Restorative clinical supervision: a reflection
A-EQUIP has been rolled out as the model of support for midwives in England since 2017, replacing statutory supervision. The non-regulatory but important supportive aspect of supervision will continue, focusing on restoration, revalidation and education. As a result, the supervisor of midwives role has been replaced by the professional midwifery advocate (PMA). The A-EQUIP model provides a framework for PMAs to deliver support and clinical supervision to midwives, through interventions such as restorative clinical supervision. Providing restorative clinical supervision is explored further in this article, to critically reflect on the beneficial outcomes for midwives facing extreme pressures and the care that women receive.
The Nursing and Midwifery Council (NMC) holds the overall responsibility for regulation of midwives. Following the removal of statutory supervision in 2017, a new model of employer-led supervision, A-EQUIP (Advocating for Education and Quality Improvement) was introduced in England (NHS England, 2017). NHS Trusts should now follow the same investigation and supervision of practice process for all staff (NHS England, 2017). The other three countries in the UK have also adopted employer-led models of supervision, but have chosen to continue to use the term ‘supervisor’ rather than professional midwifery advocate (PMA). A-EQUIP was introduced in seven pilot sites throughout England in 2017 and implemented locally at University Hospitals of Leicester NHS Trust in 2018.
NHS England (2017) studied the needs and requirements for midwives, present and future, during the development of A-EQUIP. Some of the stresses and pressures emphasised in today's workplace are not necessarily new; Kirkham (1999) also highlighted inadequate skill mixes, low staffing numbers and long working hours. More recently, the Mind the Gap report (Jones et al, 2015) discussed ‘Generation Y’ becoming an increasing part of the workforce and highlighted the requirement for employers and educators to consider models of supervision as a strategy to support staff according to the likely needs of each generation. Similar pressures have been recognised by the Royal College of Midwives (RCM) in Why Midwives Leave—Revisited (RCM, 2016). This evidence reinforced the continued strain that midwives face in the workplace and the requirement for support to enable them to manage pressures and carry out their role to the best of their ability. Supervision, in its supportive function, is still considered a principle part of midwifery practice and in light of this, the supervisor of midwives role has been replaced by the PMA (Figure 1).
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