Revalidation Explained
David Foster, Head of the Nursing, Midwifery and Allied Health Professions Policy Unit, Department of Health
What is revalidation?
Revalidation will affect all Nursing and Midwifery Council (NMC) registrants and will be implemented in 2016. It is the new process by which all nurses and midwives will declare and demonstrate that, on a three yearly cycle, they practise safely and effectively throughout their careers. As a consequence, it is the most important change to NMCregulation since the introduction of the post-registration education (Prep) standards by the NMC in 2001. It is an exciting prospect but some people consider it daunting: it need not be.
The NMC is overhauling the system it uses to make sure we practice safely and effectively and that we consistently exhibit high degrees of professionalism and good practice. This was in response to the Francis report into the standards of care at Mid-Staffordshire {popup=372}{1}{/popup}.
It is essential for public safety that we are competent and safe practitioners and the public should rightly expect us to show that we are up-to-date in our practice. And this will apply to all nurses: not just NHS nurses, not just those in clinical practice giving hands on care, but also those in managerial and leadership roles, in education, research, public health and policy jobs.
Provided the NMC Council approves the new system, which they are expected to do in October 2015, revalidation will be effective from April 2016. All of us who are due to re-register (that is those who are at the end of the three yearly cycle where we have to renew our registration with the NMC) will start using revalidation. This means that by April 2019 everyone on the register will have undergone revalidation.
How does revalidation differ from PREP?
This process of renewal every three years is not new. Until now this three yearly renewal has been based on the Prep standards. Preprequires us to make a self-declaration to the NMC that we have undertaken 450 hours of practice and 35 hours of continuing professional development (CPD) in the preceding three years. Those of us who took Prep seriously will find that revalidation presents only modest changes.
The requirements for revalidation differ from Prep in that, although there is still a need to undertake 450 hours of practice in three years, the hours needed for CPD go up by 5 hours to 40 hours over three years. Also the nature of the CPD will be slightly different in that 20 of the 40 hours will need to be participatory. This is to ensure that there is interactive learning in participation with other nurses and to guard against all CPD being done in isolation in front of a computer as e-learning. Participatory learning can take many forms; it could be formal classroom or on the job training or structured courses or be activities such as mentoring, coaching or shadowing. The important feature being that the learning is relevant to your scope of practice and that there is evidence of what has been done with supporting evidence of learning through reflection.
Another new component part of revalidation is feedback. And not just feedback for its own sake, but being responsive to it and using it to change your practice as a consequence. This feedback is, however, causing some anxiety about who might provide it, how it might be collected and how to deal with negative feedback. In reality, we are likely to use a range of sources. Feedback could come from patients, their families and carers, colleagues, mentors or through the appraisal system – but it must never be acquired by coercion. Indeed, using complaints could be very valuable. They might feel like a negative source of information, but they are important stimuli for learning. And that highlights a significant feature of revalidation: it is about our continuing ability to practise safely and effectively: it is not about managing performance. The NMC will not be interested in seeing the original feedback, which will remain confidential, but it will be interested in a reflective account on the feedback which demonstrates what has been learnt and how it has changed practice for the better or that it has reinforced good practice.
Revalidation will also require five reflective accounts over the three year period on how CPD or feedback has changed or improved practice and how it is relevant to the Code.We will then have a professional development discussion with another nurse about their reflections on the Code, CPD and feedback.
In meeting these new requirements we will not just declare that we have met the standards we will also have to seek third party confirmation that this is the case. Confirmation is simply a process of endorsing that the requirements of revalidation have been met. It is not a judgement on performance or fitness to practice: if there are concerns about competence and performance they must be handled separately and in a timely manner. You should not wait for revalidation to address a serious fitness to practise issue with the NMC.
The NMC expects that confirmation will be provided by your line manager. The preferred, and indeed ideal, confirmer is a line manager who is also an NMC registrant. There will be instances where the confirmer may not be a registrant and so an additional professional discussion will need to be held with a registrant who is not the line manager (for self-employed nurses the NMC will provide guidance on how to access confirmation at a later date). The professional development discussion with another NMC registrant will normally cover reflections on the Code, CPD and practice-related feedback.
The NMC is currently piloting and testing the new system. It is anticipated that the final standards and guidance on revalidation will be approved in October 2015. As part of the pilots the NMC will also decide how best to audit our portfolios of evidence and how many it will audit in any one year to satisfy itself that the process is effectively protecting the public. The pilots will be evaluated and revalidation itself will start in April 2016 for those renewing their registration at that time. There will also be an evaluation of the effectiveness of revalidation starting 2016.
There is a reasonable emphasis on the role of employers to support the system of revalidation. No good employer would want to employ a nurse who cannot revalidate and many will have sufficient CPD opportunities on offer to meet the NMC’s criteria and have effective appraisal systems to contribute to the process. It is ultimately your responsibility to maintain yourability to practise safely and effectively, keep up-to-date and have evidence to revalidate. It is a profoundly important aspect of professional practice to take this responsibility seriously as an individual.
New Code
There is one other new and crucial element to revalidation and that is the revised NMC Code [2] The Code, published in January came into effect on 31st March 2015. It contains the professional standards that registered nurses must uphold whether they are providing direct care to individuals, groups or communities or bringing their professional knowledge to bear on nursing practice in other roles, such as leadership, education or research. It also aims to promote a culture of professionalism and accountability and states that employers should support their staff in upholding its standards as part of providing the quality and safety expected by service users and regulators.
The Code is absolutely central to the revalidation process as a focus for professional reflection – and it’s a really important feature of this process to recognise that we will revalidate against the standards in the Code and not our job description.
Preparing for revalidation
Preparing for revalidation well in advance and collecting evidence as you go along will make the process easier: it need not be onerous or daunting. So, to get ready:
- make sure you have an NMC Online account and find out your renewal date. If you don’t yet have one refer to the NMC’s step by step guidance on setting up your account
- keep a portfolio (a simple ring binder is fine to start with although the ultimate system will be electronic)
- know the Code and the revalidation requirements
- have a discussion with your manager about the requirements of revalidation
- identify your confirmer and, if your confirmer is not a registrant, also identify a registrant with whom to have your reflective and professional development discussions
- make sure you have an appraisal and take the lead in your appraisal discussion and structure it around the Code
- gather evidence of your 40 CPD hours and ensure you can demonstrate that 20 of them were participatory
- log incidents and situations about which you write your five reflective pieces – and write your reflections as soon as you can (they need not be long and complicated but do need to have three parts: the issue, reflections, and the impact on your practice)
- consider how you will gather your feedback and reflect on it
- talk to colleagues about revalidation and check the NMC website for the most up-to-date and accurate information and advice
Revalidation is vitally important to every single nurse who wants to continue practising. It is also crucial that providers of care understand what revalidation meansas a process and as a good employer. The NMC, quite rightly, wants all nurses to practise with a high degree of professionalism, ability and accountability in whatever setting they work. In primary care, nurses give care for some of the most vulnerable people in society: they need to trust their nurses and know that they are in safe hands. Revalidation might not mean anything much to them but they need to be confident that every nurse deserves their place on the register and that revalidation is an effective process to ensure that.
Acknowledgement: Thanks to Dr Katernina Kolyva, Director of Continued Practice at the NMC for reviewing this article on behalf of the NMC.
The NMC is overhauling the system it uses to make sure we practice safely and effectively and that we consistently exhibit high degrees of professionalism and good practice