There are a variety of reasons why clinical supervision is relevant for nurses caring for people with HIV. Since HIV has become a chronic condition rather than a life-threatening, terminal illness there is now a far greater emphasis on care in the community. Working in the community or general practice requires the nurse to work more autonomously than in the acute sector. This is an attractive aspect of the job for many nurses. However, it potentially poses challenges which warrant the provision of supervision on account of the complexity of the clients’ health issues, and the resultant risks to which the supervisee, the clients and the employer may be exposed.
There are numerous potential risks. Apart from compassion fatigue and vicarious trauma associated with working with complex clients who are unwell, nurses may also find themselves in a position which is outside their knowledge level or scope of practice. For example, they may be asked by their client for advice on an ethical dilemma around the disclosure of blood-borne virus status or safer sexual or injecting practices. It is, at the best of times, difficult to answer queries of this sort briefly, without the opportunity to explore the context and reason behind the question. In the context of a nursing appointment, this is even harder. Providing a response that is either inaccurate or that may be interpreted as discriminatory and stigmatising is a risk. By providing misinformation in this situation the client (and others) may, inadvertently, be harmed. There is also a risk that the organisation may be held responsible in some way for the information offered and that its reputation might thus be affected.
People with HIV who need nursing care often present the nurse with an enormous range of clinical, psychosocial, cultural, social and ethical challenges. The clients in this group, whether they are being cared for in a community or hospital setting, may often be unwell and present with more than one complex, clinical issue. The nurse is often required to use skills more frequently utilised by social workers, community, alcohol and other drug workers, mental health practitioners and pastoral care workers. It is worth noting that social workers and health-care workers in the mental health and drug and alcohol sectors are routinely provided with clinical supervision by their employer. There is also a requirement to access supervision as part of their registration with their professional bodies.
Clinical supervision holds a mirror up to the work that the supervisee is doing with clients. As the supervisory relationship strengthens and develops it allows the supervisee a space to discuss issues or clinical presentations that may be troubling or unsettling for them. The impact of working with this client group can and does cause compassion fatigue and burnout. Clinical supervision is an important safety net as well as an essential part of a nurse’s professional development and self-care.