Revalidation: getting your practice-related feedback right
It’s an essential part of revalidation, but gaining feedback from a variety of sources can seem daunting. Here’s how to make the process straightforward.
It’s an essential part of revalidation, but gaining feedback from a variety of sources can seem daunting. Here’s how to make the process straightforward
Seeking practice-related feedback is an essential part of the revalidation process. But gaining the necessary five views, from varied sources, on your care and work can be a challenge for nurses going through the Nursing and Midwifery Council’s (NMC) mandatory scheme to re-register.
Hampshire-based ophthalmic nurse Jane Bates, writing in Nursing Standard, describes asking patients for feedback as the worst aspect of revalidation. Although she acknowledges patients are a valid source of feedback, she says asking for it raises ethical issues. ‘I find it difficult, nay impossible, to ask a patient to feedback on my "performance",’ she says. ‘What if they thought I was only treating them well for the sake of a glowing report?’
Anecdotally, nurses say this is one of the more difficult aspects of revalidation, the system introduced in April 2016 to demonstrate that nurses can practise safely and effectively. Providing five items of practice-related feedback is one of eight steps that every nurse must complete to re-register every three years, as well as completing 450 hours of practice and five written reflective accounts.
Thank you letters
The practice-related feedback requirement is intended to encourage nurses and midwives to be more responsive to the needs of patients and service users.
Nursing Standard's senior nurse editor Richard Hatchett says there are some simple ways to make the procedure easier. To help our readers get the most from revalidation and to make the process as smooth as possible, Nursing Standard provides revalidation information and resources online. Our weekly reflective accounts and practice-related feedback articles show how registrants have gathered feedback, how they have reflected on it and how this has informed their practice.
‘The main aim of practice-related feedback is being able to reflect on it,’ says Mr Hatchett. ‘The key is to get a variety of feedback from a range of sources. People presume it is patient-related feedback – everyone was shocked at first and thought it was outrageous that we have to ask patients. Our world is our patients, but it is practice-related feedback, which means it can come from a variety of sources. The idea is that we look at the feedback and reflect on it against the Code.’
‘Nurses often don’t capture when patients or colleagues thank them. They need to consider noting more conversations’
Even nurses in patient-facing roles don't need to get all their feedback from patients. In fact, the NMC makes it clear that a range of sources is preferable. Nurses do not necessarily need to quiz their patients about the care they receive, as they can note down casual conversations and remarks made by patients and families, or use written information such as thank you cards or letters.
In an example given by the regulators, appropriate sources of feedback include positive verbal feedback from a student the registrant is mentoring, a thank you letter from a patient, verbal feedback given in an annual appraisal, a written complaint from a patient about care she received on a ward and verbal feedback from a colleague.
Positive or constructive
The NMC says that team performance reviews and serious event reviews could be used as sources. Feedback can be formal or informal, written or verbal and positive or constructive.
Nurses should keep a note of the feedback, including how it was used to improve practice, which could be helpful when it comes to preparing the five reflective accounts. However, they should not record any information that might identify an individual, even if the person has died.
The NMC also suggests registrants consider how the feedback relates to the Code, and this could be expanded on by including it in one of their reflective accounts.
‘Feedback when something hasn’t gone as well as intended raises self-awareness and helps us consider how we would like to be or what we can learn for next time’
The University of Surrey's head of the school of health sciences, Melaine Coward, encourages nurses to be creative and courageous in their choice of feedback, so that they get the most out of the experience. Dr Coward says nurses often don’t capture when patients or colleagues thank them. She says she has used a complimentary text message she received from a colleague as a piece of practice-related feedback, and says that nurses need to consider noting down more conversations or messages.
Along with a range of sources, a variety of responses is also helpful. Dr Coward says nurses can gain a lot from negative feedback, if they consider how it relates to the Code, how they reflected on the experience and what they learned.
‘It is brave to hold up your hands and say "I wasn’t that great",’ she says. ‘You are being brave enough to demonstrate that you have the right to remain on the register. You can learn the most from it when you say "I am not perfect and have got things wrong".’
University College London Hospital nursing and midwifery revalidation lead Alison Finch says that feedback helped her discover more about herself and her practice.
‘It is about learning something new or different about myself,’ she says. ‘There is still a misconception that it is about selecting examples that offer assurance to your reflective discussion partner or confirmer that you are a "good nurse". It is about pausing to acknowledge and appreciate your contribution to patient care, but it’s also about reflecting on feedback that offers professional challenge, when something hasn’t gone as well as intended. It’s this kind of feedback that raises self-awareness and helps us consider how we would like to be or what we can learn for next time.’
Practice-related feedback: the facts
• It is intended to encourage nurses and midwives to be more responsive to the needs of patients.
• Should be used to assess and make improvements to your practice.
• Can be obtained from a variety of sources, including patients, students, colleagues, managers, complaints, appraisals and team reports.
• Can be about your individual practice or about your team, ward, unit or organisation.
• Can be formal or informal, written or verbal, positive or constructive.
‘Choose people who will be objective’
Lee Thorogood did not find completing the practice-related feedback element of revalidation straightforward, as he was working in a role that did not involve patient contact.
Mr Thorogood, who now works for HM Prison Downview in Sutton as head of healthcare, worked for a clinical commissioning group in 2016 when he revalidated. He sought the views of five colleagues, but feels that this was of limited benefit, as he managed them all and wonders if they would have felt unable to provide honest reviews.
‘You should choose people who are going to be objective, but by nature you choose people who you like and get on with, and it was quite flattering,’ says Mr Thorogood. ‘I think that nurses should have to collect more than five pieces of feedback and there should perhaps be a way of providing it anonymously, so that the nurse doesn’t necessarily approve it.’
Having learned this from his first experience of revalidation, he will seek feedback from a range of sources next time. He expects that, working in a prison, it may be possible to get a wider range of views, for example from nursing colleagues, officers, the governor and prisoner advocates, but adds that asking prisoners for their views could be inappropriate, as there is a power imbalance in the relationship.
Erin Dean is a freelance journalist