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Supporting nursing, midwifery and allied health professional teams through restorative clinical supervision

10 November 2022
Volume 31 · Issue 20


The mental health and wellbeing of healthcare staff have been significantly affected by the demands resulting from the recent COVID-19 pandemic. Restorative supervision is a type of clinical supervision that supports reflective practice that can help build practitioners' resilience by focusing on the individual's experience, aiming to sustain their wellbeing and their motivation at work. This model has been shown to reduce stress and burnout and increase compassion satisfaction. This article discusses the implementation of a restorative clinical supervision programme used to support staff wellbeing in nursing, midwifery and allied health professional teams in a large London-based NHS trust.

Restorative clinical supervision is a type of reflective clinical supervision that allows professionals a constructive space to think about and process their experiences, enabling them to deliver more effective care. This type of supervision is ideal for professionals experiencing emotionally demanding workloads, and it works by enabling individuals to process the difficult emotions that they may be continually exposed to, through a supportive confidential relationship so that the worker feels restored (Proctor, 1986; Wallbank and Woods, 2012). The COVID-19 pandemic has placed an extraordinary amount of emotional pressure on the healthcare workforce in the UK. Increased levels of stress, anxiety, depression and insomnia have been reported in health professionals working on the frontline during COVID-19 (British Medical Association, 2020; Coto et al, 2020; Kelly, 2020; Baldwin and George, 2021). Addressing the mental health needs of health professionals and providing them with adequate support is even more important now than it has ever been before.

There is substantial evidence of the link between staff wellbeing and quality of care delivery. The World Health Organization (2020) highlighted that ‘keeping all staff protected from chronic stress and poor mental health … means that they will have a better capacity to fulfil their roles’. This has also been emphasised in a report by The King's Fund, where the importance of focusing on the health and wellbeing of nurses and midwives was seen as being essential to the delivery of high-quality, compassionate, professional and effective care (West et al, 2020).

It is recognised that during the pandemic, frontline staff were working under extremely challenging circumstances and therefore would benefit from restorative clinical supervision. By processing some of the challenges and complex situations being faced, restorative supervision can support staff to be more effective in their role, increase resilience and reduce the negative impact their work may have on them. Research shows that resilience helps to reduce burnout, increase empathy and compassion, reconnect with the joy and purpose of practice, and improve physical and mental health; therefore enabling staff to provide better quality of care to their patients in return (NHS England, 2016). This article discusses how a model of restorative clinical supervision was rolled out to nursing, midwifery and allied health professional staff in a large acute NHS trust in London.

Restorative clinical supervision

Restorative clinical supervision is an evidence-based model underpinned by the Solihull Approach (, motivational interviewing and leadership theories. It contains elements of psychological support, including listening, supporting and challenging, and allows the supervisee to improve their capacity to cope, especially in managing difficult and stressful situations (Proctor, 1986). It is designed to help individuals build up compassionate resilience, which can support those working in roles where they are experiencing significant emotional demand (Wallbank and Woods, 2012). This model of clinical supervision has been shown to be effective in reducing stress and burnout and increasing compassion satisfaction (the pleasure that someone derives from doing their job) (Wallbank and Hatton, 2011). Historically restorative clinical supervision was commonly used in the community setting within health visiting teams (Baldwin and Kelly, 2020) but more recently it has been delivered as part of the A-EQUIP model for the national Professional Midwifery Advocate (PMA) (NHS England, 2017) and Professional Nurse Advocate (PNA) programme (NHS England/NHS Improvement, 2021). The A-EQUIP model supports nurses and midwives in four ways, and restorative clinical supervision is one element of it, the others being personal action for quality improvement, education and development, and monitoring, evaluation and quality control (Figure 1). Restorative clinical supervision works by restoring ‘thinking’ capacity, enabling the professional to ‘understand’ and process thoughts, which ‘frees’ them to contemplate different perspectives and inform their decision making (Pettit and Stephen, 2015). According to Maben and Bridges (2020:2744), ‘without looking after self, nurses cannot look after others and are therefore likely to need others (colleagues, friends (peers) and managers) to remind them to think of themselves’.

Figure 1. The A-EQUIP Model as adapted for use by nurses and midwives

Benefits for the individual and organisation

Positive effects associated with restorative clinical supervision for the individual include (Pettit and Stephen, 2015):

  • Positive impact on the immediate wellbeing of staff
  • Staff feeling ‘valued’ by their employers for investing in them and their wellbeing
  • Significant reduction in stress
  • Significant reduction in burnout
  • Improvement in their compassion satisfaction
  • Ability to function better
  • Reduced stress levels while maintaining compassion
  • More effective management of work-life balance
  • Increased enjoyment and satisfaction related to work.

Benefits for the organisation include (Pettit and Stephen, 2015: Rao et al, 2021):

  • Better service outcomes
  • Improved work satisfaction
  • Improved retention of staff in the group receiving supervision
  • Improved user satisfaction
  • Improved working relationships and team dynamics.

Implementation of restorative clinical supervision in a London NHS trust

Initially there were two trained and experienced restorative clinical supervisors within the trust, who had been previously trained in the community. During the first wave of the COVID-19 outbreak, they offered restorative clinical supervision to any staff who wanted to access it to support them with the increased levels of stress and anxiety they were experiencing at the time (Baldwin and Kelly, 2020). The demand for the sessions started to increase as the pandemic continued, and it soon became clear that additional resources were needed to meet the increased needs. With support from senior managers, the supervisors introduced a restorative supervision training programme to increase the number of supervisors within the organisation.

The training to become a restorative clinical supervisor consists of one full day of training, which is interactive and covers the principles, theoretical framework, as well as practical aspects of delivering the session, based on the Wallbank model (Wallbank, 2016). This is then followed by three to five one-to-one supervision sessions at monthly intervals (each session lasting up to an hour), so that the trainee supervisor can experience receiving restorative clinical supervision as a supervisee. Once the trainee supervisors are deemed suitable to be a restorative clinical supervisor by their own supervisor (the person who provides the one-to-one sessions), they are able to supervise others on a one-to-one basis and in a group setting. An important aspect of this model is that all supervisors need to access restorative clinical supervision for themselves while supervising others – this is provided in the form of regular group restorative clinical supervision, facilitated by an experienced supervisor.

Attending the training and receiving the three to five one-to-one supervision sessions does not necessarily mean that everyone would be a suitable candidate to be a supervisor. Restorative clinical supervision is not teaching, counselling or therapeutic sessions, and it is not the role of the supervisor to come up with solutions or answers, even if the supervisee presents as being distressed. Generally, health professionals, especially nurses, want to fix things and make people feel better. In this case, the role of the supervisor is to try to ask questions and gently probe around the issue, which allows the supervisee the opportunity to see things from a different perspective. It is important for supervisors who have been working in a teaching capacity to re-think their role within restorative clinical supervision to avoid falling in to the trap of becoming a ‘fixer’. Even experienced supervisors can fall into this trap and this is why it is important that all supervisors continue to receive their own supervision to allow them to reflect on the sessions and learn from them.

The supervision sessions are confidential, with the usual proviso that information is shared if the supervisee is in agreement or the supervisor has concerns that need to be shared outside the meeting. Each supervision session is led by the supervisee and it follows their agenda, allowing them to talk freely in a safe environment. The supervisor's main purpose is to listen. Gentle questioning and challenging from the supervisor allows the supervisee to reflect and ‘free’ up their thoughts, allowing them to see things objectively, making them a more efficient practitioner. Wallbank and Robertson (2008) found that restorative clinical supervision contributed to the improvement of patient care, allowing them to process their workplace experiences and restore their capacity to think.

Over the past 2 years, restorative supervision has been offered to a number of staff, including nurses, midwives and allied health professionals from various departments across the trust. This in-house restorative clinical supervision programme has been so successful that it is now part of the trust's Health and Wellbeing Strategy and forms part of the overall health and wellbeing offer for staff.

In total, 33 restorative clinical supervisors have been trained in the trust. In addition, there are 15 trained PNAs and 5 PMAs, who are now working collaboratively with the team to increase the pool of supervisors within the organisation. Since April 2020, 115 members of staff have received restorative clinical supervision and this number is likely to increase as the number of supervisors increase through the in-house restorative supervisor training and the national PNA and PMA programme.

Evaluation of restorative clinical supervision

There is a robust evaluation strategy in place to evaluate the restorative clinical supervision sessions. This includes completion of a pre-evaluation questionnaire by the supervisee before starting their supervision sessions and one post-evaluation questionnaire after their last supervision session. The questionnaire contains the Professional Quality of Life (ProQOL) scale, a validated tool to measure compassion satisfaction, burnout and secondary traumatic stress (ASPR TRACIE, 2022). Qualitative data are also collected in these questionnaires relating to the sessions themselves (numbers, format, content, frequency etc), the impact/benefits (personal wellbeing, coping strategies, providing a safe environment etc), the supervisors (qualities such as being encouraging, respectful and inclusive) and the overall experience of the programme. The evaluation tool was rolled out from January 2022 and the first evaluation using this tool is due to take place in December 2022. These will be analysed and the feedback will inform how future sessions are offered and delivered.

The data will also be shared at the trust's senior nurses, midwives and AHP meetings, which will feed into the trust board meetings. As well as the benefits, a number of enablers and barriers were identified (Box 1, Box 2). These issues are regularly reviewed and discussed at the senior staff meetings to ensure that adequate support remains in place for the successful implementation of the programme.

Box 1.Identified enablers for the implementation of restorative clinical supervision (RCS)

  • Organisational compassionate leadership providing protected time to attend RCS sessions
  • Senior leadership ambassadors who represent RCS at board level
  • Becomes part of the trust's wellbeing agenda
  • Having an RCS lead for the organisation co-ordinating training and supervisors, collecting and collating data
  • Providing RCS to all supervisors, recognising their needs
  • Working collaboratively, strengthening professional relationships

Box 2.Identified barriers for the implementation of restorative clinical supervision (RCS)

  • A lack of understanding of RCS and the associated benefits (Macdonald, 2019)
  • The title can be misunderstood by different health professionals
  • Problems in getting time away from delivering care and time needed to provide RCS (Rouse, 2019)
  • Not enough supervisors to provide RCS
  • Lack of a private space to hold RCS sessions

Feedback from staff

Staff who have accessed restorative clinical supervision provided feedback in many different formats. In the initial stages, during the first wave of the pandemic, feedback was received via email. Following this a brief evaluation form was introduced, which contained three main questions, exploring:

  • Did the sessions provide an opportunity to talk and share work concerns in a safe and confidential environment?
  • Did the sessions enable the supervisees to reflect on practice and stressors at work and allow them to prioritise their own wellbeing?
  • Comments on overall experience of the sessions (including what worked well, what could be improved, how useful was it etc).

Feedback received to date suggests the sessions provided staff with an opportunity to reflect, talk and share work concerns in a safe and confidential environment, as illustrated in the following quotes:

‘Being able to reflect on and voice my concerns and anxieties in a safe environment will enable me to engage in better relationships with my colleagues.’

‘Being a nurse, I wanted to “do my bit” [during the Covid-19 outbreak] but I am scared. Being able to express my concerns and thoughts about these anxieties is helpful because it's not something I would admit to in case I was thought of as selfish and weak.’

‘I feel supported and all my concerns were kept confidential’

‘Because it was 1:1 session and especially with someone outside the department, I think it was easier to open up and talk.’

Staff also talked about being able to recognise stressors at work and prioritise their own wellbeing through the use of better coping strategies:

‘I'm more mindful of the stressors at work.’

‘I am able to reflect on my practice and accept that some situations cannot be changed.’

‘I have started to think about me as well as patients and family.’

‘Sometimes I tend to just think and think and get frustrated because I see more of what is not done or is pending. With this session, I started slowly changing my approach and look at the problems in a very different angle. I still get stressed at time but I think I am learning to manage it better.’

‘Useful to talk through areas of worry and to have time to think about and discuss different coping strategies.’

‘It was a very helpful experience almost like therapy for work-related topics and studies. Despite having home stresses as well this process enables me to prioritise work stresses and triggers to allow space for me to process my home situation more effectively as well myself. I would love to be able to part take in this process one to one on a more regular basis.’

Many talked about not knowing what to expect from restorative clinical supervision, as this was something newly introduced to the trust. However, once they attended the sessions they found them to be beneficial.

‘I was not very sure about RCS before and even doing the first session I was very nervous as if I was going for exam or interview. I use to feel like what is the point anyway, I will vent out and that will be that, nothing will be changed.

I see the session differently at present because I feel like even though there are no answers to everything, I learned the different approach or ways to look at the problems. I try to reflect on what I achieved in every shift nowadays unlike before when I use to just moan about what was pending. And all in all, I think I managed to find another very nice person at work who is eager to listen and help if need be.’

‘When my manager first asked me to attend the sessions, I agreed half hearted, as I believed it would be the same old, someone telling us how to feel, react and further develop in dealing with difficult situations, I was completely wrong. The sessions were all about the group experiences, reflection and suggestions. It was time to offload and to learn that every problem that was discussed, most of us also had the same problems, just knowing we weren't alone was a huge relief and quite often others were able to offer advice about how they dealt with things, what went good, what could have been better.’

For some, it also provided them with a goal and direction for their work and future career:

‘I went away with ideas on ways to improve and also enabled me to reflect on what I am good at.’

‘Just a few words to say thank you very much for all the sessions with you. I was really struggling with my health, both physically and mentally and was not even sure of moving forward with my career as a nurse. Attending these sessions with you has really helped me a lot to grow and improve both personally and professionally.’


The COVID-19 pandemic in particular has had a negative impact on the health and wellbeing of healthcare staff, not only in the UK but also worldwide (Søvold et al, 2021; Tokac and Razon, 2021). Therefore, supporting their mental health is absolutely crucial to enabling them to maintain their own wellbeing, which in turn would enable them to provide high-quality patient care (West et al, 2020). This article has explored how a programme of restorative clinical supervision was rolled out in a large London NHS trust to meet the emotional demands of the healthcare staff. The aim of restorative clinical supervision is to promote self-awareness and professionalism, through a formalised approach to supportive reflection, allowing practitioners to continually develop and flourish. A need for this type of support for the workforce was evident in this organisation, especially following the impacts of the COVID-19 pandemic, where emotional restoration was crucial (Baldwin et al, 2021).

Although during the initial stages of implementation of the programme there were no standardised ways of collecting feedback, the email feedback received from staff demonstrated the value of the sessions (Baldwin and Kelly, 2020), which enabled further development of the programme. Through the support and commitment of managers at every level (team, department, division and trust board level), this programme was implemented, and it now forms one of the many health and wellbeing offers within the trust. This restorative clinical supervision programme now has a structure in place to be built on further to continually build capacity to support more staff through this form of support. At the same time, robust data collection and evaluation processes are in place to ensure that all supervisors have access to group supervision for themselves and high-quality standards are maintained for all supervision sessions offered.

The feedback from the staff involved shows that clinicians who engaged in restorative supervision were not only able to talk and share work concerns in a safe and confidential environment, but also recognised stressors at work and prioritised their own wellbeing through the use of better coping strategies. Addressing how participants respond emotionally to the work of caring for others and providing nurturing support can foster resilience, motivation and encouragement that can be drawn on in times of stress (Proctor, 1986). For many participants, the opportunity of reflecting and having time to create ‘headspace’ provided them with a goal and direction for their work and future career. The King's Fund report The Courage of Compassion (West et al, 2020) highlighted the importance of such supervision as essential for nurses and midwives to cope with the emotional challenges of their role, develop their reflective capabilities, and enable them to address professional challenges in new and innovative ways, contributing towards a healthy workplace culture. The feedback from the participants at the trust in question suggests that it could also contribute to career development and progression. By focusing on staff wellbeing there is an opportunity to improve the quality of care delivered, staff compassion and professionalism (West et al, 2020). The train-the-trainer programme adopted in this organisation also means that this implementation model is likely to be more sustainable with the continual development of supervisors – creating more capacity for providing ongoing restorative support to the workforce. This programme could be adapted by other healthcare organisations wanting to support the health and wellbeing of their healthcare staff during such challenging times.


  • The COVID-19 pandemic has had a significant impact on the mental health and wellbeing of healthcare staff
  • Restorative clinical supervision is a type of reflective supervision that can reduce stress and burnout and increase compassion satisfaction in healthcare staff
  • A cascade programme of restorative clinical supervision was implemented in a large London NHS trust
  • Recipients of the programme have reported personal and professional benefits in relation to their wellbeing
  • There is potential for other healthcare settings to use this model of supervision to support the health and wellbeing of their staff

CPD reflective questions

  • How has the COVID-19 pandemic affected you and your colleagues?
  • What do you do to maintain your own health and wellbeing?
  • How do you think restorative clinical supervision can support you and your colleagues in the workplace?
  • How could such a programme of restorative clinical supervision be implemented in your organisation?