Revalidation for practice nurses

Much of the information available on revalidation is – unsurprisingly – aimed at the majority of registrants who work in large institutions, leaving many practice nurses unsure how they will fulfil the NMC’s requirements. Further clarification is expected but in the meantime, the NMC’s Director of Continued Practice Dr Katerina Kolyva has this advice

When it comes to revalidation, start early. That’s the top tip for practice nurses, and indeed for every registered nurse and midwife in the UK. The next is don’t panic. Early feedback from the pilot sites suggests that revalidation is achievable and beneficial.

The 684,000 nurses and midwives in the UK make up the largest professional healthcare register in the world. The difference that small changes can make towards improving the quality of practice cannot be underestimated. Revalidation has the potential to be a catalyst for these changes.

Our Council’s decision on introducing revalidation is fast approaching (8 October 2015), and we have learnt a great deal from piloting the process across 19 different sites in the four countries of the UK. We are now focusing resources on making the adjustments and improvements identified by the pilot, to ensure that revalidation is a success.

Initial findings from the evaluation show that many nurses and midwives found revalidation more straightforward than they expected, and that the requirements built on things they already do in their day-to-day practice. We are hearing that reflection on practice, for which revalidation will provide a structured framework, is already happening on a regular basis in many cases. This is excellent news and gives us confidence that the revalidation model will work for the thousands of committed, hard-working professionals on our register.

The pilot gave us valuable insight and feedback on exactly how we can improve the guidance for nurses and midwives so that every aspect of revalidation, and its relation to the other requirements, is more fully explained. We’re committed to providing more information about the role of the confirmer, as well as making sure that we communicate important messages about revalidation to the primary care, independent and social care sectors. Our commitment to making these improvements means there will be more information and clarity on various aspects of revalidation coming before October, when our Council will make a decision about rolling out revalidation across the UK.

REGULAR REFLECTION

Revalidation isn’t a point in time test. Rather it’s a way of thinking regularly about your practice using the Code as the basis for this reflection. So even if your renewal date is some way off, it’s still a good idea to become familiar with the new requirements, what the changes mean and why they are being introduced.

There are a few key things that everyone on our register can do to get ready for revalidation. The first is to sign up to NMC Online. Revalidation will all be online, so it will be essential to have an account. Each individual’s NMC Online account shows when their revalidation date falls, so they know how long they have to meet the requirements. Taking the time to read the provisional revalidation guidance is another important way that practice nurses, no matter when they are due to revalidate, can prepare. Preparation is key to making sure all aspects of the requirements are manageable and achievable.

Every nurse and midwife across the UK, regardless of their employment setting, scope of practice, and level of seniority, should have the opportunity to familiarise themselves with revalidation and what it involves. To make sure this is the case, we are producing various additional resources to help everyone to understand the requirements.

We have a confirmer tool on our website that will help clarify who can act as a confirmer depending on the revalidating nurse or midwife’s professional circumstances. We know that practice nurses and nurse practitioners might find it less straightforward than others to identify a confirmer, and this tool should be helpful. Feedback from the pilot showed that there is a need for more clarity around the role of the confirmer, and we are working on providing this.

We will also be publishing case studies to help nurses and midwives who don’t have access to the same ready network of fellow professionals as those who work in a hospital setting, understand how they can meet the revalidation requirements.

Revalidation is not about removing people from the register; far from it. It’s about encouraging professionalism and embedding the Code on a daily basis, as well as giving nurses and midwives the opportunity to reflect on their practice and engage with other professionals. Revalidation has the potential to tackle professional isolation by ensuring that all nurses and midwives participate in discussions with peers and senior colleagues in order to stay on the register. If an individual finds that they don’t have an obvious network of fellow professionals from which to choose a confirmer and professional development discussion partner, they should be proactive about reaching out to others and building up a network.

PERSONAL RESPONSIBILITY

While many employers will want to support their staff through the process, revalidation is ultimately the responsibility of the nurse or midwife. This responsibility involves a certain amount of thinking on the part of each individual about how they can fulfil the requirements, but it should also be a very empowering experience. Revalidation has the potential to boost not only public protection, but also the reputation of the nursing and midwifery professions.

Every nurse and midwife will have to revalidate in the same way, but individuals might have different approaches to meeting the requirements depending on their scope of practice and employment setting. I interviewed Jan Glaze, a nurse practitioner and BACCG locality nurse member at NHS Bracknell and Ascot CCG, to hear about her experience of the revalidation pilot and advice she has for other practice nurses.

First hand experience of revalidation

Jan Glaze, the pilot lead at NHS Bracknell and Ascot CCG and a Nurse Practitioner & BACCG Locality Nurse Member

Q. What were your feelings about revalidation before you started; did you have any concerns?

A. I know that lots of other people were quite anxious about revalidation before they began, but I was really excited by it. I like change, so I’m not typical.

I think revalidation is an opportunity to bring nursing to another level. I knew that doctors had to revalidate and I thought, this is really great because we’re going to be able to stand up as nurses and say: this is what it means to be a nurse.

Q. How did you find the experience, and were any aspects different from your expectations?

A. It was less onerous than I’d expected; I found it really straightforward. I almost wanted it to be more challenging! It’s really important to consider our professional position on a daily basis.

The NMC has absolutely got the way to do revalidation right. The model is spot on; reflecting on the Code and getting feedback will help us to understand the kind of nurses we are. I think nurses should be challenging themselves to do more. Five reflective pieces is a good start, but I would encourage everyone to extend the idea of seeking feedback beyond the revalidation requirements so it’s really embedded in daily practice. I want us to really take it on board as professionals, and to prove what good practitioners we are.

Q. Were there any areas of the pilot that you felt could be improved when revalidation is introduced?

A. There’s been some confusion around what is meant by feedback and CPD. It took me a while to understand exactly what was being asked for with the feedback. I had to really think carefully about what I had to reflect on, and how I could obtain feedback.

I also found the confirmer and professional development discussions a bit confusing; I think these roles need some clarification. It seems like the confirmer has to be a line manager, when often practice nurses and nurse practitioners don’t necessarily have a line manager who works in a clinical capacity. Many of our line managers are practice managers and don’t hold professional qualifications. There has to be a way to make this absolutely clear before revalidation is introduced.

Q. Can you tell me about anything you personally did to make revalidating as a nurse practitioner easier?

A. I started to think very early on about who I would do my professional development discussion with. For me, working in the CCG meant I had a big pool of people to pick from, but many other practice nurses don’t have the same amount of choice.

The NMC has produced a fantastic tool on their website to help us identify who our confirmer could be. It’s a simple flow chart to help recognise the steps to take; exactly what everyone needs. I found this the most useful resource of all when I was going through the revalidation pilot.

Q. Do you have any revalidation tips for practice nurses and nurse practitioners who didn’t go through the pilot process?

A. Start early! Make sure you have identified your confirmer and spoken to him or her, and that you’ve chosen the person you want to do your professional development discussion with. Book the date for the professional development discussion as early as you can, even if it’s three months in the future. That will give you something to work towards, and will help you make the most of the discussion.

Start thinking about the collection of feedback now, and where you can get it from. Formal education settings aren’t the only way of developing. There are lots of other ways to get feedback on practice, for example significant event analysis, meetings and letters from patients.

Finally I would reassure everyone that this isn’t a difficult process. It’s absolutely doable, so don’t worry.

Q. Which aspect of the revalidation requirements did you find most useful; which do you think will most benefit your professional practice going forward?

A. I found the discussion with a fellow registrant very useful. That was the moment when I was sitting down with another nurse and I began to recognise what sort of practitioner I was. By talking through what I’d written with someone, I saw how I could develop.

During my discussion, I thought – hey, this could go viral! We could really use this conversation not to whinge and complain about what’s going on, but to reflect more deeply on where we want to go as practitioners. That for me was the most valuable part.

In my discussion it became apparent that practice nurses may lack access to clinical supervision, so this is something we are now developing in our CCG.

Q. What benefits do you think revalidation will have on the wider healthcare sector?

A. I think revalidation will bring massive benefits, absolutely huge.

It will enable people to really decide what sort of practitioner they want to be, by encouraging reflection on things that are going wrong and ways to improve, as well as giving people a chance to recognise when things have gone well. It will help people take responsibility for their own development, and think about all the different ways that they can develop beyond formal education.

I think it will make us all more mature as practitioners. We need to stop living in a blame culture, and start analysing what went wrong. Revalidation will help us all learn from mistakes and from feedback.

Q. Is there anything else you want to say to other nurses about revalidation?

A. One thing that some people might not understand is that the confirmer is not there to confirm fitness to practise. There’s a lot of worry about this, and people are shocked when they find out that revalidation isn’t about fitness to practise.

Revalidation is a brilliant opportunity for us; I’m very passionate about it. There’s bad press about nursing, and yet patients love nurses. We need to show how good we are.

CONCLUSION

The NMC’s final decision on the expected roll out of revalidation is expected next month, but in the meantime practice nurses need to make sure that they know when their revalidation date will fall due, use the online tool to identify a suitable confirmer and start the process of reflecting on their practice. The experience from the pilots suggests that revalidation is nothing to fear, but on the contrary is an empowering experience that can help you develop as a nurse.