Proposed Supervision Plan

Proposed Supervision Plan For: / Registration Number:
Period of Supervision:
Frequency of Supervision Reports: / If three months supervision: a report should be submitted to the Board within 10 working days after the end of one month and three months.
If six months supervision, a report should be submitted to the Board within 10 working days after the end of one month, three months, and six months.
Supervision Plan Summary / Requirements: To be approved by the Board
Name of Practice:
Address of Practice:
Proposed Primary Supervisor:
Hours of work per week:
Proposed Alternative Supervisor(s)
(to supervise in the absence of the primary supervisor):
Proposed Implementation Date: / The date of issue of an APC with the condition of practice under supervision: ______
Statement from the Supervisor: / After the first month of supervision. Additional statements are required as part of each Supervision Report
Peer Review: / To occur after one and three months (and also at the end of six months – where the period of supervision is 6 months). The Peer Review document, signed by the practitioner and supervisor must be submitted to the Board as part of each Supervision Report.
Clinical Reasoning/Case Study (including discussions): / To occur weekly, for the first month of supervision. The frequency of these discussions may be reduced to once per fortnight after the first month. A record of each discussion, signed by the Supervisor(s) to be forwarded to the Board as part of each Supervision Report
Staff Professional Development including in-service training and journal reviews: / Required attendance at in-service meetings, at least once per month. A record of attendance (signed by the Supervisor(s)) must be forwarded to the Board as part of each Supervision Report
Continuing Professional Development (CPD): / An updated CPD logbook must be submitted as part of each Supervision Report
Reflective Statement – Practising under Supervision: / To be completed by the Practitioner and forwarded to the Board as part of the final Supervision Report
Competency Templates: / To be completed by the practitioner, co-signed by the Supervisor(s), and forwarded to the Board as part of the final Supervision Report
Professional Development Activities: / An updated Professional Development Plan outlining professional development activities planned during the period of supervision must be submitted as part of the first supervision report. A second updated plan which outlines future professional development activities after the end of the Return to Practice Programmemust be submitted as part of the final Supervision Report.Applicants must ensure that the “Date Achieved” column in the Professional Development Document is completed only for those activities/goals that have been successfully concluded/achieved.

Supervision Report Documentation

The first Supervision Report will consist of:

  1. A statement from the supervisor regarding the practitioner’s progress and competence to practise autonomously
  2. A Peer Review Document, completed and co-signed by the Practitioner and the Supervisor(s)
  3. Documented Clinical Reasoning Discussions, co-signed by the Supervisor(s)
  4. Confirmation of attendance at Staff Professional Development (in-service) meetings, signed by the Supervisor(s)
  5. An updated CPD Logbook
  6. An updated Professional Development Plan outlining professional development activities planned during the period of supervision

Where the period of supervision is 6 months or more, subsequent Supervision Reports will consist of:

  1. A statement from the supervisor regarding the practitioner’s progress and competence to practise autonomously
  2. A Peer Review Document, completed and co-signed by the Practitioner and the Supervisor(s)
  3. Documented Clinical Reasoning Discussions, co-signed by the Supervisor(s)
  4. Confirmation of attendance at Staff Professional Development (in-service) meetings, signed by the Supervisor(s)
  5. An updated CPD Logbook

The final Supervision Report will include all of the above, and will also include:

  1. A Reflective Statement prepared by the practitioner to cover the supervision period
  2. A completed Competency Template document, prepared by the practitioner, signed by the supervisor(s)
  3. An updated Professional Development Planwhich outlines future professional development activities after the end of the Return to Practice Programme

Agreement to the contents of the above supervision plan:

Signature of Practitioner (Returner to Practice):______

Signature of proposed Primary Supervisor:______

Signature(s) of proposed Alternative Supervisor(s):______

______

Date:______

.