A fair assessment? The NMC wants to use employers’ staff appraisals in its new system of revalidation – despite concerns about the quality of appraisals. Erin Dean reports The Nursing and Midwifery Council has indicated that it wants revalidation to be linked to employers’ existing systems of staff appraisals. As well as discussing their work performance, as usually happens in an appraisal, nurses and midwives will reflect on how well their practice has adhered to the values set out in their professional code of conduct. Under revalidation, registrants will need to have their fitness to practise confirmed by a third party once every three years; the most obvious candidate for this role is the manager or supervisor who conducts the appraisal. Harnessing employers’ appraisal systems to the new system of revalidation, due to be introduced in late 2015, could help bring the NMC code of conduct closer to everyday practice. The regulator has said it wants to ‘marry regulation and professionalism with performance in employment’. Appraisals will be expected to include a review of reflective accounts in which registrants will have to demonstrate what they have learned from feedback from managers, colleagues, patients and their carers. The approach to be used will be confirmed in draft plans published later this year and tested in pilots in 2015. But the use of employer appraisals in revalidation is controversial. There are widespread concerns about the quality of appraisals that nurses receive now, and it has been pointed out that many nurses do not even receive an annual appraisal. It is not yet clear what will happen to nurses and
midwives who are self-employed or work for organisations that do not offer appraisals. An NMC spokesperson says: ‘We know that appraisals do not happen in the same way across the landscape of nursing and midwifery, so the proposed model is flexible to incorporate this.’
Regular and meaningful
‘Having said that, appraisals are good practice for all employers and staff, and we strongly encourage anyone who employs a nurse or midwife to make sure that appraisals are happening regularly and meaningfully,’ the spokesperson adds. According to the 2013 NHS staff survey, 84 per cent of staff had an appraisal, but only just over half of these felt that it helped them improve how they do their job. Almost 80 per cent said they felt the appraisal helped them to agree clear objectives for their work, and more than 60 per cent
What makes a good appraisal? NHS Employers says that good quality appraisals should provide staff with: A clear understanding of their role and the part they play in their team and organisation. An agreed set of work objectives. A plan for acquiring and applying the knowledge and skills they need to do their job well and achieve their organisation’s linked objectives. The NMC intends revalidation to ‘enhance’ existing employer-run processes such as appraisal by requiring nurses and midwives to also reflect on how they have adhered to their professional code. Appraisal will be an opportunity for individuals to obtain third party confirmation that they have followed the code and remain fit to practise.
said it made them feel their work was valued by their employer. These statistics only cover nurses working in the NHS. The RCN has raised serious misgivings about mixing professional regulation with employer processes. It says there is a high risk of confusion of purpose and, ultimately, poor decision making under such a system. RCN head of policy Howard Catton says that reflecting on areas of nursing practice that need to be improved is an important part of revalidation, but points out that nurses may not feel comfortable raising these issues in an employer-led appraisal. ‘There are lots of issues around appraisals,’ he says. ‘How are systems going to be put in place to ensure that everyone is being revalidated at appraisal to the same level, and what about people who work in places where there are no appraisals? If appraisal is used, the NMC needs to set out much more clearly some guidance about what is expected.’ Part of appraisals’ appeal to the NMC is that building on existing systems should save time and money. Creating an alternative system for revalidation could be costly and complex. Appraisals are also being used by the system of revalidation introduced for doctors by the General Medical Council. The Royal College of Midwives (RCM) has also raised concerns about using appraisal for revalidation, and said the annual review undertaken already by supervisors of midwives would be more appropriate. An annual review usually focuses on
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Employer’s responsibility
Guy’s and St Thomas’ NHS Foundation Trust deputy chief nurse Yinglen Butt is concerned that some nurses currently receive no appraisal, or a poor one. ‘How can appraisals be a significant part of the revalidation process if not all employers are making this a fundamental staff provision? It is the responsibility of employers to ensure that there are systematic processes in place that enable their employees to have an annual
appraisal,’ Ms Butt says. ‘A good appraisal should set out agreed objectives for the employee, so that the individual’s performance can be measured. It is also about talking through what has gone well, what has not gone quite as well, and what could be done to improve these.’ She adds that nothing which comes up in an appraisal should be a surprise, as the nurse’s progress should have been discussed at regular reviews through the year. ‘Appraisals should also discuss aspirations, and support and training needs. This does not have to be formal training; it can include shadowing and mentoring.’
SUMMARY
reflection on practice, maintaining registration and training needs. It can also include feedback from colleagues and clients. RCM director for midwifery Louise Silverton says she is optimistic that the NMC will approve the use of the annual review in its final plans. ‘The annual review already looks at continuing professional development and learning needs. Midwives came out strongly in support of using the review,’ she says.
Staff appraisals will have an important role to play in the NMC’s new system of revalidation
The NMC wants to link the proposed system of revalidation to employers’ systems of appraisals. As well as considering job performance with their manager or supervisor, nurses and midwives will be required to reflect on how they have adhered to the code and have their fitness to practise confirmed. Every nurse and midwife should have regular and meaningful appraisals. Author Erin Dean is a freelance journalist
Paulette Lewis, interim assistant director and operations manager at Ealing Integrated Care Organisation, says employers’ responsibilities under revalidation need to be clarified. ‘The principles are good, and should ensure that nurses are maintaining safe practice. Nurses will be required to produce evidence, so they will have to take more responsibility in ensuring that they have gained the necessary training and development. ‘The question is, what if nurses do not meet the requirement and provide evidence to say they are fit to practise? What systems do employers need to put in place to ensure that their nurses will meet the requirements for revalidation? The NMC will need to be clear about this, and it requires close working with the NHS’ NS For more on revalidation, go to www.revalidation.zone Next in the series, October 22: confirmation
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midwives who are self-employed or work for organisations that do not offer appraisals. An NMC spokesperson says: ‘We know that appraisals do not happen in the same way across the landscape of nursing and midwifery, so the proposed model is flexible to incorporate this.’
Regular and meaningful
‘Having said that, appraisals are good practice for all employers and staff, and we strongly encourage anyone who employs a nurse or midwife to make sure that appraisals are happening regularly and meaningfully,’ the spokesperson adds. According to the 2013 NHS staff survey, 84 per cent of staff had an appraisal, but only just over half of these felt that it helped them improve how they do their job. Almost 80 per cent said they felt the appraisal helped them to agree clear objectives for their work, and more than 60 per cent
What makes a good appraisal? NHS Employers says that good quality appraisals should provide staff with: A clear understanding of their role and the part they play in their team and organisation. An agreed set of work objectives. A plan for acquiring and applying the knowledge and skills they need to do their job well and achieve their organisation’s linked objectives. The NMC intends revalidation to ‘enhance’ existing employer-run processes such as appraisal by requiring nurses and midwives to also reflect on how they have adhered to their professional code. Appraisal will be an opportunity for individuals to obtain third party confirmation that they have followed the code and remain fit to practise.
said it made them feel their work was valued by their employer. These statistics only cover nurses working in the NHS. The RCN has raised serious misgivings about mixing professional regulation with employer processes. It says there is a high risk of confusion of purpose and, ultimately, poor decision making under such a system. RCN head of policy Howard Catton says that reflecting on areas of nursing practice that need to be improved is an important part of revalidation, but points out that nurses may not feel comfortable raising these issues in an employer-led appraisal. ‘There are lots of issues around appraisals,’ he says. ‘How are systems going to be put in place to ensure that everyone is being revalidated at appraisal to the same level, and what about people who work in places where there are no appraisals? If appraisal is used, the NMC needs to set out much more clearly some guidance about what is expected.’ Part of appraisals’ appeal to the NMC is that building on existing systems should save time and money. Creating an alternative system for revalidation could be costly and complex. Appraisals are also being used by the system of revalidation introduced for doctors by the General Medical Council. The Royal College of Midwives (RCM) has also raised concerns about using appraisal for revalidation, and said the annual review undertaken already by supervisors of midwives would be more appropriate. An annual review usually focuses on
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SCIENCE PHOTO LIBRARY
Employer’s responsibility
Guy’s and St Thomas’ NHS Foundation Trust deputy chief nurse Yinglen Butt is concerned that some nurses currently receive no appraisal, or a poor one. ‘How can appraisals be a significant part of the revalidation process if not all employers are making this a fundamental staff provision? It is the responsibility of employers to ensure that there are systematic processes in place that enable their employees to have an annual
appraisal,’ Ms Butt says. ‘A good appraisal should set out agreed objectives for the employee, so that the individual’s performance can be measured. It is also about talking through what has gone well, what has not gone quite as well, and what could be done to improve these.’ She adds that nothing which comes up in an appraisal should be a surprise, as the nurse’s progress should have been discussed at regular reviews through the year. ‘Appraisals should also discuss aspirations, and support and training needs. This does not have to be formal training; it can include shadowing and mentoring.’
SUMMARY
reflection on practice, maintaining registration and training needs. It can also include feedback from colleagues and clients. RCM director for midwifery Louise Silverton says she is optimistic that the NMC will approve the use of the annual review in its final plans. ‘The annual review already looks at continuing professional development and learning needs. Midwives came out strongly in support of using the review,’ she says.
Staff appraisals will have an important role to play in the NMC’s new system of revalidation
The NMC wants to link the proposed system of revalidation to employers’ systems of appraisals. As well as considering job performance with their manager or supervisor, nurses and midwives will be required to reflect on how they have adhered to the code and have their fitness to practise confirmed. Every nurse and midwife should have regular and meaningful appraisals. Author Erin Dean is a freelance journalist
Paulette Lewis, interim assistant director and operations manager at Ealing Integrated Care Organisation, says employers’ responsibilities under revalidation need to be clarified. ‘The principles are good, and should ensure that nurses are maintaining safe practice. Nurses will be required to produce evidence, so they will have to take more responsibility in ensuring that they have gained the necessary training and development. ‘The question is, what if nurses do not meet the requirement and provide evidence to say they are fit to practise? What systems do employers need to put in place to ensure that their nurses will meet the requirements for revalidation? The NMC will need to be clear about this, and it requires close working with the NHS’ NS For more on revalidation, go to www.revalidation.zone Next in the series, October 22: confirmation
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