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Practice comment

'Gather feedback to build up your evidence for revalidation'


The Francis report has given impetus to what many agree is long overdue - an effective system for nurse regulation. I want people to be confident in nurses

I also believe that nurses strive to be competent, safe and caring practitioners and they deserve a revalidation system that enables them to show this.

Listening to nurses, however, it is clear that the proposals put forward are generating concern, fear and frustration about who’s involved, the costs, time and ultimately its effectiveness.

Proving fitness to practise is not new. Nurses are required to re-register annually with the Nursing and Midwifery Council and to declare, every three years, they have met the post-registration education and practice requirements. They are required to work for at least 450 hours in relevant practice and to complete and record at least 35 hours CPD activity. In the new process, these two standards will remain.

The new elements for revalidation include demonstrating adherence to the NMC Code and gathering third-party feedback. This feedback will focus on two areas: the first is evidence to support reflections on practice and could be from patients, carers, peers or students, while the second is feedback confirming fitness to practise, which could be from a manager, another registered nurse or a supervisor.

Although this is concerning to some, the new elements may have benefits. The NMC Code is to be revised to include a greater emphasis on what nurses do to meet the standards. This may support them as they make decisions to ensure patient care is safe and of high quality. Gathering feedback from patients - although daunting for some - is a great way to capture learning in practice and evidence of nurses’ expertise. Many already collect letters, stories and other data from patients (with consent) to use in the appraisal process. Evidence from colleagues can also be used. For example, I have been undertaking observations of practice and providing verbal and written feedback to staff; this evidence could be used for revalidation.

Feedback from managers and employers about fitness to practise appears to have generated much debate, especially if nurses perceive they have a challenging relationship with a line manager and/or there are concerns about professionalism. When this is the case, nurses need to be courageous and raise their concerns, just as they would about care standards.

Get ready for revalidation by refreshing your portfolio. It’s also worth thinking about the role of annual appraisals. If done well, these can prepare you for revalidation. If you are not being appraised, revalidation may give you leverage to talk with employers about changing this.

Finally, don’t miss the chance to have a say in what happens by contributing to the consultation. Complete the online survey and contribute to the development of a system that is workable and fair for all. 

Theresa Shaw is chief executive, Foundation of Nursing Studies.

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Readers' comments (10)

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  • Having to ask patients and relatives for feedback is demeaning not only for the nurse, but also the patient.

    Think about it: you nurse a patient over a period of days, weeks or months, you build a rapport not just with them but their relatives and any regular visitors. You are nice to them and treat them as an individual and with respect, because you're a nurse and that's what you do. The patient trusts you as does their relatives.

    Then, just as the patient is about to be discharged, you approach them and ask them for a reference to use as evidence in order to meet the requirements of the revalidation.

    In that instant, you've broken the nurse-patient bond that you spent time building. The patient and their relative instantly think that all of the care and attention you've given them has been driven by an an ulterior motive; they now question everything you've previously said and done. The patient feels duped and you can understand why.

    Is that really what we want? Feedback from patients is fine if they send in a thank you card of their own volition, but rarely is it addressed to one nurse in particularly, more often the ward team as a whole.

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  • Hugely important points above but will the powers that be take such concerns on board. This already feels like a disaster waiting to happen. Hopefully improvements in staffing levels are at last being addressed. How many nursing hours will be spent on the revalidation process, once more taking nurses away from the patient.

    This needs very careful consideration.

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  • I must say I am not looking forward to asking patients for feedback - not because I am not confident of a good repsonse but because I feel that it is not appropriate. Next patients will feel they should be giving us a tip just like in a restaurant to thank us for good service!!!

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  • Point 18 NMC code of conduct:

    You must refuse any gifts, favours or hospitality that might be interpreted as an attempt to gain preferential treatment.

    Surely obtaining feedback from patients could be defined as a 'gift' under the NMCs own code as the patient may believe he will get preferential treatment were he to give positive feedback.

    I think the NMC need to understand their own code before rail-roading revalidation through!

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  • "Surely obtaining feedback from patients could be defined as a 'gift' under the NMCs own code as the patient may believe he will get preferential treatment were he to give positive feedback".

    This will be why the NMC are reviewing the Code.

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  • How can theatre staff gain feedback, walk- in centre staff? Outpatients staff for a one off visit on route to consultant team?
    Can patients still identify who is actually a 'nurse' for the purpose of re validation.
    How will children's nurses obtain patient feedback? And I totally agree with the 'gift' theme.
    I also think I would find it demeaning and patronising to do this as a patient when I review my experiences. I had eye surgery soem recent time ago. I saw a nurse each time for my OPD appointments - briefly for the history check (first tiem was two nurses) and eye drops. When I attended for DAY surgery, I had one nurse do the pre-op check, one nurse take me into the waiting area, one nurse take me to the pre-op room/anaesthetic room, one nurse (or was it an ODP?) assist with that part, in theatre I was aware of the surgeon, obviously there was a scrub nurse possibly runner or that coudl have been an HCA. and some others. Post op, I was escorted back to the post op recovery area via the recovery room by a nurse ot ODP, then had observations taken by a different nurse, tea and biscuits and another check by a different nurse and take home dressings, care of eye and instructions for follow up by yet another nurse. The visit was successful, I had no post op complications, no infection, but how could I feedback on that as a patient? In and out in less than 2 hours. Repeated 4 weeks later- apart from the consultant surgeon they seemed different staff but I was having EYE surgery to correct visual problems so could not be quite sure, never darkened the door step in 2 years. And I am to be convicnee that professional re-validation would be based on this. Sorry for tedious posting as those of you aware and sentient beings do not need this, but just in case this kind of thing goes to our wonder mover and shaker idea people bouncing on band wagons....

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  • 'nurses need to be courageous and raise their concerns, just as they would about care standards'. A fine aspiration, but so much research and anecdotal evidence to suggest that this is far easier said than done, especially where one's job is at stake.
    As other commenters have made clear, the big problem with this is lack of clarity. The NMC wants us to join in the consultation process but it is very hard when the regulator has so little to say on how things will work in practice.
    The point about gifts is well made and encapsulates the NMC's muddle on this.

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  • Not that keen on asking patients for feed back on my care. I feel patients may feel under pressure to give feed back they may not really feel in order to stay on the side of the nurse. Especially if return visits are needed to the department that the nurse works in. colleague reviews can work in the same way. I recently was asked to give feed back for a review from one of the doctors where I work. I did not really want to do this but felt compelled to do it as I would have work with the man in the future. You can guess the kind of report I gave him.

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  • How can it be credited when service users have mental health illnesses.

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