Regulatory supervision is more than “watching" a student. It is a professional decision-making process that uses assessment, communication, risk evaluation, and ongoing supervision planning to protect clients while supporting student learning.

This learning resource helps you apply the BCCNM standard in everyday clinical moments.​ 

Key standards​​

Midwives: Regulatory Supervision of Students

​​​What is regulatory supervision?

Regulatory supervision is a professional decision-making process midwives use when students perform client care activities that require midwifery knowledge, skill, ability, and judgment. It protects clients while supporting student learning.

Applies to: student midwives in clinical placements and, in some settings, students from other regulated health professions when midwives supervise their entry-level practice.

Bottom line: clinical practice consolidates learning. Students are required to have gained sufficient knowledge, skills, ability, and judgment to perform the activity under supervision through their program.

​​​

Regulatory supervision pr​​​ocess

Use this scenario to follow along as you learn each step of the supervision process.

Practice scenario: “I've do​ne this in lab…"

Ava, a midwifery student, confidently offers to perform a vaginal exam and cervical assessment during active labour “independently." The client is uncomfortable, anxious, and has had a prior difficult exam experience. You have not yet assessed Ava's competence in this clinical context. 

What should you do next?

Step 1 — Determine student activities 

In the moment: A student offers to do an activity.

Your goal: decide what the student can do safely right now based on student knowledge, skill, ability, and judgment, and risk.

What y​​​ou do

A. Confirm the activity fits you (the supervising midwife)

Proceed only if:

• The a​ctivity is within your scope of practice, and
• ​The activity is within your individual competence

When supervising across professions, ensure the activity fits your scope/competence and aligns with the student's program competency expectations.

​B. Confirm the student's readiness for the specific activity

Confirm what the student has gained sufficient knowledge, skills, ability, and judgment through their education program (or equivalent) to safely perform the activity. Use reliable sources such as:

• ​Program expectations and skill verification/sign-offs
• Instructor or preceptor feedback (education context)
• Observed performance in clinical practice
• The student's understanding of indications, steps, safety checks, and limits
• Documentation of prior supervised practice (where applicable)

What yo​​u can say (quick script)

• ​“Tell me what you've done with this in practice and what you'd do if the client's condition changes."
• “Walk me through how you will approach the client and steps to performing the assessment or something like that."

Common decision tr​​aps

• ​“They've done it in lab." Lab practice ≠ readiness for complex/high-risk client situations.
• Staffing pressure. It doesn't change what's safe.

C. Client consent (when possible)

Before the student participates, obtain the client's consent when possible and document according to practice setting expectations.

Ava has practised cervical assessment in lab and observed several exams in practice but has performed only one exam with direct coaching. You decide she will not perform the exam independently.

Step 2 — Set conditions​ for safe performance 

In the moment: You've decided Ava can participate—but not independently.

Your goal: make performance safe by setting conditions and a supervision plan.

In Step 2, y​​ou complete two linked actions:

• Set the conditions by de​fining what the student can do, what requires your involvement, and what safeguards must be in place.

• Develop the supervision plan by confirming the supervision level and where and when supervision will occur, communication and escalation expectations, and how supervision will be maintained across​​ the shift.

Supervision options (choose based on risk/student readiness)​​

• ​Direct: you are physically present, able to observe and intervene immediately
• Indirect: you are on-site/nearby, able to provide timely consultation/feedback consistent with the conditions and can be contacted by phone, pager, technology
• Virtual: you are not physically present and available through technology

Wh​​at you base it on

• ​Student readiness: student knowledge, skills, ability, judgment, and support needs
• Client factors: client's condition, risks, and preferences
• Activity risk: complexity and risk level of the activity
• Practice context: practice setting/work environment
• Supervision team: who else is involved in the supervision. Clarify roles if more than one supervisor
• Evaluation: how you will evaluate what was done and its effects

What you can say (qui​​ck script)

• “Here's what you'll do, here's what I'll do, and here's where you'll pause."
• “If anything changes, we stop and I step in." 

​Set ​​the conditions

Av​a may:

• ​Gather supplies and support client comfort/positioning
• Obtain a focused history and explain the exam (with you present/available as appropriate)

• ​​​Assist with documentation after you confirm findings

Ava does not perform the exam independently. Ava completes the exam and you remain present for any complex steps and to respond to unexpected findings.

Supervision plan​

• Level: Direct (you are at Ava's side)
• When/where: present for the exam; activity pauses if you step away
• Real-time checks: Ava pauses at agreed checkpoints (e.g., before starting, before any change in plan, and immediately if the client reports increased pain/concerns)
• Evaluation: you observe in real time, confirm findings, and monitor the client's response during and immediately after the exam
   

Step 3 — Manage and monitor risk throughout care​

In the moment: the student is performing and the situation may evolve.

Your goal: protect the client by anticipating risk, stepping in early, and updating conditions as needed.

What you do

• Anticipate and mitigate risks
• Confirm care proceeded as planned
• Evaluate client outcomes and response
• Intervene early when safety concerns arise
• Support reporting of incidents/near misses

• R​evise conditions and the supervision plan as needed

What you can say (quick script)

• ​“Pause there—let's reassess together."
• “I'm stepping in now. We'll debrief after." 

During the exam, the client becomes distressed due to discomfort from incorrect hand positioning and a lack of clear communication about what to expect next. You immediately stop the exam, support the client, reassess the plan of care, and coach Ava on respectful, trauma-informed approaches and reflective learning.
 

Step​ 4 – Evaluate care and provide feedback

Review the care provided by the student, assessing whether all planned steps were completed safely and effectively and client response and outcomes.

Provide constructive, timely feedback, focusing on clinical reasoning and communication. Guide the student in identifying what they would do differently next time, supporting their learning and accountability.

Quick debrief with Ava (1–2 minutes)​​

• W​hat went well? (preparation, communication, client comfort, pausing at checkpoints)
• ​What needed intervention—and why? (importance of maintaining client comfort through proper technique, ongoing check-ins, and transparent communication throughout the process)
• What will you do differently next time? (review landmarks/technique beforehand, agree on exactly when Ava will pause, practise hand positioning and client communication cues)
  
• What conditions apply next time? (direct supervision for the exam; Ava may assist with prep/history/documentation; add a “pause before exam begins" checkpoint and a “pause before documenting findings" checkpoint)

Closing: Support safe student participation by setting clear conditions, staying directly involved when accurate assessment findings matter, and updating the supervision plan for next time.
 

If something go​​es wrong

If a student's actions harm (or could harm) a client, the midwife:

• Takes immediate steps to ensure client safety,
• Notifies appropriate supports (e.g., lead/most responsible midwife, practice setting supports, faculty as applicable), and

• Assists the studen​​t to follow incident reporting processes according to applicable policies and procedures of the practice setting and/or educational institution.

Key point: You may not be accountable for events you could not reasonably foresee, but you are accountable for appropriate supervision decisions, conditions, communication, and professional judgment.
 

Communic​ation and learning environment

Midwives who provide regulatory supervision:

• Clarify roles and responsibilities with the student and instructor/faculty as needed
• Support the student to speak up about risks and ensure reporting occurs per policy
• Ensure the student is aware of relevant BCCNM standards and practice setting policies and procedures
• Ensure the student uses the appropriate title when communicating and documenting
• Address professional practice issues promptly and constructively (e.g., boundaries, discrimination)
• Communicate respectfully and act to create a safe learning environment
• Reflect and take action to support culturally safe learning and client care in alignment with the Indigenous Cultural Safety, Cultural Humility and Anti-Racism practice standard
  
  

​​The 4Q check — Know before you permit

Use before approving any activity:

1. What knowledge, skills, ability, and judgment has the student gained through their education program?
2. Is this activity within my scope and individual competence?
3. What are the risks for this client in this situation?
4. What conditions and level of supervision are required—and how will I evaluate outcomes?
   ​
   ​
   

​A​​pply your understanding: Erica's scenario (suturing a perineal tear)

Consider the follo​wing scenario and apply your understanding:

A client has just had a vaginal birth. You assess and identify a second-degree perineal tear that requires suturing. The client is tired, uncomfortable, and anxious about pain. The environment is busy, and the newborn is also being supported. Erica, a student midwife you are supervising, says, “I can do the full repair and chart it. I've done this several times before for other clients." You don't yet know Erica's level of knowledge, skill, ability, or judgment with second-degree repairs in real clinical situations.

Step​​ 1 — Determine student activities

Before Erica performs any part of the repair, what information do you need to make a safe supervision​​​ decision?

A. Whether Erica feels confident completing the repair independently.

Incorrect. Being confident doesn't necessarily mean Erica has the necessary knowledge, skills, ability, or judgment.

B. How many times Erica completed suturing in lab and how confident she is now.

Incorrect. Lab practice alone is insufficient for a clinical repair with real risk to the client.

C. What Erica has demonstrated in clinical practice: documented skill verification/sign-offs, observed repairs, experience with second-degree tears, ability to maintain asepsis, manage hemostasis, use appropriate technique, and identify when to pause and ask for help.

Correct. Safe supervision requires reliable evidence of what Erica can safely do in practice.

D. Whether the unit is short-staffed and could benefit from Erica working more independently.

Incorrect. Workload pressures do not determine what is safe when supervising students.

Step​​ 2 — Set conditions

Based on Erica's request and the client's situation, what conditions and supervision plan are most appropriate?

A. Erica completes the full repair independently because she has done similar repairs before.

Incorrect. Prior exposure alone does not justify independent performance. A second-degree repair carries clinical risk and may require real-time intervention.

B. Erica completes the full repair alone and reports back immediately when finished.

Incorrect. Reporting back after the fact is not enough for an activity where bleeding, pain, or technique concerns may require immediate action.

C. Erica completes selected components of the repair with you present; you remain responsible for clinical judgment, pain management decisions, confirming layer closure, and ensuring safe outcomes.

Correct. You set limits and remain directly involved in assessment interpretation and decision-making.

D. Erica does not participate in the repair until she completes more formal training.

Incorrect. The safest approach is participation with conditions—not unnecessary exclusion.

Reminder: Obtain the client's consent (when possible) for the student's involvement, including what parts of the repair the student will perform, and document according to practice setting expectations.

Step​ 3 — Manage and monitor risk

During the repair, you notice the client's pain is increasing and Erica is struggling to maintain tissue alignment. What should the supervising midwife do next?

A. Tell Erica to continue and finish quickly so the repair is done.

Incorrect. Continuing without addressing pain and technique concerns increases risk and client distress.

B. Ask Erica to troubleshoot independently so she can build confidence.

Incorrect. Higher-risk moments are not appropriate for independent student decision-making.

C. Pause, reassess the client's comfort and pain management, correct technique as needed, decide what Erica should continue under direct supervision, and step in to complete any higher-risk components.

Correct. You intervene promptly to protect client safety and support safe learning.

D. Stop the repair completely and ask another clinician to take over, regardless of the situation.

Incorrect. If you can safely continue, stepping in and adjusting the plan is usually more appropriate than handing off solely due to a learning need.

​​​
Step 4 – Evaluate care and provide student feedback

Q​​​​uick debrief (2–3 minutes)

When appropriate, debrief with Erica:

• What went well? (e.g., asepsis, instrument handling, client communication)
• What required intervention—and why? (e.g., pain escalation, tissue alignment risk)
• What will you do differently next time? (specific actions)
• What conditions apply next time? (what Erica may do; what requires your direct involvement)

Closing: This case shows how to support safe student participation during perineal repair: confirm readiness, set clear conditions with appropriate supervision, step in early when risks emerge, and update the plan for next time.​​​​