Journal of Psychiatric and Mental Health Nursing

, 2003,

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231–238

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Editors: Submissions address:

Blackwell Science, LtdOxford, UKJPMJournal of Psychiatric and Mental Health Nursing1351-0126Blackwell Science Ltd, 200310569Burnout amongst CMHNsP. Burnard

et al.

10.1046/j.1351-0126.2002.00569.xResearch-in-briefBEES SGML

Research in brief

S. Tilley

1

& M. Chambers

1

Department of Nursing Studies, University ofEdinburgh, Adam Ferguson Building, GeorgeSquare, Edinburgh, EH8 9LL, UK

The effectiveness of clinical supervision on burnout amongst community mental health nurses in Wales

Background to the study

The role of clinical supervision in the nursing work-force has been well established. A small number ofstudies have given an indication of a number of ben-efits as a result of experiencing clinical supervision.These benefits include increased feelings of supportand personal well-being (Butterworth

et al

. 1996),increased knowledge and awareness of possiblesolutions to clinical problems (Dudley & Butter-worth 1994), increased confidence and decreasedincidence of emotional strain and burnout(Hallberg & Norberg 1993), and higher staffmorale and satisfaction leading to a decrease in staffsickness/absence and increased staff satisfaction(Butterworth

et al

. 1996).The Clinical Supervision Evaluation Project

(CSEP) (Butterworth

et al

. 1997) reported difficul-ties in the use of existing research instruments tomeasure the process of clinical supervision. Fiveinstruments were used to measure stress, copingskills, job satisfaction and psychological status from586 nurses engaged in the process of clinical super-vision. Only two instruments were found to besensitive to changes with respect to the clinicalsupervision process; these were the Minnesota JobSatisfaction Scale and the Maslach Burnout Inven-tory. The recommendations of the final report sug-gested that only these would be of value in futureevaluation studies. Further research using qualita-tive data from the CSEP was conducted to developa new evaluation scale to measure the process ofclinical supervision, the Manchester Clinical Super-vision Scale (MCSS) (Winstanley 2000a).

The relationship between clinical supervisionand job satisfaction has been investigated by severalresearch studies. Begat

et al

. (1997) identified the

potential for clinical supervision to influence satis-faction amongst nurses. Hallberg (1994) showedthat nurses receiving regular clinical supervisionreported improved satisfaction. These studies,however, were both conducted in Sweden and theyconsisted of very small study populations. TheMCSS was field tested on a sample of 560 hospitaland community nurses working within a variety ofspecialities and it was found that nursing staffperceived improved care and skills and increasedjob satisfaction as a result of effective clinical super-vision (Winstanley 2000a).

The findings from research regarding clinicalsupervision and burnout are inconclusive and con-tradictory. The majority of findings are from severalsmall Scandinavian studies (Hallberg 1994, Palsson

et al

. 1994, 1996, Berg

et al

. 1994). The CSEP (But-terworth

et al

. 1997) undertaken in the UnitedKingdom (UK) and based on substantial numbers ofnursing staff reported that burnout levels may bereduced as a result of the introduction of clinicalsupervision. It was hypothesized that high scores onthe MCSS may be associated with lower levels ofburnout. The findings from the field test showedsome associations between the scores on the newscale and levels of burnout. For instance, for allstaff finding time for sessions in a busy work sched-ule led to increased levels of burnout for emotionalexhaustion and depersonalization. This is an areathat the current research will investigate in furtherdetail.

Now that a new tool has become available formeasuring the clinical supervision process, furtherwork can be undertaken in the area of burnout withlarge samples in the UK. Previous work has beenconducted in Europe and this limits generalizabilityto the UK as different countries operate differenthealthcare systems. The MCSS scale recommendssamples of 50 or more in any subgroup in order thatthe measure can truly be effective. There is a need toreplicate this work on larger samples within the UK.

Research in brief

232

© 2003 Blackwell Publishing Ltd,

Journal of Psychiatric and Mental Health Nursing

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, 231–238

Data regarding piloting, field testing and validityand reliability of the scale can be found in the

Manchester Clinical Supervision Scale User Guide

(Winstanley 2000b).

Aims

The aims of the present study are twofold: to deter-mine the numbers of CMHNs who have received atleast six sessions of clinical supervision and toestablish the effectiveness of clinical supervision interms of levels of experienced burnout. Theresearch instruments used were the Maslach Burn-out Inventory (Maslach

et al

. 1996) and TheManchester Clinical Supervision Scale (Winstanley2000a). It was hypothesized that high scores on theMCSS may be associated with lower levels of mea-sured burnout. The null hypothesis is that clinicalsupervision will not have any effect on levels ofexperienced burnout.

Methods

The clinical directors of each of the 11 NHS Trustsin Wales were contacted in order to gain permissionto undertake the survey and to establish a contactperson who was responsible for the CMHNs withineach Trust. This contact person then provided theresearchers with the numbers of CMHNs workingwithin their Trust. At the time of the survey 817CMHNs were reported to work within Wales. Theresearch instruments along with a demographicquestionnaire were distributed to CMHNs via avariety of methods. Some Trusts provided namesand addresses of their workforce and the question-naires were posted to individuals, or the question-naires were distributed via the CMHN leader forindividual CMHTs within the Trust. Stampedaddressed envelopes were provided to return thequestionnaire. After one month non-respondentswere followed-up by mailing them a reminder.

Progress of the study

The response rate was 32%; previous work con-ducted by the authors had achieved a response rateof 49% 3 years earlier. It could be that CMHNs arebecoming an over-researched population and thismight explain the low response rate. Data analysis

is currently underway and it is hoped that theresults will be available by January 2003. Datafrom the project will add to knowledge on thereliability and validity of the scale amongstCMHNs and will be forwarded to Dr Julie Win-stanley, who is also a consultant to the project.

References

Begat I., Severinsson E. & Berggren I. (1997) Implemen-tation of clinical supervision in a medical department:nurses’ views of the effects.

Journal of Clinical Nursing

6

, 389–394.Berg A., Hansson U. & Hallberg I. (1994) Nurses

creativity, tedium and burnout during 1 year of clinicalsupervision and implementation of individuallyplanned nursing care: comparisons between a ward forseverely demented patients and a similar control ward.

Journal of Advanced Nursing

20

, 742–749.Butterworth T., Bishop V. & Carson J. (1996) First steps

towards evaluating clinical supervision in nursing andhealth visiting. Theory, policy and practice develop-ment. A review.

Journal of Clinical Nursing

5

, 127–132.

Butterworth T., Carson J., White E., Jeacock J., ClementsA. & Bishop V. (1997)

It is Good to Talk: an Evalua-tion Study in England and Scotland

. School of Nursing,Midwifery and Health Visiting, University of Manches-ter, Manchester.

Dudley M. & Butterworth T. (1994) The cost and somebenefits of clinical supervision: an initial exploration.

International Journal of Psychiatric Nursing

1

, 34–40.Hallberg I. (1994) Systematic clinical supervision in a

child psychiatric ward: satisfaction with nursing care,tedium and burnout and the nurses’ own report on theeffects of it.

Archives of Psychiatric Nursing

8

, 44–52.Hallberg I. & Norberg A. (1993) Strain among nurses

and their emotional reactions during 1 year of system-atic clinical combined with the implementation of indi-vidualised care in dementia nursing.

Journal ofAdvanced Nursing

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, 1860–1875.Maslach C., Jackson S.E. & Leiter M.P. (1996)

MaslachBurnout Inventory Manual

, 3rd edn. Consulting Psy-chologists Press, Palo Alto.

Palsson M., Hallberg I. & Norberg A. (1994) Systematicclinical supervision and its effects for nurses handlingdemanding care situations.

Cancer Nursing

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, 385–394.

Palsson M., Hallberg I., Norberg A. & Bjorvell H. (1996)Burnout, empathy and sense of coherence among Swed-ish district nurses before and after clinical supervision.

Scandinavian Journal of Caring Sciences

10

, 19–26.Winstanley J. (2000a) Clinical supervision: development

of an evaluation instrument. PhD thesis, School ofNursing, Midwifery and Health Visiting, University ofManchester, Manchester.

Winstanley J. (2000b) Manchester Clinical SupervisionScale User Guide. School of Nursing, Midwifery andHealth Visiting. University of Manchester, Manchester.

© 2003 Blackwell Publishing Ltd

,

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, 231–238

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Research in brief

PHILIP BURNARD

1

ProfessorDEBORAH EDWARDS

2

Lead ResearcherBEN HANNIGAN

3

LecturerANNE FOTHERGILL

4

LecturerDAVID COYLE

5

LecturerLINDA COOPER

6

LecturerTARA JUGESSUR

7

LecturerJOHN ADAMS

8

LecturerSchool of Nursing and Midwifery StudiesUniversity of Wales College of Medicine

Cardiff

96December 2002

553Research in briefResearch in brief10.1046/j.1351-0126.2002.00553.xResearch in brief

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