NMC urged to make feedback prong of revalidation ‘meaningful’

The Nursing and Midwifery Council has been urged to make amendments to the feedback element of its revalidation system, in order to make it “more meaningful” to registrants.

“We continue to recommend that the NMC looks to adapt the feedback element” 

Review report

The recommendation was made following an independent evaluation of the NMC’s revalidation system following its advent three years ago.

In response, the NMC has agreed to review the feedback component and is considering moving to a ’quality over quantity’ approach.

The NMC introduced revalidation as a successor to the previous post-registration education and practice standards, or PREP.

One of the key differences between revalidation and PREP was the requirement to obtain five pieces of practice-related feedback from patients, families, colleagues or managers.

The NMC commissioned Ipsos MORI Social Research Institute to conduct annual reviews of the revalidation system for the first three years with the final report published this week.

The report noted that NMC bosses had hoped that registrants getting feedback from patients would in turn result in “greater responsiveness to patient need and improvements in practice”.

However, the review found that registrants were not always sure how to get feedback from patients and families, and said the NMC “could do more to support this”.

It noted how nurses and midwives in more isolated roles and those working with vulnerable patients, or who had little contact with patients, faced particular barriers.

Registrants were found to be using “passive” routes to collect feedback from patients, such as thank-you cards, rather than directly asking for it.

“The passively collected feedback which was often used was seen to be less likely to lead to meaningful change,” said the report.

While the review found a small increase in cases of registrants actively seeking practice-related feedback from patients by those who had recently revalidated compared to those who had not, this was not sustained with numbers dropping again within two years of going through the process.

Meanwhile, many registrants said they received no more feedback than they had done prior to revalidation.

The review found that these barriers led to many registrants using feedback from colleagues rather than patients.

“Therefore, evidence that the feedback requirement contributed to improved responsiveness to patient needs was therefore limited,” concluded the report.

The review went on to recommend a host of changes to make the feedback requirement of revalidation “more meaningful”.

“We continue to recommend that the NMC looks to adapt the feedback element seeking to make it more meaningful to registrants, and ensuring feedback is used in a constructive, critical and helpful way,” it said.

These included the NMC outlining the principles and value of constructive feedback in revalidation guidance.

It noted as well that more could be done to get registrants to reflect on their feedback, including requiring them to base at least one of their five reflective accounts required for revalidation on a statement they had received, and using the feedback in their discussions with their employers.

The review also asked the NMC to think about “reducing the number of pieces of feedback but include a means for people to describe how they have used this feedback constructively”.

In addition, it said the NMC could work with other professional regulators to create common approaches for collecting and using feedback patients and from other healthcare professionals.

The NMC outlined its commitments to addressing the issues identified in its latest annual report into revalidation.

One of the solutions suggested by the NMC was to allow registrants to gather fewer pieces of feedback.

“Effective feedback is key to meaningful change and we think we can do more to provide guidance in this area,” said the NMC.

“People report that the quality of feedback is variable with nurses and midwives sometimes being passive recipients of feedback rather than seeking it proactively.

“This might be best achieved by moving away from specifying numbers and focusing more on quality.”

The NMC said it also recognised that there could be barriers to collecting feedback, particularly from people who use services, patients and their families.

“We want to work with patient representative groups and others to understand what support we can provide to help overcome these barriers,” it added.

“We look forward to using this information as part of our wider organisation strategy development work”

Emma Broadbent

Overall, the independent review determined that the first three-year cycle of revalidation had proven to be a success.

“There were no substantial issues with the process, and from the statistical analysis, positive effects were identified relating to nurses’ and midwives’ understanding of the Code and shifts in attitudes and behaviours,” it said.

Between April 2016 and March 2019, a total of 611,46242 registrants had successfully revalidated representing 93% of those who were due to revalidate during that time.

The overall number of nurses, midwives and nursing associates letting their registration with the NMC lapse over the three years was 42,16743 (6.4%).

The lapsing rate of 6.2% in year three was identical to the lapsing rate in the second year and similar to the 6.9% rate in the first year.

Emma Broadbent, director of registration and revalidation at the NMC, said both the independent and the regulator’s own evaluations identified “some interesting insights and welcome challenge”.

“We look forward to using this information as part of our wider organisation strategy development work to ensure we continue to grow revalidation and help support and sustain further improvements now and for the future,” she added.