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Revalidation 2: How reflection can raise standards of nursing care

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Reflection as part of revalidation helps to ensure nurses and midwives act upon their learning. Discover what the process entails and how it can improve quality of care

Citation: Kolyva K (2015) Revalidation 2: How reflection can raise standards of nursing care. Nursing Times; 111: 44, 16.

Author: Katerina Kolyva is director of continued practice at the Nursing and Midwifery Council.


Reflection is an essential building block of revalidation. The aim of revalidation is to foster a culture of reflection and improvement among nurses and midwives. As part of this process the Nursing and Midwifery Council wants them to link their practice to the code (NMC, 2015a). By taking time to reflect on their practice, nurses and midwives can use the process to improve standards of care for patients.

Pilot feedback

Feedback from the NMC revalidation pilots around the UK have shown that nurses and midwives are positive about their experiences of reflection (NMC, 2015b). Most were pleased that they are being encouraged to regularly reflect on their practice and strive to constantly improve. Participants found that, although they thought about their practice every day, recording their observations made a big difference in the way they approached and considered their work. The reflective element of revalidation was also a useful starting point for discussions for those who have regular appraisals.

Principles of reflection

There are two key aspects of reflection in the revalidation requirements: written reflective accounts and the reflective discussion. These are outlined in Box 1 (NMC, 2015c).

The idea of thinking about professional conduct and analysing whether it is good practice or can be improved is a well-used tool among health professionals. Indeed, most nurses and midwives already undertake the process of reflection in their day-to-day activities. The only difference with revalidation is that reflections will now be formally recorded and discussed with another nurse or midwife.

Benefits of reflection

As part of the revalidation process, reflection offers a number of opportunities to nurses and midwives. First, it makes professional development more meaningful because it ensures nurses and midwives act on their learning. Second, reflection allows the code to become the focus of practice and improve standards of care delivered to patients. Finally, reflecting on practice increases self-awareness and motivation to make improvements.

The revalidation pilots (NMC, 2015b) demonstrated that many nurses and midwives already reflect on practice, and revalidation will simply formalise this process.

Box 1. Reflective accounts

Nurses and midwives must prepare five written reflective accounts in the three-year period since their registration was last renewed. Each reflective account must be recorded on the approved form and must refer to either of the following:

  • An instance of CPD
  • An event or experience from professional practice and how this relates to the Code (NMC, 2015c);
  • A piece of practice-related feedback (see part 3 of this series for more information on feedback).

The accounts should be simple, concise and short written insights. An NMC form sets out what needs to be covered, ensuring each reflective account focuses on what has been learned from the experience and how this relates to the code.

Reflective discussion

Your reflective accounts need to be discussed with another NMC-registered nurse or midwife. This constitutes the reflective discussion requirement of revalidation. The discussion could take place as part of an existing appraisal process and centres on these accounts and any areas where improvements can be made. This approach is designed to encourage a culture of sharing and improvement across the nursing and midwifery professions. The discussion should be in an open environment, focus on individual experiences and provide another professional’s perspective.


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