Meeting professional standards in nursing and midwifery

Revalidation of learning and practice will be an essential part of re-registration for nurses and midwives by 2014. Graham Johnson, clinical lead – nursing at Bupa Health and Wellbeing, looks at the requirements.

In the near future, nurses will face an overhaul of how continuing professional development (CPD) and fitness to practice will be assured. The current post-registration education and practice (Prep) standards will be replaced by a revalidation system.

In the meantime, nurses must continue to meet the standards of professional requirements for education, and their employers should support this by providing clinical supervision.

The Nursing and Midwifery Council (NMC) plans to introduce a system of revalidation for all nurses and midwives by 2014 with the aim of increasing public confidence in nurses and enhancing the protection of the public and patients.

The NMC states that the main aims of revalidation are:




  • to enable the NMC to confirm, on a continuous basis, that nurses and midwives are fit and safe to practise, and that their skills and knowledge are up to date and specific to their current area and scope of practice; and
  • to promote a culture of continuous improvement in practice to both nurses and midwives.

Guidance and advice will reflect contemporary practice and be based on consultation with stakeholders.

The NMC plans to hold a public consultation on the draft standards in late 2012. The NMC is also developing a process to undertake regular Prep audits, involving random samples of registrants who apply to renew their registration.

Until revalidation is introduced, nurses remain individually responsible for meeting the practice and learning requirements set by the Prep standards. If you apply to renew your registration but do not fulfil these requirements, the NMC may decide not to grant your application. Your registration will then lapse and you will not be legally entitled to practise as a registered nurse or as a midwife.

Professional requirements for education and practice

The”Nursing and Midwifery Council post-registration Prep standards on education and practice, standards and guidance” are designed to help nurses to provide a high standard of practice and care. Prep helps nurses to keep up to date with developments in practice and encourages them to think and reflect for themselves. It also enables the nurse to demonstrate to the people in their care, colleagues and themselves that they are keeping abreast of the latest knowledge and continuing to develop practice.

The Prep requirements include a commitment to undertake CPD. This element of Prep is referred to as Prep (CPD).

There is no such thing as an approved Prep (CPD) learning activity, although nurses are required to document, in their personal profile, relevant learning activities and how they have informed and influenced practice.

You can meet the Prep (CPD) standard in many different ways. The important things to remember are that:




  • it doesn’t have to cost any money;
  • there is no such thing as approved Prep (CPD) learning activity;
  • you don’t need to collect points or certificates of attendance;
  • there is no approved format for the personal professional profile;
  • it must be relevant to the work that you are doing and/or are planning to do in the near future; and
  • it must help you to provide the highest possible standards of practice and care.

The Prep (CPD) standard is to:




  • undertake at least 35 hours of learning activity relevant to practice during the three years prior to registration renewal;
  • maintain a personal professional profile of learning activity; and
  • comply with any request from the NMC to provide proof of how you have met these requirements.

To meet the CPD standard, it is useful to record day-to-day activities that can be applied to meet it. Suitable examples are:



  • attendance at a training course;
  • providing clinical supervision or training a fellow colleague;
  • giving a presentation to colleagues or clients on a clinical topic;
  • developing a specific procedure or policy document;
  • accessing an online training programme; and
  • reading a CPD article in a journal that is relevant to specific practice.

This can be used to inform the NMC when you are invited to complete the notification-to-practice form.

Formal learning

Formal learning opportunities are those leading to some form of academic or professional award. This may vary from distance-learning programmes through to short courses, to degree programmes.

Competence-based learning

Examples of this include:




  • Experiential and work-based learning: These have been important drivers in nursing education in recent years and often make up part of formal education programmes. However, they can be equally well used on an individual basis.
  • Mentorship: An experienced nurse mentor can be assigned to a newly employed nurse or where a nurse is taking on new duties. The mentor can facilitate personal and professional development through encouraging reflection, identifying gaps in knowledge and skills and providing structured feedback to enable the nurse to develop and expand their practice with safety and confidence.
  • Shadowing: Work shadowing is designed to allow practitioners undergoing professional development to gain knowledge and understanding about the work of a colleague in a similar position in order to enable them to understand better their own context, situation, position, tasks and job purpose. The value of this type of learning is in providing the practitioner with a real insight into the role of a particular post.
  • Secondments: These are a useful way for nurses to gain valuable experience without giving up their current post. They offer opportunities to acquire new skills, qualifications and facilitate professional development. Practices should look upon these favourably because of the potential value of the skills that can be gained and brought back to the practice.
  • Case review: Problem or random case analysis is a learning activity that is commonly used in many areas of clinical practice. It is often undertaken informally between work colleagues and peers. This is a powerful learning tool and can both promote shared learning and help to identify learning needs.
  • Clinical audit: Audit activity is a useful way of considering clinical and operational issues across nursing teams. Reviewing findings provides a good opportunity for the team to learn together as well as highlighting further learning needs for the team or individuals.
  • Self-directed learning: This is a process whereby the learner takes the initiative and responsibility for the learning process. It requires no formal teaching input and can be facilitated by a range of methods and resources. These are available from a number of sources, including the Royal College of Nursing, Nursing Standard, Nursing Times, the British Medical Association, Occupational Health, the Health and Safety Executive and the Health Protection Agency, all of which have a dedicated professional development section. Several of these sources also allow the user to record the outcome of any training undertaken for the purposes of Prep.
  • Reflective practice: Reflection is the examination of personal thoughts and actions. For nurses, this means focusing on how you interact with your colleagues and with the environment in which you work to obtain a clearer picture of your behaviour. It is a process by which you can better understand yourself in order to be able to build on existing strengths and take appropriate future action.








What revalidation will deliver

Proposals for revalidation were confirmed in February 2012. They will deliver:

  • a standard and guidance that build upon and replace the Prep standards;

  • an enhanced renewal of the registration process;



  • an enhanced continuing professional development (CPD) validation process that:




    • focuses on identifying the outcomes of learning activities and their impact on fitness to practice; and



    • ensures that CPD activities include different modes of learning, are relevant to the current area and scope of practice and that they help improve practice;



  • a risk-based audit process that is based on a sound statistical model combining risk-based, random and stratified sampling methods processes for:




    • the submission and assessment of evidence;



    • provision of feedback;



    • resubmission of evidence, if necessary;



    • removal from the register for those who do not meet the standard; and



  • a cost-efficient infrastructure to support the revalidation system that also enables nurses and midwives to record CPD activities and renew their registration online.



Mandatory updates

In addition to the learning needs that are identified as part of a personal development plan, there are several areas where all professionals need regular updating. Depending on your specific work area these could include:




  • basic life-support skills;
  • anaphylaxis;
  • protection of vulnerable people;
  • knowledge of data protection and freedom of information;
  • the Equality Act; and
  • moving and handling.

Clinical supervision

Organisations employing occupational health nurses will want to support their personal development and continuing professional education. Line managers need to have systems in place to ensure that these regular updates take place or else link into local training plans.

The NHS Management Executive defined clinical supervision as “a formal process of professional support and learning which enables individual practitioners to develop knowledge and competence, assume responsibility for their own practice and enhance consumer protection and safety of care in complex situations” (NHS Management Executive, 1993).

A professional development programme for nurses should:




  • promote and support the professional development of nurses;
  • encourage reflection on practice and evidenced-based practice;
  • support nurses to demonstrate competency to the NMC; and
  • assist qualified nurses to practise safely and effectively, fulfilling their professional responsibility within their scope of practice under the NMC Code of Conduct.

Clinical supervision should be available to registered nurses throughout their careers so that they can constantly evaluate and improve their contribution to the care of people. Along with the NMC’s Prep standard, clinical supervision is an important part of clinical governance.

Preceptorship

The NHS describes preceptorship as: “A foundation period of preceptorship for practitioners at the start of their careers which will help them begin the journey from novice to expert.”

The NMC says that preceptorship is about “providing support and guidance enabling ‘new registrants’ to make the transition from student to accountable practitioner”.

One key step in this process is to ensure that the newly registered nurse has access to suitable CPD opportunities to meet their needs and to build their confidence as a practising professional.

Personal professional profile

As part of their Prep requirements nurses are required to maintain a personal profile. The purpose of this is to record their learning activity for re-registration purposes.

A profile is a personal document. It does not belong to the NMC or to the nurse’s employer. The contents are private and confidential. Employers and managers do not have the right to look at it.

The profile has two key functions:




  1. It contributes to professional development by helping nurses to recognise and appreciate their abilities, achievements and experiences.
  2. It provides an information source to which nurses can refer in order to collect material about standards of education following registration.

The benefits of maintaining a profile are that it:




  • helps to assess nurses’ current standards of practice;
  • helps develop nurses’ analytical skills through reflection on what they do;
  • enables review and evaluation of past experience and learning to help plan for the future;
  • provides effective and current information for when nurses apply for jobs or courses; and
  • demonstrates experiential learning, which may allow nurses to obtain credit towards further qualifications.

There are no set procedures for building a profile, however, there are three broad, inter-related steps:




  1. Reviewing experience to date.
  2. Self-appraisal.
  3. Setting goals and action plans.

Clinical appraisal

Many different titles have been given to the process of reviewing performance and identifying development needs, including appraisal, personal development planning and performance review.

The appraisal process is part of a continual period of planning, monitoring, assessment and support to help staff develop their skills and be more effective in their role. The annual appraisal interview sits at the heart of the process. There is evidence from the NHS and industry that an effective appraisal process increases the effectiveness of the organisation.

The appraisal process should be seen as a positive approach to development. It is therefore not:




  • about creating unrealistic expectations or rewards;
  • a vehicle for evaluating/increasing pay entitlements;
  • to be used as a counselling exercise for non-learning and development issues;
  • a variant or sub-set of disciplinary procedures; or
  • a substitute for the reviewer’s responsibility to provide ongoing feedback to staff.

Personal development plan

The personal development plan is the most important output from the appraisal process. It is a record of what the individual nurse needs to do in order to effectively fulfil their role.

It is important that plans are reasonable and achievable rather than extensive wish lists. They should be directly based on the strategic direction and plans of the business sector and reflect the business needs and objectives.

Personal development plans will also reflect the individual nurse’s own career aspirations and there may need to be an agreement between the nurse and line manager on which aspects of the personal development plan each will support.

The personal development plan should be signed off by both the line manager and the nurse, and copies kept by each as a means of reviewing achievement of the plan.

References

NHS Management Executive (1993). “A vision for the future. Report of the chief nursing officer”.

NMC references. Nursing and Midwifery Council post-registration and practice (Prep).

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