Taking a moment to reflect on the last few months of leading nursing during the COVID-19 pandemic, I feel that, although the response of the NHS was truly one to be proud to be part of, we are all now very tired, and the risk of burnout is high.
Bailey and West (2020), writing for The King's Fund, epitomise the moment for me:
‘Compassionate and collective leadership (individually and institutionally) are core to ensuring staff have the right support.’
They go on to identify that the role of leaders is to truly listen to those they lead, to genuinely strive to understand the challenges they face, to feel with them, to empathise with them, and to take responsibility for helping them deliver the high-quality care they wish to deliver.
Among other opportunities to listen to staff during the pandemic, we have increased the opportunities for clinical supervision. Uptake for this has been good, and feedback has been extremely positive, with a wide skill mix of staff attending sessions. Clinical supervision has needed to be agile and has been accessed by either a digital group session, face-to-face or telephone sessions. To date, staff preference has been for face-to-face clinical supervision using different models and there are several types that can be adapted to suit local environments. With this in mind, we have used an open approach to the support offered and proposed an hour that the individual/team can use to suit their needs.
The aim of clinical supervision is to provide:
‘An opportunity for staff to reflect on and review their practice, discuss individual cases in depth and change or modify their practice and identify training and continuing development needs.’
Most sessions have concluded with an appreciative inquiry question to promote positive psychology and offer staff an opportunity to leave the session empowered. Themes have varied and include:
Dall'Ora et al (2020) undertook a theoretical review of nursing burnout. They reviewed a wide range of workforce studies, finding that often burnout is identified as a nursing ‘outcome’. Yet, burnout itself—what constitutes it, what factors contribute to its development, and what the wider consequences are for individuals, organisations, or their patients—is rarely made explicit.
When undertaking the review, Dall'Ora et al (2020) used subscales of the Maslach Burnout Inventory (MBI) scale to measure burnout. Maslach theorised that burnout is a state that occurs as a result of a prolonged mismatch between a person and at least one of the following six dimensions of work:
They also found that a large number of studies included factors that fall outside of the Maslach model. Six areas were identified:
Just one month before the COVID-19 pandemic, the 2019 NHS Survey results were released (NHS England, 2020). They revealed the highest level of stress ever recorded among NHS staff. The NHS was, and is, in the midst of a workforce crisis. Burnout has significant potential consequences for staff and patients, and while the recent events have shone a light on healthcare workers' burnout, and the many interventions that have been used to support staff, burnout is not new.
Although the response from the public and from the Trust to support wellbeing has been overwhelming and has almost certainly improved our overall feelings of value, reward and sense of community, as leaders we must assure ourselves that there is a strengthened systematic approach to wellbeing and that this is resourced. Measures that relate to wellbeing must be taken seriously and continue to improve. I believe clinical supervision is one of the key areas to invest in.