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Trust trials new model of testing competency

In April 2016, the Nursing and Midwifery Council’s new revalidation model will come into force. The Western Health and Social Care Trust in Northern Ireland was one of 19 organisations across the UK that undertook a pilot to test the new model.

The April 2016 start date for revalidation – a new model that will require nurses to demonstrate every three years that they are fit to remain on the nursing register − is fast approaching.

Some nurses in Northern Ireland are among those who have already helped test out the model and their experience could offer guidance to other nurses and employers about to embark on this huge task.

A total of 122 volunteers from all sections of the Western Health and Social Care Trust took part in the Nursing and Midwifery Council (NMC) pilot earlier this year. The trust was one of 19 pilot sites in the UK.

From left: acting ward manager Annmarie O’Dwyer, deputy director of nursing Anne Witherow, executive director Alan Corry-Finn and clinical research nurse Sinead O’Kane

Trusts in Northern Ireland are integrated, providing health and social care, and covering both acute hospitals and community settings, so they may employ a broader range of nurses than English trusts.

Under revalidation, nurses will need to complete 450 hours of nursing practise every year, plus 40 hours of continuing professional development (CPD) every three years.

The trust’s deputy director of nursing Anne Witherow says that when roadshows were first held on revalidation some years ago ‘there was a sense of nervousness among staff that this was going to be beyond them’.

She adds: ‘But my sense was that this was the right thing to do and we should not step away from the challenge.’

Each of the trust’s 22 lead nurses involved in the pilot took responsibility for recruiting volunteers from their areas to ensure there was good representation from across the trust.

The trust started to recruit in January and February this year with the end of May being the cut-off date for getting all the information for revalidation together, giving the participants a short timescale to complete the work needed.

From left: Sinead O’Kane, Annmarie O’Dwyer and Anne Witherow

Picture credit: Harrison Photography

The reflective writing quickly came through as a key concern: 111 out of the 122 nurses chose to attend a workshop on the activity. ‘That tells you something,’ she says. ‘They do it anyway at the bedside or in the patient’s home… they reflect all the time.’

Ms Witherow says of the pilot: ‘We are in a much stronger position to say to nurses this is a challenge but you can do it.’

The experience has crystallised the importance of the confirmer in the process, but the trust has around 150 nurses whose line manager is not a nursing professional. The trust wants conversations around professional development and reflective pieces to be done by another nurse in these cases. ‘That is critical for the validity of the process,’ says Ms Witherow.

‘We need to skill people up to have these fairly courageous conversations with others,’ she adds. ‘The confirmer is critical. We are seeing this as a professional decision.’

Ms Witherow suggests there could be a three-way conversation between nurse, line manager and professional confirmer in such cases.

Two-way partnership

Executive director of nursing and primary care older people’s services Alan Corry-Finn adds that for some nurses who are not in traditional front line jobs, there is a need to identify opportunities that will contribute to their portfolio.

But overall he says: ‘The staff who agreed to undertake the pilot found revalidation easier than they thought.’

The pilot, however, has exposed issues about culture. Ms Witherow says nurses were expecting the trust to do things for them rather than taking it on themselves as part of their professional role. This will need to be changed when nurses embark on revalidation for real.

‘It does encourage you to think about what you are doing and the study days you do’

Nursing Standard spoke to three nurses at the Western Health and Social Care Trust about their experience of the revalidation process.

Home dialysis nurse Bridgeen Canning says that some parts of the process were time consuming, but overall her experience was positive.

She says that the CPD requirement was relatively easy to meet as mandatory courses could be included; what took time was collating evidence of the courses she had attended.

The reflections had to be done in her own time for the portfolio. ‘Having to learn how to link the code to what I learned from courses has been beneficial,’ she says.

Annmarie O’Dwyer was acting up as ward manager on an acute medical unit when she volunteered for the pilot. ‘I was quite scared about revalidation because I did not know what my role as a ward manager was going to be in it and I wanted to find out.’

She had concerns about the information she needed to submit for the CPD section because certificates were not always provided after in-house training or teaching sessions by drug company representatives, she says.

However, she had undertaken sufficient training for this not to be an issue. She highlights reflective writing as probably the most challenging part of the portfolio for many nurses.

‘As the manager of a unit I was concerned about getting people to take ownership of this,’ she explains. ‘A lot of people thought it was the manager’s responsibility. Other managers have come across the same.’

Valuable component

Conversely, reflective accounts were also identified as one of the most valuable components by nurses who said that they made them reflect on their practice in a useful way.

The pilot also highlighted the importance of annual appraisals in providing two-way feedback to help nurses meet NMC requirements and to provide early warning of difficulties.

Clinical research nurse in critical care Sinead O’Kane says that initially switching to revalidation from the post-registration education and practice (PREP) system was time consuming because existing information stored electronically under the old model could not be moved across. However, the Northern Ireland Practice and Education Council for nursing and midwifery has now produced a revalidation portfolio site.

Ms O’Kane says some nurses may be in settings where contact with their line managers is infrequent. Colleagues and peers may be better placed for confirming they have undergone revalidation.

She says the ‘jury is out on whether this is the right format’ but adds: ‘It does encourage you to think about what you are doing and the study days you do.’

Overall, all three nurses seem positive about the process. Their concerns centred on the time taken to put together the portfolio.

‘Going forward, keep it updated,’ says Ms O’Dwyer. ‘If you continually chip away at it, it shouldn’t be a laborious task anymore.’

‘We will play our part but you have to remember it is a partnership,’ she explains.

The need for that support is being taken on board by the trust. Mr Corry-Finn says: ‘You need some dedicated support on the ground. I know some people’s view is that revalidation is an issue for registrants but it would be a vast challenge for us if a number of people did not revalidate.’

Staff who undertook the pilot found revalidation easier than they thought

He adds that trusts also need to think about aspects such as IT and how records are stored and their availability to nurses.

The importance of appraisals is also central. These offer a chance to check how nurses are coping with revalidation, raise any issues and is an opportunity for the nurse to highlight any concerns they may have. For example, they may need to complete more CPD hours.

Raising these issues at an appraisal provides an opportunity for any problems to be resolved well in advance of a revalidation deadline – although Ms Witherow stresses that appraisals should not be linked with fitness to practise.

Well organised trusts – such as the Western Trust – are appraising staff regularly, but that is not universally true in the NHS, let alone in smaller settings. Mr Corry-Finn says that the importance of appraisals in revalidation re-emphasises the role of the ward manager, charge nurse or team leader who is likely to be involved in them.

There are also practical steps that trusts can take to make the introduction of revalidation easier. One is shaping ‘revalidation’ for their organisation – how many staff need to be revalidated and when over the three-year process. The Western Trust discovered that there were peaks in July and September each year, although total numbers were spread fairly evenly over the three years.

NMC director of continued practice Katerina Kolyva says the feedback from the pilots has been that revalidation is achievable. ‘When you do it for the first time you always put more time, effort and resources into it, and possibly more anxiety. I think all the anxieties will be alleviated’.

‘Start now’ would be our message

The Northern Ireland Practice and Education Council (NIPEC) for nursing and midwifery was asked to support revalidation by Northern Ireland chief nursing officer Charlotte McArdle. It has been working closely with the NMC and appointed Frances Cannon as project manager.

Communication with nurses as well as employers has been an important strand of its work, and NIPEC has been working to raise awareness across Northern Ireland about the revalidation process.

The council has run more than 40 roadshows to date, which have attracted 1,736 registrants. ‘Registrants are keen to get information,’ says Ms Cannon. ‘People have so many misconceptions.’

NIPEC will also have a revalidation video on its website and has updated its online development portfolio to allow registrants to record everything needed for the revalidation process.

There has been a shift in consciousness around revalidation, with more registrants seeking further details from the NMC.

Ms Cannon says feedback from Northern Ireland has proven vital to influencing the national revalidation programme. The big concern has been the reflective pieces and the need to demystify what’s involved. ‘It’s something that registrants are doing anyhow; it is just committing it to paper and writing it down.’

And she adds: ‘The message is start now. As time goes by, this may well become second nature.’

Read more about NIPEC’s work in next week’s Nursing Standard

For further information and advice on revalidation visit www.rcni.com/revalidation. Read the Nursing and Midwifery Council's guide to revalidation at www.nmc.org.uk/standards/revalidation .

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