The Nursing and Midwifery Council’s decision to go full steam ahead with revalidation, despite England not stating it is ready for implementation, is a brave one.
In fact, one could argue its chief executive Jackie Smith was demonstrating one of the 6Cs – courage. That is even though she’s not a nurse.
For in deciding to go ahead with revalidation without approval from the Secretary of State, she is one of the very few people to actually nail her colours to the mast and introduce a Francis report recommendation.
“The biggest reason to support revalidation UK-wide is just good old-fashioned common sense”
There are a number of reasons why the Department of Health must introduce compulsory revalidation for all nurses and midwives in England from April, and should not delay this decision.
First, delaying it sends a very clear message to the nursing profession that nurses and midwives aren’t equal to doctors. The DH supported medical revalidation – and backed it with £110m of government money – but wants to hang around counting the pennies rather than getting on with implementing nursing and midwifery revalidation wholeheartedly. Revalidation offers nurses and midwives an opportunity to demonstrate that they maintain and update their skills and reflect on their practise. These activities are essential for safe and effective professional practice – why on earth wouldn’t the Department of Health support that?
Second, if Wales, Northern Ireland and Scotland all say they can afford to implement the system, why can’t England? And if it can’t afford it, why didn’t the Department of Health speak out before the system was approved to start in April 2016? It seems that nurses and midwives aren’t considered important enough to be kept informed of these developments – don’t they deserve some honesty and respect from the DH? A duty of candour is considered to be a good idea for anyone involved in health – I’d say it should apply to our policy makers as well as frontline staff.
Third, if revalidation is only voluntary for employers it will create a two-tier system, in which those with more resources will support their staff to go through the process, while trusts with less money, plus some care homes and small GP practices, may not. As the pilot has proved – and common sense dictates – those organisations and individuals who arguably need it most are the most likely to opt out and decide to not support their nursing staff, and ultimately may not benefit from its implementation.
“Smart employers will still implement revalidation and support their staff”
In addition, if the NMC puts pressure on individual registrants to revalidate, but their employers don’t support them through the process, it again falls to the nurse or midwife to shoulder all the responsibility for remaining on the register. Of course they are more likely to migrate towards employers that will support them, exacerbating the already deepening recruitment and retention problems experienced by some organisations.
Smart employers will still implement revalidation and support their staff – or they just might find they don’t have any staff left to support.
But the biggest reason to support revalidation on a UK-wide basis is just good old-fashioned common sense. The continuing professional development (CPD) hours have not gone up, and the requirements to collect five pieces of feedback and write five reflective accounts and discuss these with another registrant are simply formalising activities that should be done already. So the health secretary appears to be concerned that the requirement to have a confirmation meeting once every three years – which can be embedded within annual appraisal systems – will take nurses and midwives away from direct patient care. Really?
Is it really unreasonable to require registrants to have at least one conversation about practice with at least one other registrant and/or their line manager at the very least every three years? For the vast majority of nurses and midwives these conversations will simply confirm that they take responsibility for maintaining their skills and knowledge, and learn from their experiences. However, a tiny minority don’t fulfil these responsibilities, and without revalidation employers – and patients – have no way of knowing who they are.
“Revalidation must be introduced in April by all four countries, with consistency, sending a clear message to the public that all four countries value patient safety and their nurses”
Revalidation proves that nurses and midwives continue to develop and reflect on their skills and knowledge. Sir Robert Francis recommended it, and the government gave the nursing and midwifery regulator a tough time in the wake of the Francis report. However, the NMC wasn’t allowed to change the way it operates and runs fitness to practise cases because it required legal changes that the government wouldn’t make time for in the last parliament.
But now the NMC is trying to follow the recommendations made by Francis it is getting no support from secretary of state.
I think that’s called having your cake and eating it. Blame the regulator when things go wrong, and shun the regulator when it tries to do the right thing.
Ms Smith is demonstrating the kind of leadership sadly lacking in many parts of nursing – and she is standing up for nursing and what’s right for the patient. Revalidation must be introduced in April by all four countries, with consistency, sending a clear message to the public that all four countries value their nurses and midwives, and put a high value on patient safety.
Come on England, support your nurses and stop putting barriers in the way of fantastic patient care. Or is it just that the government doesn’t like a workforce that is strong, empowered and able to evidence its value?