Career advice

Paul Vaughan: Reflective practice will give nursing its voice back

Employers and nurses have a lot to gain from reflective practice, says RCN West Midlands regional director Paul Vaughan

Reflective practice can be a powerful agent for change. Picture: iStock

The nursing profession prides itself on its ability to reflect on practice to improve patient care. Yet we have seen a number of high-profile cases in recent years where care has not been provided at the level you would expect. 

In his 2013 report on the inquiry into poor care at Mid Staffordshire NHS Foundation Trust, inquiry chair Sir Robert Francis QC suggested the Nursing and Midwifery Council (NMC) introduce a system of revalidation similar to that of the General Medical Council. 

Central to the new revalidation process, introduced in April last year, is the need for registered nurses to provide evidence of reflection on their practice, and to engage in a reflective discussion with another registered nurse about their work. 

Giving nursing a voice 

When used effectively, reflective practice enables nurses to integrate their emotional response and practical experience into a better understanding of the care they deliver. It guides them in their practice to incorporate research and apply theory, to ensure patients receive the most up-to-date and effective care. This is a powerful agent for change. 

Re-establishing a culture of reflection will enable nurses to question why things happen, rather than how. Reflective practice will give nursing its voice back. 

Nursing can be lonely, especially in challenging times, and while nurses can make time to reflect alone, the true power of reflection is in sharing your thoughts and feelings with a fellow practitioner. 

The NMC’s decision to require nurses to have a reflective discussion with a fellow registrant is a good one. As well as helping nurses to expand their thinking on their practice, sharing information with another nurse is a supportive experience. 

‘On action’ to ‘in action’

Employers have a lot to gain from nurses taking part in reflective practice. As nurses reacquaint themselves with the skills of reflection, they can move from reflecting ‘on action’ to reflecting ‘in action’. 

Reflection on action, which is part of the revalidation process, involves looking back at something that happened and learning from that experience, so that practice can be improved. As we develop our reflection skills, we can become more adept at reflecting in action. This means that we are paying attention to our feelings as an event unfolds, and how these feelings impact on our behavioural responses at the time. 

Thinking about how the theory would apply in the situation we are facing at that moment leads to nurses being able to have an even better response to the challenges they face in their daily work, and improves patient care. 

It is therefore essential that nurses and employers do not see the NMC requirement for a reflective discussion as a tick-box exercise. If employers truly believe that staff are the most important resource they have, they need to ensure nurses have protective time to reflect on their practice.

Jobs Fairs in 2017 

Paul Vaughan will be presenting his talk on reflective discussion for revalidation at the RCN Bulletin Jobs Fair at the NEC in Birmingham on 2-3 March. For more information, including the seminar programme and a full list of exhibitors at the event, visit the jobs fair website here.

Jobs fairs will be held on the following dates this year:

20-21 April – London 
8-9 June – Glasgow
5-6 September – Liverpool
3-4 October – London


Paul Vaughan is RCN West Midlands regional director