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NMC backs revalidation plans despite concerns

The Nursing and Midwifery Council has approved plans for the revalidation of the profession - provided the new system can be shown to be worth the cost.

Council members were given the opportunity to debate three options for the introduction of revalidation by 2015 at their meeting yesterday morning. However, they were unanimous in backing the third option.

This will see increased audit of post registration education and practice portfolios and require registrants to collect feedback from patients and colleagues every three years. The nurse or midwife must then declare they have had had an appraisal and are fit to practise.

Lay member Louise Scull, who is also vice chair of Nottingham University Hospitals Trust, warned any system would need to be worth the cost to the wider health and social care system. She said if this could not be proven she would prefer the second option, which involves only increased audit.

Both options have the same £4.5m start up costs and £1m annual running costs. However, the second option would not require any extra investment from employers or registrants in collecting feedback or conducting appraisals.

Other council members also raised concerns. Stephen Thornton called for the NMC to invest in a “completely independent evaluation” to look at whether revalidation had “any impact on patient safety”.

Judith Ellis told council there was concern among nurses working in academia about what revalidation would mean for them and called for all registrants to be subject to the same system of revalidation.

She also raised concerns about relying on employers to conduct good quality appraisals. The NHS staff survey for 2012 found that, although nationally 83% of staff reported having an appraisal, only 37% said they were well structured.

Professor Ellis said: “We know that the value of appraisal varies dramatically across the health service… if we are developing a system that’s reliant on other peoples’ processes, that is a concern.”

NMC chief executive and registrar Jackie Smith acknowledged that appraisal was “variable and patchy”, but said that was “not a reason” for not introducing the proposed model of revalidation. She said revalidation could help drive up the quality of appraisal.

Speaking to Nursing Times after the meeting, NMC chair Mark Addison denied that a requirement for a nurse or midwife to sign a declaration saying they had undergone an appraisal in the last year risked becoming a “tick box exercise”.

“There are tick boxes that are lies where you haven’t had an appraisal, in which case the audit system would kick in. A tick box where a registrant will be required to say they have had an appraisal will encourage trusts and registrants to take it seriously,” he said.

The NMC will consult on the proposals until next summer and plans to begin piloting the model in early 2015.

Readers' comments (17)

  • Just a few points: how will those nurses who don't have direct patient contact or whose patients are unconscious e.g. NHS Direct, theatres and ICU get positive feedback to enable them to re-register?

    What about those who work with patients who do not have capacity e.g. Mental Health or LD nurses?

    What about nurses who work in prisons where the 'clientele' are unlikely to cooperate?

    As per usual, the NMC is run by a shower who have never been near a patient in years, they've not got a clue.

    If these plans do go ahead, I think the NHS are going to have a huge number of nurses who, due to either not having an appraisal or not being able to supply the necessary 'evidence' being unable to re-register.

    What a pantomime!

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  • NMC:

    Nursing & Midwifery Circus

    Run by clowns

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  • as it's the members who fund the NMC then we should be the ones who decide what is best.
    who is going to decide which patient will give feedback - how will this be monitored for fairness, how many patients will be asked per nurse.
    how much more will the NMC charge per registrant to put this idea into place?
    why does it need changing, what is wrong with their old system - if it failed, why did it fail and what exactly have we been paying them for?

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  • Can the unions not ballot members as to whether they have any confidence in the NMC?

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  • Anonymous | 13-Sep-2013 11:15 am

    Just a few points: how will those nurses who don't have direct patient contact or whose patients are unconscious e.g. NHS Direct, theatres and ICU get positive feedback to enable them to re-register?

    Good point, those unconscious patients ringing NHS Direct will be difficult to track down :)

    Linking appraisal to revalidation is not something to give up lightly. Appraisal is each registrants opportunity to sort out their development and get their concerns aired. This should be a requirement of revalidation - as it is for doctors.

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  • Nick Addison's quote on tick boxes makes no sense. How will the NMC know which nurses ticking boxes are telling lies?

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  • I think I read on this forum (or somewhere similar) that teachers used to be regulated by an out-of-touch body like the NMC, but they managed to get rid of it. Any help on how they managed to achieve this would be greatly appreciated.

    I'm not against staff appraisals being used to revalidate someones fitness to practice, but I think this nonsense about having to get statements from patients is meaningless.

    I work for an absolutely repulsive individual who intimidates and bullies her staff and I worry - not only for myself - but for those in a similar position to me, that 'revalidation' would be yet another stick in which to threaten staff.

    Nursing being the nasty, bitchy profession that it is makes me extremely uneasy about my manager having the power to put in jeopardy my whole livelihood. Safeguards will need to be in place.

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  • How often do the powers that be at the NMC have to revalidate ? Who do they get appraisals from? Do we even know who these faceless individuals are?

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  • Anonymous | 13-Sep-2013 6:32 pm

    I think one of them might be Joe 90.

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  • The disadvantage of directly linking employment appraisal and revalidation is that this increases the likelihood of a culture of secrecy and bad practice becoming endemic. How will the whistleblower raise concerns when they know that not only their job, but also their career is dependent on their boss's appraisal of them.
    Nursing has always had a back stabbing culture that generally has prevented bad practice persisting, however reduction in post numbers has meant that good care is almost impossible for staff to achieve best practice, even when working hours of unpaid overtime a week (which many nurses do).
    Because of the autonomous nature of their work and the culture for doctors generally, revalidation is little more than a rubber stamping operation where they have a budget for their development. How many consultants and registrars have continued to practice despite being bullies towards their staff or portraying completely unacceptable behaviour.
    Whilst the practicalities demand that non-registrants can appraise registrants for revalidation, how does a non-professional evaluate the expected and good practice behaviours of a professional. Nurses raising concerns to their management all the time may be seen as bad whereas a nurse continuing to work quietly in a poor environment may be seen as good by a management who is focused on achieving financial aims and targets.

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  • i hope that when this begins in 2015 and nurses are given bad reports to the point of losing their jobs; that the nurses are able to see the report on them and appeal, otherwise many nurses could lose their job and more pressure and unsafe practice due to poor staffing levels.

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  • I can see nurses spending more time and effort with patients who are willing to give the them good feed back, this whole nonesense will cause one patient to be given more time than another.
    Bribing in anyway is wrong and all patient should be treated equal.
    With understaffing vulnerable patients are at risk when another burden is put upon nurses, to get feedback from patients. Also, will all this goings on happen on work time, or extra pay be given to nurses to come in on their offdays to sort this rubbish out.
    As mention before about bullying.
    Unfortunately, I have had the experience of bullying from a senior sister as I challenge the unfairness in the department.I will never want this to happen again.
    By giving bullies the stick to beat us with, is this what the NMC want for those of us who wish to challenge what is wrong?
    As a nurse paying a lot to the NMC for the public to be protected from me, I am against public money and my money to be wasted in this foolish NMC plan.

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  • The NMC does not care a damn about registrants concerns. For me the single most horrifying aspect of this system is having your registration hanging by the thread of someone else's subjective opinion with the potential risks of unfairness/bullying etc etc.

    One question: let's say a nurse/midwife manager produces a really bad report which merits someone being removed from the register. How will the NMC react? By simply suspending the registrant pending the hearing in 12-18 months time as at present?

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  • Anyone who gives feedback, should be assessed themselves and deemed 'fit to comment'. There should be a strict criteria as to whether a person is 'qualified' to comment (make sure they are not too subjective, bully, background check etc...) before they are able to assess a nurse and say if they can be a nurse (and understand the reasons behind the nurses actions & judgements.

    Will all nurses spend time chasing after people, begging them/asking in the right way/right time/right 'voice' if they can have a reference pretty please.....

    Well done my money.

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  • for those who haven't heard this poem - well worth taking a look

    Nursing the Nation: a student’s response
    Molly Case

    or on YouTube

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  • Anonymous | 16-Sep-2013 6:47 am

    Sorry, but this pretty much summed up all the teeth gnashing and hand wringing that went on at the RCN Conference. They really need to get a spine and mount some tough, effective opposition to the onslaught on Nursing. Poetry ain't going to do it for our patients.

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  • Surely the NMC should be focusing more on the fact that nurses are still so poorly paid compared to other "professions" .
    How can a "professional" in the year 2013 be deemed to be worth just £30,000 or thereabouts.
    I think they should be far more worried about the number of nurses moving abroad for a decent and well deserved qulaity of life !!
    Its a disgrace in this country and the fact we all pay £100 annually plus RCN fees etc is outrageous !! And most of us are sick and tired of hearing re the NHS having to use agencies ! Many of us can only survive financially in this country by ONLY working as an agency nurse ! No surprises there !

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