Developing Clinical Supervision Guidelines for Nurse Managers to Support Registered Nurses in Lesotho

AIM: Clinical supervision supports registered nurses' professional development and ensures quality patient care. In Lesotho, clinical supervision is unstructured, with limited guidance for nurse managers. This study developed evidence-informed clinical supervision guidelines for nurse managers to support registered nurses in public hospitals in Lesotho and established expert consensus on their content. DESIGN: A methodological study design. METHODS: A multiphase methodological study design was employed, comprising three phases: Phase 1: concept analysis, Phase 2: empirical exploration with nurse managers and registered nurses and Phase 3: guideline development and expert consensus. Findings from the concept analysis and empirical exploration involving nurse managers and registered nurses were integrated to develop clinical supervision guidelines, guided by a researcher-developed framework informed by the Appraisal of Guidelines for Research and Evaluation II instrument and Donabedian's model. A three-round Electronic Delphi survey with 21 national and international experts was conducted to establish consensus on the validity, reliability, applicability, clarity, relevance, comprehensiveness, flexibility and acceptability of the guidelines. RESULTS: Eight context-specific clinical supervision guidelines were developed, organised into structure and process domains to ensure an outcome of comprehensive and effective clinical supervision. Guideline 8 was classified as structural, guidelines 1, 2, 3, 4, 5 and 7 were classified as process-oriented and guideline 6 was considered to have both structural and process characteristics. Expert consensus was achieved on all guidelines. CONCLUSION: The clinical supervision guidelines, developed through expert consensus, provide a structured, evidence-informed and consensus-based framework that can strengthen nurse managers' clinical supervision, support and mentorship of registered nurses, while supporting registered nurses' competence and well-being, with potential benefits for patient-care quality. Adoption of these guidelines could enhance an efficient, supportive and accountable nursing care environment in Lesotho. IMPLICATIONS FOR NURSING PRACTICE: The clinical supervision guidelines may provide a structured, evidence-informed and consensus-based framework for standardising nurse managers' clinical supervision in public hospitals. Their implementation could strengthen accountability, communication, professional support, workforce development and performance management, while improving registered nurses' competence and overall healthcare quality. IMPACT: The study provides an evidence-informed, context-specific framework to standardise clinical supervision, strengthen nurse managers' supervisory capacity, improve registered nurses' competence and well-being and enhance patient safety and the overall quality of healthcare in Lesotho's public hospitals. REPORTING METHOD: This multiphase study was reported in accordance with four reporting methods, namely: The Quality Appraisal Tool for Studies with Diverse Designs, Standards for Reporting Qualitative Research, Accurate Consensus Reporting Document and Reporting Items for Practice Guidelines in Healthcare. PATIENT OR PUBLIC CONTRIBUTION: This study did not include patient or public involvement in its design, conduct, or reporting.