Big lessons in revalidation

A huge revalidation pilot at Aneurin Bevan Health Board in Wales – more than 800 staff embarked on the process in February – has delivered important lessons for other organisations and individual registrants about what to expect when they begin the process.

When it comes to revalidation pilots, they don’t come any bigger than the one at Aneurin Bevan University Health Board in Wales.

Nearly a quarter of the board’s nurses have now gone through the revalidation process, and the senior nurse on the revalidation team, Carolyn Middleton, is delighted with the uptake.

This is not just about the nursing profession, it is about public protection

All nurses who were required to submit their three-yearly notification of practice form in the first nine months of this year were invited to join the pilot. Out of just over 1,000 nurses in this cohort, 888 said they would do so – and 813 of them completed within a relatively tight timescale. Twenty-two of those who said they did not want to take part later changed their mind, and have been able to participate partially.

Dr Middleton says that there was some ‘general anxiety’ about the process at the start of the pilot in February. But these fears dissipated as it progressed, and most registrants found the process relatively easy.

One of the more challenging aspects was collating evidence of practice hours. ‘It is not difficult but it is fiddly and the template did not lend itself to it,’ she says. ‘People did have anxieties about the reflective pieces but I would not say it was a massive problem.’

The need to have feedback as part of the reflective process did concern some nurses. ‘People were not sure what was expected of them,’ she says. However, one registrant devised a template to record feedback, which was then shared and used by many others.

Senior nurse Carolyn Middleton’s advice is to start your revalidation early so you have plenty of time to prepare

Dual registration

One significant outcome of the pilot concerned those with dual registration as both a nurse and midwife. Although the number of hours has not changed, revalidation will require them to provide more evidence of practice hours in both areas.

Jane Dale (left), assistant director of organisational learning at Aneurin Bevan University Health Board with nurse director Denise Llewellyn

Those who are actively using both parts of their registration, or who are doing a shift a month in their secondary area to ensure they meet the hours requirement, have had no difficulty in this. But a number of those who are not actively practising in both areas are now uncertain whether they will try to keep up their dual registration, says Dr Middleton.

RCNi’s revalidation portfolio is available free to subscribers at rcni.com/portfolio.

The portfolio – which allows you to log your CPD evidence, practice hours, reflective accounts and appraisals – is NMC compliant and portable, so you can take it with you throughout your career

The health board decided to do what it could to support nurses who were not directly employed by them, but who were part of the local health economy. These included nurses working in general practice surgeries and care homes. Many of these nurses work without a large team of peers around them and face particular challenges with revalidation – such as the need to have a nurse carry out their professional development discussion (PDD); this was achieved by using nurses from outside their immediate teams in some cases.

The practice nurse: ‘Revalidation is brilliant’

Dee Caulfield (pictured below) is the lead nurse in a general practice in Chepstow and volunteered to take part in the pilot to support a colleague who was going through the process.

Dee Caulfield: impressed with the pilot

She says revalidation is ‘absolutely brilliant’. ‘It is an essential means by which nurses can prove they are doing what they are supposed to be doing. It can’t help but raise standards,’ she says.

Many of her team were concerned about the reflective writing and she acknowledges it can be an issue for nurses who trained before reflective practice became so prominent. However, the process of reflection was already being embedded and the team is adopting an appraisal tool developed by the health board that will link to elements of the revalidation process.

She did, however, struggle with having to get everything done in just over two months.

As the senior nurse in the practice, she had to look outside the organisation for the nurse who could carry out her professional development discussion (PDD), although she could fill this role for other members of staff herself. She completed the process two days before the deadline.

Ms Caulfield now has an online document that she updates each time she does something relevant to revalidation.

So what would Dr Middleton’s advice be to other organisations? She says they should encourage nurses to start the process early: their registration will be at risk if they miss the deadline.

Aneurin Bevan produced a ‘revalidation in 16 days’ guide for those who needed more structured support; this detailed one action a day that would allow them to complete the process.

The dual-registered midwife: ‘It was an absolute nightmare’

Not all registrants had a good experience. One community midwife who is also qualified as a nurse, and who did not want to be named, found the process extremely time-consuming, mainly because she was one of a small number of registrants selected to provide further information to the NMC as part of its checking processes. She has limited access to IT at work and found providing this information onerous.

She is critical of the information provided by the NMC, saying she was uncertain how much documentation she needed to supply.

‘It was an absolute nightmare,’ she says. ‘I am reasonably computer-literate but I got anxious when I could not upload what I wanted to.’

All of the IT issues have been reported to the NMC and some collaborative work between the regulator and Aneurin Bevan’s IT department and revalidation team is now taking place.

As well as being a midwife, she works in a gynaecology clinic, which counts towards her practice hours as a nurse. She says some dual registrants found it difficult to get clarity about what part of their practice would count for nursing or midwifery.

‘I seriously considered putting in my notice because it was so complicated,’ she says.

‘We want to get people into the mindset that they need to have prepared in advance to get it in,’ she says. Nurses due to go off work need to plan. And those who change jobs coming up to revalidation need to think about evidence from their old employer.

‘We are linking revalidation to our annual review process,’ she adds. ‘We want to map where nurses are in terms of their revalidation each year.’ This can flag up problem areas in advance and minimise the chances of nurses falling off the register because they have not completed the process.

Nurse director Denise Llewellyn stresses the importance of top-level support for revalidation. ‘This is not just about the nursing profession, it is about public protection,’ she says. ‘It is important that the organisations sign up to it.’

The hospital nurse: ‘It was a little bit time-consuming doing reflections’

Julie Perry splits her time between working as a recovery nurse at the Royal Gwent Hospital, Newport, and as a clinical nurse specialist in pain.

She found going through the revalidation pilot relatively painless, and was one of a number of nurses going through the process from her area. ‘As long as you were doing what you were meant to be doing and had done your study days, it was fine,’ she says.

‘People were apprehensive about the reflections. It was a little bit time-consuming, especially because we only had a short time to do it,’ she adds. ‘But there were quite a few templates that had been set up for us and they were useful.’

Her advice to other nurses is to ensure they keep records from study days and other training, and to look out for appropriate opportunities to gather feedback.

IT and HR departments need to be involved, but she also sought to learn from doctors’ experience of similar systems. ‘The registrant is accountable,’ she says. ‘We need to make this as simple as we can for the individual on the front line.’

The board is looking at whether the electronic staff record can collate practice hours and CPD hours to save nurses having to do it.

It has been a huge opportunity to revitalise the beliefs and values of the profession

Both Ms Llewellyn and Dr Middleton say there have been many positives from the pilot. Nurses’ awareness of the new NMC code of conduct has been raised because revalidation’s learning activity has to be underpinned by the Code.

The nurse manager: ‘I feel ahead of the curve’

Assistant director of organisational learning Jane Dale (pictured) had been keeping a portfolio for the PREP system, but admits it was a bit disorganised.

The revalidation pilot means she had to spend some time sorting it out. ‘In a way it was helpful because I needed to put it into some sort of framework, which is a good discipline,’ she says.

‘One of the challenges for me as a manager was to demonstrate what part of my time was related to my nursing and clinical skills, and what part of it related to other parts of my role.’

The answer for her was to go through her diary and mark up how each block of time had been used. She used colour coding to map this.

Ms Dale works closely with the medical director. Doctors who are involved in a serious incident are asked to write a reflective piece about it, an approach that could be extended to nurses as part of their revalidation, she suggests.

‘I have a lot of meetings with families after something has gone wrong. I probably need to include in my reflections a little bit of the feedback from those.’

She adds: ‘I feel ahead of the curve because when revalidation comes around again, I am prepared and I can support my team when they come up to it.’

Her portfolio was signed off by senior nurse Carolyn Middleton after she had undergone a professional development discussion.

‘It has been humbling to listen to the things people have been doing,’ says Dr Middleton. Ms Llewellyn adds: ‘It has been a huge opportunity to revitalise the beliefs and values of the profession’.

See Nursing Standard’s revalidation coverage at tinyurl.com/pg6834b Carolyn Middleton and colleagues have published a CPD article in this month’s Nursing Management. Go to journals.rcni.com/r/nm-revalidation

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