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Revalidation – a Blessing or a Curse?

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NMC Revalidation

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. 

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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.

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.

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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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NMC launches consultation on proposed standards for nursing associates

Under the plans nursing associates would also be subject to the same revalidation requirements as nurses and midwives when renewing their registration with the NMC as well as the same fitness to practise processes should something go wrong.

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The Nursing and Midwifery Council has announced the launch of the consultation the proposed approach to the regulation of nursing associates.

The Nursing and Midwifery Council (NMC) have outlined an approach to education including ambitious standards of proficiency for the role that will enable nursing associates to deliver first-class care.

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According to Health Education England (HEE), the Nursing Associate role is a new support role which will sit alongside existing healthcare support workers and fully-qualified registered nurses to deliver hands-on care for patients. The role is designed to bridge the gap between healthcare assistants (HCAs) and registered nurses.

2,000 trainee nursing associates are currently just over half-way through their two-year training programmes to become registered nursing associates and HEE has announced 45,000 extra places before 2027.

The NMC has set out how they expect the existing Code, with a new introduction, to apply to nursing associates as well as nurses and midwives, ensuring that the same high standards of professional behaviour and conduct will apply to everyone on the register.

Jackie Smith Chief Executive and Registrar of the NMC said: “This is a hugely exciting step on the road to regulation for this new profession and we want to hear the views of all those with an interest in the role.

“We think that our proposals will ensure that nursing associates are equipped with the skills they need to deliver excellent patient care and to support registered nurses and other health and care professionals throughout their careers.”

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Under the plans nursing associates would also be subject to the same revalidation requirements as nurses and midwives when renewing their registration with the NMC as well as the same fitness to practise processes should something go wrong.

Over the coming weeks, the NMC will be holding workshops across the country for trainees, registered nurses, employers, patients and the public. There will also be regular twitter chats and webinars with lots of opportunities for people to learn more about what regulation means for the new role and share their views.

The Consultation on the regulation of a new profession will run until 2nd July 2018.

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NMC removes cap on hours student nurses can complete in simulated practice

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The Nursing and Midwifery Council has announced it will lift the cap on simulated training for student nurses.

The Nursing and Midwifery Council (NMC) has announced it has removed the hard cap on the number of clinical hours, which is currently set at 300 hours, student nurses can instead complete in simulated practice.

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Initially, the regulator said it wanted to raise the cap to 1,150 hours but critics raised concerns about the reduction in time on clinical placements.

The results of the consultation showed that a significant proportion of respondents wanted there to continue to be a cap as many showed concern it would reduce the total number of hours completed on clinical placements.

Instead, the NMC has not specified a cap but warned that they would be monitoring universities use of simulation.

The NMC says this flexible approach aligns with other UK healthcare regulators.

An NMC spokesperson told the NursingTimes“We will no longer state a maximum number for hours of simulation to be included in educational programmes for pre-registration nursing.

“Our new approach is to be less prescriptive and more outcome-focused, allowing autonomy to enhance and develop forms and uses of simulation for learning and assessment that facilitate safe and effective care,”

“However, we will monitor and ensure that the type of simulation, and how it is applied, is appropriate to meet the learning outcomes of our standards through our educational quality assurance process,”

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NMC to ‘investigate’ rise in the annual registration fee

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The nursing regulator will keep the fee at £120 for this year but says it will need to review the fee ahead of next year.

The Nursing and Midwifery Council has confirmed it will not raise the annual registration fee this year but says it will need to review the payment in more detail ahead of next year.

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Falling numbers of nurses are the “greatest risk”, admits the NMC, and goes on to explain that it predicts a £1.4m loss between the current financial year and 2018-19 because of nurses leaving the register.

Offical figures show that more nurses are now leaving the NMC register than joining.

The yearly retention fee payment has seen a rise of 64% since 2013 despite NHS pay being increased by only 4%.

Although nursing associates are set to join the NMC it is thought the two budgets would be ring-fenced.

It states; “Our budget for 2018-19 assumes a continuation of the fee at £120 with a further potential decline in income as described previously.

“Given we are in a relatively healthy financial position, we are not proposing an increase in the fee this year.

“During 2018-19, we will be reviewing the fee level in more detail, as well as improving the modelling of income for future years. This reflects growing concern about the long-term trend of the size of the register”.

NMC fee increases are approved by the Privy Council and are subjected to external consultation.

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