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Final lessons from road-testing revalidation

As of April 1, all nurses and midwives will have to revalidate with the Nursing and Midwifery Council every three years to remain on the register. The largest of the UK revalidation pilots took place at Aneurin Bevan University Health Board in Wales. This article looks at how the pilot experience has equipped the board to predict nurses concerns and steer them through the revalidation process.

Revalidation is rapidly becoming a reality for many nurses and their employers, with the first cohort of nurses and midwives having to complete the process by April 1 to remain on the register.

But some areas have a head start: they were part of last year’s pilot schemes, which were designed to test the system in practice. The experiences of these sites have now been evaluated and have influenced the introduction of revalidation across the UK.

The positive news is that the Nursing and Midwifery Council (NMC) has listened to many of their concerns, and the sites have found being part of a pilot has helped them prepare to put more nurses through revalidation.

Aneurin Bevan University Health Board assistant director for patient safety Jane Dale (left) in a reflective discussion with Carolyn Middleton

Picture credit: Martin Chainey

The biggest pilot site was the Aneurin Bevan University Health Board in Wales, which was featured in Nursing Standard last October (journals.rcni.com/doi/abs/10.7748/ns.30.6.18.s21). Just over 1,000 nurses and midwives were invited to take part in a pilot last year, starting in February, with 888 saying they would and 813 completing the process.

The work done with the cohort of nurses in the pilot has meant the board can predict what the major concerns will be, and the ‘pinch points’ in steering them through revalidation. It is now staging weekly workshops for those coming up to revalidation, and one-to-one work with those who need it.

Senior nurse on the revalidation team at the health board Carolyn Middleton says: ‘They spend just over an hour with us in a workshop, and we don’t want anyone to go until they are happy and know what they are doing.’

Nurses due to revalidate can be identified through the electronic staff record used in Wales and England, enabling them to be targeted with invitations to the roadshows. This is being done several months in advance; the June cohort had already been contacted in February, and by the end of February many nurses due to revalidate in April had completed everything they needed.

Although the NMC is contacting people 60 days before their revalidation, some registrants may find this leaves them short of time.

Despite the high-profile pilot, a large number of nurses in each cohort at the health board did not know when they were due to revalidate until they were contacted.

‘The lack of understanding is surprising,’ says Dr Middleton. ‘About a quarter of people who come to our sessions don’t know their dates.’

Falling off the register

Those revalidating in April need to have completed the process on the first day of the month. One concern is that nurses think they have until the end of the month, so risk falling off the register at that time. If this happens, they will need to re-register, which can take up to six weeks. Nurses who fall off the register will not be able to work as a registered nurse in that time.

People remain worried about reflective accounts, but once we take them through it they are fine

‘We are encouraging people to try to finish a week early, so if they have a problem they have a couple of days’ breathing space,’ says Dr Middleton. This could allow time to find a new confirmer if the intended one was off sick, for example, or to find additional details of continuing professional development.

Top tips from the Welsh pilot

Identify nurses due for revalidation several months before the actual date to allow plenty of time for them to prepare the required evidence.

Remember that nurses who are due to revalidate in any month need to submit on the first day of the month. If they miss this date, they will fall off the register at the end of the month.

Running workshops for nurses well in advance of their revalidation date can quell many anxieties. However, some nurses will need one-to-one time.

Consider setting up a working group to enable revalidation teams in different areas to share experiences and learning, and also responses from the NMC to queries. In Wales this has been helpful.

Expect to have a rush of people who submit in the last couple of days, and ensure those leading on revalidation are available to help them.

In the Aneurin Bevan pilot, 270 out of the 813 nurses and midwives who completed the process did so in the two days before the deadline. Although they were working to a shorter deadline than normal, this indicates that NHS organisations should expect a rush in the last few days of each month and may need to offer support during this time.

This, she says, has confused some people. But she adds that many concerns about the process can be dispelled relatively quickly, and she has yet to find anyone who has not done the required hours, even if they have had maternity or sick leave during the three-year period before revalidation.

Staff members who are dual registrants need to demonstrate practice hours in both areas to revalidate, and it is not always easy to be clear what is nursing and what is midwifery.

‘I don’t think there is sufficient clarity from the NMC on what constitutes a nursing activity and what constitutes a midwifery activity,’ says Dr Middleton. She suggests that some people, although not in her board, may decide to give up one registration in these circumstances.

The requirement to write five reflective accounts has also concerned many nurses in the pilot. ‘People remain worried about reflective accounts, but once we take them through it they are fine,’ she says. The NMC form for this is helpful, she adds, as it makes clear reflective accounts don’t have to be essays and can involve a list of bullet points.

Revalidation champions

How well some other aspects of revalidation are working may take longer to assess, adds Dr Middleton. For example, the system of having confirmers and someone to sign off the reflective discussions has worked well so far, with nurses able to find suitable people who are willing to take on the role. But there could be some nurses, particularly those working in isolated or unusual jobs, who will struggle to find appropriate people for this.

So has the experience of the pilot been reflected in what the NMC has done to refine the revalidation process? Dr Middleton says some things have changed in response to concerns raised, such as issues with uploading additional information. This will only be requested for a few registrants, but it is a big issue for those affected. The NMC has changed what it does in such cases and will initially go to the confirmer, rather than the registrant.

From now on, the revalidation process should become easier. Dr Middleton says: ‘As more people do it, we get closer to a crucial mass of people to support others. We are using the people who have already done it as champions, because they can offer reassurance and guidance’.

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