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 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 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, and may include appraisals, serious event reviews, complaints or praise.

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.

Refelctive 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 over 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 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

Some children’s and young people’s nurses have raised concerns that it will not improve standards and that nurses will struggle to find time in their busy schedules to carry out revalidation. But nursing leaders say that revalidation offers specialist nurses the chance to highlight their skills and expertise, and the benefits they offer patients.

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.

Value

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

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 as confirmers.

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.

Portfolio

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. 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 (rcni.com/portfolio).

Children’s nurses views' on revalidation

 

Divisional head of nursing and clinical governance in the children’s and women’s division at Oxford University Hospitals NHS Foundation Trust Annette Dearmun

‘One of the most valuable parts is the reflective discussion. It is a good opportunity for children and young people’s nurses to look at their practice and, in particular, the patient experience and learning for the future. There is a tendency for people to learn from things that didn’t go so well but I would encourage nurses to also pick events where things went well so they can focus on the development of positive behavior that they want to see in their practice, rather than just the negative aspects. It is important that the confirmer facilitating the reflective discussion with the person undergoing revalidation is able to pull out the positive aspects from the events.’

Senior fellow in the faculty of health and social care at Edge Hill University, Ormskirk, Lancashire, Toni Bewley

‘Many nurses in practice and education are panicking about the process and contacting me and asking for me to write feedback on their practice. Revalidation is not going to have a positive impact on practice for children’s nurses. It may, however, ensure that people who are not actively fulfilling practice or continuing professional development hours must sharpen up, as they now have to get a confirmer signature.

I am concerned that the Nursing and Midwifery Council does not seem to have criteria for assessing the portfolio. It is not clear what happens if the nurse does not appear to have completed documentation satisfactorily.’

Lecturer in children’s nursing at the University of Leeds Joanna Smith

‘Revalidation offers a real opportunity for nurses across all scopes of practice to work with their manager to ensure their ongoing development needs are met.

There is no doubt that the current economic climate is driving the way care services are delivered, but safe and effective care can only be underpinned by nurses having up-to-date knowledge, and the skills and competencies necessary to deliver high-quality care.

‘For nurse academics, this will include demonstrating the quality of their teaching, learning and research activities. The vast majority of nurses, whatever their scope of practice, will already be meeting the requirements for revalidation.’

 

 

 

 

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