Revalidated, Reregistered, Relieved!
Deborah Glover MBE, Editor PCNR
BSc (Joint Hons), Dip. Care Policy & Management, RGN
Whose bright idea was this...?
You’ve just spent several days going through your underwear drawer to find all your certificates and bits of feedback and reflection in preparation for completing your revalidation paperwork.
You’ve spent several hours pouring over the Code to check which bits you can relate your reflection to, and have filled in your chosen template.
Then the cat sits on your keyboard and deletes everything… To whom do you direct your curses?
No, not Florence Nightingale (got you there!). It’s Ethel Bedford-Fenwick, Nurse Number 1 on the Register. Florence was opposed to a national Register of nurses, believing that having to pass a written examination would exclude working-class women. Instead she set standards for nursing as an “art” or “calling”, emphasising nurses’ morality; the best nurses were kind, moral, and decent – and to ensure morality was not compromised in the Crimean hospitals, no female nurses were allowed on the wards after 8:00 pm. She believed that lack of formal education did not preclude a woman from making an excellent nurse, so long as she possessed these other moral qualities [1].
Florence also postulated that a national Register would be out of date almost from the moment of publication as new nurses constantly entered the profession, and until a new Register was printed, names could not be added, meaning that some would not be included for years after they completed training (No NMC on-line in those days!). She believed that local registers (i.e. managed by the employing organisation) would be far more contemporaneous. In addition, because there was no national curriculum for training and the Register did not indicate where a nurse had trained, the ‘quality’ of nurse was not assured. More to the point, there was no mechanism for removing nurses who were found to be unfit; it even proved difficult to sack nurses for being drunk on the job or ‘displaying egregious amoral behaviour’ [1].
Given that she is seen as the founder of nursing (that’s what good PR can do!), she didn’t think that nursing was strictly a profession, using the term pejoratively in regard to nursing…”the “book-and-examination business” [1]. But of course, there is no denying what she achieved and perhaps today, she may see things somewhat differently.
Fortuitously I think, Mrs B-F and her associates prevailed and the national Register was born; becoming a Registered Nurse (or State Registered Nurse, or Registered General Nurse – there’s been a few incarnations of the name) is something to strive for and to be proud of. Remaining on the register now requires us to demonstrate that contrary to Florence’s belief, we are professionals.
‘Paper, paper, everywhere…’
So, as one of the first to revalidate – my excitement somewhat dampened by Jackie Smith’s tweet stating that 1000s had also completed the process – how did I find it?
As many of you know, I have approached this with a great deal of scepticism. It seemed rather like a sledgehammer to crack a nut, a knee-jerk reaction to the Francis enquiry. And at first glance, there seemed to be an awful lot of sections to complete. But actually, after a couple of reads and a look at the templates provided by the Nursing & Midwifery Council (NMC), I realised it wasn’t so bad. The bits and bobs you need to have or complete in order to revalidate are summarised in [Table 1].
Practice hours
This is probably the easiest section to complete. It merely requires you to record dates of work, the name of the organisations(s) you have worked at, the number of hours and a brief description of the work undertaken.
Continuing professional development
Again, easy enough, although I had to exchange emails with the revalidation team regarding my ‘proof’; since PREP did not require us to have certificates of attendance/proof of being at a study day I had no reason to collected these. Now documentation proving attendance is required.
Remember that reading PCNR, Tweeting and the use of other social media [2], or having a conversation can be classed as CPD provided you reflect upon it and relate it to the Code and your practice. Much of this can be done from the comfort of your own home, including a proportion of the participatory aspects (social media, webinars, etc).
You must relate this feedback to the relevant parts of the Code.
Practice-related feedback
This as the most challenging aspect for me, and I suspect many other practitioners who work outside the ‘usual’ organisations; for example, clinical nurse specialists working for industry, self-employed practitioners, and those working in social enterprises. I rarely solicit or spontaneously receive feedback from the organisations I work for, nor do I have a manager, so appraisal was not an option for feedback.
I did however, assume that getting repeat business was a form of feedback in itself, and used emails from those with whom I had worked. I included ‘negative’ feedback because you can learn some of your greatest lessons from this. Our first instinct when criticised is to feel discombobulated, particularly if you feel that you have done a good job, or if you haven’t realised you have not quite come up to standard. Perhaps our second is to try and forget it. Generally though, that rarely works and we descend into the ‘Long Dark Teatime of the Soul (with thanks to Douglas Adams), awake at 3 am wondering if you are;
- going to be sacked
- decried on Twitter
- as useless as they clearly think you are.
Fortunately, after a few days of utter despair involving chips and curry sauce and a Jeremy Kyle fest, instinct three kicks in and we start to a) put the episode in context and b) work out what went wrong and what you’ll be doing to ensure it doesn’t happen again.
Written reflective accounts
While I suspect most of us reflect upon our practice on an informal basis (travelling home from work, chatting at coffee, etc), actually sitting down and recording such reflection is not so easy. I say that as someone whose nurse training didn’t include written reflection – the assumption was that as any spare time would be spent trying to turn a semi-circle of linen into a hat, polishing your k-skips and chasing up the laundry department for that 7th apron…
However, the template provided by the NMC is really rather idiot-proof and guides structured reflection. They aren’t looking for War & Peace, rather a few succinct sentences!
Again, you should reflect on an incident or two where it wasn’t necessarily positive – this demonstrates that you, as a professional are prepared to acknowledge your limitations and learn from any experience.
An example of one of my reflective accounts is shown in Table 2.
Reflective discussion
Personally, this proved to be invaluable. While I do reflect on my practice and often have an informal chat with a friend about work, I do not have a formal framework such as an appraisal, for reflective discussion. To be honest, I didn’t think this was much of an issue until I had the discussion.
It made me realise how helpful this can be; for example, being able to discuss the negative feedback I received took me from wanting to go down to the bottom of the garden and eat worms to exploring the issue from both sides, considering which variables contributed to the situation, and what steps I would take in the future to prevent a repeat. More importantly, it reassured me while that the work I do is not direct patient care, it requires many of the skills I learnt as a nurse. This vindicated my belief that remaining on the register and being a nurse was important to me as an individual and as a professional.
Lessons learnt
- Keep study day/conference certificates of attendance – unlike PREP, you now need proof of attendance rather than the previous ‘honesty box’ approach
- Relate your revalidation to the Code, and reflect on and report how you will use lessons learnt in future
- Unless you are a clinical nurse, much of the Code is not applicable
- Reflect on ‘negative’ experiences as well as the positive ones – we all learn from our errors!
- Don’t feel you have to write pages – a few succinct sentences will suffice as long as they contain the information required
- Don’t try and do all of this the week before you are due to revalidate! Get into the habit of completing the templates on a regular basis, or as soon as possible after an event (appraisal, conference, incident etc)
- Use the revalidation team if you have any concerns or questions – they are an excellent resource
- Don’t buy templates and/or ‘expertise’. Free templates are provided by the NMC (http://revalidation.nmc.org.uk/what-you-need-to-do), with examples of completed sections