Analysis

Reflective practice is vital to the revalidation process

By the start of this month, the first emergency nurses to use the new revalidation system will have completed their applications and maintained their registration. By April 2019, every nurse and midwife in the UK will have gone through the system developed by the Nursing and Midwifery Council

By the start of this month, the first emergency nurses to use the new revalidation system will have completed their applications and maintained their registration. By April 2019, every nurse and midwife in the UK will have gone through the system developed by the Nursing and Midwifery Council (NMC).

The new process, which replaces Prep requirements, is intended to ensure that the 685,000 nurses and midwives on the NMC register can demonstrate their ability to practice safely and effectively. It also aims to encourage registrants to reflect on the role of the NMC code of conduct in their practice, and demonstrate that they are ‘living’ the standards it sets out.

According to the NMC, revalidation is not about making an assessment of a registrant’s fitness to practise, but promoting good practice and improving public confidence in the profession.

Eight-step process

All nurses will go through an eight-step revalidation process before submitting their applications through an NMC Online account. More than 80% of nurses and midwives have already signed up, and the regulator is urging the remaining registrants to do so as soon as possible.

The NMC will contact all nurses at least 60 days before their application for revalidation is due. The deadline for submission is the first day of the month in which registration expires. Nurses must then confirm they have completed 450 hours of practice in the previous three years, or 900 if they also practice as a midwife. These practice hours must reflect each nurse’s current scope of practice, and can include providing direct care to patients, managing teams, teaching others and helping to shape or run a care service.

Registrants must have records of 35 hours of CPD, at least 20 hours of which must have included participatory learning, such as attending conferences. Nurses should record descriptions of the learning topics, and how they relate to practice and the relevant parts of the code of conduct.

Practice-related feedback

All registrants should provide five examples of practice-related feedback, which can be written or verbal, formal or informal. These can come from patients, colleagues and management, and can include appraisals, serious event reviews and complaints. The NMC recommends that registrants make notes about the content of feedback, including how it informed improvements to practice, but that they should be careful not to record information that could identify other people.

Another important element of revalidation is five written reflective accounts from the previous three years. These must refer to continuing professional development, practice-related feedback or experiences of practice. Their inclusion is intended to encourage registrants to engage in reflective practice so that they can identify the changes or improvements they need to make.

Nurses must then have reflective discussions about the five accounts with other NMC registrants. These discussions should relate to the code of conduct and the NMC has produced a form to record them. Their purpose is to ensure that nurses and midwives do not work in professional isolation, and to allow them to talk about their professional development and improvement. They also give them opportunities to respond constructively to feedback and reflect on specific situations.

Nurses and midwives then have to complete a health and character declaration, which involves stating whether they have been convicted of criminal offences or issued with a formal caution, and that they have suitable professional indemnity cover.

Confirmer

Each portfolio of evidence gathered by the registrant is then studied by a confirmer, who checks that all the requirements have been met. The NMC says that the confirmer should be the nurse or midwife’s line manager where possible, but that if no line manager is available, another nurse or midwife, or regulated healthcare professional. Line managers do not have to be NMC registered to act as confirmers and, in exceptional circumstances, a professional who does not work in health can be a confirmer.

Registrants can then log onto their NMC Online account to complete their revalidation. They should have their portfolios with them to confirm they have met each of the requirements. They will also need the names, contact details and NMC pin numbers of their reflective discussion partners and confirmers.

Evidence need not be uploaded as part of this process, which involves completing an online form, and need not be completed all at once. However, the annual NMC fee should be paid at this point.

Registration

Each registrant will receive an email confirming that his or her registration has been renewed within two days of the application being submitted. The NMC will check an undisclosed number of portfolios each year, and if a nurse or midwife has been chosen for a portfolio check, he or she will be informed within 24 hours of application submission.

To manage and record their portfolios, nurses can use documents provided by the NMC or access support from other areas, including their employers or the RCNi portfolio.

The full list of requirements is set out in below.

  • 450 practice hours, or 900 if renewing as both a nurse and midwife
  • 35 hours of CPD including 20 hours of participatory learning
  • Five pieces of practice-related feedback
  • Five written reflective accounts
  • Reflective discussion
  • Health and character declaration
  • Professional indemnity arrangement
  • Confirmation
Significant change

NMC director of registration Tom Kirkbride, says: ‘This is a significant change for nurses, which builds on good practice already in the health sector.’

He adds that registrants can access NMC guidance materials. ‘The process is new and different, but when people read the materials they can see it is not as complicated as they had thought. They can also talk to their colleagues.’

Outgoing RCN head of policy Howard Catton says revalidation offers specialist nurses the chance to highlight their skills and expertise.

‘Specialist nurses may have colleagues in management positions who have not fully grasped their potential,’ he says. ‘Revalidation can be a helpful way of demonstrating to them the value of what specialist nurses do, and how it benefits patients and improves services.

Opportunities

Mr Catton adds that nurses should embrace revalidation. ‘Some think it is a difficult regulatory process, but it provides opportunities, to reflect on their practice and how they can develop themselves, their teams and their organisations.’

One of the first nurses to complete revalidation, Marcela, is a practice nurse who works on some weekends as a band 5 nurse in an emergency department.

She told the NMC that, thanks to the guidance, she understood how to complete the process and found the reflective accounts particularly helpful. ‘Revalidation is the best thing that could have happened to nurses and midwives,’ she says. ‘It encourages them to be a bit braver. It will give nurses the power to say “this is what needs to be done”.’

What emergency care professionals think

Amanda Burston, RCN Nurse of the Year and major trauma co-ordinator at Royal Stoke University Hospital:

‘I was among the first group of nurses to revalidate because my registration was due to be renewed. I have learned not to leave everything until the last minute. Putting aside an hour a week to add to the online portfolio makes this an easily adopted practice, rather than a chore. Revalidation should become part of normal, everyday nursing practice, and using an online portfolio helps with this.

‘Time must be given to staff to allow them to produce true reflections of themselves, their progress and their contributions to health care. Allocating one hour a week from the nursing rota to reflective practice would allow more personal growth and professional development, and lead to improved knowledge and skills in the delivery of patient care.’

Linsey Sheerin, clinical co-ordinator in the emergency department at Royal Victoria Hospital, Belfast:

‘Many nurses see the reflective pieces as the most challenging part of revalidation, but they are not as difficult as they seem. In emergency care, there are many situations and events that we can reflect on, from bringing newborns into the world to holding the hand of a dying patient, as well as the adrenaline pumping moments we experience in resuscitation rooms.

‘Sometimes, we handle situations well; at other times, we fall apart. But reflecting on these moments can help us to get to know ourselves and our behaviours better.

‘While some may not write down their reflective accounts regularly, we have been encouraged to be reflective practitioners for a long time. And by identifying our goals for development, we have something to focus on in subsequent reflections.

‘Revalidation should not be seen as a chore. Although we are busy and it takes time, it is ultimately about reassuring our patients that we are fit to practice.’

Janet Youd, chair of the RCN Emergency Care Association and nurse consultant in emergency care:

‘In theory, revalidation should be fairly easy, but in my experience, emergency nurses tend to work best when under pressure, and some will submit their work at the deadline.

‘Emergency nurses should have plenty of opportunities for reflection and feedback. The challenge is to prepare in advance instead of leaving it until the day before it is due. We cannot simply tick a box and pay the fees to renew registration, and I expect some nurses could run into problems with their registration by not leaving themselves enough time.’

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