The Duality Of Power In Nursing Supervision: A Systematic Review Of Barriers, Facilitators, And Technological Innovations In Clinical Supervision Practices Across Healthcare Settings
Abstract
Background: Nursing supervision is a pivotal managerial instrument for determining quality of care, yet its implementation remains fragmented across primary care, emergency departments, nursing homes, clinical education, newly graduated nurse orientation, and operating rooms, resulting in inconsistent outcomes.Aims: To synthesize recent empirical evidence (2021–2026) on the conceptualization, barriers and facilitators, and innovative strategies in nursing supervision.Methods: This systematic review followed PRISMA 2020 guidelines using PubMed (n=143), PubMed Central (n=961), and ScienceDirect (n=2,552), yielding 3,656 records. After filtering (2021–2026, open access), 415 records remained; 386 unique records were screened, with 142 eligible after title and abstract screening. Full-text assessment excluded 130 records (macro-level hospital management = 120; irrelevant outcomes = 8; non-empirical = 2), resulting in 12 studies for synthesis.Results: Thematic synthesis identified nursing supervision as a dual construct: power repressive-disciplinary and productive-supportive, influenced by structural-organizational gaps, resource constraints, supervisor competence and readiness, and relational-communicative dynamics. Quantitative evidence involving 495 clinical mentors across 30 hospitals showed that institutional psychological support and formal training were independently associated with improved mentoring motivation, attitudes, and practices (OR=2.908; 95% CI=1.430–5.913; p=0.003). Innovations included the Johari-window-based self-awareness model, Severinsson’s Nursing Supervision Model, reflective group supervision in clinical orientation, and validated non-technical skills instruments (inter-rater reliability 0.83–0.91), complementing gamification and the 3V6W framework.Conclusion: Effective nursing supervision requires a shift from vertical control to horizontal dialogue, supported by institutional investment, continuous formal training, standardized instruments, and educational technology.