Analysis

Reflective practice is vital to the revalidation process

At the beginning of this month, the first nurses to use the new revalidation system will have completed their applications to maintain their registration. By April 2019, every nurse and midwife in the UK will have gone through the same process.

At the beginning of this month, the first nurses to use the new revalidation system will have completed their applications to maintain their registration. By April 2019, every nurse and midwife in the UK will have gone through the same process.

Developed by the Nursing and Midwifery Council (NMC) to replace post-registration education and practice requirements, revalidation is intended to ensure that all 685,000 registrants demonstrate that they can practise safely and effectively.

It also aims to encourage nurses to reflect on the role of the NMC Code in their practice and demonstrate that they meet the standards it sets out.

Good practice

According to the NMC, revalidation also promotes good practice and will improve public confidence in the profession.

All nurses will complete an eight-step process before submitting their revalidation 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.

NMC director of registration Tom Kirkbride says: ‘This is a significant change for nurses, but it builds on good practice. It also gives the public and other stakeholders a sense of what nurses and midwives do.’

Not complex

He wants to reassure nurses that revalidation is not a complex process and that the NMC provides guidance materials to help them. ‘Revalidation is new and different, but when people read the materials and talk to colleagues, they will see it is not as complicated as they thought.’

The NMC will contact all nurses at least 60 days before their applications for revalidation are due. The deadline for submission is the first day of the month in which the registration expires.

As part of the revalidation process, nurses must confirm they have completed 450 hours of practice in the past three years, or 900 if they are renewing as nurses and midwives. These practice hours must reflect each nurse’s scope of practice, for example, providing direct care to patients, managing teams, teaching other staff or helping to run a care service.

Continuing professional development

Registrants must also record 35 hours of continuing professional development (CPD), of which at least 20 hours must involve participatory learning, such as conferences. Nurses should describe the topics they studied, how they relate to their practice and which parts of the Code are most relevant.

All registrants must collect five pieces of feedback, which can be written or verbal, formal or informal. The feedback can be given by patients, colleagues or managers, in the form of appraisals, serious event reviews or complaints.

The NMC recommends that registrants keep notes on the content of feedback, including how it was used to improve practice. Nurses should be careful not to record information that could identify other people.

Reflective accounts

To encourage nurses and midwives to engage in reflective practice and identify areas for improvement, the NMC requires registrants to write five reflective accounts of practice from the previous three years. These accounts must refer to CPD, practice-related feedback or experiences from professional practice. Nurses and midwives must then have reflective discussions with other NMC registrants about these five accounts and how they relate to the code of practice.

The NMC has produced a form to record the discussions, which are intended to ensure that nurses and midwives do not work in isolation and can talk about their professional development and improvement. They also offer nurses opportunities to respond constructively to feedback and reflect on how situations have affected them.

Finally, registrants must complete health and character declarations, stating whether they have been formally cautioned about, or convicted of, crimes, and that they have suitable professional indemnity insurance cover.

The requirements are:

  • 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

Nursing leaders say that revalidation offers specialist nurses the chance to highlight their skills and expertise, and the benefits they offer patients.

Opportunities

Outgoing RCN head of policy Howard Catton says: ‘Nurses need to embrace revalidation because it provides opportunities, not only to reflect on practice, but to think about how they can improve and develop themselves, and their teams and organisations.

‘There are those who think this is a difficult regulatory process with hurdles to be jumped, but this is the wrong mindset. Specialist nurses may have colleagues in management positions who have not grasped their potential.

‘Revalidation can be a helpful way to demonstrate to them the value of what specialist nurses do, how it benefits patients and improves services.’

Confirmers

Portfolios of evidence gathered by registrants are read by confirmers, who check that the requirements have been met. The NMC recommends that, where possible, confirmers are registrants’ line managers and says that line managers need not be NMC registered to act in this important role.

Where line managers are unavailable, nurses or midwives can take on the confirmer role. If they are unavailable, other regulated healthcare professionals can do so. In exceptional circumstances, professionals who do not work in health care can act as confirmers.

Registrants can log on to their NMC Online accounts to complete the revalidation forms. They should have access to their portfolios to confirm they have met each of the requirements.

Contact details

They will also need the names and contact details of their reflective discussion partners and confirmers.

No evidence has to be uploaded as part of this process, which does not have to be completed all at once. However, the annual NMC fee should be paid at this stage.

Within two days of submitting their applications, registrants should be sent an email to confirm that registration has been renewed. The NMC will check an undisclosed number of portfolios each year.

If a portfolio has been chosen for checking, the nurse or midwife concerned will be informed within 24 hours of submitting their application.

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

Mental health nurses set out their views:

Cris Allen, independent mental health nurse

‘It is sensible that a more robust revalidation is put in place, but getting the time to complete what is involved may be difficult. Mental health nurses are skilled at reflection and will be able to develop the required reflective pieces, but finding time and organisational support to undertake reflective discussions may be a challenge.

‘I am concerned that some nurses never have a proper appraisal and this will need to change if that is to provide one of the bedrocks to revalidation.

‘Time to develop and assemble the portfolio and revalidation material will challenge people as there is never any down time in the workplace these days, so it’s another thing to do in one’s own time. Education, development and training opportunities for nurses are becoming more sparse, apart from the required essential training, so it is questionable whether nurses will get the required, participative, and other, development sessions that they are required to undertake.’

Ian Hulatt, RCN mental health adviser

‘It may be tempting to assume that clients who are detained will be reluctant or negative in their responses to requests from registrants for feedback, but I don’t think that will necessarily be so.

‘Even the most ill people do appreciate what mental health nurses are doing in difficult circumstances, and will appreciate their kindness and patience when they have been most ill.

‘The reflective accounts will enable mental health nurses to celebrate the achievements they make with their clients and identify the skills used.’

Kate Hendy, memory nurse at Avon and Wiltshire Mental Health Partnership NHS Trust

‘A comprehensive method of ensuring that nurses are fit to practise is essential. Relying on individuals to validate their own work is a valuable process, but firming up on this and requesting practice related feedback is all to the good.

‘Reflective accounts have always been a feature of growing as a nurse and can help individuals identify further training needs. It can put nurses in a strong position when requesting training and it can help nurses look at training in a different way.’

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