A new framework for post-registration professional development in Wales aims to ensure nurses’ training needs are identified at a personal and strategic level
In May 2014 the chief nursing officer for Wales launched a new governance framework for post-registration nurse education in Wales. This article describes how the framework was developed and how it will be used in practice.
Citation: Barton D, Ryley N (2014) A framework for post-registration development. Nursing Times; 110: 26, 16-17.
Authors: David Barton is academic lead for nursing and head, Department of Nursing, College of Human and Health Sciences, Swansea University; Nicola Ryley is assistant director of nursing at Aneurin Bevan University Health Board, Newport.
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In 2012 the chief nursing officer for Wales implemented a review of the current and future generic skills and educational needs of nurses working in NHS Wales. The final report, Aligning Nursing Skills - Guidelines (NHS Wales Shared Services Partnership, 2014), explored whether the nursing workforce was fit for purpose in a rapidly changing healthcare environment. Specific health issues such as diabetes, dementia, patients who were acutely deteriorating and the physical health needs of those in mental health settings are presenting skills challenges for nurses. In response to these, the review focused on how clinical nurses could be given the tools and knowledge to lead change and deliver high-quality care.
Keeping up to date
A driver for the review lay in the Nursing and Midwifery Council requirement that all registered nurses keep themselves updated to maintain their registration. However, the review team noted that post-registration education and practice principles had to be supported by governance principles that enable practitioners and employers to achieve these outcomes in a strategic and planned way. It was evident this was not always the case, and this deficit was a key issue for the NMC’s initiative to develop a revalidation system (NMC, 2013).
Until the Aligning Nursing Skills framework was developed, NHS Wales did not have a universal approach to assessing, evaluating and assuring the skills base of the nursing workforce. However, a number of models were in use, notably the Advanced Practice Framework (National Leadership and Innovation Agency for Healthcare, 2010), which could inform a universal framework for Wales. The review team used a simple two-stage approach to develop the new framework:
- In stage 1 we identified the following: NHS Wales needed to identify the general and specific skills base and continuing professional development needs of the nursing establishment. Registered nurses are required to keep themselves professionally updated and fit for practice, and to have evidence to demonstrate this, but there was no mechanism for assuring this outcome.
- In stage 2 we developed an all-Wales Aligning Nursing Skills governance framework for all registered nurses (NHS Wales Shared Services Partnership, 2014). This is based on a CPD cycle that enables strategic planning and identifies personal, transferable skills. We also decided to use, extend and adapt the Advanced Practice Portfolio developed for NHS Wales (NLIAH, 2012) so it can be used by all nurses.
A personal portfolio was devised to support annual personal development reviews (PDRs). These reviews should highlight skills deficits and give management and the board information so they can respond to education deficits and plan for future needs. Each nurse’s personal portfolio should be reviewed annually by an internal reviewer, such as a line manager, against an agreed set of criteria. A system should also be in place that enables other professional, managerial and academic reviewers to select a sample of portfolios to assess.
Nurses are responsible for demonstrating and providing evidence of their core skills and keeping them updated; employers are responsible for ensuring an effective PDR cycle is in place that identifies nurses’ CPD needs. This process forms the foundation of the framework.
All NHS Wales organisations will be required to implement and support a structured governance framework that sets out a clear PDR process founded on individual registered nurses’ portfolios of evidence-based practice and CPD outcomes. This governance cycle will assure the skills of the organisations are adequate and feed into the strategic CPD planning cycle.
Pre-registration undergraduate nursing programmes in Wales and across the UK have undergone revalidation after new standards and competencies were introduced (NMC, 2010). The intention is that the Aligning Nursing Skills framework will be linked with these schemes, and enable newly qualified nurses to build on their student portfolios.
The all-Wales collaborative on pre-registration nurse education has brought consistency in the documentation used by student nurses at all universities in Wales. Their competence portfolios are with them at the point of registration and new registrants will use these to form the foundation of their Aligning Nursing Skills portfolio. Maintaining a portfolio of professional evidence throughout each nurse’s career needs to become the norm.
The CPD/PDR cycle
The Aligning Nursing Skills governance framework offers material structure and guidance on the cyclical process of CPD and annual PDRs. This principle had already been articulated within the Knowledge and Skills Framework (Department of Health, 2004) and the new governance portfolio is intended to enable evidence of the competency to be demonstrated. The KSF describes PDR as a partnership process between an individual and reviewer; it links the process to the principle of lifelong learning and its place in preparing the health workforce to be fit for purpose.
The key intention of the governance framework is to structure the portfolio of evidence by providing clear guidelines and examples for practitioners. Staff should adhere to the KSF’s guiding principles, using the framework to inform and identify the knowledge and skills that underpin their practice. Reviewers noted the difficulties individual practitioners have in describing “evidence” and so provided guidance and structure (Fig 1).
The Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales promoted the pillars (domains) of practice (NLIAH, 2010) as a means of structuring evidence collection. Practitioners can use this to section their portfolio, giving structure and direction for both practitioners and reviewers.
Collecting the evidence
The chief nursing office for Wales identifies key annual objectives and themes (Fig 2); the guidance framework regards these as key areas practitioners can use to plan their CPD and provide evidence of it.
In the wider context it will be important that the framework is equitable, measurable and fair. All registered nurses will have to keep a portfolio and should get an annual PDR with an appropriate assessor. Assessments are expected to reveal a spectrum of competence, and where practitioners are deemed to be underperforming local protocols and work plans should be used to remedy this. Organisations will be expected to make arrangements for a sample of portfolios to be second assessed, for example by the second line manager, a university provider or by the development of a core team of assessors in each organisation who can provide objective comment to the review by the line manager.
This article has outlined the development and principles of the Aligning Skills for Nurses governance framework (NHS Wales Shared Services Partnership, 2014). This innovative work was launched across Wales in May 2014 and is based on a CPD cycle that enables strategic planning and identifies personal transferable skills. Formal evaluation processes are being developed and will be implemented 12 months after the launch of the framework, with the outcome of that evaluation being disseminated.
- Governance mechanisms are needed to ensure nurses fulfil their responsibility to remain professionally competent
- Personal portfolios can support nurses’ annual personal development reviews
- It is nurses’ responsibility to demonstrate and provide evidence of their core skills and keep them updated
- Employers are responsible for ensuring they have a personal development review cycle that identifies nurses’ learning needs
- A structured governance framework can set out a clear process for personal development reviews
Department of Health (2004) The NHS Knowledge and Skills Framework (NHS KSF) and the Development Review Process. London: DH.
National Leadership and Innovation Agency for Healthcare (2012) Advanced Practice: The Portfolio. Llanharan: NLIAH.
National Leadership and Innovation Agency for Healthcare (2010) Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. Llanharan: NLIAH.
Nursing and Midwifery Council (2013) Draft Revalidation Strategy.
Nursing and Midwifery Council (2010) Standards for Pre-Registration Nursing Education.
NHS Wales Shared Services Partnership (2014) Aligning Nursing Skills - Guidelines. An All Wales Governance Framework 2014.