Occupational health nurses will be familiar by now with the process of NMC revalidation, but concerns remain about how to plan ahead and meet the requirements in practice. Catherine Kelsey offers advice.
Although the road to revalidation has not been without its problems (Merrifield, 2015), it is clear that this has now been firmly embedded into professional nursing practice. The urgency to establish a revalidation system for nurses was highlighted by the serious care failings in high-profile cases such as those identified at Mid Staffordshire hospital (RCN, 2014). Revalidation aims to improve public protection by making sure that nurses remain fit to practice throughout their career (RCN, 2016).
For many nurses, this is the first time they have maintained a portfolio, and I have spoken to some who are very worried. However, it doesn’t have to be challenging, and can instead be a platform for demonstrating what we do. For occupational health nurses, it could be a great way to build new relationships, reduce isolation and work collaboratively to increase our combined voice.
A critique of the literature on revalidation has made for interesting reading since its inception and eventual launch in October 2015 (Harris, 2014; Paton, 2014; Bhardwa, 2016).
The Nursing and Midwifery Council (NMC) has stated clearly how nurses can complete the revalidation process and provide examples as guidance. It is essential that all nurses take full responsibility for ensuring they are aware of revalidation requirements. Don’t leave it to anyone else.
Anecdotally, the consensus among those who have already revalidated is that it is not an onerous task and the key to successful completion is to begin the process early.
Although we have known for quite some time that things were going to change, it is surprising how many are leaving the process until the last minute.
Starting promptly will help you to capture your learning early on within your revalidation period and hopefully stop the worries from accumulating.
All occupational health nurses, whether sole providers or as part of a multidisciplinary team, should have some form of plan that determines how they will meet revalidation requirements. The challenge to OH is to make the NMC code of practice (NMC, 2015) fit with our professional practice.
As we are required to use the code (NMC, 2015) to promote safe and effective care and reinforce professionalism and trust, it is essential that we are conversant with its contents, and not just when we are writing our reflective accounts. The more we know about the NMC code, the more likely we are to be able to integrate the standards into our professional practice.
Always make sure you have a copy close to hand. Good advice is to keep it within your portfolio, on your desk or in the bag you use for work (RCN, 2016). Another option is to know where you can access it on the internet – you never know when you might need it.
The code must also be used to support our reflective accounts. We are required as part of revalidation to record five reflective accounts as a means of demonstrating what we have learned.
Examples of accounts could include: attending a continuing professional development (CPD) event; doing an accredited higher education programme; or reading and reviewing professional articles.
It is important to remember that we can demonstrate learning from our successes as well as our shortcomings. The final section of the reflective accounts form is the requirement to relate our reflections to the NMC code. Don’t forget, we are also required to make a link to it in our CPD log template.
Revalidation could hardly be considered a panacea for all ills, however it is an opportunity to build strong working relationships with our colleagues, to work alongside other OH professionals and to help gain further insight into our professional roles and responsibilities, and perhaps even find out a little more about ourselves.
Much of the literature has sought to provide information on the process of revalidation – for example, Romano-Woodward’s article (2015) – so it is not my intention to reinvent the wheel, but to encourage you to think about the positive aspects of revalidation. Whether or not revalidation improves the protection of the public or helps to build trust, only time will tell.
Begin the process of NMC revalidation early
Record your 450 hours of practice. This should be a straightforward process. Start early and you will soon have your required hours even if you only work one day a week. There is no obligation to record any more.
Examples of evidence to demonstrate this include: time sheets; payslips; rotas; invoices; and contracts. It may also be wise to keep a copy of your job specification and role profiles (Nursing Matters, 2016), which provide evidence to support your scope of professional practice.
Record your CPD activities
All nurses are required to undertake 35 hours of CPD every three years – 20 of which must be participatory learning (NMC, 2015). There are many learning opportunities available. Don’t just think about those specific to OH, but broaden your horizons.
Many nurses have expressed concern that without attending formal courses they may be unable to meet the requirements of the participatory learning hours. This is where joining an OH network can be useful. Participatory learning is simply learning with others – although you should actively participate rather than simply sitting on the sideline. Asking questions and actively debating can be a useful way to enhance your knowledge and understanding.
Internet-based activities
Massive Open Online Courses (MOOCs) have gained significant attention in the past few years as a new technological approach to learning in higher education, providing free online educational opportunities to a global audience (Yousef et al, 2015) and encouraging unlimited participation (Kaplan and Haenlein, 2016).
FutureLearn is one example of an organisation that provides MOOCs, offering a diverse selection of courses from various leading universities and cultural institutions from around the world.
These are delivered over several weeks and can be accessed via your mobile, tablet and desktop, so you are able to fit your learning around you. Some recent examples of MOOCs delivered in conjunction with FutureLearn include: understanding anxiety, depression and CBT; mindfulness, wellbeing and peak performance; and the diabetes epidemic.
Networking opportunities
Join local OH networks, some of which have key speakers and provide opportunities for networking and revalidation support – for example, the West Yorkshire OH Group.
For all registered nurses working in OH, whether novice, newly qualified or highly skilled specialist community public health nurses, this can be a great opportunity to talk through your practice and gain valuable advice. If you are an independent OH practitioner, attending OH groups can also help you gain access to a reflective partner and confirmer.
Charities and social organisations
If you are supporting an employee diagnosed with a particular condition, the likelihood is that there is an organisation that offers learning resources and training to help you develop your knowledge. For example, Parkinson’s UK provides useful learning opportunities and insights into how Parkinson’s disease develops and progresses.
The National Centre for Smoking Cessation and Training (NCSCT) is a social enterprise that supports the delivery of evidence-based practice and local smoking cessation services, as well as the control of tobacco programmes. NCST provides a number of online learning opportunities that are certificated and may be of use to you if you are supporting smoking cessation programmes.
Workplace experts Acas also provide a number of interactive online learning courses that are free and simple to use and provide certification on completion. Topics include: bullying and harassment; conflict resolution; equality and diversity; and pregnancy and maternity.
Acas also undertakes a number of research projects; one recent publication being “Managing Older Workers: A report for Acas” (Beck and Williams, 2016). All of these help to keep our knowledge up to date and enable us to be at the forefront of workplace health and wellbeing.
It is not necessary to pay to go on specialist courses to meet revalidation requirements. Although such courses may be useful in enhancing your professional skills, any relevant learning activity can count towards CPD. It is important to remember, however, that it is your responsibility to decide what activity you consider useful to your professional development and whether or not you believe it is appropriate for revalidation requirements (NMC, 2015).
We all like to share our experiences, and by having open discussions (while maintaining confidentiality) with our colleagues, we are in a great position to share what went well and what perhaps didn’t go so well. It is all professional learning and can be recorded as part of revalidation.
This can be undertaken with allied professionals, including physiotherapists, counsellors and OH physicians. Gaining constructive feedback from our colleagues can be a great way to enable critical reflection and to encourage us to think about our professional practice.
If you are making any departmental changes, consider revalidation and use the NMC templates to capture what you did and ultimately how you evaluated the change. If you receive any positive, constructive or even negative feedback as a result of the changes, record it in your practice-related feedback and reflect upon it. It all adds up.
Although not an essential requirement for revalidation, appraisals can also be a great opportunity to determine learning needs and plan career progression. It can also help shape revalidation portfolios.
Reflective accounts
This can be challenging as it can be difficult to know how much, or how little, to write. Take a look at the examples provided by the NMC (2015). If these don’t help, begin to write a reflective account that encapsulates the work undertaken, along with the learning gained and how you applied this to professional practice.
You might want to keep it open and add something later, particularly if new information or new evidence comes to light. And don’t forget to use the NMC code (NMC, 2015) in your reflections.
Reading articles in professional journals is a great way to reflect on your professional practice and to keep up to date with what’s going on in nursing in general. Again, consider how this can be applied to professional practice. A good example is the new framework “Leading Change, Adding Value” (NHS, 2016). This builds upon “Compassion in Practice” (2012), and is directly aligned with the “Five Year Forward View” (2014), and we should consider its implications for our professional practice.
Practice-related feedback
Anecdotally, for many, practice-related feedback has perhaps caused the greatest concern in working towards revalidation, and the NMC has done much to allay those fears. Managers and employees, do give positive and constructive feedback; learn to hear those precious words and reflect upon why they were said.
The more you attune your senses to hearing these words, the more you will hear them and learn to recognise their true value, not just for revalidation but for your professional practice and the profession as a whole.
Examples of practice-related feedback can include: written testimony; nominations for awards; verbal feedback; thank-you cards; and team feedback and texts. But remember, you must reflect on the reasons you received it and the impact of your practice. I even received a tweet once saying thank you for my involvement. You just need to remember to fill in the template as soon as possible after you receive the feedback.
Reflective partner and confirmer
Your discussion should be a time that you and your reflective partner enjoy. It is an opportunity to showcase what you do and have done over the previous three years.
As a reflective partner, you should be fully aware of the role and be willing to act in a way that preserves the integrity of the profession. If your reflective partner is also a nurse, they can act as your confirmer too. There is no need for them to be on the same part of the register as you, but they must have an effective registration (NMC). This document provides clear details on the role and responsibilities of the confirmer.
Become a lifelong learner
The aim of revalidation is to encourage all nurses to become lifelong learners, protect the public from poor practice and to uphold the good name of the profession. It is about encouraging and promoting good practice and strengthening public confidence (NMC, 2015).
Nursing Matters (2016) suggests ways in which employers can help support nurses to revalidate, however they must not rely on their employers to support them through revalidation, as the responsibility lies firmly in the hands of individuals. Recognise every opportunity to collate evidence and reflect on new learning, no matter how insignificant it may feel. This is central to ensuring we meet all the criteria.
Revalidation also has the potential to encourage a heutagogical or “self-determined” approach to learning as defined by Hase and Kenyon (2013), the aim of which is to encourage the development of autonomous learners who are equipped for the complexities of modern working environments (Blaschke, 2012).
This is perhaps no more evident than within the nursing profession. There may be some way to go before all nurses become self-determined learners, however it could be argued that revalidation is a step in the right direction.
Stepping up: moving forward
As Dr Alastair Leckie, a former president of the Society of Occupational Medicine (SOM) once stated: “One of the problems for OH nursing is that it is such a small part of the overall nursing contingent out there that it is difficult to get its voice heard. But it has to be all about engagement in the first instance; understanding what it is about and buying into the process.” (Paton, 2014).
Revalidation is a great way to achieve this. For many, it may be tempting to see revalidation as surveillance, but we should recognise this as an opportunity not only to showcase the work that we do, but also to promote professional learning and uphold the good name of the nursing profession.
It can also encourage us to think about our own professional practice and to meet the needs of our employers. Each employer is different and will require individual skills. Aligning ourselves with those by using revalidation effectively can present a win-win situation. It all depends how we choose to see revalidation.
Conclusion
There has perhaps never been a more challenging time for the nursing profession and for OH. An ageing workforce, employees with increasing co-morbidities, changes to pensions and erosion of healthcare budgets are just some of the complex issues we face.
Revalidation is a further concern for many nurses, with rumours of some preferring to be removed from the register rather than complete the process. This should not be a reason for leaving the profession. All nurses should see it as an opportunity to right some of the wrongs of concerns raised in documents such as the Francis Report (2013). It can also be an opportunity to regain some of the respect nursing appears to have lost.
So whether revalidation is considered a new panacea in nurse education or simply a step in the right direction, let’s all embrace this next phase of nursing and be proud to showcase the new knowledge gained and integrated into professional practice.
Catherine Kelsey is nursing lecturer, Faculty of Health Studies/School of Nursing, University of Bradford.
References
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Nursing and Midwifery Council (2015). “The code professional standards of practice and behaviour for nurses and midwives”. London, NMC.
Nursing and Midwifery Council. “Revalidation: information for confirmers”. London: NMC.
Nursing Matters (2016). “NMC revalidation for nurses: practice hour requirements”.
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Paton N (2014). “Will the NMC force occupational health to split from other nurses?”. Occupational Health.
Romano-Woodward D (2015). “NMC revalidation: OH roadshows provide lessons on key issues”. Occupational Health.
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Royal College of Nursing (2016). “Eight ways to improve your reflection”.
Royal College of Nursing (2014). “RCN briefing on the Nursing and Midwifery Council consultation on a proposed model of revalidation”. RCN Policy and International Development.
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