but, with greater support from both teaching institutions and practices, this could be improved. Having mentors who are confident in their roles, and therefore confident in their assessment of students, is imperative to ensure that a new generation of the profession has undergone adequate training, are safe in their practice, and are themselves inspired to support SVNs. 

References

Holt, S. L., Vivian, S. R., & Brown, H. (2021). Training and preparedness of clinical coaches for their role in training student veterinary nurses in the United Kingdom: An exploratory inquiry.The Journal of Veterinary Me
dical Education, e20200100. https://jvme.utpjournals.press/doi/10.3138/jvme-2020-0100

NMC [homepage on the internet] (2018). Who can be practice assessors?; C [cited 2021 August 2] Available from: https://www.nmc.org.uk/supportinginformation-on-standards-for-stu- dent-supervision-and-assessment/ practice-assessment/ who-are-practice-assessors-and-how-are-theyprepared/ who-can-be-a-practice-assessor/

RCVS [homepage on the internet]. (2011). VN Standard August c2011 [cited 2021 April 30]. Available from: https:// www.rcvs.org.uk/news-and-views/publications/

RCVS [homepage on the internet]. (2017). TP handbook; c [cited 2021 April 30]. Available from: https://www.rcvs.org.uk/news-and-views/ publications/tp-handbook/

Webb, C., & Shakespeare, P. (2008). Judgements about mentoring relationships in nurse education. Nurse Educ Today, 28(5)