Open Journal of Nursing, 2013, 3, 373-378 OJN Published Online September 2013 (
Clinical supervision for novice millennial nurses in the
perinatal setting: The need for generational sensitivity
Jo Watson1,2, G. J. Macdonald2, Donna Brown1,2
1Sunnybrook Health Sciences Centre, Toronto, Canada
2Lawren ce S Bloomberg Faculty of Nursi n g, University of T o ronto, Toronto, C anada
Received 18 May 2013; revised 19 June 2013; accepted 10 July 2013
Copyright © 2013 Jo Watson et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This paper reports on a qualitative research study
that examined the experience of expert and novice
nurses participating in a new, reflective program of
“clinical supervision”, intending to facilitate the tran-
sition of new graduate nurses into the workforce.
Three patterns emerged during the constructivist
inquiry: readiness to reflect, valuing of clinical super-
vision, and sustainability of the clinical supervision
model. The researchers suggest generational sensitiv-
ity as a key perspective to consider when developing
engaging workplace strategies for millennial nurses.
The article offers recommendations for the imple-
mentation of clinical supervision and would be of in-
terest to nurse leaders in a clinical setting.
Keywords: New Graduate Nurses; Clinical Supervision;
Generational Sensitivity; Constructivist Inquiry
Novice nurses face real challenges when entering the
workplace. They are particularly vulnerable to high
levels of burnout, increased levels of depersonalization,
and lower levels of personal accomplishment than more
experienced nurses [1,2]. Difficulties for these new
members of the profession lead to rising attrition rates
and possible marginalization [3,4]. New programs and
approaches are needed that engage novice nurses in the
profession by helping them transition into the workplace.
During this transition, novice nurses could benefit from a
system of support that fosters reflective practice.
1.1. Review of the Literature
Born between 1980 and 2000, most current graduates
belong to Generation Y and are known as millennials [5].
Millennial nurses expect quick access to their leaders and
want prompt, frequent feedback [6]. Unlike previous
generations, millennials are drawn to work that they
perceive to be meaningful and to work environments that
support a work-life balance [7,8]. Having grown up
learning and working in groups, they favour teamwork,
collaboration, interdependence and networking [9].
The difficulties that new nursing graduates experience
are well described in the literature [2,7]. Novice nurses
find the first months of work the most difficult. They are
acutely aware of missing their clinical instructor and may
even contemplate leaving the profession [2]. New
graduates have long been labeled as inadequately pre-
pared to transition easily into the workplace [10]. This is
not surprising since the new graduate’s experience is
recognized as a time of significant professional adjust-
ment [7].
Recommendations have been made to develop work-
place strategies focused on easing new graduates’ tran-
sition into professional practice [3,7]. One potential
support identified for new nurses is participation in the
practice of clinical supervision (CS) following orien-
tation. Clinical supervision, an approach used for
decades in the United Kingdom, is a “formal process of
professional support and learning, which enables prac-
titioners to develop knowledge and competence and
assume responsibility for their own practice” [1], pre-
viously cited in the London Department of Health 1993
[11]. This approach to supporting staff has been linked to
the provision of quality care, role socialization, and
acculturation [7].
A key element of clinical supervision is the in-
volvement of experienced or expert nurses who provide
support and guidance to novice nurses and promote
reflective practice. Expert nurses work to create a safe
environment, share their wisdom explicitly, facilitate
reflection and provide effective feedback [12]. Novice
nurses participating in clinical supervision are expected
to identify key concerns in practice, remain open to
J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378
feedback, and engage in reflection [12]. Clinical super-
vision takes place after a formal orientation has been
successfully completed. It is not meant to be a type of
preceptorship and does not include shared shifts or
hands-on clinical sup port.
Suggested benefits of participating in clinical super-
vision include increased confidence, decreased isolation
and burnout, increased feelings of support, decreased
sick time, as well as improved listening, problem solving
and coping skills [13-18]. The value of clinical super-
vision has been specifically highlighted for novice nurses
in [19, 20]. These benefits suggest clinical supervision is
an ideal approach to foster the engagement of novice
nurses in reflective professional practice. Yet, uptake of
this initiative has been inco nsisten t and no t all reports are
positive. Concerns raised in the literature regarding
clinical supervision include resistance, fear and suspicion,
as well as the lack of organizational and policy support
While there is no clear consensus on how clinical
supervision is best implemented in clinical practice, the
value of clinical supervision for novice nurses has been
established [14]. Clinical supervision is an initiative
worthy of consideration as a means of professional
development for Canadian nurses and as a strategy to
support novice nurses during their transition into the
profession. There are no reports of clinical supervision
being implemented in Canadian practice settings or,
more specifically, evaluated in perinatal units.
1.2. Study Introduction, Guiding Questions
The purpose of this study was to explore the experience
of novice and expert nurses during their participation in a
program of clinical supervision, introduced into a Ca-
nadian, perinatal setting. The research question guiding
the study was: What is the nature of the experience of
novice nurses and expert nurses who participate in a
program of clinical supervision during the first year of
the novice nurses’ clinical practice?
The goal of the CS program was to support and
engage novice nurses during their transition into the
profession in their first year of practice.The CS program
was introduced in a letter sent out to novice nurses, who
had completed their formal orientation. Novice nurses
were asked to review written material and guidelines
about CS before the meeting. Participants were paid for
their time at their regular hourly rate. The letter also
invited the nurses to a one-hour group session to
introduce the research study.
The Clinical Supervision program consisted of three
meetings, between paired novice/expert nurses. These
meetings followed the formal orientation and were
completed within the first year of the novice nurses’
employment. Meetings were unstructured and allowed
the novice nurses to reflect upon any successes, concerns
or questions they may have had about their professional
life. The initial meeting took place within three months
of the end of orientation. Subsequent meetings between
expert nurses and novice nurses were held within the
next nine months. This meeting schedule resulted in
novice/expert nurse dyads planning to meet a total of
three times during their first year of practice.
Ten novice nurses were invited to participate in the
study. These ten nurses were practising in the perinatal
setting, had successfully completed their formal
orientation program, and were beginning their mandated
clinical supervision program. In this program, each
novice nurse was paired with an expert nurse. Three
expert nurses, who were providing individual clinical
supervision to one or more of the cohort of ten novice
nurses, were also invited to participate in the study. The
three mid-career, expert nurses worked in advanced
practice nursing roles in the perinatal setting.
Three novice nurses and the three expert nurses
volunteered to participate in the study. The novice nurses
were identified with the millennial age cohort while the
expert nurses were identified with the baby boomer age
cohort. The expert nurses did not know the identity or
number of the novice nurses who were research
participants. The novice nurses were not aware of the
identity or number of expert nurses who participated in
the re search study.
Separate focus groups, one for novice nurses and one for
expert nurses, took place after the program of clinical
supervision was completed. Data was collected through
two focus groups that provided the opportunity to explore
the research question with the novice and expert nurses.
Focus groups are a methodology particularly well suited
for use with small gr oups of vulnerable participants who
may find the interaction with peers empowering [26].
Separate sessions were held, one with the novice nurses
and one with the expert nurses. Similar open ended
questions guided both focus group discussions. The
groups were facilitated by the same doctorally-prepared
nurse who was experienced in focus group methodology
and aware of the importance of encouraging dialogue
between participants [26]. Three novice nurses and three
expert nurses attended their respective focus group. At
each focus group, open-ended interviews were audio-
taped and the tapes were transcribed. The novice nurse
focus group preceded the expert nurse focus group. This
supported the facilitator’s ability to probe the expert
nurses in areas that the novice nurses had discussed, such
as the suggestion to have a group based CS model rather
Copyright © 2013 SciRes. OPEN ACCESS
J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378 375
than the novice/expert model. Approval to conduct the
study was received from the hospital’s research ethics
This study took place at a tertiary perinatal unit in a
large, urban teaching centre where 4000 births take place
annually. This setting was the workplace of two of the
investigators. Participants included nursing staff from the
Birthing Unit and the Mother-Baby Unit. New staff had
completed a formal orientation process that consisted of
ten to 12 weeks of clinical preceptoring and in-class
learning. At the time of this study, there was no ongoing
support for staff after the formal orientation ended.
The CS study used a constructiv ist analysis that led to
the identification of patterns from the qualitative data
collected in the two focus groups. In a constructivist
analysis overall patterns emerge and are named as the
data is examined, without prior selection of theoretical
perspectives [27]. The two lead investigators reviewed
the transcripts in hard copy word documents and
completed the analysis, using co lour coding. Initially the
data for the novice nurses and expert nurses was
analyzed separately. However, the early patterns from
each of these two participant groups were directly related,
and led to the researchers merging the findings. Three
main study patterns emerged, incorporating data from
both the novice nurses and expert nurses. Further
analysis revealed three smaller themes in the first pattern.
Initial study findings, both patterns and themes, were
reviewed with the expert nurses to ensure face validity.
Their feedback was incorporated into the ongoing
analysis. The expert nurses confirmed the patterns and
themes were valid from their perspective. The novice
nurses were not involved in this valid ation process.
During the constructivist data analysis three main
patterns emerged: Readiness to Reflect, Valuing of Clin-
ical Supervision, and Sustainability of Clinical Super-
vision. Three themes identified within the readiness to
reflect pattern were timing, uncertainty and resistance.
Separate themes were not identified in the other two
3.1. Pattern One: Readiness to Reflect
The response of novice nurses and expert nurses revealed
a limited readiness to reflect on the part of the novice
nurses. They reported being “surprised by the idea of
clinical supervision”. One stated, “I think we were kind
of feeling why is this going to help us?” The expert
nurses noted that the novice nurses weren’t ready to
reflect on their practice and wanted instead to focus on
solidifying their clinical skills. As one expert nurse stated,
“I didn’t feel them [the novice nurses] necessarily
hesitating to bring things up, but just genuinely didn’t
really feel like they had a lot of difficult situations to
bring up.”
Timing. Novice Nurses expected to be given time to
prepare and to have meetings during scheduled shifts,
rather than during additional paid hours, one stated, “[I]
don’t want to do nursing after hours.” Although they
were paid to attend meetings, they did not want to spend
their personal time on CS. Expert nurses found it difficult
to book meeting times with the novice nurses. Novice
nurses needed to be approached several times before a
meeting time could be confirmed. As one expert nurse
stated, “There was a bit of avoidance”.
Uncertainty. The novice nurses were uncertain about
the intention of CS and were apprehensive about what to
expect, “I don’t know what you call it, worried, I guess”,
“…surprised at the idea of clinical supervision, con-
cerned”, while another nurse felt uncertain and “…didn’t
know how to prepare…”
Resistance. Resistance to engaging in the clinical
supervision program was evident in the dialogue of the
novice nurses. Novice nurses spoke in terms of
involuntary relationships, “Seeing that we are going to be
locked up together” and commented that meetings were
difficult to organize, “It was difficult to get together”.
One novice nurse questioned the usefulness of the model
of clinical supervision, “And I guess I came in there
feeling like it wasn’t all that useful because we sit there
and talk about the same things we talk about all the
time.” The novice nurses resisted engaging in an activity
they didn’t value and were expected to participate in.
Expert nurses identified novice nurses’ resistance and
avoidance. Shift work and concerns regarding con-
fidentiality were reasons cited for this resistance.
Expert nurses struggled to establish a relationship with
the novice nurses. Novice nurses remained confused
about the goal of clinical supervision, wondering why the
expert nurses did not come to the practice setting to work
with the novice nurses on their scheduled shifts. The
novice nurses were focused on doing, while the clinical
supervision model encouraged them to reflect upon their
practice with an expert nurse outside of the clinical
setting. Both the novice and expert nurses recognized
that the novice nurses did not seem ready initially to
engage in a reflective process such as clinical super-
3.2. Pattern Two: Valuing of Clinical
Valuing of Clinical Supervision had both positive and
negative dimensions. Despite the challenges introducing
clinical supervision in this setting, there were indications
that both groups found some value in the relationships
they developed. One novice nurse stated, “I just had a
Copyright © 2013 SciRes. OPEN ACCESS
J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378
run-in with [someone] ...and we talked about that. My
expert nurse also had an experience. It was nice that she
had similar stories.” Expert nurses identified that some
novice nurses were having a hard time eliciting support
on their units, and so having the opportunity to talk to the
expert nurse was a valuable resource. One expert nurse
stated, “I think it is valuable because I think that first
year of a new grad can make or break their decision to
stay in nursing.” Two quotes from the expert nurses
speak to the value of the CS program to facilitate the
development of supportive relationships, “So in the later
sessions I did find they were probably a little more
confident in bringing those kinds of things forward” and
“I have continued on with the people that we have hired
and I find it’s a great benefit.”
However, there were questions from both groups
regarding the value of clinical supervision. In the novice
group, commen ts from two of the n ovice nurses included:
“I didn’t find that we really had enough clinical stuff to
fill the whole time”, “I felt like we were just chatting”,
“[I] didn’t have much to talk about at meetings. One
novice nurse stated, “I felt floored and confused because
I didn’t know what it was about so was interested in
knowing how that would help me in my practice.”
Overall, the valuing of clinical supervision by the
novice nurses was low. Expert nurses felt that the novice
nurses didn’t see the purpose of the meetings and
described that some were difficult to sit through because
the novice nurse had nothing to discuss. Meetings felt
uncomfortable, “I found my first session quite contrived”.
Expert nurses reported that initially trust was lacking , “It
was just I remember there wasn’t that trust there”, but
once trust developed, novice nurses looked to the expert
nurses for reassurance and clarifi c at i on .
3.3. Pattern Three: Sustainability of Clinical
Novice nurses offered suggestions to foster the sus-
tainability of the clinical supervision model. One novice
nurse indicated she would like to see the expert nurse
more often. Another talked about increasing choice re-
garding who would provide clinical supervision, “Choos-
ing [a] preceptor works much better. Maybe [we
could]… pick expert nurses for clinical supervision, not
be assigned”. Other suggestions included having the
sessions begin earlier and take place more often.
Expert nurses suggested improvements in the ap-
proach to CS that could make future relationships
sustainable. One expert nurse wondered if it would have
been beneficial to have expert nurses who were
colleagues in the un it rather than someone in an advance
practice nurse role. Expert nurses and one novice nurse
suggested a group approach to clinical supervision might
be more effective. Both novice and expert nurses shared
suggestions on how to improve the model of clinical
supervision that addressed the challenges they had
The findings of this study highlight the experiences of
novice and expert nurses participating in a program of
clinical supervision at the end of their orientation to a
perinatal unit. Valuing of clinical supervision was a
dynamic pattern, with the expert nurses placing a higher
value on the potential of clinical supervision while the
novice nurses critiqued the reality of clinical supervision.
Novice nurses described a lack of readiness to
participate, uncertainty and resistance. The expert nurses
also identified these responses in the novice nurses.
Elements in the design of a CS program, specifically
timing, frequency of meetings, and choice of expert
participants, if designed well, could better foster novice
nurses’ engagement. Expert nurses thought highly of the
opportunity to offer this support to new staff, in contrast
to the novice nurses who questioned its purpose. All
participants made recommendations to improve imple-
mentation of the program in orderfor clinical supervision
to continue. Our findings suggest that the novice and
expert nurses recognized that clinical supervision n eeded
to be tailored to meet the needs of the novice millennial
nurses to increase overall engagement.
The findings of this study lead to recommendations for
other centres considering CS as a model of support for
novice nursing staff. In retrospect, it is clear that specific
elements of our model impacted how CS was received in
our setting. The lack of clarity regarding the purpose of
CS, and the timing and frequency of meetings were
barriers to the novice nurses’ readiness to reflect and
value clinical supervision.
Timing and frequency of meetings were also problem-
atic. CS meetings were scheduled outside of work hours
and novice nurses participating in this study were
resistant to this. Other studies have also reported nurses’
ambivalence about participating in programs of clinical
supervision [21,23]. While clinical supervision sessions
should occur often enough that the learners’ needs are
met, timing and frequency of meetings should be taken
into consideration to support millennial nurses’ values
and assumptions about workplace culture and work-life
balance. We recommend that timing of sessions should
be built into the novice nurses’ schedules so that there is
not an expectation for them to participate outside of
scheduled shifts.
Nurses participating in earlier CS studies did not make
Copyright © 2013 SciRes. OPEN ACCESS
J. Watson et al. / Open Journal of Nursing 3 (2013) 373-378 377
their participation a priority. Instead, they described
using other approaches to receive emotional support
from peers [20]. Similarly in this study, the novice nurses
indicated that they created their own support system
within the workplace. Yet, having only an informal
support system is potentially problematic since reliance
solely on informal peer discussions does not ensure
reflection on practice or the development of responsi-
bility for their own practice. Pairing novice nurses and
experienced nurses who did not interact regularly was
also a weakness in this design. Overcoming resistance
would require engaging novice nurses in the develo-
pment of a model that ensures timely feedback. Other
authors have suggested a shift away from a novice/expert
nurse dyads towards peer group-based clinical supervi-
sion [4,21,28]. This approach might have more appeal to
millennial nurses and engage them more actively in
For centres considering CS as a way to support novice
nurses, we encourage close attention be paid to the needs
and expectations of millennial learners and suggest the
term generational sensitivity, modeled after the accepted
notion of cultural sensitivity, be used. Generational
sensitivity regarding this group of novice nurses would
include a model where the novice nurse selects the ex-
perienced nurse to wo rk with, rather than being assigned
an expert nurse, and small group cohort meetings rather
than meeting one-on-one. Studies that reported positive
outcomes related to the implementation of clinical
supervision were designed with orientation sessions that
were conducted away from the workplace and novice
staff were given the option to select their own supervisor
[29, 30]. Novice nurses may not have felt at ease meeting
with the expert nurses or may not have met often enough
to establish a supportive relationship. There is growing
evidence that providing support to new graduate nurses
is valuable especially if that support is provided by
experienced nurses close at hand [2,31].
Millennial novice nurses may purposefully seek out
supports that are closer in experience to the novice nurse,
rather than the expert nurses. If generation is an
important motivator, novice nurses may choose an
experienced nurse who is closer in age to them rather
than the most expert nurse in the setting. Such a model
may work effectively if the experienced nurses have
timely access to the support of the expert nurses. A CS
model where experienced nurses support reflective
practice in new graduates, while expert nurses then
support experienced nurses, may be more effective.
While CS was well supported in this study in terms of
budget and staffing, this was not enough to ensure the
program’s success. We recommend modification to the
design of this model of support based on our learning
and evaluation pr ior to full implantation in other settings.
We also recommend further evaluation of clinical
supervision in settings where the modifications sug-
gested for practice have been implemented.
While Clinical Supervision is well integrated into
professional practice in the United Kingdom, this is the
first time CS has been evaluated in Canada or in a
perinatal setting. This study included a small sample size
and findings cannot be generalized but may be of value
to settings who have similar models of clinical super-
There is now a body of literature describing the
challenges and difficulties that new graduate nurses
experience [1,2,32]. This study highlights some chal-
lenges when clinical supervision was introduced in a
Canadian perinatal setting. Recommendations for deve-
loping a program of clinical supervision for novice
nurses include using experienced colleagues rather than
expert nurses, ensuring that the timing of sessions is
immediate and during scheduled working hours, and
giving novice nurses the opportunity to identify a ex-
perienced nurse in their practice setting, rather than
having one assigned. An informal, flexible approach to
new nursing gradu ates, based on generational sen sitivity,
is suggested to provide the support needed to engage
novice nurses and promote reflection in the first year of
professional practice.
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