Analysis

Nursing’s first revalidators give the process an early vote of confidence

Ever since a 2011 Commons health committee report described the nursing regulator’s system for ensuring fitness to practise as ‘wholly inadequate’, the Nursing and Midwifery Council has been gearing up for revalidation.

Under the post-registration education and practice (prep) system, nurses could renew their NMC registration without much fear of having to prove they had spent 450 hours in practice and 35 hours on continuing professional development over the previous three years.

Revalidation promises to be more robust. When the replacement to prep was introduced in April, so were a number of additional requirements, such as the need for nurses to gather practice-related feedback and to write reflective accounts.

This month the NMC and professional organisations breathed a collective sigh of relief when the first audit of revalidation was released. So far the process has been a success; 14,362 of the 15,873 due to revalidate in April did so successfully. In addition, the total number of people who left the register last month (3,075) was in keeping with the proportion to leave in April over the past six years.

More will be known about the success of revalidation in the coming months, particularly after September, when almost three times the usual monthly average number of registrants are due to renew.

NMC chief executive Jackie Smith says nurses and midwives are embracing revalidation, ‘which should reassure patients and the public they are receiving safe care at the hands of professionals who regularly reflect on their practice’.

‘There was some anxiety that more might leave than had done previously’

RCN professional lead for education (standards and professional development) Gill Coverdale says it is reassuring that the numbers leaving the register are no higher than would usually be expected, adding: ‘There was some anxiety that more might leave than had done previously.’

Ms Coverdale praised the NMC’s efforts to ensure nurses were aware of the new process – including a revalidation website, case study films, emails to registrants and seminars.

The RCN, Unison and Unite have played their part by briefing members, and the first feedback from nurses who have completed revalidation is now filtering through.

Unite professional officer for regulation Jane Beach says: ‘Members thought it would be really onerous, but when they did it they thought it was good reflecting on what they had done and getting their evidence together.’

Ms Coverdale says RCN members have reported that revalidation is achievable and they have been able to find resources to help them through the process.

Unison head of nursing Gail Adams says while some found it ‘stressful’ trying to meet the requirements, ‘members commented on how easy they found the online process once they had completed their portfolio’.

Peak times

Just under one third (221,100) of the NMC’s total registrants (692,000) are due to revalidate by April next year.

Twice as many people are due to revalidate in September (51,200), compared with the second highest monthly total (25,000) next March.

This is because historically most nurses join the register in September, immediately after they qualify. This peak renewal month could also pose problems because it follows straight after the summer holiday period, Ms Beach says. ‘A lot is going to depend on registrants being organised. If they leave things late, like the reflective discussion or the confirmation meeting, they could find that the individual they need to do them with is on holiday.’

The NMC agrees that nurses should aim to meet the revalidation requirements early, so they have time for their reflective and confirmation discussions. It says extra staff will be in place in September, as was the case for peak renewal periods in previous years, and it has tested the system so does not anticipate difficulties for nurses submitting applications that month.

The NMC will soon announce which independent body it has chosen to undertake the formal evaluation of revalidation over the next three years.

But Ms Adams says the benchmark for revalidation’s success will be whether the vast majority of nurses and midwives renew their registrations. She says it will be important to find out the reasons why those who leave the register when they are due to revalidate choose to do so.

Unite plans to carry out surveys to find out more about people’s revalidation experiences, Ms Beach says. ‘We have not had any real difficulties raised with us, but after September it might be different,’ she says. ‘That will be the real test’.

For further information and resources visit RCNi’s revalidation webpage at www.rcni.com/revalidation

‘An interesting learning process’

Nurse Mary Makarau, pictured, who provides specialist support and care to HIV-positive people in their own homes, was part of the first cohort of registrants to revalidate successfully.

Picture credit: David Gee

She says her manager was helpful in advising her on what she should include in her revalidation application.

Ms Makarau, who works for Central London Community Healthcare NHS Trust, says: ‘It was helpful to have an extremely supportive manager, who was also my confirmer, involved right from the start of the process. It was an interesting learning process for us both.’

She adds that the reflective discussions gave her ideas on how to improve her future practice.

Her top three revalidation tips for fellow nurses are:

Start preparing for revalidation in good time to avoid any panic.

Collect information, such as achievements and training days, throughout the year and keep your records up to date.

Do not hesitate to seek help from the NMC, your manager or colleagues who have been through the process.

Revalidation timeline 1995 1998 2006 2011 2013 2015 2016
  Post-registration education and practice (prep) is introduced to ensure nurses and midwives stay up to date in practice. A survey of 3,000 nurses finds many are confused about what the system requires of them. A Nursing Standard investigation reveals that only 60 registrants have been checked for compliance with prep requirements since the introduction of a monthly checking system five years previously. The Commons health committee says prep is ‘wholly inadequate’, unfit for purpose and involves no routine assessment of whether nurses have met the minimum requirements. In his report into failings at Mid Staffordshire NHS Foundation Trust, Sir Robert Francis recommends a system of revalidation for nurses, similar to that for doctors. The NMC approves a model of revalidation. Revalidation is piloted in a range of healthcare settings. Auditors find large NHS organisations are aware of requirements but smaller ones are not. In October, the NMC council gives revalidation the go-ahead. Revalidation is introduced in April and 90.48% of the 15,873 registrants due to revalidate that month do so successfully. The NMC hails the system a ‘major success’.

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