Analysis

Care home nurses may desert rather than face revalidation

Two months ago, the Nursing and Midwifery Council launched a revalidation model that all nurses and midwives in the UK will have to undertake to maintain their registration.

Two months ago, the Nursing and Midwifery Council launched a revalidation model that all nurses and midwives in the UK will have to undertake to maintain their registration.

The new model aims to raise awareness of the NMC Code, the professional standards expected of nurses, and better ensure that nurses can deliver care safely.

It replaces post-registration education and practice requirements (prep) and nurses will need to revalidate every three years to renew their registration.

Some of the requirements are similar to prep and should be seen as an extension to what nurses did under the old system, according to the NMC.

By April 2019, all 685,000 nurses and midwives will have gone through the system.

While revalidation requirements are the same for all nurses, in some sectors nurses – particularly those working independently or in isolation – may find the re-registration process more daunting.

Revalidation requirements:

  • 450 practice hours or 900 hours if revalidating as both nurse and midwife
  • 35 hours of continuing professional development. Of those, at least 20 hours must have included participatory learning
  • Five pieces of practice-related feedback
  • Five written reflective accounts
  • Reflective discussion
  • Health and character – fit and able to practise
  • Professional indemnity arrangement
  • Form signed by confirmer

At a recent event held by recruitment consultancy Liquid Personnel for adult social care recruiters, HR directors and recruitment consultants expressed concerns about care home nurses being overwhelmed by the prospect of revalidation.

One HR director said: ‘We thought nurses were being inundated with information about the requirements, and yet we still hear nurses who are confused about it or do not understand it. Nurses do not get the fact that we cannot physically employ them if they do not revalidate. If they don’t revalidate, they are no longer on the register.’

Cost implications

HR directors and consultants discussed the cost implications should nurses fail to revalidate, which could further worsen the current nursing shortage in the sector.

One recruiter to care homes said: ‘An increasing number of nurses who are nearing retirement will just leave.

‘A couple of nurses have said they won’t renew their Pin but will look for jobs in their field that do not require it.’ The concerns have also been expressed in other forums, and by the nursing profession too.

Crisis in recruitment

A nursing lecturer from South Wales, who places pre-registration nursing students in care homes and trains mentors, told Nursing Older People: ‘We already have a crisis in recruitment in this field and nurses say that revalidation is the final straw and that they see no reason to do it when they can just give up nursing. For many nurses revalidation is an extra burden. It is very disheartening.

‘Nurses in care homes are in such short supply and to lose so many experienced staff will be a huge blow.

‘A dire staffing situation for nursing homes could fast become critical which will ultimately impact on the care of our older people.’

Access to training

She adds that nurses in care homes often struggle to obtain CPD because of difficulties getting time off for training or because they have poor access to the internet and other learning materials in their workplace. Finding people who can act as confirmers can be tricky in care homes too, she says.

She fears nurses’ concerns about revalidation could jeopardise her mentorship training programme – a process that takes three months for each individual.

‘I worry I could lose a number of my mentors,’ she says. ‘We can’t afford to lose them as they are so passionate about the job and they want to show young students that working in a care home is not what they think it is.’

Buddying arrangements

Amanda Scott, managing director of Sunrise Senior Living, which owns 27 care homes in England and Wales, says her organisation has taken steps to help nurses prepare for revalidation, such as through providing revalidation and clinical skills workshops.

Deputy nurse managers have buddying arrangements to enable them to do reflective discussions with peers across care homes.

The care home provider also runs a six-day RCN-accredited clinical governance development programme to provide nurses with face-to-face learning and foster advanced clinical skills.

Supporting staff

‘There’s already a shortage of nurses, which is a great shame, so we took the decision to ensure we supported our staff in preparing for revalidation to prevent nurses leaving the register as much as possible,’ she says.

‘We have not had anyone tell us that they are falling out of registration because they do not want to revalidate, and we believe that’s because they feel knowledgeable and supported.

‘My experience with any new regulation or process has always been to put the underpinning work in as early as you can so people feel they can put in place the steps or actions required.’

RCNi survey reveals concerns

RCNi, which publishes Nursing Older People, recently surveyed nurses about their ability to access CPD, and two thirds (65%) of the 2,909 registrants (including 495 older people’s nurses) who responded are concerned about being able to fulfil the required CPD hours.

A total of 81% of nurses would like protected time for training.

Reasons nurses give for falling behind with CPD include lack of time, backfill, funding and manager enthusiasm.

Campaign

RCNi has launched the #1hour2empower campaign calling on employers to support nurses by giving them protected time for training.

Public Health England nursing and midwifery revalidation lead and Queen’s Nurse Helen Kirk says she has heard of care home nurses having difficulties gaining access to information or a registrant line manager.

‘Providers need to look at how they can get the message out to nursing homes or managers of care homes,’ she says. ‘The accountability for revalidation resides with the nurse and is not an organisational responsibility, but employers need to make sure managers understand the process and what they need to do to support their staff.’

The RCN runs events and provides information resources that HR managers and employers can access to help guide their staff through the process.

Help for employers

RCN professional lead for education standards and development Gill Coverdale says: ‘We feel that our role is to support employers as well as registrants and we have a department that works specifically with the independent sector to build confidence and capacity.

‘We are reassuring anyone we meet or advise that revalidation is achievable; it builds on prep, but has additional criteria that those who have gone through revalidation attest to being doable.’

Between April this year and the end of March next year, 221,100 registrants are due to go through the revalidation process. Of those, the NMC projects that up to 29,300 could leave the register (13.3%). Of the first cohort in April, 1,401 (8.8%) of the 15,873 who were due to revalidate left the register. Just over 90% successfully revalidated, while the remaining few registrants are currently involved in fitness to practise proceedings.

The NMC says the figures are in line with what it would usually expect for those who leave the register.

‘Since the revalidation pilots we have run a series of workshops across the country targeting nurses working in the independent sector, walking them through the revalidation process,’ says an NMC spokesperson. ‘We’ve also run a series of workshops targeting employers, including care home managers, giving them an introduction to revalidation and guidance on how to support their nurses through the process.’

Learning from pilot sites

Bupa UK Care Services was one of 19 pilot sites to provisionally test the model across health and social care settings last year. It employs approximately 4,400 nurses across 280 care homes in England, Wales and Scotland.

The organisation has used the learning from the pilot to make adjustments and reassure staff about completing the process.

It runs revalidation events, has a UK-wide revalidation co-ordinator and has deployed revalidation champions to support those needing assistance. It also alerts all nurses of their forthcoming renewal date. All managers have also been informed – particularly those who are non-clinical – to ensure they fully understand the requirements.

Bupa UK Care Services head of professional and practice development, care and quality Paul Edwards explains: ‘We need to make it straightforward so they see it as a natural part of being a nurse.’

Career pathway

The organisation has also put in place a learning and development career pathway for staff so that there are opportunities for training and developing skills. Managers meet directly with nurses to talk about the requirements of revalidation, including the organisation’s use of paper-based portfolios for gathering evidence.

‘We want revalidation to sit alongside nurses’ learning and development and not be seen in isolation,’ he says. ‘Staff feel more confident when processes are in place to support them and they can see us investing in their development.’

Jennifer Sprinks is RCNi assistant editor

More information

NMC's step-by-step guide to revalidation

RCNi revalidation resources 

RCN's revlidation guide

 

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