What is Revalidation, what does it mean to you? What does it mean to me? I have spoken to quite a varied selection of nurses, from differing branches, some of whom have been in nursing for a considerable time, some of whom like me, have only been nursing for a few years. From each individual, the response has been much the same – “How do the NMC propose to manage this, when in actual fact, they have never asked to see my portfolio of evidence – how will things change.”
I have spoken to nurses with 20 to 30 or more years of experience, each of them have said the same – “In all my years as a nurse, I never been asked, nor do I actually ever recall any nurse i have ever known being asked – to provide an evidential portfolio of professional competence and development.”
This got me thinking, and asking myself the very same question – how are they going to manage this, in particular when I read a parliamentary report dating back to 2013 that stated “the NMC has adopted an approach to revalidation which they say can be introduced within their current legislation, within the specified timescale to December 2015, and which is affordable within their current resources” stating that the financial burden will be approximately £1.50 per registrant. In this report, Peter Griffiths, Chair of Health Services Research of Southampton University told the Commons Meeting, “there was a real risk that the new system could become a fairly bureaucratic exercise”, and “there’s a real danger that the resource isn’t enough to do anything that’s really worth doing,” : House of Commons (2013). I asked myself whether in actual fact, revalidation held any significance, would revalidation actually be more significant than what the NMC currently has in place, and asks us as qualified nurses to do, which seems to be – amassing our portfolio of CPD (Continuing Professional Development) for no one to look at. Being a realist, I am sure that some nurses somewhere, have been asked to produce this evidence, however, I have not come across anyone who has been asked to do this – an interesting question I would put to the audience of this blog is – “which of you as qualified nurses, have been asked to provide evidence of Continuing Professional Development ?”
There is a provisional document available “How to Revalidate with the NMC” (2015) Article 17 within this provisional guidance states “Each year we will select a sample of nurses and midwives to provide us with further information to verify the declarations that they made as part of their revalidation application. Such a request does not necessarily mean that there are any concerns about your application, and you can continue to practise while we review the information that you provide. If you are selected to provide further information, you will need to do this quickly and within the timeframe that we specify” which as far as I can see, will follow on from each registrant making an online declaration via NMC ONLINE – that they meet the revalidation criteria and requirements….. is this really different from what we actually do right now?
This guidance document states that practitioners must complete a minimum amount of practice hours over the three year period of revalidation, Article 27 of this document states that “Only hours that are relevant to registered nursing or midwifery practice contribute toward meeting the practice hours requirement. Your practice hours will relate to your own specific scope of practice and are not limited to direct patient care. For some roles, practice will include non-clinical practice” The question I have raised in my mind, and in particular, this may be pertinent to RNLD nurses, who are working in various and numerous differing roles – “ Who exactly will quantify and agree – what is meant by practice hours”, as I suspect in some RNLD roles, this could be open to debate, and may cause difficulty for some RNLD practitioners when it comes to revalidation. Certainly for me, in my current role, this will not be an issue, as I am working full time hours, and in a specific nursing led service, however, I suspect there are many contentious issues lurking in wait for some of my RNLD colleagues whose roles are diverse and perhaps not quite as clear cut in “nursing “terms.
We as nurses will also be required to provide confirmation of fitness to practice from a “third party” who will confirm whether or not we are fit to practice, and as a matter of interest, this person does not need to be an NMC registrant. ( see article 93 : “How to Revalidate with the NMC”), and whilst this may help a lot of RNLD nurses, who may be working in the community in isolation, and not with other nurses, there is the potential for this again, to become a contentious issue when revalidating, which may be open to abuse. Employers may abuse this position of power, in particular where venture capitalists are taking over private health care services, whose first priority appears to be to their shareholders and a “return on their investment” (Nightingale 2013). The competent practice of a registered nurse can be severely impacted by the nature of the environment they work in, and the nurse may be seen as a “troublemaker” in such an environment, which may lead to an inappropriate “balance of power” between line manager and practicing nurse, whose revalidation is upcoming – another contentious issue.
The House of Commons Report (2013) also states in article 91 “ With regard to the costs of implementing this system, we were told that initial costs for the NMC were affordable, but that the more significant costs of revalidation would fall on employers; however the NMC was clear that additional costs associated with revalidation would not be borne by registrants” Whilst I expect that my employer may meet the “more significant costs” I suspect that there may be issues with some employers, who may “baulk” at the ever increasing burden of bureaucracy and red tape they are required to wade through every day in order to run their businesses, this could lead to some nurses, particularly those who may be nearing the end of their nursing careers, to “throw in the towel” and leave the profession, which may lead to skill shortages.
It is my opinion, that there is a need for us as nurses, to be able to evidence our practice, our continued professional development, and our suitability to continue to practice. I am convinced that generally, the majority of all nurses, of all branches, are fit to practice, and give “their best” each time they turn up for a shift. I am just not sure that “Revalidation” is the vehicle that will deliver professional recognition and “improve public protection” in the way that the NMC suggest it might. I am sure that revalidation will raise many challenges, and contentious issues. I hope my scepticism is unfounded, and it becomes a great success. I will sit on the fence and happily wait to be proved wrong.
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House of Commons Parliamentary Report. (2013). Accountability Hearing with the Nursing and Midwifery Council –Health Committee.Available: http://www.publications.parliament.uk/pa/cm201314/cmselect/cmhealth/699/69910.htm. Last accessed 3rd April 2015.
The Nursing & Midwifery Council. (2015). How to Revalidate with the NMC.Available: http://www.nmc-uk.org/Documents/Revalidation/How%20to%20revalidate%20final%20draft.pdf. Last accessed 2nd April 2015.
Nightingale, L. (2013). Who Owns Care Homes, cit. The Commodity of Care, Dimon, C., appendix.
Author: Graham Burrell