Clinical supervision under pressure: a qualitative study amongst health care professionals working on the ICU during COVID-19

Figures & data

Table 1. Characteristics of participants.

	Total n	Redeployed* n	Number of years’ experience in current employment for all
Nurses	22	10	24 (range 1–45) yr
Physicians	4	3	4.6 (range 1.5–7) yr

*Redeployed nurses included registered nurses, operation room technicians, anesthesia technicians.

Table 2. Themes, salient findings, and contrasting participant quotes.

Themes	Salient findings	Contrasting quotes
Open attitude	Respect, honesty and transparency are mentioned as key elements of successful supervision	‘Easily accessible, no question is too much, no question is too stupid or redundant.’ (I-14) ‘I was only seen as a helping hand and nothing more, asking questions was not appreciated’ (I-12)
(2) Observing own boundaries	Being aware of the (limits) of one’s competence is mandatory for effective supervision and patient safety.	‘I’m not a certified ICU nurse, so please talk me through it’ (I-1) ’We were part of the team proning patients, you know, we walked in and suddenly one of the patients’ oxygen levels dropped and the alarm went off. When we asked the ICU nurse nearby: we see that this happens, can you help us? And she said: That is not my patient.’(I-13)
(3) Gauging coworkers’ capacities	Redeployed personnel lacking relevant knowledge, skills and experience were more of a burden than a help	‘Anesthesia technicians are very good, really, I enjoyed working together, despite our different job descriptions’ (I-9) ‘ … supervising those people [volunteers without ICU or even medical expertise] only took up time and energy instead of being really helpful.’ (I- 1)
(4) Being available	Availability of supervision is reported as a critical element. Face-to-face is preferred over telephone consultation	‘ … , you can always call me. I’d rather have you calling me once too many times.’ (I-9) ‘Redeployed physicians did not always know who their supervisor was or how to reach them’ (I-8)
(5) Providing feedback	Feedback on performance was highly valued. Unfortunately, there was not always time nor place to give and receive feedback	‘Every shift was evaluated. That created a safe environment’ (I-9) ‘Well, what lacked in my opinion was a moment to sit together and reflect what we encountered with patients and how to improve this.’ (I-10)
(6) Continuity in care and teams	A consistent schedule and team composition was preferred to create a more constant and efficient workforce	‘Oh, today I’m scheduled at ICU X, I’ve not been there yet, but Lisette has, so we decided to swap shifts to ensure continuity’ (I-19) ‘Redeployed personnel had different qualifications, different skills, so every time it was a discovery to find out what they were capable of.’ (I-6)
(7) Combining supervision with workload	The workload was very high, balancing patient care and providing supervision was challenging	‘The supervision I have given, was minimal, merely because of the high workload … It was, well, trusting the redeployed workers and hope that they could complete their task and ask questions if needed.’ (I-6) ‘…it was just too busy, not enough certified personnel, too many patients’(I-7)

Table 3. Essential factors for supervision in health-care professional’s education and the seven identified themes from this study.

Hauer et al. Factors influencing a supervisor’s trust in a trainee		Themes distilled from this study
I	Features of the supervisor	Open attitude, gauging coworkers’ capacities, being available, providing feedback
II	Characteristics of trainee	Open attitude, observing own boundaries, gauging coworkers’ capacities, providing feedback
III	Trainee – supervisor relationship	Continuity in care and teams, combining supervision with workload
IV	Practice context	Continuity in care and teams, combining supervision with workload
V	Nature of the task	Gauging coworkers’ capacities, continuity in care and teams, combining supervision with workload

Data availability statement

The interviews that support the findings of this study are accessible via Appendix S2.