RCN: Eight ways to improve your reflection

In a brief follow-up to my blog on Reflection, the RCN has published an excellent guide:  Eight ways to improve your reflection.  The guide also contains a short film Revalidation video: How to reflect

Whether you are looking at ways to ensure your revalidation goes smoothly – or just train to improve your habits and practices on reflection this is a must read!

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Reflection and Reflective Practice:  A Nursing perspective

 

Do as I say – and as I do!

I have always been an avid fan of reflective practice and use it in my public health and trade union roles.  I tended to be free-handed and free-wheeling with my reflections, covering 3-4 pages of typewritten A4 sheets (I don’t ‘write’ anything these days!).  In relatively recent times, I have come to read up on various models on reflection and find that I sit somewhere outside of them, but agree with many of the principles that they assert.

To Reflect or not to Reflect?

Why am I writing this blog?  Well, with the advent of the Nursing & Midwifery Council decision to introduce the process of Revalidation, they have mandated the use of and documentation of reflective practice (written reflective accounts and reflective discussion).  Those less familiar with the processes and practices of reflection (and less comfortable with the idea of reflection in general) felt they will struggle with this aspect of Revalidation, so I thought I’d put all of the resources in one place for handy reference.

I really do like the idea of and ethos behind reflective practice.  It really makes us think about what we’ve heard, what we’ve learned and what people say about us as practitioners – and what we are going to do as a result of that feedback / experience.  With a little practice, anyone can build reflective practice into their day to day work and not make this all seem like an unnecessary add-on.  When I speak to practitioners about reflection, they realise that they do indeed participate in reflective practice but just don’t realise it (and don’t document it!).

 Adverse Incidents in Practice

A great deal of what I’ve written about in regard to reflection has been in the context of NMC Revalidation.  As a Public Health Professional and Trade Union Rep, the practices inherent with reflection are very useful as part of documenting (and evidencing) ongoing development and improving the practice delivered to / with others.  Other than for ‘development’ and Revalidation, what else is reflection good for?  For Nurses, we are often involved in the investigation of adverse events (such as medication administration errors, etc.).  I find that if the practitioner conducts their own reflective journey on the clinical incident and they can document this journey, it goes a long way toward convincing the investigators (and perhaps others in more formal processes later) that you have learned from the process and taken steps to improve / prevent re-occurrence / risk of further incidents.

More and more these days I am seeing Managers ask for reflections as part of ongoing processes (formal and informal), and so by getting into the practice of doing reflections and documenting them professionally, you can really assist in this.

 References

This RCN Guidance on Reflection and Reflective Practice answers a lot of questions such as:  What is Reflection?  Why do it?  What models are there?  How can I improve my reflective practice?

The NMC Revalidation Microsite  Contains everything you always wanted to know about the subject of Revalidation with the NMC.  Specifically:  NMC Guidance on Written Reflective Accounts  A guide and discussion about the reflective accounts.  The NMC Code – including  the four pillars linked to reflection / revalidation: Prioritise people; Practise effectively; Preserve safety; & Promote professionalism and trust.  The Mandatory Template NMC Written Reflective Account template form that you must use for revalidation (but not necessarily for all your reflection needs).  Also included are some NMC Completed Forms and Templates which includes some great examples of written reflective accounts that you can emulate!  The final part of the process is the reflective discussion, and here you can find the NMC Reflective Discussion Process and Mandatory Template (for Revalidation purposes, but useful generally in discussing your reflections with another registrant); including this Guidance Sheet to help you get the most out of reflective discussions.

The RCN also has a RCN Revalidation Subject Guide which includes key resources from the RCN and others on the process of Revalidation with the NMC.

Homework

Read this blog.  Share it with a colleague.  Follow the RCN and NMC links above and some of the links that they refer to in their guidance.  Talk to your fellow professionals about this.

What do your colleagues in the multidisciplinary team say about you as a practitioner?  What do patients / relatives / carers / service users / others say about you as a practitioner?  Do you act on any of this feedback?  Do you change your practice in any way?

So – in regard to revalidation then – you have now acquired some continuous professional development (on the subject of Reflection / Reflective Practice) and can log this into your NMC CPD Log (some of the learning was on your own, but some was participatory).  In listening to others, you also have Practice Feedback and can log some of this (anonymously) into the NMC Feedback Log.  As an early attempt at documenting your reflective journey, you could reflect on the reflective practice (the CPD you’ve just undertaken), and type / write this onto an NMC Written Reflective Account template form.

 My example

I spent 1½ hours reading; an hour in discussion about it; 5 minutes to enter it into my CPD Log and another 5 minutes entering each bit of feedback that I’d recalled receiving into my Feedback Log.  I then spent ½ hour writing up the reflective account.  All in all, this one ‘episode’ satisfied several different aspects of my triennial Revalidation requirements.

 What Next?

If you ever want help, advice support or more information on this, please do not hesitate to get in touch with me!

Continuing Professional Development: meeting our needs and fulfilling our obligations

The requirements for continuing professional development (CPD) have been with us in nursing for quite some time. The Nursing & Midwifery Council (and the UKCC before them, alongside other professional regulators) required a number of hours between each renewal cycle for many years. The requirement had been to have 35 hours of CPD evidenced within a Post Registration Education & Practice (PREP) portfolio. As you will now be aware, the PREP standards have been replaced by the new renewal process – Revalidation.

As an activist with the Royal College of Nursing, I spend a lot of time discussing nursing and nursing-related issues. Prior to Revalidation coming along, very few registrants voiced concerns that they were unable to meet the PREP standard of 35 hours of CPD over the 3-year renewal cycle. Since the draft proposals for Revalidation were made public last year though, a great many have raised concerns about their ability to meet and evidence the required number of hours. Some of this is about access to CPD generally; some of it is in relation to the new standard requiring at least 20 hours of ‘participatory learning’ amongst the minimum of the 35 hours. In the following paragraphs, I will endeavour to outline ways in which NMC registrants might consider ways in which to meet the CPD requirements as well as referencing the guidance provided by the NMC on their excellent Revalidation Microsite.

I like to be organised; and I hate leaving things till the last minute. For that reason, I like to plan things out. For this reason, I will plan out my next revalidation cycle to plot out the CPD requirement evenly across the 3-year cycle. This will mean ensuring that I have about 12 hours of CPD (7 of which will be ‘participatory’). So really, for every hour of reading and studying, I will want to add another hour to that where I spend it discussing my learning with others. Knowing ahead of time what records and documentation I will need to ‘evidence’ my CPD will allow me to collect and store the information as I go along. Trying to collect and retrieve many hours’ worth of CPD … covering the previous three years of practise … in the last few days or weeks before your revalidation application deadline … is not the best way to do things. I admit, the requirements have changed (slightly) and I have had to do some searching and retrieval myself in the last few weeks. But moving forward into my next revalidation cycle (toward August 2019), I pledge to keep much better, contemporaneous records of CPD!

We can all meet the standards for CPD in hundreds of different ways; but spending money on expensive courses just to say “I was there” is one luxury that many of us can’t afford. Maintaining NMC registration is a personal contractual obligation that we make with our employer. If I do not meet the requirements for renewal (revalidation), then I am removed from the register and cannot practice. Although it is in my employer’s interests to ensure that I am up to date with the latest nursing practise, it is not their responsibility pay for (or give me paid time off of work to do) CPD. So given the above, what can I do to learn, develop, maintain my knowledge & skills and improve services? Funny you ask…

NMC Revalidation & CPD

The NMC document ‘How to revalidate with the NMC’ linked to The Code (March 2015) are the primary references for all things revalidation. How to revalidate, pages 15 – 17 offers excellent guidance on what you need for CPD and how you need to record and evidence it. An important note (which we may come back to later) is that CPD must be relevant to your scope of practice. The NMC-recommended CPD Log Template is a convenient way to record the dates, methods, topics, links to the Code and hours for your CPD. It is very self-explanatory, so I won’t spend any more time on this, other than to suggest using it as a consistent way of recording your CPD. Any reputable e-portfolio will have a very similar format, I would imagine.

As noted above, CPD needs to be relevant to your scope of nursing practice. As well, by definition, CPD is defined as continuous professional development. So things like fire training, which you get every year or so, is not really continuous learning and is not (normally) specific to your role as a nurse. In the discussions below, I hope to identify a number of simple, straightforward and accessible ways in which just about anyone can achieve the NMC’s CPD requirements for revalidation.

First of all, let’s see what the NMC has to say about it! Again, How to revalidate contains Guidance Sheet 3 (on pages 43-44) which offers suggested examples of CPD activities (participatory vs. individual) as well as types of evidence recommended. There are some excellent examples there and very few of them require any expenditure (other than your time) and many are applicable to workplace settings (e.g. not undertaken during your off-duty hours). My advice is to follow the guidance and not to over-elaborate CPD. It really is quite simple to achieve and document as long as you are just a bit meticulous in recording opportunities undertaken.

NOTE: Some of the examples given involve specific incidences of undertaking CPD involving other named individuals. The NMC is very clear in their guidance that your Revalidation portfolio should not breach data protection and confidentiality. I would recommend reviewing the relevant sections of ‘How to revalidate with the NMC’ (Guidance Sheet 1, Page 39) and The Code as relates to these issues.

Because CPD is not new and we’ve always had a requirement to ‘do’ (and evidence) CPD, I am going to leave detailed discussion of ‘individual’ CPD for another day. My scope of practice is related to my dual roles: public health nursing and trade union / professional organisation. In these two roles, I feel like I am always reading and learning new things; developing practice; supporting service redesign etc. So from a perspective of achieving 35 hours, I have never had any difficulty. If I’m honest, the people who I hear complaining the most about the difficulty in achieving CPD hours are those who suggest that the employer is responsible for their CPD and that they should never have to do any learning outwith paid time at work. As stated above, it is a contractual obligation on my part to remain on the NMC register, and I have no issue with investing some of my own time in my personal and professional development.

There are some NMC registrants who work in areas such as a nursing bank, an agency, in isolated areas and in self-employed roles who may struggle with some aspects of CPD (specifically on the ‘participatory learning’ elements). It might be worth reflecting at this point on the justification for adding in a ‘participatory’ element to CPD (and indeed to reflective discussion and confirmation) – ‘to challenge professional isolation by requiring learning through engagement and communication with others’. For ‘isolated’ registrants (and others), I will spend time outlining what participatory learning is and creative ways in which this requirement can be achieved.

Participatory Learning

So what is ‘participatory learning’? How to Revalidate, paragraph 49 (on page 16) states clearly that…

Participatory learning includes any learning activity in which you personally interact with other people. It is an activity undertaken with one or more professionals or in a larger group setting. The group does not always need to be in a common physical environment, such as a study group or conference. It could be a group in a virtual environment (such as an online discussion group). The professionals that you engage with through participatory learning do not have to be healthcare professionals.

I’ve highlighted what I think are the main points to be taken from this section. The inclusion of one or more professionals means that this can be undertaken through discussion with any professional and not necessarily others on the NMC register; and it needn’t be in a formal classroom setting or in a face-to-face physical setting.

Using Twitter Chats to evidence Participatory Learning

I am an avid user of Twitter. In the UK, there is a group called @WeNurses and another called @NurChat who support networking and connections with and between nurses and midwives. One thing they’re excellent at is hosting Twitter chats – an hour’s worth of discussion on topics relevant to nursing (including revalidation). During the discussions, up to hundreds of other professionals are on at the same time, all contributing to the conversation. By logging in and asking questions / making comments, I also get mentioned. At the end of the chat, the host then provides a certificate of participation, a summary of the discussion and a list of participants. Earlier this year, there was a chat about Practice nurses – see the summary etc. here for details.  As your evidence, you can’t go far wrong as it will even name check you as a participant (if you contribute).

You needn’t be an expert in social media (professional media) to benefit from these sorts of virtual discussions, and seven Twitter Chats a year could meet your full participatory learning needs. If you spend an hour before preparing, and an hour afterword reading on subjects you’ve learned / heard about, then the ratio of individual to participatory learning could be satisfied without ever leaving the comfort of your settee! WeNurses (and its various other WeCommunities) offer Twitterversity which is an excellent introductory learning and development opportunity for those new to Twitter – I would highly recommend it!

I accept that everyone can master the skills necessary to participate fully in a virtual, online discussion group. I would suggest though, that if access to other participatory learning opportunities is a major obstacle, then investing in development of even rudimentary skills required to enable participation is a must!  It has been truly eye-opening and beneficial for me to be able to participate in these sorts of discussions and they open up opportunities and avenues that I had not previously considered possible.

This article by the Royal College of Nursing has a really good introduction to NMC Revalidation, online CPD and the use of Twitter Chats to achieve the goal of participatory learning.  Again, if you are new to the professional use of social media, then I would highly recommend perusing the RCN materials.

It may seem daunting at first but I found that a great strategy is to get to open up a Twitter account (or dust off your old, unused account!), get to know the basics of Twitter, find a Twitter Chat that interests you – and then just watch / observe for a while to see how it works. If you’re like me, it won’t take long before you find that you have something to say!

If anyone is near enough to Glasgow and wants to do an actual participatory session using Twitter during a live Twitter Chat, I am game and can easily get us a room booking with full IT support!

Good Luck!

I wish you all the best in meeting your CPD goals. I know Twitter is not the be-all / end-all and it’s not for everyone – but if you struggle (or think you might struggle) to achieve the participatory learning element of the NMC requirement for CPD, then it certainly is a cheap and accessible way to do it!

NMC & Revalidation: Updates

Payment of NMC Fees

Most of you will now be aware of the introduction of the ability to pay your NMC in quarterly instalments as opposed to one annual payment.  I was concerned about the risks to ‘failed direct debits’ and removal of nurses / midwives from the register.  I pay my NMC fees annually, and accept that there is a risk every year.  I pay on the first of the month, so have some time to rectify any bank errors before I am formally removed for the register.  Payment is my personal responsibility and nothing to do with my employer; the NMC may send me notification (if I have set up email notifications; otherwise by post), but this is no guarantee that I will receive it.   My point here is that if you elect for quarterly instalments, it increases that risk of missed payment from once a year to four times a year (quadrupling the risk?).   I asked the NMC for their position on this.  Their process is as follows:

  • If ONE payment fails, the NMC will send you a 14-day notice to pay the FULL amount due. If, after that notice period expires you have NOT paid the full amount, you are removed from the register.

I would urge all registrants setting up direct debits for NMC fees to consider how they will deal with risk and what steps they will take to ameliorate it.  One possible solution might be to set up notifications on your phone calendar for the dates DDs are due to be paid on, just to check (your bank statement) to ensure that they’ve actually gone through.

Risk of Reflections being used against you in court?

In a recent court case, a trainee doctor’s reflective account was used in evidence in a case – and then later against the trainee.   I am not certain about the comparability of reflective accounts in medical practice and Nurses / NMC revalidation, but it does strike me that NMC Registrants may need to consider how they document their written reflective accounts.

NMC Online Revalidation Application

Once all your templates are completed (practice hours, feedback, CPD, reflections, reflective discussion & confirmation), you are effectively ready to proceed with your NMC Online Revalidation Application process.  There is no uploading of templates – just transcribing some of the information onto the online form and ticking boxes to say that they are completed (this process spans over about 15 screens).  The link above contains a handy video, complete with screenshots, to take some of the mystery out of the application process.  Your ‘application window’ is 60 days from your Revalidation Application Date (check your statement of entry on NMC Online to determine YOUR RAD!).  My RAD was 1st August, my window opened on 1st June (and I completed it then).  Very easy and straightforward!

Any questions, queries, comments or suggestions to me in the usual way(s)!

Continuing Professional Development: meeting our needs and fulfilling our obligations

NOTE:  Just for info, I have blogged here on previous topics related to revalidation and even mention CPD in one or two of them.  It might be useful background for you go back to them after reading this one if you want to explore the other requirements.

CPD is one of those things that has been with us in nursing for some time.  The Nursing & Midwifery Council (alongside other professional regulators) has required a number of hours between each renewal cycle for many years.  The requirement had been to have 35 hours of CPD evidenced within a Post Registration Education & Practice (PREP) portfolios.  As you will now be aware, the PREP standards have been replaced by the new renewal process – Revalidation.  In this post, I will explain the changes from PREP to Revalidation specifically as they apply to CPD.

As an activist with the Royal College of Nursing, I spend a lot of time discussion g nursing and nursing-related issues.  I have innumerable conversations with other NMC-registered nurses and midwives and only prior to Revalidation coming along, very few nurses voiced concerns that they were unable to meet the PREP standard of 35 hours of CPD over the 3-year renewal cycle.  Since the draft proposals for Revalidation were made public last year though, a great many have raised concerns about their ability to meet and evidence the required number of hours.  Some of this is about access to CPD generally, but some of it is in relation to the new standard for CPD that requires at least 20 hours of ‘participatory learning’ amongst the minimum of the 35 hours.  In the following paragraphs, I will endeavour to outline ways in which NMC registrants might consider ways in which to meet the CPD requirements as well as referencing the guidance provided by the NMC on their excellent Revalidation Microsite.

I like to be organised; and I hate leaving things till the last minute.  For that reason, I like to plan things out.  For this reason, I will plan out my next revalidation cycle to plot out the CPD requirement evenly across the 3-year cycle.  This will mean ensuring that I have about 12 hours of CPD (7 of which will be ‘participatory’).  So really, for every 2 hours of reading and studying, I will want to add another hour to that where I spend in discussing my learning with others.  Knowing ahead of time what records and documentation I will need to ‘evidence’ my CPD will allow me to collect and store the information as I go along.  Trying to collect and retrieve many hours’ worth of CPD … covering the previous three years of practise … in the last few days or weeks before your revalidation application deadline … is not the best way to do things.  We’ve always had a requirement to do CPD and to maintain a portfolio / folder, so should not really be working that way now.  I admit, the requirements have changed (slightly) and I have had to do some searching and retrieval myself in the last few weeks.  But moving forward into my next revalidation cycle (after August 2016), I pledge to keep much better, contemporaneous records of CPD!

As NMC registrants, we can all meet the standards for CPD in hundreds of different ways; but spending money on expensive courses just to say that I was there is one luxury that I can’t afford.  Maintaining NMC registration is a personal contractual obligation that we make with our employer.  If I do not meet the requirements for renewal (revalidation), then I am removed from the register and cannot practice.  Although it is in my employer’s interests to ensure that I am up to date with the latest nursing practise, it is not their responsibility pay for or give me paid time off of work to do CPD.  So given the above, what can I do to learn, develop, maintain my knowledge & skills and improve services?  Funny you ask…

The NMC document ‘How to revalidate with the NMC’ linked to The Code (March 2015) are the primary references for all things revalidation.  How to revalidate, pages 15 – 17 offers excellent guidance on what you need for CPD and how you need to record and evidence it.  An important note (which we may come back to later) is that CPD must be relevant to your scope of practice.  The NMC-recommended CPD Log Template is a convenient way to record the dates, methods, topics, links to the Code and hours for your CPD. It is very self-explanatory, so I won’t spend any more time on this, other than to suggest using it as a convenient and consistent way of recording your CPD. Any reputable e-portfolio will have a very similar format, I would imagine.

As noted above, CPD needs to be relevant to your scope of nursing practice.  As well, by definition, CPD is defined as continuous professional development.  So things like fire training, which you get every year or so, is not really continuous learning and is not specific to your role as a nurse.  In the discussions below, I hope to identify a number of simple, straightforward and accessible ways in which just about anyone can achieve the NMC’s CPD requirements for revalidation.

First of all, let’s see what the NMC has to say about it!  Again, How to revalidate, contains Guidance Sheet 3 (on pages 43-44) which offers suggestions examples of CPD activities (participatory vs. individual) as well as types of evidence recommended.  There are some excellent examples there and very few of them require any expenditure (other than your time) and many are applicable to workplace settings (e.g. not undertaken during your off-duty hours).  My advice is to follow the guidance and not to over-elaborate CPD.  It really is quite simple to achieve and document as long as you are just a bit meticulous in recording opportunities undertaken.

NOTE:  Some of the examples given involve specific incidences of undertaking CPD involving other named individuals.  The NMC is very clear in their guidance that your Revalidation portfolio should not breach data protection and confidentiality.  I would recommend reviewing the relevant sections of ‘How to revalidate with the NMC’ and The Code as relates to these issues.

Because CPD is not new and we’ve always had a requirement to ‘do’ (and evidence) CPD, I am going to leave detailed discussion of ‘individual’ CPD for another day.  My scope of practice is related to my dual roles:  public health nursing and trade union / professional organisation.  In these two roles, I feel like I am always reading and learning new things; developing practice; supporting service redesign etc.  So from a perspective of achieving 35 hours, I have never had any difficulty.  If I’m honest, the people who I hear complaining the most about the difficulty in achieving CPD hours are those who suggest that the employer is responsible for their CPD and that they should never have to do any outwith paid time at work.  As stated above, it is a contractual obligation on my part to remain on the NMC register, and I have no issue with investing some of my own time in my personal and professional development.

There are some NMC registrants who work on nursing bank, agency, isolated areas and self-employed registrants who may struggle with some aspects of CPD (specifically on the ‘participatory learning’ elements).  It might be worth reflecting at this point on the justification for adding in a ‘participatory’ element to CPD (and indeed to reflective discussion and confirmation) – ‘to challenge professional isolation by requiring learning through engagement and communication with others’.  For ‘isolated’ registrants (and others), I will spend time outlining what participatory learning is and creative ways in which this requirement can be achieved.

So what is ‘participatory learning’?  How to revalidate, paragrapgh49 (on page 16) states clearly that…

Participatory learning includes any learning activity in which you personally interact with other people. It is an activity undertaken with one or more professionals or in a larger group setting. The group does not always need to be in a common physical environment, such as a study group or conference. It could be a group in a virtual environment (such as an online discussion group). The professionals that you engage with through participatory learning do not have to be healthcare professionals.

I’ve highlighted what I think are the main points to be taken from this section.  One or more professionals means that this can be undertaken through discussion with another professional.  It needn’t be an NMC registrant and it needn’t be in a formal classroom setting.  As well, said discussion need not take place in a face-to-face physical setting.

Example 1:  I am an avid user of Twitter.  In the UK, there is a group called @WeNurses and another called @NurChat who support networking and connections with and between nurses and midwives.  One thing they’re excellent at is hosting Twitter chats – an hour’s worth of discussion on topics relevant to nursing (including revalidation).  During the discussions, up to hundreds of other professionals are on at the same time, all contributing to the conversation.  By logging in and asking questions / making comments, I also get mentioned.  At the end of the chat, the host then provides a certificate of participation, a summary of the discussion and a list of participants. Earlier this week there was a chat about Practice nurses – see the summary etc. here for details.  You needn’t be an expert in social media (professional media) to benefit from these sorts of virtual discussions, and seven Twitter Chats a year could meet your full participatory learning needs.  If you spend an hour before preparing, and an hour afterword reading on subjects you’ve learned / heard about, then the 2:1 ratio of individual + participatory learning could be satisfied without ever leaving the comfort of your settee!

Not everyone can master the virtual discussion skills necessary to participate fully in an online discussion group.  I would suggest that if access to actual participatory learning opportunities is a major obstacle, then investing in developing even the rudimentary skills required to enable participation.  It has been truly eye-opening and beneficial for me to be able to participate in these sorts of discussions and they open up opportunities and avenues to me that I had not previously considered possible. I am on Twitter as @The_Pars and you can contact me as per details on this blog site (or by sending m a tweet) if you want more information or some support to get started in virtual discussions.  There are a great many examples of virtual discussions that could take place (including on Facebook and elsewhere), but I’ve included the examples above as the NMC use them and they also take a lot of the strain out of the recording and evidencing of other forms of online discussion by providing direct evidence of your attendance / participation, whereas other places you’d need to be more studious in note taking, etc.

Example 2:  A good example of simple, participatory learning is as part of practice development situation at work.  You (or your student / newly qualified colleague) requires to learn a new skill and as part of this requires to have a supervised session whilst they undertaken it (e.g. catheterisation).  For those of you who are mentors, coaching and mentoring colleagues is an excellent way to achieve your participatory learning requirements.  Team Meetings (if you have them) are also useful if there are elements within the meetings where practice development, policy implementation and other related issues are discussed.

In my experience, the participatory elements to skills development are only a small percentage of the time taken to learn, consolidate and share with others, so always remember to document and record your individual and participatory elements of learning outwith the direct episodes.

Example 3:  We are all know the more formal, face-to-face classroom engagement that would count as participatory learning (study days, workshops and conferences).  Because paid time off is becoming less and less accessible to many organisations, the move toward e-learning is becoming increasingly popular.  One way to translate virtual learning via e-modules from individual learning to participatory learning is to follow up your completion of the topic(s) with some discussion of the learning elements with another/other professional(s).  I can’t remember the last time I have undertaken a course of e-learning in any subject and then not spent some time discussing it with colleagues.  What is the point of learning if we keep it all this great information to ourselves! J

The main thing to remember about the more ‘casual’ examples of participatory learning is the need to maintain accurate records and evidence of the learning.  Noting down an hour to do an e-module and then recording in short notes the ½ hour or hour that we spent talking to our colleague(s) is really quite simple and effective – the hours really do mount up quickly if you do this regularly.

Example 4:  Following on a similar theme, many of us read journal articles, publications, and do small-scale, private research on topics of interest.  I had a colleague who came to me with a long-term condition that I was not familiar with; I read up on the subject and looked at ways in which the condition could impact on work and vice-versa, and how the job / role / working patterns could be adjusted to support her.  In this example, it was related to my scope of practice and I used the learn to improve my practice in a way that supported her and informed her ‘return to work’ plan over time, the same as you might do for a patient in your care whose treatment / care plan might need specialist knowledge and skills.  In this case, all that I have done so far is individual learning – but by discussing this learning opportunity / outcomes with others, I can document (anonymously) my participatory learning with colleagues, and translate some of that new information into revised practice, protocols and pathways for future.

  • Another extension of the private learning into participatory learning is the development of a ‘journal club’. This might require buy-in from the employer and/or a significant contribution of ‘off –duty’ time from participants.

I am aware that there are some registrants whose individual learning styles really lend themselves to the more formal, class-room / face-to-face methods of learning.  I find them extremely useful in a lot of solutions too and am certainly not trying to put people off of them; merely looking at solutions to those who find attendance difficult and inflexible.  Being an activity in a trade union / professional organisation, I am aware that they offer a number of free learning opportunities; some during the ‘working week’ and some at evenings.  It is always useful to keep in contact with local Branch officers / activists to see what they have on offer.  Similarly, Professional Forums and Professional Networks also have, in addition to virtual discussions (such as the Twitter Chats mentioned above) actual face-to-face meet-ups which are often very cheap or free. My advice is really to think creatively.  Unless there is a particular subject that you cannot learn through methods which cannot be achieved except through paying for and attending a commercially provided course, then look around and be flexible in your learning styles!

And so concludes my exploration of CPD… Do you have any other ideas out there about how we can be more creative to meet our individual and participatory learning requirements?  I’d be happy to hear from you!

Revalidating as a Trade Union Rep

Prologue

I am a Steward for the Royal College of Nursing.  As an accredited trade union (TU) representative for a professional organisation (PO), I receive paid time off from my substantive post in order to carry out my TU / PO duties.  In my case, I do a substantial amount of work in this area (4 days per week out of 5).  In reality, this amounts to 80 % of my employment.  My RCN duties involve sitting on professional groups relevant to nursing and nursing practice as a staffside representative, working in partnership with my employer to support development of policy, patient / service pathways, service development, workforce change and others.  In addition, I support and represent RCN members in a number of areas related to employment and professional nursing practise issues.  My substantive post is working as a public health professional (health improvement / health promotion).

I am also a Registered Nurse – registered with the Nursing & Midwifery Council (NMC).  As such, like all other registrants with the NMC, I am required to renew my registration every three years.  From next month (April 2016), that renewal process is changing – and the new process called Revalidation which continues on the work of PREP, adding additional elements into the process.  Everything any registrant needs to know about revalidation can be found on the NMC Revalidation Microsite, including forms and templates (described below) and even a set of completed forms and templates to give you an idea of what the information might look like on the forms.  The definitive guide ‘How to Revalidate with the NMC’ is well worth a read, alongside this journey!

I am not a ‘real nurse’ – Will I be able to revalidate?

When I first started to hear rumours about revalidation, I heard all kind of scary stories that made me think that I might not be able to renew my registration:  I do not work in ‘clinical nursing’, I work a substantial amount of hours outwith my substantive post (as a TU rep); my substantive post is not nursing (per se) and my line manager is not a nurse.  So, I set out to allay those fears and to learn everything that I could about Revalidation and the processes required to meet triennial renewal with the NMC.  I am pleased to say, that all of my fears were completely unfounded – and my public health and TU/PO roles are both recognised buy the NMC as acceptable settings for nursing practice.

This is my story; I hope that it resonates with others working in similar roles and possibly helps those working in TU/PO positions to see how work in these areas can be used to support (and provide evidence for) their own revalidation.

My renewal date is August this year; so potentially my registration could expire on 31st August 2016 if I do not revalidate.  I need to complete my NMC Online Revalidation Application as early as 1st June and not later than 1st August and I need to pay my annual fee before the expiry date (I have direct debit set to come off my account on 10th August).  Before I apply, I need to make sure I have everything I need to be ready to complete the application.  You will need an account via NMC Online – so make sure that is done well in advance, that you use an accessible email address for this purpose and that you can view your statement of entry with the NMC.

The NMC Code

The Revalidation process is centred around the new ‘Code’ which was approved in March 2015 (copies were sent out to every registrant early last year).  Many steps of the revalidation process require some reference to the ‘Code’.   It would be very useful to have a working knowledge (and a handy reference copy) of the ‘Code’ as it is your living guide to nursing as well!

 

The following is my step-by-step process in my preparations for revalidating and completing my first ever revalidation application:

Step 1:  Practice Hours

To revalidate, I require to evidence that I have completed the minimum of 450 practice hours since my last renewal (in August 2013).  I downloaded the NMC-recommended practice hours template from their website.  When looking at the template, I was immediately reassured to see that both areas of my professional practice are explicitly defined as an appropriate nursing & midwifery ‘work setting’ for the purposes of revalidation.  So rumours of difficulty revalidating for nurses & midwives working in these areas were greatly exaggerated (and a full-tie trade union rep will have no difficulty revalidating due to lack of ‘clinical nursing hours’).

On the practice hours log template, I completed two entries on the form:

Line 1 – About my work in public health setting, 7.5 hours per week, approximately 40 weeks per year, so about 300 hours per annum x 3 (600 hours).  Technically I could stop there, as I have evidenced the minimum practice hours, but I will continue…

Line 2 – About my work in TU/PO setting, 30 hours per week, approximately 40 weeks per year, so about 1200 hours per annum x 3 (3600 hours).

NoteMy 2 disparate roles are equivalent to 20%/80% of my working practice.  Although it is not an explicit requirement, it makes a lot of sense to relate the other elements of revalidation to my specific area(s) of practice.  (e.g. Evidence supportive of my learning and development in public health and trade union areas is more reassuring when my practice hours, reflections, feedback and CPD are relevant to these areas of practice).

On the two entries in the practice hours log template, I put in the inclusive dates between my last renewal to my next (1st Sep 2013 – 31st Aug 2016); my employer is technically the same for both roles (NHS Greater Glasgow & Clyde); I copied & pasted the work setting from the list of options (public health and TU/professional body respectively, in my case) and for scope of practice, I chose three areas for each role (as the roles cross-cut widely between the three): Policy, Education & Consultancy.  My registration is ‘Nurse’ as I am not a midwife nor am I on any specialist register; lastly, I very briefly described each role in the final section of each line – paraphrased from my Job Description’s Job Purpose section and from my (Steward) Role Descriptor.

My practice hours log template needs to be backed up by evidence within my Portfolio to convince a third party that I have actually completed the requisite number of hours.  It is expected that it will be my (non-nurse) line manager who will act as my confirmer.  As such, he will not require a great deal of evidence.  In my portfolio, I have facilities time requests, substantive post job description, the Steward Role Descriptor, etc.  I could even have P60s and time sheets, but I can’t see me needing this level of evidence to convince him, when he is the person signing off my paid hours every month.

Step 2:  Continuing Professional Development

To revalidate, I require to evidence that I have completed the minimum of 35 hours of CPD since my last renewal (in August 2013).  Of that 35 hours, at least 20 hours of CPD needs to be done through ‘participatory learning’ (with other professionals).  I downloaded the NMC-recommended CPD Log template from their website.  I consider myself very fortunate because, as an organisation, the RCN invests a lot in terms of ongoing learning and development for its trade union reps.  I found enough CPD evidence in one 12-month period than I would need for three for revalidation purposes!

Because I did not have the template since 2013, I went back to my records (some paper; some electronic) and took collated together dates of conferences, training programmes, delegate packs and other evidence that I’ve maintained in / with / for PREP, including a pile of my own notes that I had maintained over the intervening years.  I filled in each section on the self-explanatory template form for each CPD session that I felt significant enough to note, working backward in time, until I got to 2014 (by which time I had satisfied the 35/20 hours minimum requirement.  The information required for the form is very brief and most of it I got from the agenda or presentations for conferences or notes I’d taken myself, all of which I will keep in my portfolio, as my confirmer will need to see evidence that I did actually complete the CPD.  For each entry on the form (I have six entries at the moment), I chose the pillar of the code that was most relevant to each.  I do not need to evidence every pillar in my CPD log and there is no right or wrong answer, as most CPD could apply equally to a number of pillars.  (Most of my CPD was gained through attendance at RCN representative study days, RCN Scotland Reps Conference, Congress and Joint Reps Conferences.)

After today, I will be more aware of the need to keep the types of evidence to support my learning, and will note entries on my CPD Log template on an ongoing basis (as opposed to doing it retrospectively at the time of my need to revalidate!

NOTE:  As described above, my roles divide up to a 20/80 split.  For this reason, I will select evidence to support CPD to a similar ratio:  20% of my CPD hours in public health settings; 80 % in trade union / professional body settings.

Step 3:  Practice Related Feedback

To revalidate, I require some evidence (not necessarily written) that I have listened to feedback from others about my area of practice (and not necessarily about me, personally).  The minimum is five examples of practice feedback since my last renewal (in August 2013).  I downloaded the NMC-recommended Feedback Log template from their website.  I found it extremely easy to recall examples of feedback including, but not limited to: supervision sessions with my line manager; case supervision discussions with RCN Officers; Case Management discussion with colleagues; feedback from participants after delivering training to them, feedback from members that I represent (and a host of potential others!).  Again, the Feedback Log template is self-explanatory and the information required for it is very brief.  This form must be anonymous and there is no requirement to hold evidence of this feedback in your portfolio.  Have a look at the exemplar Log in the set of completed forms and templates to give you an idea of what the information might look like.

Please note that practice feedback need not be specific to you or about you.  An example could be a case discussion at a rep’s meeting where a colleague had a potentially disastrous outcome in a case they were representing, where the manager was misrepresenting policy.  This is about my area of practice; it is something I can learn from; and it is information that I used as a trigger to change (improve) my practice (but it is not specifically about me).

NOTE:  Again, my roles divide up to a 20/80 split.  For this reason, I will select feedback to a similar ratio:  one in regard to public health activity; four in regard to trade union / professional body activity.

Step 4:  Written Reflective Accounts

To revalidate, I require having documented a minimum of five written reflective accounts since my last renewal (in August 2013).  I downloaded the NMC’s manadatory Reflective Accounts form from their website.  You can hand-write them or fill them in directly or like me, do them in a word document and then cut and paste into the appropriate sections of the form later.  I have a reflective style all of my own; some people have used various models of reflective practice over the years and have gotten used to their own style of reflecting and recording of reflection.  As far as the NMC is concerned, they have no preference or requirement for any particular style or model – do it however way suits you – but at the conclusion, you will need to document your reflective account on their mandatory template.

Information required for the template is fairly light:  A title; a brief description of what you are reflecting about; what you learned; how you applied that learning to improve your practise and which pillar of the code it most appropriately aligns to.  For each Reflective Account that I have done, I chose the pillar of the code that was most relevant to each.  I do not need to evidence every pillar in my Reflections and there is no right or wrong answer, as most CPD could apply equally to a number of pillars.  In most of mine, I have selected more than one pillar for each.

You can choose to reflect about either a CPD session that you have undertaken; or one or more of your examples of practice feedback; or an event or experience related to your area of practice (again, like the feedback, the event or experience does not have to be about or involve you personally.

So what do I reflect about?  Of the five pieces that I have done, one was about a CPD session that I attended (RCN focus group on scrutiny & inspection); as the NMC Code is central to revalidation (and it is fairly new), I did my second reflective piece on the Code itself (now I am much more familiar with the Code and it comes up in casework and revalidation all the time!); I did my third reflective piece specifically about reflective practice – because my public health role and revalidation both require reflective practice.  I thought I could develop bespoke practise that would assist me and others on the NMC register working in public health to be able to do reflection to support both (it saves us doing the same thing twice!); I did my fourth reflective piece on feedback I had received after delivering a Revalidation Masterclass (and how I used that feedback as a spur to raise awareness with colleagues – e.g. through blogging my experiences!).   My last piece was about a member who had taken a unilateral decision to resign, without full knowledge of the implications of their decision.  As a result of this, I changed the way I document and present case discussions with / to members, clearly outlining the options, with pros and cons for each.  At least then if they act unilaterally, they are making a somewhat more informed choice than the member I’d represented above.

Step 5:  The Reflective Discussion

At some time during my revalidation cycle, when I have evidenced the minimum of 5 written reflective accounts, I will be required to hold and document a reflective discussion session with another NMC registrant.  The reflective partner need not be an expert in any of my areas of practice.  All they need are skills at reflective and the ability to lead me through a conversation about my 5 written reflective accounts.  The NMC has provided a reflective discussion guidance sheet; it would be reasonable to suggest that you and they both become familiar with this guidance before having the conversation.

In my case, my line manager is not a registered nurse or midwife, so they cannot be my reflective partner.  I do however have an RCN Officer who is involved in my supervision of my representation role (steward case management in particular).  It is my intention to use the RCN Senior Officer as my reflective partner, and will set up a meeting with her, for this purpose, in April 2016.  In some sectors, employers are nominating reflective partners (and confirmers).  It makes sense to follow the employer recommendations for this, unless you have other reasons for nominating your own.

Ahead of my meeting to hold the reflective discussion, I will send my reflective partner copies of my 5 x written reflective accounts as well as the mandatory NMC Reflective Discussion Template form, with my name and PIN already competed on it (both can be sent by email).

Once we’ve completed discussions about the 5 accounts, the reflective partner will then complete the Reflective Discussion Template, print it and sign it and then hand it to me.  As a courtesy, I will copy this for them, as they may need to refer back to it, should they be contacted later as part of the NMC verification (audit) process.  This then gets placed into my professional portfolio

Step 6:  The Confirmation Process

Now that I have effectively evidenced all of the requirements elements of revalidation, I am ready to submit to a third-party confirmer process.  It is the expectation of the NMC that the conformer is your line manager.  In some sectors, employers are nominating confirmers.  It makes sense to follow the employer recommendations for this, unless you have other reasons for choosing your own.  As you can complete this process within 12 months of your revalidation application, it might make sense to combine this meeting with / at the time of your annual appraisal / supervision / eKSF / PDP-review meeting.

The confirmation process needs to be completed within 12 months of your revalidation date.  In my case, had I known all about revalidation at the time, it technically could have been done as early as September 2015 for my upcoming August renewal.  I will schedule a face-to-face meeting with my line manager specifically to undertake the confirmation process.  Had my line manager been able to do my reflective discussion, I could have scheduled a single meeting in which they could undertake my confirmation immediately after finalising my reflective discussion template form.  The NMC has produced guidance for confirmers and it would be useful if both you and your confirmer are familiar with the process and their role within it.

In my case though, I am scheduling a confirmer meeting with my line manager in May 2016 (after my reflective discussion meeting which I will have done in April).  In advance of our meeting, I will complete the personal details (Name, PIN & last renewal date) for my mandatory NMC template Confirmation form and email it to my confirmer.  In the meantime, I will organise all of the evidence that I will require to support the elements of revalidation:  all of the completed template forms / logs as discussed above, any additional evidence in my professional portfolio (as may be required to satisfy my confirmer that I have, for example, done the CPD, completed the practice hours, etc. as appropriate).  On the day, it should not take more than a few minutes for the conformer to check that he has seen (or is satisfied that I have evidenced) all of the elements required for revalidation, as above.

Once we’ve completed the confirmation process, the confirmer will then complete the NMC template Confirmation form, print it and sign it and then hand it to me.  As a courtesy, I will copy this for them, as they may need to refer back to it, should they be contacted later as part of the NMC verification (audit) process.  This then gets placed into my professional portfolio

Step 7:  The Revalidation Application Process

Now I am ready to apply for revalidation.  The dates I need to be concerned with are my revalidation date (the end of the month I am due to revalidate: 31st August 2016); my revalidation application date (the beginning of the month I am due to revalidate: 1st August 2016); and the window in which to revalidate, which is within 60 days of my revalidation application date (no earlier than 1st June and no later than 1st August 2016).  The NMC will be emailing me, using the email address that I used to sign up to my NMC Online Account.  They remind me of the upcoming dates and deadlines.  Because I have prepared in advance of the ‘window’ opening, I will be ‘revalidation ready’ and able to apply the day my window opens (1st June).  I will either follow the link in the reminder email, or simply go to the NMC website and log in to my NMC Online Account.  There will be a link available (if I am within the ‘window’ period, to click to apply.  A web form will the open, asking me to fill in details relevant to my application.  It will require that I have my templates and forms handy, as the information in them will be used to complete the various pages of the application process.  I will NOT upload or send the NMC any documents as part of this process.

At one of the final screens, the NMC will verify my payment process.  If I have a direct debit /. Stranding order set up with them, it will show on this screen.  If I wish to apply in lieu of payment (my direct debit comes off on 10th August), then I finish my application at this stage.  I should get an email back confirming that I have applied (not that I am renewed yet!).  Renewal will not be completed until the application and the payment are both with the NMC. In my case, this will be on or about 10th August.

I will be proactive and put a reminder in my diary to check my NMC Online ‘statement of entry’ after 10th August.  It should then be updated to give my new revalidation date of 31st August 2019.  If it does not, I will take action immediately to ensure my registration does not expire on the 31st August!!

Well; I have applied.  So what next?

NMC Revalidation Verification (Audit)

In some cases, NMC registrants will be selected for verification / audit.  The NMC will send an email within 24-48 hours of receipt of your Revalidation Application.  The email will contain a web link, taking you to their online revalidation verification form.  Like the revalidation application form, it will be a series of screens asking you to complete additional information to support your revalidation application.  The revalidation application basically involves you ticking boxes to confirm that you did the relevant practice hours, 5 reflections, etc. – it is my understanding that the verification form would be asking for additional details about your CPD; practice hours, etc.  You will NOT upload or send the NMC any documents as part of this process.

If you are selected for verification, your Confirmer (and possibly your Reflective Discussion partner as well) will also get an email within 24-48 hours of you submitting your revalidation application.  This is why it is a good idea to give a copy of the relevant template forms to them, as they will need to refer back to this information on these forms to complete their part of the verification process.  Like your verification online form, they too will be presented with a series of screens asking them to complete additional information to support your revalidation application.  It is my understanding that the verification form (for them) will be asking them to confirm their identity and confirm that it was indeed them that signed the relevant template forms that you referred to in your application.   They will NOT upload or send the NMC any documents as part of this process.

If you receive an email as part of the verification process and you have reason to believe that your confirmer or reflective partner will be unable to respond their request(s), I would advise contacting the NMC immediately, so that action can be taken to address this,.  I imagine in a ‘worst case scenario’, that the NMC may require you to complete either process again.

It can take from 4 – 12 weeks for the NMC to complete the verification process.  I would recommend completing the application as soon as you are able (I will do mine as close to 1st June as possible) in order to avoid unnecessary delays and to try to ensure completion of everything (including possible verification processes) by my registration expiry date.

NOTEThe NMC will retain you on the register until the completion of the verification process – even if this extends beyond the registration expiry date.  Subsequent renewal dates will not be affected.

Portfolio – to e- or not to e-?

As an RCN Accredited Representative, I have free access to the RCNi e-Portfolio; and as an NHS employee in Scotland, I have free access to the NES e-Portfolio.  I will admit to being a fan of technology and an early implementer to most things ‘e-‘.   For revalidation purposes, I have had to result to historic records already maintained in PREP and my professional portfolio (both of which are a combination of electronic records (at work and at home) as well as paper records and files 9mostly stored at work).  When the draft proposals for revalidation were made in the summer last year and continuing on from when the final proposals at the end of October 2015, I have trawled my electronic files and paper files to complete and evidence the revalidation requirements.  I did so storing everything on the ‘cloud’ – Gmail, Google Docs, Dropbox, home and work hard drives, etc.  I logged in to both the RCNi e-Portfolio and the NES e-Portfolio to play about with them and test them out.  To me, they are much of a muchness, with little to choose between them.  NES is wonderful as it can easily double for revalidation and pubic health (and it is free, for my lifetime, so they say!).   If the RCNi is free to reps, it is quite a useful tool as well.  Given thought that I have just had to trawl through historic records to get ‘revalidation-ready’ this year, I did not really need either of them; using them this year would mean doubling up the work I’ve already done; and the NMC does not require anyone to have or use electronic portfolios – I will not recommend using either of them (yet).  Moving forward (regards my revalidation cycle between 2016 and 2019), I will endeavour to start using them, and will use paper records less and less.

To e- or not to e-?  I’ll let you decide.  What I would suggest is that no one should pay for an e-portfolio (not purely for revalidation).  There are too many free tools out there that can do the job just as well, without the added expense!

Epilogue

Revalidation is a new process – I only really found out what would be required of me a few months ago (October 2015).  So for this revalidation cycle, I have had to push through, prepare and collate more information in a relatively short time than I will need to do for my next renewal (circa August 2019).  Moving forward, I will ensure that I space things out (over the three year period), like the 5 written reflective accounts.  I kept records about most of the elements of revalidation (like practice hours and CPD), as I needed them for PREP and my generic professional portfolio anyway, but other pieces of evidence that I have had to go searching for was a bit more problematic.  Going forward, I will keep accurate notes in word documents, ready to cut and paste into the template forms well in advance, so that when the time comes, I am ready to revalidate.  I might also forward plan the confirmer (and reflective discussion) meeting(s) as early as possible so that everything is done as efficiently as possible (combing them with meetings already in the diary for supervision, appraisal, etc.).   When June 2019 comes around, I will be more than ready to revalidate (again!).

 

RCN Resources:

Revalidation:  A quick Update on Practice Related Feedback

 

You will be aware by now that Revalidation is coming!  As you will have seen if you’ve read any in my series of blogs before, revalidation builds on the previous Nursing and Midwifery Council in the UK (the NMC programme of registration renewal (PREP) and adds a few additional new elements as well.  One requirement is that nurses and midwives need to listen to feedback from patients, relatives, carers, colleagues, managers and others.  They need to take note of this feedback and near the time of their renewal; they need to discuss how they’ve used this feedback to improve their practice.  As with my blog on Reflection (29th Feb 2016), registrants can also do written reflective accounts about their feedback.

When the NMC unveiled their final proposals for revalidation in October 2015, they included a number of templates (some suggested; some mandatory) for the recording of evidence to support the various elements (practice hours, CPD, reflection, etc.) but at the time they did not include a template for practice feedback.  After a number of requests and listening to the pleas or registrants, they have not introduced a template that can be used for this purpose.  Here is the link to the practice feedback template and guidance for the use can be found in the ‘Revalidation Bible’ How to Revalidate with the NMC.

The practice feedback template is a quick and easy (and anonymised) way of recording P-RF as and when it happens, so that when you are ready to Revalidate, you have examples of at least the minimum 5 examples of feedback, ready to discuss with your confirmer.

NOTE:  You do not require evidence for P-RF.  Just note down anonymously what the feedback was, how you came by it, and how you used it to improve practice.  There is a ‘worked example‘ of how the template can be used (along with completed examples of all the others templates), but the PRF sample is ‘cut off’ and incomplete.  I will raise this with the NMC and hope that they amend the page.  Visit the NMC Revalidation microsite often as the pages do get updated frequently.

2nd March 2016:  I Tweeted the NMC and raised the issue of the ‘incomplete’ practice feedback template.  If you follow the worked example‘ link, you should now see the missing line has been rectified.

As always, please leave feedback and ask any question you want – I am happy to try to answer any queries you might have.

 

Reflection for NMC Revalidation – what are people frightened of?

 

In my mind, the reflective accounts and the subsequent reflective discussion are potentially the most powerful and influential aspects of revalidation.  The potential to realise true improvements in the care that we provide to others is significant and no amount of CPD can make a difference to our practice unless we consider what we’ve learned and apply that learning.  Without involving a fellow registrant in the process, we risk limiting the ideas for exploration & improvements.  I am a strong advocate for reflective practice and am really pleased that the NMC has included this in the revalidation process.

In a recent poll that I conducted, I asked registrants to tell me, of all the elements required for revalidation, which one concerned them most.  The result was that almost 60% cited the reflective practice element as the most concerning.  For that reason, I promised to write a blog outlining the process and hopefully reducing the anxiety associated with it.

I won’t go through the whole history and process of Revalidation here.  If you have not already done so, please read my previous blogs for more information and read the NMC’s definitive guide ‘How to Revalidate with the NMC’.

But we already do reflection

I’ll begin by saying that I have been living and breathing revalidation since I heard about the first draft proposals being mooted last year.  I have been talking to registrants, facilitating presentations on the subject and learning as much as I can about it.  In my experience, nurses and midwives are using reflective practice every day and as part of that, they are having reflective discussions with their colleagues as well.  There are very few registrants that I’ve corresponded with or spoken to who are against reflective practice or suggest that they don’t, won’t, or will not ‘do reflection’.  At the end of the day, most of the anxiety is related to taking something we do naturally every day and actually documenting it.  Revalidation is all about introducing assurance to the nurse and midwifery renewal process, so documenting that we reflect, and what we reflect on and how we use that reflection to improve the practice / service that we provide to others is a very important aspect of the ethos of revalidation.

Other registrants have been through academic courses in the recent past and the coursework involved formal reflective modelling, the use of academic referencing and a requirement to produce reflective assignments that amounted to hundreds & thousands of words!  Be assured that NMC Revalidation does not require academic-level reflective pieces.

Before anyone gets in a panic, the first thing that I would recommend is to have a look at the NMC’s Revalidation microsite. Included within the pages is a series of ‘worked examples‘ – various Revalidation templates completed as examples to give registrants an idea of the length, depth and discussion required.  Included in them are a few examples of the NMC’s expectation of what a written Reflective Account might look like.  The templates for written Reflective Accounts are required to be used for this purpose and as you can see, the standard required of them is not onerous.  I’ve already done my minimum number of 5 WRAs required for my Revalidation (I’m due in August!).

So how do I do a Reflective Account and what do I write about?

Here’s how it goes: A:  consider one of your CPD sessions… or B: one of your recent episodes of practice related feedback… or C:  an event or experience related to your area of practice.  Note which of these you are doing as the reflective account, and briefly state this in the second section of the template.  It would help to give a title of the piece in the first box.

Secondly, make brief notes of what you learned in regard to the instance noted above. Note this in bullet point fashion (or in paragraph form) in the third section of the template.

Thirdly and perhaps most importantly, make brief notes of what you did as a result of this episode and the learning from it to improve your practice.  Note this in bullet point fashion (or in paragraph form) in the fourth section of the template.

Lastly, consider how best this reflection relates to the pillars of the NMC Code.  In the Code, you have four choices: Prioritising People; Practicing Effectively; Preserving Safety and Promoting Professionalism & Trust.  All you really need to do here is copy and paste the most relevant pillar of the code (from the choice of the four above) and paste this into the final section of the template.

I was taught in school to answer questions in complete sentences, so when I’m completing my templates, I usually put something to describe my decision-making process:

This subject is most relevant to promoting professionalism and trust, but could equally apply (and apply in some measure) to both practicing effectively and preserving safety

Don’t feel obliged to follow my verbose example – look on the NMC website and follow their example.  Do not over complicate things!

When I have completed five of the reflective accounts, I can then arrange to have a reflective discussion with another NMC Registrant.  The Reflective Partner can be your confirmer – and the Discussion can be done just ahead of (and at the same meeting) that you have your confirmer session – but that is not necessary if you want to do this one in advance.

For most of us, we have reflective discussion all the time.  We can even have separate discussions alongside and after each individual written reflective account; but for revalidation purposes, you only need to record ONE reflective discussion form (using the mandatory template) to cover you for all of your written reflective accounts.

The NMC has produced a very handy reflective discussion guidance sheet.  Read this and make certain that your reflective partner is also familiar with it.  The guide outlines what each person needs to do to make it a rewarding and productive process.  In advance of the scheduled meeting for the reflective discussion, send copies of your written accounts to the reflective partner so that they can be familiar with and aware of the topics that you are preparing to discuss.  In a protected session, in a suitable venue (free from distractions and interruptions), you can discuss your reflections, the learning from them, and the improvements to practice that you’ve taken.  A good reflective partner will challenge you to look in areas and at things that you may not have previously considered.

Once you have discussed all five of your relative accounts, give the Reflective Discussion (mandatory) template to your reflective partner.  You’ll have filled in your name and NMC PIN at the beginning of the form; at this stage, your Reflective Partner will then complete the rest of it.  Look again at the series of ‘worked examples‘ – it really is only very brief notes on the part of the Reflective Partner.

Once the template form is completed, ensure the Reflective Partner dates it, signs it and returns it to you.  I would then leave a copy with them as a courtesy, as there is some potential that they could be contacted in the future to verify your revalidation application.  The form can then be stored safely and securely within your portfolio, ready for your confirmer session.  Remember that you will need information from this form when you are making your online revalidation application.

NOTE:  You do not upload or send this form or anything else to the NMC!)

As I’ve suggested above, I recommend that before anyone starts to write a reflective account, that they take time to look at the NMC’s worked examples of already completed written Reflective Accounts and the Reflective Discussion templates.  Follow these examples as a really good idea on how much time and effort you (and your reflective partner) need to take to complete them need to be on them.  Again, do not over complicate things!

It’s really easy – it’s taken me about 20-30 minutes from start (a blank template) to completion on the Reflective Accounts.  As I’m already having multiple reflective discussions anyway, the final, recorded reflective discussion should be quite straightforward and should only take 30-45 minutes at the most.

I would recommend that you not wait until tour revalidation date is upon you – space them out from your first year to your third and make it easy on yourself!  In my case, revalidation is almost upon me (I got my first heads-up email today!!), so I’ve had to work through them a bit quicker – but next cycle I’m going to do 2-3 of them a year, so that when my next revalidation date comes (August 2019), I will be ready well in advance…

So what are you waiting for?  Get stuck in!

I’m ‘Revalidation Ready’ – what comes next?

 

I have read the guidance document ‘How to Revalidate with the NMC.  I have completed the following steps:

  • 450 Practice Hours completed (and documented, using the suggested but useful template)
    • Evidence to support this is in my Portfolio
  • 35 hours of CPD completed, including at least 20 hours which was participatory learning (and documented the sessions, using the suggested but useful template)
    • Evidence of dates, subjects, etc. is in my Portfolio
  • I have also recalled 5 x episodes of Practice-Related Feedback (and documented using the mandatory template)
    • There is no requirement to present evidence to the confirmer.
  • 5 x Written Reflective Accounts completed (and documented using the mandatory template)

So what do I do next?

My employer has let me know who they expect my confirmer to be.  I think their expectation is that my confirmer will also support my reflective discussion.  I considered their suggestion(s) of confirmer and reflective partner, but wondered why I couldn’t select my own reflective partner (or even my own confirmer!?).  Technically, and according to the NMC, my revalidation is owned and controlled by me.  They also ‘strongly recommended’ that my confirmer is someone known to me through line management (and probably the person that does my appraisal, KSF/PDP review, performance review or whatever processes I am managed through).  So it kind of makes sense and is easier just to follow my employer’s recommendations for confirmer.  I will come back to that shortly…

I am naturally reflective and have the equivalent of reflective discussions with my colleagues all the time.  This sort of reflective practice is strongly encouraged by the NMC.  For the purposes of revalidation evidence though, I only need one Reflective Discussion template to be completed covering the minimum number of 5 x Written Reflective Accounts (both requirements must be documented using the mandatory templates).  So, I approach my line manager at the stage I’ve completed my reflections, and we set up a date, time and suitable venue to have a reflective discussion.  The manager has (hopefully) read the Reflective Discussion guidance published by the NMC and they know what’s expected of them.  In advance of the meeting, I provide them with my 5 x Written Reflective Accounts so that they are aware of what we are going to discuss.  We meet, have the reflective discussion; they then complete the Reflective Discussion template, sign it and returned it to me.  As a courtesy, I will copy the form and leave a copy for their records (and my personal file?).  The completed and signed template form then goes into my Portfolio.

NOTE:  Please be aware that the reflective partner MUST be an NMC registrant. 

In my personal case, my confirmer is not an NMC registrant, so I will need to complete the reflective discussion with someone else who is on the register; preferably someone known to me through my employment.

Confirmation

So – I am now ready for confirmation!  In instances where your line manager is your reflective partner and your confirmer, it might make sense to have this meeting scheduled at the same time, so that you complete the confirmer session immediately at the conclusion of your reflective discussion.  If it is less than 12 months prior to your revalidation date, then you are ready for confirming.

After the reflective discussion, the process of confirming can take place.  The manager has read the Guidance for Confirmers published by the NMC and they know what’s expected of them.  You bring in your portfolio of evidence, including all your completed templates and evidence to support them, where required.  You bring along (or have available) a Confirmation Template (mandatory form).  The manager then walks you through the required elements for revalidation, to ensure that you have documentary evidence (where required) to meet each of the elements of revalidation

What is the confirmer there to do then?

The Confirmer is there to confirm that you have evidence to support at least the minimum requirements of the elements of revalidation:  450 practice hours; 35 hours of CPD, of which at least 20 hours must have been participatory; 5 x examples of practice related feedback (no formal evidence is required); 5 x written reflective accounts; and completed a reflective discussion.  Having confirmed the completion of the required / suggested templates and confirmed sight of sufficient evidence to support them, the confirmer than completes and signs the mandatory Confirmation Template form and returns it to me.  As a courtesy, I will copy the form and leave a copy for their records (and my personal file?).  The completed and signed template form then goes into my Portfolio.

 

What is the confirmer NOT there to do?

The confirmer is not there to discuss your fitness to practice or your performance / capability.  If there are any concerns in these areas, these are all managed through separate processes, independent of revalidation.  The confirmer can only refuse to sign off the confirmation template form if they feel you have not provided sufficient evidence to support the minimum number of elements required for revalidation (as noted above).  If your templates are all completed and all the elements of revalidation are evidenced for the confirmer to verify, then the process shouldn’t take more than 10-15 minutes, in my view.

 

NOTE:  Your Professional Indemnity and Health & Character declarations are made by you at the time of your revalidation (online) application. The confirmer does not check these and you do not require to show them any evidence in regard to these.

 

So that’s’ me all done!  I am Revalidated!  Actually, I’m not – I still need to apply.  My registration expires the end of August 2016 (my renewal date).  This means that my revalidation application date is the 1st of August – the deadline by which my application must be made.  So the NMC Online service, which I registered for, is sending me regular updates leading up to my application date.  60 days before the date, I get the email to say that my revalidation application window is now open!  I can now follow the link to NMC Online, log in to my account and complete the online form.  I do not upload any evidence to the NMC.  All I do is complete the online form, citing information contained in my already-completed templates in order to fill in the appropriate sections of their form.  At the end of the process, I click ‘send’.  The final part of the process (from my point of view) is to ensure that my annual payment is sent and received.

 

NOTE:  At the end of your application process, you will be directed to the payments screen.  You can pay at the time of application.  If you are showing as having a suitable payment method in place (e.g. direct debit or standing order), then you can complete the application in advance of your payment being submitted (e.g. I don’t need to pay in June if my automated payment is set up for 10th August).

 

So what next?

At the time I click ‘send’ (and pay my annual fees), the NMC checks that all the appropriate processes have been completed and they then decide to renew your registration.  You can verify this by checking your ‘statement of entry’ by logging in to your NMC online account.  In my case, I will probably submit my application in early June, but my automated payment is not submitted until 10th August.  I may get an email back stating that my application has been received, but I will not be renewed (revalidated) until the payment is confirmed as received.  I will ensure that I check my bank statement and NMC Online Statement of Entry immediately after the payment is submitted, to ensure I am officially revalidated (and my new Revalidation Date is confirmed as August 2019).

 

NOTE:  It is the intention of the NMC to produce a film, showing screenshots of the online application form as it is competed, with voiceover instructions.  This should be completed and available on the NMC Revalidation microsite for late March / early April 2016.

 

Verification?

In some cases, the NMC will select some registrants for ‘Verification’.  It is my expectation that those selected for verification will be sent an email from the NMC within 24 hours of clicking the ‘send’ button on their NMC Revalidation Online Application.  The email will contain a link to an online form which the registrant will then be required to complete.  Again, there is nothing uploaded to the NMC – they never want to see your templates, your forms or your evidence.  Everything that you need to be revalidated remains in your portfolio and is shared between you and your confirmer (and perhaps some with your reflective partner).  Once you complete the online verification form, the NMC will review the information you’ve sent and make a decision about your renewal (revalidation).

At the same time that the NMC has sent you an email, they’ve also sent an email to your confirmer, asking them to complete an online verification form.  The Conformer will be required to complete this – if they do not respond, they could put your registration at risk!  Like your online form, the confirmer will be required to complete this to verify that they have seen your evidence and completed templates.

 

NOTE:  If you have been selected for verification and have reason to believe that your Confirmer has not / cannot respond to the online verification process (they may have retired, left the organisation, or other reason), I would recommend that you contact the NMC immediately upon receipt of your request for verification.  It may be that you will need to undergo another conformation process to satisfy verification.

 

The Verification process itself is expected to take about 2-4 weeks, but according to the NMC, it could take as long as three months.  Your registration will not expire as long as the verification process is ongoing.  I imagine that a more extensive verification process might eventually require your reflective partner being contacted (if this is not the same person as our confirmer).  In very rare circumstances, the NMC might require specific evidence if it cannot be verified in any other ways.  It would be extremely unusual and rare for verification to escalate to this stage.  The best advice is to ensure that your portfolio is as complete as it can be; that the evidence is accessible if and when required.  Remember that here is no requirement to have an online / e-Portfolio

It is not complicated!

I hope by now that you are Revalidation Ready and less fearful of the impending process.  It really isn’t complicated – and the majority of people that I speak to who are fearful of the process have not read and digested the guidance sufficiently or they are over-complicating the process.  I would urge you to consider being proactive NOW if you have any fears, anxieties or concerns about the process; do not procrastinate.  Check with your employer and other organisations locally to see if they are offering revalidation awareness sessions – they really are very useful opportunities to consolidate your revalidation knowledge and enables you to ask questions and network with others (and make useful contacts for future participatory learning!).

If you want to contact me, I would be more than happy to help you, if I can!

All the best with your Revalidation journey!