Analysis
NMC urges nurse managers to prepare for new revalidation The assessment changes may be 18 months away, but senior staff need to make changes in behaviour from now on, writes Jennifer Sprinks WITH A new revalidation model for assessing nurses’ fitness to practise coming into force in December 2015, the Nursing and Midwifery Council (NMC) is urging nurse managers to get ready for the looming deadline. On average, 20,000 nurses a month renew their registration. The first to be validated under the forthcoming system will be those renewing their registration on January 31 2016. However, NMC director of continued practice Katerina Kolyva says nurse managers should ensure that they, as well as their staff, look at how they can fulfil the requirements of revalidation, which replaces post-registration education and practice (PREP). Change in behaviour ‘The key message is that revalidation does not only affect people on their renewal date,’ she says. ‘It is a change in behaviour we want to see from people on December 31 2015. They will need to demonstrate they meet the requirements of the code on an ongoing basis and ensure they have regular appraisals and get reflective feedback. If they leave it until their renewal date, it is effectively too late.’ The NMC is consulting on a revised code of conduct, which sets out the standards and practices to which all nurses need to adhere. The consultation includes detailed plans for the revalidation model, incorporating feedback from nearly 10,000 responses the NMC received earlier this year. Dr Kolyva says a critical aspect of preparing for revalidation is ensuring that continuing professional development (CPD) is in place to enable compliance with the code. Nurses will be expected to complete 8
July 2014 | Volume 21 | Number 4
40 hours of CPD every three years, 20 of them in ‘participatory learning’, such as mentoring, shadowing or group training. ‘People need to start engaging with the code more and putting it into existing systems such as appraisals,’ says Dr Kolyva. ‘Some places are starting to include the values of the code in job descriptions, appraisal forms, inductions and peer reviews.’ Dr Kolyva says nurse managers must remember that they are just as accountable to the code as every other nurse or midwife. ‘We need directors of nursing to understand that their role is not
just managerial – the code applies to them as much as ward nurses. They need to be thinking about their own standards too.’ Nurse managers may also have a role as ‘confirmers’ – responsible for confirming that nurses they manage comply with the code and are fit to remain on the register. ‘They will need to think about what readiness they need, their adherence to the code, ensure systems are in line with the code and begin reflecting on feedback,’ says Dr Kolyva. However, a common concern raised in the first consultation on revalidation related to who would be the confirmer for nurses whose managers are not registrants, such as practice nurses, prison nurses, community nurses and the self-employed. The NMC has amended the revalidation model accordingly. ‘We are proposing that, where the line manager is a registrant nurse or midwife, they should be the confirmer; and that people without registrant managers should seek feedback from an additional person, such as a nurse or midwife who is a peer and knows them well,’ says Dr Kolyva. She acknowledges the risk that revalidation could become a mere box-ticking exercise, rather than an ongoing assessment of someone’s compliance with the code. Random audits To review the model’s effectiveness, the NMC will be conducting a combination of randomised and risk-based audits regularly across the register in the whole of the UK. ‘This has to happen regularly, not just once a year, ’says Dr Kolyva. ‘We definitely want to demonstrate that it’s different to PREP and is fit for purpose.’ Health unions, including the RCN and Unite, have expressed concerns that ever-tightening budgets in the NHS could restrict nurses’ opportunities for accessing continuing professional development and meeting revalidation requirements. The unions are also concerned about the linking of appraisals and employment processes with professional standards and registration, because appraisals are often concerned with an organisation’s objectives rather than an individual’s professional development needs. NURSING MANAGEMENT
Analysis Dr Kolyva says the current consultation is exploring these concerns. ‘Appraisals are a difficult route because they focus on being fit for purpose, for instance for the job an employee is in, rather than fitness to practise. We understand the concerns, but we have to use existing processes rather than creating new ones. If there is something we need to do to ensure appraisals are effective, then we will do it.’ Patient harm Dr Kolyva wants to emphasise that managers must not use revalidation as another route for making fitness to practise referrals to the NMC. She hopes employers will engage with individuals about their compliance with the code at an earlier stage, ‘before patient harm happens’. ‘Revalidation is about enhancing professionalism by encouraging nurses and midwives to reflect on the code and standards of practice,’ she says. Under revalidation, nurses may be expected to submit five reflective accounts of how they have learned from patients’ feedback. They will be able to store their evidence however they choose, but the only option for submitting the material to the NMC will be electronically. Of more than 10,000 nurses surveyed in April by Nursing Management’s sister title Nursing Standard, 64% said their portfolio is paper-based, 2% have it stored electronically, while 33% use a mixture of the two. But Dr Kolyva insists: ‘We have not laboured much on how it should look and will leave it to the employer, mentor or supervisor to decide. It is not lengthy reflective pieces we want to see,
but outcomes showing how reflection has improved their practice.’ The proposed revised code includes a new clause on the duty of candour, added after a recommendation issued in the Francis report last year into care failings at Stafford Hospital. It states that everyone on the register will have a ‘personal and professional responsibility’ to speak out if they have concerns about patient safety. The NMC wants nurse managers to protect staff who blow the whistle on poor practices and ensure their concerns are escalated promptly and appropriately. Dr Kolyva advises that this could be ‘as simple as listening’, because ‘trusts should already have systems in place for raising concerns’. Another section concerns the duty to ‘ensure that the fundamentals of basic care are adhered to and delivered effectively and compassionately’, including giving patients adequate access to nutrition and hydration. Dr Kolyva says it would depend on the situation and case in hand as to whether a failure to report concerns could risk a nurse’s registration being renewed, but adds: ‘If a nurse fails to comply with the code and thereby is putting patients at risk of harm, they could be putting their registration at risk.’ The draft code also covers social media, stating that nurses should not refer to employers, colleagues or past or current
If a nurse fails to comply with the code and thereby is putting patients at risk of harm, they could be putting their registration at risk
Online guide to upcoming changes RCN Publishing has prepared a special online guide to revalidation that is free to subscribers of Nursing Management. The guide has a range of resources, including continuing professional development articles on preparing for staff appraisals. It also contains important information about
NURSING MANAGEMENT
changes to the Nursing and Midwifery Council (NMC) code. The downloadable guide is available at rcnpublishing.com/journal/gtr This area of the website will be updated whenever the NMC issues new guidance or information on revalidation. There is also a new Revalidation Zone website featuring news updates and links to useful resources, at www.revalidation.zone
Timetable ■ August 2014 The Nursing and Midwifery Council (NMC) consultation on the new code of professional conduct and draft revalidation guidance closes. ■ December 2014 The NMC expects to approve the new code and make a final decision on how revalidation will work. ■ April-June 2015 The revalidation pilots take place and the new system is evaluated. ■ November 2015 NMC members make a final decision on whether to introduce revalidation from December 31 2015. ■ 2016 An independent analysis of revalidation will be commissioned. people for whom they have cared. Dr Kolyva says this is necessary because of the increasing prevalence of social media issues in fitness to practise referrals, but it should not stop nurses from using social media as a means of sharing best practice or offering peer support. ‘Whatever a nurse would not do in a public domain around appropriateness, they should not do on social media. ‘It would not be appropriate for nurses to talk in public about confidential patient matters. In the same way, it is not right for nurses and midwives to post pictures of patients on Facebook or Twitter. Due to the style and immediacy of these social networking sites, people forget that.’ Nurses should not panic about revalidation, insists Dr Kolyva. She says nurses deemed to have failed will be entitled to appeal, just as they can under the current process. Should their registration lapse, they will be able to return to the profession on successful completion of a return-to-practise course. With adequate preparation and sufficient guidance from employers, she envisages few appeals. Nonetheless, she urges nurse managers to engage with the consultation to ensure the revalidation model is appropriate in practice. ‘None of this is set in stone,’ she says. See also opinion, page 12 July 2014 | Volume 21 | Number 4
9
NMC urges nurse managers to prepare for new revalidation The assessment changes may be 18 months away, but senior staff need to make changes in behaviour from now on, writes Jennifer Sprinks WITH A new revalidation model for assessing nurses’ fitness to practise coming into force in December 2015, the Nursing and Midwifery Council (NMC) is urging nurse managers to get ready for the looming deadline. On average, 20,000 nurses a month renew their registration. The first to be validated under the forthcoming system will be those renewing their registration on January 31 2016. However, NMC director of continued practice Katerina Kolyva says nurse managers should ensure that they, as well as their staff, look at how they can fulfil the requirements of revalidation, which replaces post-registration education and practice (PREP). Change in behaviour ‘The key message is that revalidation does not only affect people on their renewal date,’ she says. ‘It is a change in behaviour we want to see from people on December 31 2015. They will need to demonstrate they meet the requirements of the code on an ongoing basis and ensure they have regular appraisals and get reflective feedback. If they leave it until their renewal date, it is effectively too late.’ The NMC is consulting on a revised code of conduct, which sets out the standards and practices to which all nurses need to adhere. The consultation includes detailed plans for the revalidation model, incorporating feedback from nearly 10,000 responses the NMC received earlier this year. Dr Kolyva says a critical aspect of preparing for revalidation is ensuring that continuing professional development (CPD) is in place to enable compliance with the code. Nurses will be expected to complete 8
July 2014 | Volume 21 | Number 4
40 hours of CPD every three years, 20 of them in ‘participatory learning’, such as mentoring, shadowing or group training. ‘People need to start engaging with the code more and putting it into existing systems such as appraisals,’ says Dr Kolyva. ‘Some places are starting to include the values of the code in job descriptions, appraisal forms, inductions and peer reviews.’ Dr Kolyva says nurse managers must remember that they are just as accountable to the code as every other nurse or midwife. ‘We need directors of nursing to understand that their role is not
just managerial – the code applies to them as much as ward nurses. They need to be thinking about their own standards too.’ Nurse managers may also have a role as ‘confirmers’ – responsible for confirming that nurses they manage comply with the code and are fit to remain on the register. ‘They will need to think about what readiness they need, their adherence to the code, ensure systems are in line with the code and begin reflecting on feedback,’ says Dr Kolyva. However, a common concern raised in the first consultation on revalidation related to who would be the confirmer for nurses whose managers are not registrants, such as practice nurses, prison nurses, community nurses and the self-employed. The NMC has amended the revalidation model accordingly. ‘We are proposing that, where the line manager is a registrant nurse or midwife, they should be the confirmer; and that people without registrant managers should seek feedback from an additional person, such as a nurse or midwife who is a peer and knows them well,’ says Dr Kolyva. She acknowledges the risk that revalidation could become a mere box-ticking exercise, rather than an ongoing assessment of someone’s compliance with the code. Random audits To review the model’s effectiveness, the NMC will be conducting a combination of randomised and risk-based audits regularly across the register in the whole of the UK. ‘This has to happen regularly, not just once a year, ’says Dr Kolyva. ‘We definitely want to demonstrate that it’s different to PREP and is fit for purpose.’ Health unions, including the RCN and Unite, have expressed concerns that ever-tightening budgets in the NHS could restrict nurses’ opportunities for accessing continuing professional development and meeting revalidation requirements. The unions are also concerned about the linking of appraisals and employment processes with professional standards and registration, because appraisals are often concerned with an organisation’s objectives rather than an individual’s professional development needs. NURSING MANAGEMENT
Analysis Dr Kolyva says the current consultation is exploring these concerns. ‘Appraisals are a difficult route because they focus on being fit for purpose, for instance for the job an employee is in, rather than fitness to practise. We understand the concerns, but we have to use existing processes rather than creating new ones. If there is something we need to do to ensure appraisals are effective, then we will do it.’ Patient harm Dr Kolyva wants to emphasise that managers must not use revalidation as another route for making fitness to practise referrals to the NMC. She hopes employers will engage with individuals about their compliance with the code at an earlier stage, ‘before patient harm happens’. ‘Revalidation is about enhancing professionalism by encouraging nurses and midwives to reflect on the code and standards of practice,’ she says. Under revalidation, nurses may be expected to submit five reflective accounts of how they have learned from patients’ feedback. They will be able to store their evidence however they choose, but the only option for submitting the material to the NMC will be electronically. Of more than 10,000 nurses surveyed in April by Nursing Management’s sister title Nursing Standard, 64% said their portfolio is paper-based, 2% have it stored electronically, while 33% use a mixture of the two. But Dr Kolyva insists: ‘We have not laboured much on how it should look and will leave it to the employer, mentor or supervisor to decide. It is not lengthy reflective pieces we want to see,
but outcomes showing how reflection has improved their practice.’ The proposed revised code includes a new clause on the duty of candour, added after a recommendation issued in the Francis report last year into care failings at Stafford Hospital. It states that everyone on the register will have a ‘personal and professional responsibility’ to speak out if they have concerns about patient safety. The NMC wants nurse managers to protect staff who blow the whistle on poor practices and ensure their concerns are escalated promptly and appropriately. Dr Kolyva advises that this could be ‘as simple as listening’, because ‘trusts should already have systems in place for raising concerns’. Another section concerns the duty to ‘ensure that the fundamentals of basic care are adhered to and delivered effectively and compassionately’, including giving patients adequate access to nutrition and hydration. Dr Kolyva says it would depend on the situation and case in hand as to whether a failure to report concerns could risk a nurse’s registration being renewed, but adds: ‘If a nurse fails to comply with the code and thereby is putting patients at risk of harm, they could be putting their registration at risk.’ The draft code also covers social media, stating that nurses should not refer to employers, colleagues or past or current
If a nurse fails to comply with the code and thereby is putting patients at risk of harm, they could be putting their registration at risk
Online guide to upcoming changes RCN Publishing has prepared a special online guide to revalidation that is free to subscribers of Nursing Management. The guide has a range of resources, including continuing professional development articles on preparing for staff appraisals. It also contains important information about
NURSING MANAGEMENT
changes to the Nursing and Midwifery Council (NMC) code. The downloadable guide is available at rcnpublishing.com/journal/gtr This area of the website will be updated whenever the NMC issues new guidance or information on revalidation. There is also a new Revalidation Zone website featuring news updates and links to useful resources, at www.revalidation.zone
Timetable ■ August 2014 The Nursing and Midwifery Council (NMC) consultation on the new code of professional conduct and draft revalidation guidance closes. ■ December 2014 The NMC expects to approve the new code and make a final decision on how revalidation will work. ■ April-June 2015 The revalidation pilots take place and the new system is evaluated. ■ November 2015 NMC members make a final decision on whether to introduce revalidation from December 31 2015. ■ 2016 An independent analysis of revalidation will be commissioned. people for whom they have cared. Dr Kolyva says this is necessary because of the increasing prevalence of social media issues in fitness to practise referrals, but it should not stop nurses from using social media as a means of sharing best practice or offering peer support. ‘Whatever a nurse would not do in a public domain around appropriateness, they should not do on social media. ‘It would not be appropriate for nurses to talk in public about confidential patient matters. In the same way, it is not right for nurses and midwives to post pictures of patients on Facebook or Twitter. Due to the style and immediacy of these social networking sites, people forget that.’ Nurses should not panic about revalidation, insists Dr Kolyva. She says nurses deemed to have failed will be entitled to appeal, just as they can under the current process. Should their registration lapse, they will be able to return to the profession on successful completion of a return-to-practise course. With adequate preparation and sufficient guidance from employers, she envisages few appeals. Nonetheless, she urges nurse managers to engage with the consultation to ensure the revalidation model is appropriate in practice. ‘None of this is set in stone,’ she says. See also opinion, page 12 July 2014 | Volume 21 | Number 4
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