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Revalidating nurses:what's the score?

From 2015 nurses will be required to provide evidence that they are fit to practice every three years, including feedback from colleagues or patients.

The Nursing and Midwifery Council (NMC) recently launched its public consultation exercise on changes to its code of conduct.

It is revising the code so it is compatible with the proposed new revalidation system that will require all nurses and midwives to regularly confirm their fitness to practice.

Revalidation is set to be introduced towards the end of next year. Both revalidation and the revision of the code of conduct come in part as a response to the Francis report into care failings at Mid Staffordshire Foundation Trust where hundreds died amid appalling failings in care.

Robert Francis QC, the chairman of the inquiry, called for more robust checks on nurses when his report was published in February 2013. 

The current exercise is the second part of the wider consultation on revalidation. Part one, which ran from 6 January to 31 March, largely focused on how revalidation for nursing could be implemented.

The NMC's new proposals for revalidation mean that nurses and midwives will face competency checks every three years involving feedback from patients under a new code of conduct which aims to put compassion back into the heart of nursing. 

Currently nurses and midwives declare themselves fit every three years and the NMC has no power to seek information from a third party to verify their claims. 

Under the new plans nurses would have an enhanced appraisal which takes into account the learning that they've done over the year, their development, the views of patients and users and their colleagues. 

Nurses and midwives would also have to “reflect” on patient feedback and prove they have improved their care to keep their registration. 

Launching the new plans in January, Dr Katerina Kolyva, Director of Continued Practice at the NMC said: “Revalidation is a robust way to ensure that nurses and midwives keep their knowledge and skills up to date throughout their career. 

“The public has an important role to play in shaping revalidation for the nurses and midwives who care for them and their families. 

"We hope that revalidation will help the public feel confident that the people who care for them have demonstrated that 

their practice meets the professional standards we set on a continuous basis.” 

The proposal for revalidation has been backed by the Royal College of Nursing (RCN). Dr Peter Carter (pictured), Chief Executive & General Secretary of the RCN said: “The Francis Inquiry made it clear that a system for revalidating nurses needs to be introduced, and the RCN very much agrees with this. 

“Patients deserve to know that every nurse is fit to practice in a modern setting and competent for the role they perform," he said.

Dr Carter added that the RCN would be "looking fully at the detail of the proposals, including third-party feedback and how this will be incorporated. 

"We will be gathering members' views to ensure the final proposals are realistic and workable." 

Unison head of nursing Gail Adams says that anything would be better than the current system, as long as it is “proportionate, risk-based and does not lead to an increase in the registration fee”.

"We acknowledge that the current system is not fit for purpose but any new system introduced cannot have an impact on registration fees which are already too high... if that is the end product and the new system leads to an exodus because it is too onerous that it is a non-starter for us."

But what about those nurses and midwives who work outside large organisations in community and primary care settings? How can they gain the feedback they need to successfully revalidate? And who will appraise them? 

In launching its consultation, the NMC said that it wants “to cover all workplace settings and employment situations, including those where there is no appraisal system in place, to ensure that revalidation is a workable model for everyone,” but it remains to be seen how this will play out in practice.


The NMC's chief executive Jackie Smith has previously said that even though the appraisal process for nurses is not consistent the NMC do not see this is as reason alone not to introduce revalidation.

“In fact, it is a reason to introduce it, because a by-product of revalidation will be that appraisals improve. There is a public expectation that members of the profession will have an appraisal. I would expect someone caring for me to have had an appraisal,” she said.

“You should have an appraisal, you should reflect on learning and your practice, and you should reflect on the Code. I quite accept that there will be variations. In the acute sector, I am sure the process is much more consistently applied than it is in practice and community settings, because there are different clinical governances in place.

“I can see that there are challenges there but, equally, it is important to test that to see where the gaps are and for the NMC to be clear about its expectations.”

Ms Smith says that revalidation is about nurses reflecting on standards set out in the NMC's new code of conduct, and which applies regardless of setting or the work a nurse does. 

“The need to be honest and open, the need to put the patient first. Those are things that nurses will be able to deliver,” she says.

Dr Katerina Kolyva is director of continued practice and is heading up the introduction of revalidation at the NMC.

“One of the main drivers for revalidation is public expectation first and foremost, following on from Francis, there is an expectation that this is already happening and that all healthcare professionals are checked on a regular basis,” she explains.

“We are building on the current system which is inadequate and insufficient for what we want to achieve.”

She says that the NMC are using current legislation to introduce the new system and will not be following the General Medical Council (GMCs) path which had a “full-blown impact” in terms of the budget needed to finance the introduction of revalidation for doctors.

She said that revalidation “may or may not impact” on nurse registration fees in future depending on whether revalidation leads to a significant rise in fitness to practice cases.

Dr Kolyva also concedes that appraisals as part of the revalidation process might not be conducted by nurses but that GPs and other professionals could play a role. However, she says that in such circumstances nurse registrants would be needed to provide a second “confirmation”. Howard Catton, head of policy and international affairs at the Royal College of Nursing, says that the results of an RCN survey confirmed that nurses had “strong views” that they want their appraisals to be carried out by another registered nurse.

Mr Catton warns that appraisals should not get “mixed up with fitness to practice”. 

“The feedback we have had does raise the question of whether the final revalidation system has a mandatory linkage with appraisal or whether it is just something that is recommended.”

He also called for more “thought and discussion” on the proposals contained within the new code of conduct as to what it would mean for individual nurses to be responsible for confirming someone's fitness to practice.

With the consultation still underway it remains to be seen what the end of result of nurse revalidation will. Watch this space.