Transcript University Hospital of Coventry

LSA Audit 2012/13
How many midwives do you currently supervise ?
3, 18%
5
29%
0 - 5 (a)
5 - 10 (b)
10 - 15 (c)
15 - 20 (d)
20 - 25 (e)
25 + (f)
Other
9, 53%
How many of the midwives in your caseload have received a
supervisory review in the last year
1
6%
5, 29%
100% (a)
75 - 99% (b)
50 - 74 % (c)
11
65%
Less than 50 % (d)
If you were unable to meet any of them, what was the reason ? Please indicate
from the following answers.
5
14%
6
17%
Your own Long Term Sickness or Absence (a)
Supervisee Long-term Sickness or Absence (b)
5, 14%
2, 6%
Midwife did not confirm (c)
5
14%
Offered appointment postponed or cancelled by the Supervisee
(d)
11
32%
Offered appointment postponed or cancelled by your due to
other work pressures (e)
Maternity Leave (f)
Other
How satisfied were you with the following ?
Venue
Privacy
12%
6%
29%
7
41%
47%
11
65%
Timing
8, 47%
9
53%
Confidentiality
Content
24%
13
76%
Good (G)
6, 35%
Fair (F)
Poor (P)
11
65%
How often (on average) would you say that midwives approach you
for advice or support ?
6%
6%
24%
65%
Once a week (a)
Once a month (b)
Only at the supervisory review (c)
Not at all (d)
Other
How are midwives provided with 24 hour access to a supervisor of
midwives ? Tick all that apply.
6%
12%
29%
94%
24%
12%
24 hour on call via switchboard (a)
Via Labour Ward Rota (b)
Your own SOM personal mobile (c)
Email (d)
All of these (e)
Other
Please could you list the things that you discussed with you
supervisees at their supervisory review
(Tick all that apply)
6%
88%
100%
59%
100%
100%
71%
41%
ITP & PREP Guidance (a)
Professional Development and gaining competencies (b)
Lack of confidence in practice (c)
Extended sphere of pracatice (d)
Record Keeping and Audit of Records (e)
Attitude, Bullying and Professional Behaviour (f)
Debrief and support following an untoward investigation (g)
Other
How have you audited the record keeping of your supervisees
during the last year ?
1, 6%
3, 18%
One to one basis (a)
Self Review (b)
Peer Review (c)
Group Review (e)
13
76%
Not audited (d)
Other
How do you ensure appropriate feedback and action following
auditing records
12%
6%
59%
24%
35%
I note in the paper supervisory record (a)
I note on the LSA Database and print amd print off for the
midwife (b)
I make a further appointment to follow up at the end of the
review (c)
I don't follow up (d)
Other
Please prioritise (1-12) the roles listed to describe how you see youself as a Supervisor of
Midwives
100%
90%
6%
12%
6%
18%
6%
6%
12%
6%
18%
12%
80%
12%
70%
60%
12%
24%
6%
40%
6%
18%
35%
41%
29%
18%
6%
6%
12%
10%
29%
18%
12%
6%
6%
6%
6%
6%
18%
12%
18%
12%
18%
12%
6%
6%
6%
6%
6%
76%
6%
18%
35%
12%
6%
29%
12%
6%
18%
6%
12%
6%
6%
6%
6%
6%
12%
12%
30%
20%
18%
6%
50%
6%
6%
18%
18%
6%
6%
24%
6%
6%
6%
12%
6%
12%
12%
6%
24%
6%
6%
12%
12%
6%
6%
6%
Eighth
Nineth
29%
53%
6%
6%
6%
18%
12%
0%
First
Second
Third
Fourth
Fifth
Sixth
Seventh
Tenth
Supporter (a)
Counsellor (b)
Inspector (c)
Friend (d)
Mentor (e)
Preceptor (f)
Monitor (g)
Advisor (h)
Guide (i)
Disciplinarian (j)
Proactive (k)
Leader (l)
Eleventh
Twelth
Please prioritise the listed functions of supervision of midwives in order of
importance
100%
0%
6%
6%
90%
6%
12%
24%
18%
80%
6%
12%
29%
6%
6%
6%
35%
50%
29%
29%
100%
18%
40%
6%
12%
12%
30%
41%
20%
29%
29%
18%
12%
41%
29%
29%
12%
70%
60%
12%
24%
6%
18%
18%
6%
6%
Third
Fourth
12%
18%
12%
6%
12%
6%
29%
12%
24%
6%
18%
6%
24%
18%
10%
29%
24%
24%
18%
18%
6%
6%
6%
6%
Eighth
Nineth
12%
35%
6%
6%
0%
First
Second
Fifth
Sixth
Seventh
Tenth
Protecting the midwife (a)
Enabling midwives to improve their practice (b)
Safeguarding public interest (c)
Professionally developing midwives (d)
Counselling (e)
Giving guidance and support (f)
Giving professional support (g)
Inspecting equipment, documentation and drug storage (h)
Providing professional leadership (i)
Ensuring regular updating and study days (j)
Providing access to policy (k)
Eleventh
How often do you meet with your LSA Midwifery Officer
1, 6%
6
35%
10
59%
No answer
Never (a)
0 - 6 months (b)
7 - 12 months (c)
1 - 2 years (d)
To whom do you go to for advice and support in relation to your
supervisory function ?
Tick all that apply
6%
35%
6% 6%
12%
94%
88%
Head of Midwifery (a)
RCM (b)
Supervisor Colleague (c)
LSA Midwifery Officer (d)
NMC (e)
NMC Resource Pack (f)
Other
Are you confident in the support from the LSA
17
100%
Yes (Y)
No (N)
How do you contact the LSAMO. Tick as many as apply.
12
28%
16
37%
15
35%
Phone (a)
Email (b)
LSA Office Administrator (c)
I find it difficult to contact the LSAMO (d)
Other
For what reasons do you contact the LSA office ?
Tick all that apply.
53%
65%
18%
65%
94%
6%
Booking study events (a)
POSOM programme (b)
Supervisory Investigations (c)
PREP Guidance (d)
One to one discussions with LSAMO (e)
General advice (f)
Other
How do you as a Supervisor of Midwives have the opportunity
to contribute to the development /review of guidelines for
practice ?
1, 5%
7
33%
I have already been part of a guidelines group as a SOM
(a)
12
57%
I would like to participatre in a future guideline group as
a SOM (b)
Guidelines should be discussed at the SOM meetings (c)
I have never commented on guidance (d)
1
5%
Not interested (e)
Other
% Of Midwives Attending Skill Drills Workshops in...
100
90
80
86
86
70
84
88
84
78
60
50
58
40
30
34
20
10
0
1
Shoulder Dystocia
Breech Delivery
[Adult Resuscitation
Neonatal Resuscitation
Catastrophic Haemorrhage
CTG Interpretation
Normality Workshop
Waterbirth
In relation to the wider role of supervision of midwives, please
indicate in which activities you have been involved in your Trust
?
18%
59%
41%
Contributing to Trust policies (b)
Planning schemes to empower midwives (c)
Enabling midwives to prepare for new roles (d)
Providing expert advise to outside agencies (e)
24%
41%
24%
Acting as a catalyst for change (f)
Advising on commissioning maternity services (a)
Other
Do you feel confident in investigating poor practice
1, 6%
16
94%
Yes (Y)
No (N)
Have you attended an Investigation Workshop provided by the LSA
?
17
100%
Yes (Y)
No (N)
Do you receive enough help and advice from the LSA during
supervisory investigations?
1, 6%
16
94%
Yes (a)
No (b)
I have not undertaken a supervisory investigation (c)
Please rate your confidence in the following :
Undertaking an investigation
Preparing a supervisory investigation report
3
18%
2, 12%
14
82%
Conflict Handling
4
23%
12
70%
2
12%
11
65%
Supporting a midwife through
an investigation
Planning and evaluating a supervised
practice programme
7
41%
10
59%
3
18%
5
29%
2
12%
Very confident (V.)
Fairly confident (F.)
Not confident (N.)
10
59%
Have you facilitated a reflective activity for midwives during the last
year ?
8
47%
9
53%
Yes (Y)
No (N)
Is there anything within your Trust which inhibits you or your
team in undertaking your role as Supervisor of Midwives ?
6%
24%
24%
Little notice for SOM Meetings (a)
65%
88%
Lack of protected time (b)
Unit is too busy (c)
SOM team is disorganised (d)
6%
No access to a private room (e)
No access to a computer (f)
Don't know how to use the LSA Database (g)
76%
Other
Does the service provide and allow protected time for Supervision
of Midwives
4
24%
13
76%
Yes (Y)
No (N)
What is your substantive role ?
6%
6%
47%
41%
Midwife (a)
Midwifery Manager (b)
Midwife Team Leader (B7) (c)
Specialist or Consultant Midwife (d)
Head of Midwifery (e)
Midwife Teacher (f)
Self Employed or Independant Midwife (g)
Other
How long have you been a Supervisor of Midwives
2, 12%
53%
6
35%
0 - 5 Years (a)
5 - 10 Years (b)
10 - 15 Years (c)
15 - 20 Years (d)
20 - 25 Years (e)
30 + Years (f)
Other
How do you work in partnership with women ?
With a individual and her family
1
6%
With representative groups
16
94%
7
41%
10
59%
Other
5
29%
Yes (Yes)
12
71%
No (No)
Have you in the last year provided support to women/midwives
were there has been difficulty in achieving care choices ?
18%
18%
65%
76%
41%
Women wanting to change their named midwife (a)
Women wanting to make a complaint (b)
Women wanting to birth at home against guidance (c)
Women wanting a debrief following a birth event (d)
Other
Do you feel confident in challenging poor attitude
3
18%
14
82%
Yes (Y)
No (N)
Are you confident in supporting midwives requiring:
Supervised Practice
2
12%
Yes (Yes)
No (No)
15
88%
Developmental Supported Practice
17
100%
Yes (Yes)
No (No)
Are you confident in supporting midwives to support women who
want home births against advice ?
2, 12%
15
88%
Yes (Y)
No (N)
What have you found rewarding/challenging in being a Supervisor in the last 12 months?
As I am still new to the challenge of supervision it is too early to say what I have found rewarding as my supervision journey is ongoing. It has
been a time of change and turbulence as supervisory colleagues have become disillusioned and resigned.
Undertaking SOM investigation was a challenge but resulted in a good outcome for the midwives so that was rewarding and also
rewardingto know the investigation was good
The increasing numbers of supervisory investigations. Feeling more confident when undertaking investigations
Rewarding: appreciation from midwives when supporting them through difficult situations. Challenging: reminding management that the
roles differ. Combining the increasing number of investigations with the day job. Feels like holding down 2 full time jobs.
rewarding- supporting my supervisees, growing as a body of supervisors and therefore being more proactive challenging- learning to work
with managers but knowing when to stand my ground as a som
Only my newly gained experience in supervised practice program support. Nil else.
rewarding - being there to support colleagues when issues arise challenging - finding the time to achieve a totally effective role as a
supervisor
Undertaking investigations
Enjoy one to one with Supervisee's Challenging is the lack of time to undertake supervision
Being approached for support and guidance very rewarding and being able to provide. Juggling work commitments, management and
supervision. Always playing catch-up
finding time to complete notes reviews and investigations have been challanging, however I spoke to a new group of midwives about
supervision and that was fantastic!
Rewarding - seeing midwives develop, enhance their practice. Challenging the time to aprticipate in supervised practice programmes
effectivley
The challenge of managing a busy community caseload and the management of the team and finding time for supervision.
sucessful supervised practice programme
enjoy investigations where I have identified good practice and been able to let the midwives involved know.
Being supportive and a guide to development of midwives. I have found time to complete SOM activities challenging.
Supporting midwives through developmental/ supervised programmes, with a successful outcome.
How have you demonstrated your leadership skills as a supervisor?
I hope I lead by example. That I am professional, supportive and available for advice by both the women and their families
and by my midwife colleagues.
Supported Change in practice within unit
Supporting good practice, whilst challenging poor practice. supporting change
Supportive and work towards encouraging midwife to find the solutions to their problems/issues.
through reminders withthe support of clinical risk
By ensuring that I lead by example and by ensuring that all my supervisees are waware of their proffesional responsibilities
and requirements.
supported colleagues within the trust
By supporting the midwives in the unit through busy periods. By helping to change ways of working to provide more support
for staff
Sharing lessons learned from incidents. Working clinically with staff when the unit is busy. Advising staff on best practice and
challenging unsafe practice when I see it.
Hopefully a visible supervisor, willing to challenge and support change
I actively participate at our meeting as well as at most of the risk meetings. I'm part of the team of SOMs that regularly do a
session at mandatory days.
Offereing guidance Support Role model Encourager / motivator
Unsure
By supporting and facilitating home births against advise
Challenging management decisions and being an advocate for midwives in a professional manner
I believe I have demonstrated leadership by challenging poor practice and negative attitudes. I also believe providing direction
into improving services with the resources available is vital.
Being a role model for other midwives. Offering advice and encouragement to newly qualified midwives. Ensuring clinical
area safe. Promoting supervision positively
How do you as a SoM promote women centered care ?
In my daily contact with the women in my care I encourage dialogue that enables them to make informed choices and discuss
their expectations about labour, delivery and the post natal period.
promote and provide choices for women within the unit.e.g facilities and pathways review policies and procedures
devising plan of care for women whose birth choices does not meet the trust guidelines. Also meeting the women following
delivery to discuss their delivery and to ensure that their birth choices were achieved. Also been part of the trust guideline
group
Reminding midwives the focus of the midwifery role is to be with women although this is challenging faced with the changed
culture which is steering midwives to work defensively instead of with the woman and her baby as the focal point of care.
by being a role model through my own clinical acre
By ecouraging women to take a role in the planning of their own care. By promoting midwifery care and home birth. By
encouraging midwives to use their skills more in managing normal labour, to try to reduce the need for doctor involvment.
assist colleagues where needed and practice individualised care
Besides listening to women through complaints and supporting staff and patients through incidents/ adverse outcomes/
making choices, I don't do anything differently as a SOM than as a RM
Always highlight the needs of the mother and baby as a priority when changes in practice or guidelines are planned.
Ensuring staff are aware are the woman and her family are why we are here, they are our unique customers, who deserve the
best individualised care in order to create optimum customer satisfaction. I na safe enviroment
During annual reviews, when meeting with my HOM and in my day to day role as a clinical midwife
Contact with midwives Teaching
Encouraging and supporting midwives and women with thsie choice of birth units for place of birth
I promote woman centred care within my daily practice
Keep women and their families informed of all aspects of their care and ensure midwives are supported well
Listening to the women. collecting feedback through questionnares. Complaints. Looking for trends.
Promoting safe midwifery practice. offering women choices within their midwifery care
Please give any other comments you have about supervision in your unit
I have no further comment at this time.
within our local group we have a heart for supporting women and their families aiming to provide excellent facilities and choice as well
as ensuring midwives attain and maintain competence and best practice and feel supported we work well as a local team
Supervision within the unit has undergone a process of change, with increasing number of investigations. The supervisory team is
becoming a more cohesive and supportive group,
Challenging at moment since change in management structure. Midwives are feeling demoralised and fearful of the disciplinary
punitive culture that has developed- very knee jerk reactions without finding out facts.
we could perhaps "market" supervision much better although we now have a place on the intranet
Supervision is stressed in this current climate, and often feels more punitive.
i believe supervison has been through a tough period where colleagues questioned the support/role of supervision as we were often
seen/referred to as 'policing' rather than supporting, but this thought is gradually changing back to a more postive look on supervision
As a supervisory group we have been through a period of turmoil! But I believe we are coming through this and are working more
cohesively as a group together
Great SOM team some very proactive and positive SOM's. We have achieved alot in the last 12 months mainly due to the contact SOM
having time and the support of the HOM with this.
Succession planning and recruitment is key to ensure the future of optimum maternity services in a safe environment and midwife job
satisfaction
I feel that we could me more positive and a little less divisive with the midwifery teams
Difficult to have a cohesive team of supervisors of midwives becasue of cross site work, lack of availability of supervisors of midwves at
meetings. Also the increased number of investigations has increased the workload which means supervision is reactive rather than
proactive.
At present there is a feeling of being overwhelmed as we have had several supervisors step down/ leave and currently there are no ne
and up and coming SOMs to replace them
supervision within our unit is gradually become cohensive, and fair
When I first joined the SOM team it was very 'cloak and dagger' but this was raised and we have all learnt from it
I have no other comments
As unit is very busy i dont think supervision is given the time that it requires to be positve and effective.
Please comment on what further assistance the LSA could provide for you
When the time comes I know that I will have the confidence to access any advice that I need.
1
to continue with the support that they are currently providing
Continue to be as supportive as always.
continue
None
as suggested earlier to provide supervisors with adequate time to support supervisees and share what
supervision is about - self promote, which in-turn may assist with the uptake of POSOMs
Guidance on tackling poor attitude
Encourage the Trust to support supervision by giving us time to be able to do it effectively
I feel well support by fellow supervisors and the LSA
I'm happy the the current level of support although I hope that they could continue to facilitate away days for
SOMS
1:1 meeting
To continue to provide the support and advise
lsa very supportive
nil at present
No further assistance
Continue with LSA study events. Be easily accessible.
Which websites have you accessed in the last week ?
12%
29%
65%
12%
53%
41%
Any LSA website (a)
Royal College of Midwives (b)
Nursing & Midwifery Council (c)
Any local university provider (d)
Department of Health (e)
Other