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Revalidation – a Blessing or a Curse?

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Revalidation – a Blessing or a Curse?

Revalidation is the new process by which nurses and midwives on the Nursing and Midwifery Council (NMC) register will renew their registration, starting in April 2016. 

As in previous years, renewal of registration takes place every three years and on the past was achieved through the completion of a Notification of Practice (NOP) Form (now an online form).  At that time, the registrant declared that they had met the requirements for continued registration and were of good health & character and they paid their (now) annual fee.  The answer to all questions on revalidation can be found in the NMC ‘bible’ ‘How to Revalidate’ – and I would encourage all registrants to become familiar with this document.  The NMC Website has and links to PowerPoint presentations, mandatory and suggested templates / forms, guidance documents, and much more – everything you need to become an expert and controller of your own Revalidation destiny!  The following sections outline the processes in which Revalidation will take place.

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RELATED: EVERYTHING YOU NEED TO KNOW ABOUT REVALIDATION

NMC Online

The first step is to set up an account via NMC Online.  This will be the only way in which your revalidation application can be made.  It is now the process in which NOP applications are being made too (last time I did mine in August 2013 it was paper form via the post).  Here is the guidance document on how to set up your account if you have not done so by now!  The NMC will keep you updated on your own revalidation and other important issues via your NMC Online-registered email address.  They will also use this email address to contact you for verification / audit, so I always advise NOT using an email address that you can only access whilst at work.

The Code

The new NMC Code was approved in March 2015 and a copy of this was sent to every registrant in April.  The Code underpins everything within the Revalidation process and is a living guide to every registrant and their practise. Many aspects of the process will require reference to pillars and sections of the code, so I advise all registrants to have their copy of the Code handy (either the leaflet version that was posted to us, a printout of the PDF referenced above, or via the e-edition) when working through the steps below.

To e- or not to e-:  Your Revalidation Portfolio

The NMC recommends that you maintain a portfolio (and this recommendation has not changed from the previous requirements in Post Registration Education & Practice (PREP).  All of the resources discussed below (and any associated evidence) could / should be maintained within the portfolio.  There is no requirement to upload anything to the NMC.  There will be some who might choose to use an electronic portfolio as a handy way to store things.  Please note that due to issues related to data protection and information management, some forms used for Revalidation cannot be scanned and uploaded electronically.  They will need to be maintained in a paper-based portfolio only.  I will explain in detail where this is relevant.  All other forms, documents, evidence etc. that you choose to upload must NOT contain any data which can identify another person, patient etc.   The NMC has produced a Guidance Document on Portfolios which some registrants have found useful.

Practice Hours

Every nurse registrant and every midwife registrant requires to have worked a minimum of 450 hours of nursing practice relevant to their area / scope of practice within the 3-year renewal cycle.  If you are a nurse and a midwife, you will require 900 hours of practice.  The NMC have provided a handy Practice Hours Template Log that you may choose to use for recording of your practice hours.  It is unlikely that you will need actual proof or evidence of the hours, but if you do, copies of job description, work plan, work rota and other documents may assist in this process.

Continuing Profession Development

Every nurse registrant and every midwife registrant requires to have completed a minimum of 35 hours of CPD relevant to their area /scope of practice within the 3-year renewal cycle.  At least 20 of the 35 hours must have been conducted with other professionals (‘participatory CPD’).  The NMC have provided a handy CPD Log that you may choose to use for recording of your CPD.  You may want to have some evidence of your CPD handy also – such as notes from your training / study, copies of hand-outs / presentations, a certificate of attendance and other items as may be applicable.  A certificate of attendance, on its own is not sufficient as you need to evidence how you used this learning / development to improve your practice.

Practice Related Feedback

Every nurse registrant and every midwife registrant requires to have documented at least 5 sources of practice-related feedback within the 3-year renewal cycle.  The feedback should come from a variety of sources, some of which could include patients, service users, students and colleagues. Feedback can also be obtained through reviewing complaints, team performance reports and serious event reviews.  Feedback can be informal or formal, written or verbal.  Feedback does not need to be specific to you as an individual it can be about a whole ward, team or organisation (such as an inspection / audit report).  The information should be recorded anonymously so as not to identify a person or patient and the NMC have not recommended or suggested a template form.  My suggestion for a template would be to include details as below:

DateSourceAction Taken to improve Your Practice
01/01/1990 Patient 1 Patient commented that...

Refection & the Reflective Discussion

Every nurse registrant and every midwife registrant requires to have completed a minimum of 5 Reflective Accounts relevant to their area /scope of practice within the 3-year renewal cycle.  The NMC have provided a Reflective Account Form that you must use to document each of your reflective accounts.  You can choose to reflect on a range of issues, chosen from your Practice Related Feedback (see below) and/or a session of CPD (see above) and/or an event or experience in your practice.  I’ve done a few already and it does not take that long to do one (30 minutes on average?).  I would encourage each workplace to have spares of the Reflective Account Form handy, as ideas and opportunities for reflection will occur on an almost daily basis.  I am a natural reflective practitioner and use my own ‘model’ of reflection.  The NMC suggests that you can use any model you wish as long as you can take your documented reflection and fit it into / onto the mandatory form.

For each of the Reflective Accounts, you must have had a professional discussion with a reflective partner (who must be on the NMC register).  The NMC have provided a Reflective Discussion Form that you must use to document your discussions.  You can use one form for one or more discussions and it is the reflective partner who is expected to complete the detailed parts of the form.  The NMC has produced a Guidance Document on conducting reflective discussions which some registrant have found very useful.  Because the Reflective Discussion form(s) contain(s) details that can identify another individual (your reflective partner), you cannot save this document electronically.  You will need to print it off and have the reflective partner complete the form(s) manually and save it (them) in your ‘paper-based’ portfolio.

I feel that reflection and the ensuing discussion are the most important and potentially powerful vehicles for development and improved practice.  I wold suggest that you choose your reflective partner according to who you think will be effective or you; and to use one form /partner for each discussion / reflection.  I would also encourage you to complete these as you move through your triennial renewal cycle and not save them up and rush through them when you realise revalidation is imminent!

Confirmation

No more than 12 months in advance of your Revalidation Date, you should arrange to have a Confirmation Discussion. This cannot be arranged until you have gathered the evidence above and have the required forms filled in and ready for review.   The Confirmer should be the person who normally does your appraisal / supervision (e.g. your line manager) and it does not matter if this person is not an NMC registrant.  The NMC has produced an Information for Confirmers guide that is very useful.  In the main, the confirmer’s role is to act as a third party to confirm that the requirements set above have been met.  They are not there to grade or assess the elements of revalidation that you present to them nor are they there to assess your fitness to practice; simply to confirm that they have seen them.

At the completion of the confirmation discussion, the Confirmer will then be asked to complete and sign a declaration that they have confirmed your readiness to revalidate.  The NMC have provided a Confirmation Form that must be used to document your discussions.  Because this form contains details that can identify another individual (your confirmer), you cannot save this document electronically.  You will need to print it off and have the confirmer complete the form manually and save it in your ‘paper-based’ portfolio.

Revalidation Application

Once the confirmation process has been signed off, you are effectively ready to revalidate.  Your Revalidation Date is a fixed date (e.g. 18th May 2015).  In this example, your registration would expire on the 31st May 2015.  Your deadline to revalidate (your Revalidation Application Date) is therefore the 1st of the month (1st May 2015).  The NMC will send you a notification you that you can revalidate 60 days before your Revalidation Application Date (e.g. 1st March 2015).  From this notification date, you then have that 60-daty window in which to complete the Revalidation Application.

In completing the Revalidation Application, in addition to declaring that the requirements above have been completed and subsequently confirmed by a third party, you will also require to make a declaration that you are of good health & character and that you have an appropriate level of professional indemnity (as you would through NOP).  Once you have completed the online Revalidation Application, you should receive confirmation soon thereafter that your revalidation has been successful and that your registration has been renewed.

I would recommend that every registrant logs in to their NMC Online account to verify (well in advance of the registration expiration date) to ensure that their statement of entry has been successfully updated; a printed copy of which could be  retained within the portfolio and provided to your line manager / confirmer for their records.

Verification / Audit

As with the PREP portfolios, the NMC will select a small percentage of registrants for verification / audit.  It is envisaged that if you are selected, you (and your confirmer) will be sent an email within 24 hours of your Revalidation Application submission.  You will both be required to follow the link provided by the NMC in order to provide additional information to support the verification / audit process.  There is no set timescale for you (and your conformer) responding to this request, but remember that (either of you) not responding can put your registration at risk!

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Nursing & Midwifery Council

MP suggests the NHS should not fund life-extending drugs for the elderly

The MP told radio listeners he isn't sure if the “enormous expense” to keep older people alive is justifiable.

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by Chloe Dawson.
MP suggests the NHS should not fund life-extending drugs for the elderly

The Conservative MP questioned if life-extending drugs for the elderly are justifiable.

David Davies, the Conservative MP for Monmouth and Brexiteer, suggested that the NHS should not provide life-extending drugs for elderly patients who are already nearing the end of their lives.

He told radio listeners he isn't sure if the “enormous expense” to keep older people alive is justifiable after a poll revealed that 82 % of voters should support a 1p ring-fenced rise in National Insurance to ensure the NHS is properly funded.

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In August 2017, Davies suggested victims of crimes should not be provided with interpreters so that the police could save money and in response to the 2015 refugee crisis Davies claimed that majority of the people attempting to enter the UK were not refugees fleeing war, but were instead migrants "mostly young men, mostly with mobile phones, chancing their luck"

Can we justify the expense?

Mr Davies, told talkRADIO host Julia Hartley-Brewer: “There are drugs out there that will keep people alive for a few months longer, maybe being delivered at the end of what might have been a long and productive life at enormous expense.

“And I think we need an honest debate about the cost of some of these drugs because I’d like to see people in their – young people of course getting access to this – but I’m not sure how justifiable it is.

“And this is difficult to say, when somebody is in their 80s, and they’re at the end of what’s been a long and happy life, to try and keep somebody alive for an extra couple of months at a cost that that could run into hundreds of thousands of pounds is something we need to be talking about.”

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Education

NMC launches new educational standards to 'shape the future of nursing'

Part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities.

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by Ian Snug.
NMC launches new educational standards to 'shape the future of nursing'

Student nurses will start to train against the new standards from January 2019.

Last week the Nursing and Midwifery Council (NMC) launched 'ambitious' new standards of proficiency that set out the skills and knowledge the next generation of nurses need.

Alongside the new proficiencies, the NMC has introduced a more modern and innovative approach to the way universities and their practise partners train nurses and midwives - the NMC claim these changes will allow greater independence of assessment, and greater innovation by placement providers.

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The NMC has also removed its standards for medicines management and instead encourages employers to instigate rigorous medicines management procedures.

Unlimited simulation.

Finally, part of the changes includes the removal of the cap on the number of hours students can spend on simulation activities - despite concerns this could reduce the total amount of time student nurses could spend on placements.

The new standards represent two years’ work and have been developed alongside nurses - as well as students, educators, healthcare professionals, charities and patient groups from across the UK.

Jackie Smith, NMC Chief Executive and Registrar, said: “Our new standards represent a huge leap forward. They raise the bar for the next generation of nurses and not only match the demands of the role but the ambition of the profession. This is vital as in the coming years many thousands of new professionals will join our register, delivering care to millions of people.

“We’ve also overhauled the way universities train nurses and midwives. They’ll be given more flexibility to harness new ways of working and embrace technology so they can equip the nurses and midwives of tomorrow with the skills they need to deliver world class care for years to come.”

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News

PSA says the NMC "inadequate" with "cultural problems"

The Professional Standards Authority has criticised how the NMC handled concerns about midwives’ fitness to practise.

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by Sarah J.
Former newspaper exec announced as new chair of NMC

The NMC did not listen to or properly investigate concerns about Midwives at Furness General Hospital.

The Professional Standards Authority for Health and Social Care has today published its Lessons Learned Review which heavily criticises how the Nursing and Midwifery Council handled concerns about midwives’ fitness to practise at the Furness General Hospital.

The review was commissioned by Jeremy Hunt, the Secretary of State for Health and Social Care, after up to 19 babies and mothers died at the hospital between 2004 and 2012 as a result of mistakes by the staff of its maternity unit. A previous inquiry into the deaths concluded that 13 of the infants and women would have lived if they had received better care.

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The Review recognises that the NMC has made many changes and improvements since 2014, but concludes that there are two significant areas requiring additional, urgent work: the NMC's approach to the value of evidence from and communication with patients; and its commitment in practice to transparency.

The NMC failed to act on information.

The 80-page makes a series of recommendations and heavily criticises the actions of the NMC after the regulator failed to take any action for two years after information was supplied by the police on maternity staff.

Chief Executive of the Professional Standards Authority, Harry Cayton, said; "What happened at Furness General Hospital remains shocking, and the tragic deaths of babies and mothers should never have happened. The findings in the Review we are publishing today show that the response of the NMC was inadequate.

"Although the NMC has made good progress with its technical handling of complaints and concerns, there remain cultural problems which it must remedy in order for the public to have confidence in its ability to protect them from harm."

We have made improvements.

Responding to the review, Jackie Smith, the outgoing NMC Chief Executive and Registrar said: “The NMC’s approach to the Morecambe Bay cases – in particular the way we communicated with the families – was unacceptable and I am truly sorry for this.

"We take the findings of this review extremely seriously and we’re committed to improving the way we communicate with families, witnesses and all those involved in the fitness to practise process.

“Since 2014 we’ve made significant changes to improve the way we work and as the report recognises, we’re now a very different organisation.

“The changes we’ve made puts vulnerable witnesses and families affected by failings in care at the heart of our work. But we know that there is much more to do."

Lessons have been learned.

Responding to the review, Philip Graf, Chair of the NMC said: “We welcome this review and we will act on the lessons learned, ensuring that the views of families and patients are central to everything we do.

“We will also work closely with the PSA, the professions and other regulators to take forward the report’s important recommendations.”

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