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 clinical supervisor satisfaction. 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. Most respondents enjoyed clinical supervision and found it enhanced their enjoyment of their professional role. Reported challenges of the role were sufficient time with the student, competing time pressures and staying current with academic requirements. There were statistically signifi cant differences between satisfaction in the role and college or university support (p = 0.002), practice support (p < 0.001) and desire to be a clinical supervisor (p < 0.001). Satisfaction in clinical supervision was high despite challenges posed. However, with retention issues in the veterinary profession, these challenges should be reduced where possible. 

Key words clinical supervisor, clinical supervision, clinical coach, student veterinary nurses 

Introduction

In 2019, the British Equine Veterinary Association (BEVA) and British Small Animal Veterinary Association (BSAVA) undertook a recruitment and retention survey. At that time, 54% of veterinary nurse respondents suggested that they were likely to be looking for a new job in the next two years, with 35% looking to change their role within the profession, moving away from clinical practice or leaving the profession entirely (BEVA, 2019). Pay, remuneration, stress and the feeling of being undervalued were the most prolific issues within the profession when a similar study was undertaken by Robinson et al. (2019a).

Veterinary surgeons were more likely to stay within their current role. However, 43% of respondents were still looking to change their job within the next two years (BEVA, 2019). 45% of these were, again, looking to change their role within the profession, move away from clinical practice or were considering leaving the profession entirely (BEVA, 2019). Pay, being valued and the stressful work environment were again raised as some of the issues in the respective study by Robinson et al. (2019b) on the veterinary profession. 

While these figures have vast effects on practising professionals who are already qualified, they may also affect those training to enter the profession. With the stipulation that student veterinary nurses (SVNs) must be assigned to a clinical supervisor, the greater the number of registered veterinary nurses (RVNs) and veterinary surgeons that leave the profession, the smaller the pool of clinical supervisors there are to supervise these students, creating a negative cycle.

Furthermore, it is a recommendation of the Royal College of Veterinary Surgeons that supervisors are clinically mature (RCVS, 2017), which was supported by the results of Part 2 of this study. With poor retention, these requirements may be unachievable and unsustainable. Although it is not within the scope of the study to investigate general job satisfaction, the levels of satisfaction within the clinical supervisor role and the factors that may affect this will be discussed.

Aims, objectives and hypotheses

Part 1 of this study presented the aims, objectives, hypotheses, general descriptive data and methodology. Part 2 presented the statistical analysis pertaining to confidence in clinical supervision. Part 3 presents the factors relating to job satisfaction and concludes the overall study.  

Objectives

1. To determine the average workload of a clinical supervisor to include:

a. Average numbers of students per clinical supervisor at one time

b. Average numbers of students per clinical supervisor per year

c. If clinical supervisors are provided with protected time to undertake their role

2. To determine the perceptions of the role in regard to:

a. Whether clinical supervisors enjoy the role

b. If being a clinical supervisor enhances the role of RVN/MRCVS

c. If clinical supervision is seen as a challenging role

d. What the greatest challenges of the role are 

3. To determine if there are reward systems in place for clinical supervisors 

4. To determine which factors may affect level of enjoyment  

Hypothesis

There will be an association between level of enjoyment and:

• Those who wanted to become a clinical supervisor (described in Part 1)

• If the clinical supervisor feels supported by the practice (described in Part 1)

• If the clinical supervisor feels supported by the training institution (described in Part 1)

• The number of students supported at one time

• The number of students supported per year

• If the clinical supervisor is provided with time to undertake their role

Methods

The methods are described fully in part one 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.  

Results

DESCRIPTIVE ANALYSIS

295 respondents were included in this study and analysed, unless stated otherwise due to missing responses. Much of descriptive statistics are presented in Part 1. However, those relating to satisfaction were as follows:

Number of students supported

Participants were asked how many students they would normally supervise at one time; the median was one student (range 1–4).

The average number of students that a clinical supervisor would support in a year was then ascertained, with 293 replies analysed. The median response was one student a year (range 1–6). Those who responded 6 or 6+ (N = 2) worked in a role with rotating SVNs or supporting SVNs was their primary role.

Time allocated to clinical supervision activities

Participants were then asked how much time they are allocated to complete clinical supervision tasks. 67% (N = 198) of 294 respondents were not allocated time in their working day to undertake tasks relating to their role as a clinical supervisor. Of those that were, the median time allocated was 2 hours a week (range 0.5 hour to 8 hours).

Enjoyment in clinical supervision

Participants were asked to rank their feelings towards a range of statements regarding their role as a clinical supervisor. Full results can be viewed in Table 1.

Most participants stated that they enjoy being a clinical supervisor, with 42% (N = 125) and 41% (N = 120) stating that the statement ‘fully’ or ‘generally’ applies to them, respectively. Likewise, most participants ‘fully’ (34% N = 100) or ‘generally’ (34% N = 101) agreed that being a clinical supervisor improved the enjoyment of their RVN/MRCVS role. When asked if they found the role of clinical supervisor challenging 38% (N = 114) reported ‘somewhat agree’ and 30% (N = 88) stated ‘generally agree’. 

When asked to expand on the greatest challenge in the role, the three most-selected answers were:

• Time management/competing commitments, 64% (N = 188)

• Contact time with the student, 21% (N = 61)

• Staying current on the students’ academic requirements, 9% (N = 28)

Reward systems for clinical supervisors 

Participants were asked to indicate if there is a reward system in place for being a clinical supervisor within their employment, selecting as many responses as applicable. 54% (N = 159) of the participants stated that there were no reward systems in place for being a clinical supervisor. 29% (N = 86) of participants stated that being a clinical supervisor is seen as a senior role and 13% (N = 39) stated that there was a financial incentive provided by the practice for being a clinical supervisor. 17% (N = 49) of participants reported that being a clinical supervisor was a requirement of their practice’s recruitment strategy and therefore they may not have gained the job without this qualification.  

Analytic results

To achieve Objective 4, factors collated in this study were compared to level of enjoyment of the role.

Prior interest

Cross tabulations were conducted for the relationship between the prior interest of the participant in becoming a clinical supervisor and their level of satisfactions as a clinical supervisor. There were low cell counts, therefore both variables were regrouped as follows: 

Prior interest:

• ‘I was not keen to become a clinical supervisor’ combined: ‘I definitely did not want to become’, ‘I would have preferred not to have become’, and ‘I was indifferent to becoming’ a clinical supervisor’

• ‘I was keen to become a clinical supervisor’ combined: ‘I was very keen’ or ‘I was keen’ to become a clinical supervisor’

Level of satisfaction:

• ‘I am dissatisfied with being a clinical supervisor combined: ‘I definitely do not enjoy’, ‘I generally do not enjoy’, and ‘I sometimes enjoy’ being a clinical supervisor’

• ‘I am satisfied with being a clinical supervisor combined: ‘I generally enjoy’ and ‘I always enjoy’ being a clinical supervisor’

41% (N = 31) of those who did not want to be a clinical supervisor did not enjoy being a clinical supervisor, whereas 9% (N = 19) of those who wanted to be a clinical supervisor did not enjoy the role. Conversely, 59% of those who did not want to be a clinical supervisor, and 91% of those who did want to be a clinical supervisor, did enjoy being a clinical supervisor. 

Chi Square test demonstrated that these differences are statistically significant p < 0.001 and that those who are interested in becoming a clinical supervisor are more likely to have greater enjoyment in their role. 

Feeling supported by the practice

Cross tabulations were completed to test for associations between feeling supported by the practice and satisfaction as a clinical supervisor. Again, enjoyment of the role was grouped as above due to low cell counts. Feeling supported was also grouped as follows:  

• ‘Generally unsupported’ combined: I feel ‘unsupported’, ‘generally unsupported’, and ‘somewhat supported’ in my role of clinical supervisor by the practice’ 

• ‘Generally supported’ combined: I feel ‘supported’ and ‘generally supported’ in my role of clinical supervisor by the practice. Of those who did not feel supported, 24% (N = 42) did not enjoy their role. However, 76% (N = 136) still did enjoy their role of clinical supervisor. Those who were supported reported higher levels of enjoyment with 93% (N = 109) enjoying their role and 7% (N = 8) not enjoying their role 

Chi Square analysis demonstrated that there is a statistically significant relationship between these groups p < 0.001, with those feeling supported more likely to report higher levels of enjoyment. 

Feeling supported by the college

Cross tabulations were completed to test for associations between feeling supported by the college or university that the clinical supervisor’s student attends and satisfaction as a clinical supervisor. Again, enjoyment of the role and feeling supported was grouped as above due to low cell counts.

Of those that did not feel supported by the college or university, 24% (N = 36) did not enjoy their role and 76% (N = 117) did. However, 90% (N = 128) of respondents who felt supported enjoyed their role, with 10% (N = 14) still not.

Chi Square analysis demonstrated that there is a statistically significant relationship between the groups p = 0.002, with those who feel supported by the college or university being more likely to report that they enjoy their role.

Average numbers of students per clinical supervisor at one time

The median level of satisfaction for all numbers of students supported at a time was ‘(4) I am generally satisfied being a clinical supervisor’ except for those that selected 6+ which was ‘(3) I somewhat enjoy being a clinical supervisor’. The relationship between the average number of students a clinical supervisor supported at any one time and their level of satisfaction in the role of clinical supervisor was not statistically significant p = 0.422.  

Average numbers of students per clinical supervisor per year

The median level of satisfaction for all numbers of students supported in a year was ‘(4) I am generally satisfied being a clinical supervisor’. The relationship between the average number of students a clinical supervisor supported per year and their level of satisfaction in the role of clinical supervisor was not statistically significant p = 0.394.

Time provided or not provided

Cross tabulations were completed for allocation of time and level of enjoyment. Due to the variation in the number of hours allocated, this was split as ‘time is provided,’ or ‘time is not provided’. Enjoyment was again grouped for this analysis due to low cell counts.

19% (N = 38) of those not provided time to complete clinical-supervision-related work did not enjoy their role, whereas 80% (N = 160) still did. 13% (N = 12) of those who are provided time to complete clinical supervision related work did not enjoy their role, whereas 87% (N = 84) did. 

Chi Square analysis showed that there was no statistically significant relationship between time allocated to the clinical supervisor to undertake their role, and if they enjoy their role, p = 0.323. 

Discussion

SATISFACTION AND BARRIERS TO EFFECTIVE CLINICAL SUPERVISION

83% of participants stated that they ‘fully’ or ‘generally’ enjoy their role and 68% ‘fully’ or ‘generally’ agreed that clinical supervision enhanced the enjoyment of their professional role. This aligns with the findings of Part 1 of this study where only one respondent out of those no longer supporting students chose to do so due to the experience itself. Although this study identified key challenges that affected job satisfaction and 68% of respondents found the role challenging, the results demonstrate that clinical supervisors are happy in their role despite this. This is in alignment with the 2019 RCVS report on the veterinary nursing profession, whereby nurses were dissatisfied with the pay
and remuneration of their role, but still satisfied overall (Robinson et al., 2019a).

Time was reported as the most challenging aspect of clinical supervision and 67% of respondents stated that they were not provided time to undertake clinical supervision activities. The provision of time was not correlated with satisfaction. Bifarin and Stonehouse (2017) noted how time pressures, significant case loads and staffing levels negatively affected the outcome of clinical supervision within human nursing. Assessing the impacts of the challenges of clinical supervision was beyond the scope of this study, therefore it would be prudent to explore this further in future studies. While supervisor satisfaction may be high, if the student experience is impacted, changes may be required. 

The number of students allocated at one time and across one year was also not correlated to job satisfaction. However, only small numbers were reported at the high end of this variable. Those who reported supporting six or more students throughout a year were more frequently working within larger hospitals and with rotating students, suggesting an educational element to their role. The training centre overseeing the practice and the employer should ensure each clinical supervisor is able to meet the demands of the students under their supervision and recognise when a reasonable number is being breached. From this study, it appears as though this is being managed well and this is supported by Holt et al. (2021) who also reported an average of one student per clinical coach (clinical supervisor). Again, the impacts on the number of students a clinical supervisor has, correlated to student progression and level of satisfaction, would be a future area of study.

Job satisfaction was, however, likely to be affected by how supported the person felt by the practice and college and/or university. If a clinical supervisor does not feel supported by either the practice or the teaching institution, they feel less satisfied in the role.

Colleges and universities have many resources, including human resources, in place to support clinical supervisors. However, perhaps this is not being communicated efficiently or clinical supervisors may not have the time to view them and contact staff for support. A two-way approach following this study would be beneficial. Firstly, for clinical supervisors to know that the teaching institution is there to support them and, in return, the teaching institution could review the accessibility of their support services and liaise directly with their constituents as to how they would like to be supported. This may also open channels of communication, which was highlighted as an issue in the final question: ‘is there anything else you would like to add’. 19% (N = 11) of respondents reported that there could be greater support for students and clinical supervisors from the teaching institution. 

It would be for individual clinical supervisors to open discussions with the practice with regard to how they might feel better supported. Registered veterinary nurses should feel empowered to negotiate with employers to ensure efficient and effective working practices are in place and this extends to student supervision. This would also be true for the request for protected time, a higher wage or greater recognition of the role they are undertaking. While 54% of participants received no extra benefits for being a clinical supervisor, there is still a substantial portion of the population that does. Being a clinical supervisor requires an extra level of responsibility, an increased workload and it is not listed as an expectation within the respective codes of professional conduct, as it is for human nurses. If staff are not provided time to undertake this role within their working hours and their annual salary does not reflect this level of responsibility, then there should be a reward scheme in place. 

A second recommendation for practices and individuals to discuss openly is the veterinary professional’s willingness to become a clinical supervisor. Those who did not want to become a clinical supervisor were more likely to report lower levels of satisfaction. Again, whether this impacts efficiency or student outcomes is yet to be determined. However, it may be a factor that practices consider and should be explicit about when recruiting. 

Overall, it is encouraging to see that clinical supervisors are satisfied and this is a positive message for the profession and its future students. A collaborative approach from the governing bodies, the training providers, and the training practices to maintain these levels is required, with additional research to explore each factor raised in this study, correlated to student satisfaction and outcomes. Steps are being taken, such as the formation of a veterinary nursing educators’ network by the BVNA and continued congresses for clinical supervisors, to unite the voices of the profession. However, the momentum must continue; improved educational practices from happy workforces are required for lifelong learning and, ultimately, improved animal welfare – which is what all veterinary professionals should be striving for. 

Conclusions and future research

Overall, this study has explored a range of topics within clinical supervision which, as a baseline study, will be of use and interest to all within the profession. As discussed throughout, there is a lack of data in the field, therefore further research is required to make inferences or any solid recommendations in relation to student progression. However, this study has highlighted some of the many positives and key challenges of the role which should be considered. Satisfaction and confidence have been found to be high within the participants of the study which is promising, as clinical supervisors are the role models for the future of our profession on their route to registration.  

Limitations

One consideration of this study that must be noted is the potential for selection bias, as those interested in clinical supervision may have been more likely to complete the survey. This selection bias may also have affected other aspects of the study, as those more interested in clinical supervision may have a more positive outlook on the topic. 

Furthermore, while the number of clinical supervisors, including those who have left the profession, is unknown at the time of publication, when compared to the ten responses from the training providers, the response rate for this study would have been low. This may have led to the low participant responses in some fields of analysis and therefore the statistical tests, presented in Part 2 and Part 3 of this study, may have lacked power to identify significant differences between variables, or effects may have been extrapolated due to these small numbers. To overcome this, variables were grouped where indicated. However, in some cases, low numbers remained or grouping was not appropriate to achieve the objective. 

Finally, the authors of this study work in education and while they do not have any input into the clinical experience of SVNs, conclusions may have been unconsciously biased towards their experience of higher education teaching.

References

BEVA. (2019). Recruitment and retention in the veterinary profession. Retrieved April 30, 2021, from https://www.beva.org.uk/retention-survey.

Bifarin, O., & Stonehouse, D. (2017). Clinical supervision: An important part of every nurse’s practice. British Journal of Nursing (Mark Allen Publishing), 26(6), 331–335. https://doi.org/10.12968/bjon.2017.26.6.331

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. Journal of Veterinary Medical Education, e20200100. https://doi.org/10.31
38/jvme-2020-0100

RCVS. (2017). TP handbook. Retrieved April 30, 2021, from https://www.rcvs. org.uk/news-and-views/publications/ tp-handbook/.

Robinson, D., Edwards, M., Mason, B., Cockett, J., Arnill, G. K., & Martin, A. (2019a). The 2019 survey of the veter-inary nursing profession. Retrieved April 30, 2021, from https://www.rcvs.org.uk/news-and-views/publications/ the-2019-survey-of-the-veterinary-nursing-profession/.

Robinson, D., Edwards, M., Mason, B., Cockett, J., Arnill, G. K., & Martin, A. (2019b). The 2019 survey of the vet-erinary profession. Retrieved April 30, 2021, from https://www.rcvs.org.uk/news-and-views/publications/the2019-survey-of-the-veterinary-profession/