NTW Nursing Strategy Delivering Compassion in Practice Professional Nursing Portfolio

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A Complete NTW Nursing Strategy 2014-2019 Delivering Compassion in Practice Professional Nursing Portfolio Northumberland, Tyne and Wear NHS Foundation Trust 1 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Content Page Description Page No: Introduction 1 Section One : Personal Information 3 Section Two : Revalidation Checklist of Requirements and Supporting Evidence 4 Section Three : Practice Hours 6 Section Four : CPD 8 Section Five : Practice Related Feedback 10 Section Six : Written Reflective Accounts 11 Section Seven : Reflective Discussion 13 Section Eight : Confirmer Discussion 15 Section Nine : Triennial Review Checklist of Requirements and Supporting Evidence 20 Section Ten : Index of Evidence 25 Section Eleven : Witness Testimony 27 Section 12 : Miscellaneous 28 Section 13 : Annual/Triennial Review of Mentor Qualifications and Performance 29 Northumberland, Tyne and Wear NHS Foundation Trust 2 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Introduction From April 2016 the requirements for revalidation will become effective and replace the current requirements for renewal set out in the PREP (Post Registration Education and Practice Standards) Handbook. This will mean that every three years at the point of renewal of registration, nurses and midwives will need to show that as a professional they are living the Code s standards of practice and behaviour. Revalidation is about promoting good practice; building on the existing renewal process the focus is on; Up to date practice and professional development Reflection on the professional standards of practice and behaviour as set out in the Code, and, Engagement in professional discussions with other registered nurses or midwives In meeting the requirements of revalidation you will need to provide evidence that you have met a range of requirements, designed to show that you are keeping up to date and that your practice is safe and effective in line with the Code. Creating and developing a portfolio The NMC strongly recommend that you keep evidence that you have met the requirements of revalidation in a portfolio and provide a useful definition; A portfolio is a compilation of materials that exemplifies your beliefs, skills, qualifications, education, training and experiences. It provides insight into your personality and work ethic. All in all, it is a representation of your professionalism Clark University Creating a portfolio is the simplest way of keeping everything together. It will; Help you know what you still need to complete Bring clarity to both your reflective and confirmer discussions Help you be prepared if the NMC needs to see your supporting evidence as part of the verification process It will also be helpful in your appraisal discussions Your portfolio should: Contain evidence of how you meet the requirements of revalidation Be a live document developed over the three years before you are required to revalidate The NMC have also provided a checklist to make sure you have all the information in your portfolio before you have a discussion with your confirmer or submit your application. Northumberland, Tyne and Wear NHS Foundation Trust 1 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

In the Trust s Nursing Strategy Delivering Compassion in Practice Strategic Aim 6: Supporting positive staff experience we committed to implementing a nursing portfolio. This professional nursing portfolio is designed to enable you to maintain evidence that you have met NMC revalidation requirements. We will continue to add sections to this portfolio in line with ongoing development of core and specialist competency frameworks which will support career and development pathways. The frameworks are designed to support you in the consistent demonstration and ongoing development of your knowledge, skill, behaviour and judgement in practice and will support you in meeting revalidation requirements by enabling you to prepare; Five pieces of practice related feedback Five written reflective accounts Reflective discussion Confirmation discussion Northumberland, Tyne and Wear NHS Foundation Trust 2 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section One: Personal Information Name NMC PIN Number Revalidation Renewal Date Workplace Manager Professional Registrable Qualifications (e.g. RMN; RNLD; RGN) Initial Qualification Date Gained Subsequent Qualification Date Gained Recordable Qualifications (e.g. Diploma / Degree/Mentorship) Qualification Gained Date Gained Qualification Gained Date Gained Qualification Gained Date Gained (Please add rows as necessary) Northumberland, Tyne and Wear NHS Foundation Trust 3 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Two Revalidation Checklist of Requirements and Supporting Evidence It is important that you understand your responsibilities in relation to revalidation and prepare for renewal. Revalidation is the responsibility of nurses and midwives themselves not their employer. You are the owner of your revalidation process. You should ensure you maintain an up to date knowledge of NMC standards and guidance all of which can be found at www.nmc.org.uk. The NMC have also set up a revalidation microsite which can be found at www.nmc.org.uk/revalidation In meeting the revalidation requirements and keeping your evidence you must not record any information that might identify an individual, whether that individual is alive or deceased. This means that all information recorded must be recorded in a way that no patient, service user, colleague or other individuals can be identified from the information. For example any notes or reflections must not include; The name of any individual The date of any incident or event referred to The particular ward or place where the event occurred or Descriptions of unique circumstances where an individual could be identified from the circumstances Any information extracted from employer data (such as complaints logs) must be extracted in a way that no information identifying an individual is obtained, used or recorded. For example you must not forward works emails to your personal account or download and take copies of Trust s records. The NMC have provided the following forms which you may retain electronically please note we have included them in this portfolio however you should be aware that the templates may be updated by the NMC and you should regularly check via www.nmc.org.uk ; Practice hours log template (recommended) CPD Template (recommended) Reflective Accounts Form ( mandatory ) Reflective Discussion Form (mandatory ) Confirmation Form (mandatory) Revalidation Checklist of Requirements and Supporting Evidence Northumberland, Tyne and Wear NHS Foundation Trust 4 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Requirement You must practise a minimum of 450 hours over the three years prior to renewal of your registration You must have undertaken 35 hours of Continuing Professional Development relevant to your scope of practice in the three years since your last renewal or you joined the register Of those 35 hours of CPD at least 20 must have included participatory learning You must have obtained five pieces of practice related feedback You must have prepared five written reflective accounts. You must have had a reflective discussion with another NMC registrant, covering your five written reflective accounts Health and Character Declaration Professional Indemnity; you must declare that you have or will have when practising appropriate cover under an indemnity arrangement Demonstrate to an appropriate person that you have met the revalidation requirements Supporting Evidence You need to maintain a record of practice hours you have completed. This will form part of the discussion you have with your confirmer and you will also need to have this information available I the event that the NMC wish to verify your application. Your records should include; Dates of practice Number of hours undertaken Name and address of your organisation Scope of practice Work setting Description of the work you undertook Evidence of practice hours (such as timesheets, role profiles or job specifications) You must maintain accurate and verifiable records of CPD including; CPD method ( for example self-learning, course, on line seminar) Brief description of the topic and how it relates to your practice Dates the CPD was undertaken Number of hours and participatory hours Identification of the part of the Code most relevant to the CPD Evidence of the CPD activity Notes of the content of the feedback and how it has been used to improve your practice. This is also helpful when preparing reflective accounts. You must ensure notes do not include any personal data see NMC Guidance How to Revalidate with the NMC Five written reflective accounts that explain what you have learnt from your CPD activity and /or feedback and /or an event or experience in your practice, how you changed or improved your work as a result and how this is relevant to the Code. You must use the NMC form and make sure your accounts do not include any personal data see NMC Guidance How to Revalidate with the NMC A reflective discussion form which includes the name and NMC PIN number of the NMC registered nurse that you had the discussion with as well as the date you had the discussion. You must use the NMC form provided. You must ensure the discussion summary section does not contain any personal data. Registrants will make these declarations as part of their on line revalidation application. You must use the NMC form provided. Evidence to demonstrate that you have appropriate indemnity arrangements in place. You must use the NMC form provided. A confirmation form signed by your confirmer. You must use the NMC form provided. Northumberland, Tyne and Wear NHS Foundation Trust 5 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 3: Practice Hours Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see Practice hours are designed to help registrants maintain safe and effective practice and keep their skills up to date Registrants; can only count hours undertaken whilst registered Must meet practice hours in a role which requires you to rely on your skills knowledge and experience of being a registered nurse. This includes nurses who rely on their skills knowledge and experience of being a registered nurse but are in roles where their employment contract does not expressly require them to be registered with the NMC. Practice hours should reflect current scope of practice and do not have to relate to your original field of practice when you first joined the register however you comply with the Code : recognising and working within the limits of competence Scope of practice can include direct clinical care; commissioning; management ; education ; policy; research consultancy; quality assurance If you have practised for less than the required number of hours you must successfully complete an NMC approved return to practice programme before the date of your application for renewal When you apply for revalidation, you need to declare that you have met the practice hour s requirement. You do not necessarily need to record individual hours of practice you can describe them in terms of standard days or weeks. If you have worked in a range of settings you will need to set them out individually. You only need to inform the NMC about the most recent hours you have undertaken to meet the minimum 450 hours. You will also be asked to; Whether you are currently practising Where you undertake practice including details of your scope of practice and work setting If you are not currently practising where you undertook your most recent practice including scope of practice and work setting NMC provide a practice hour s log template The Confirmer will need to see; Written evidence that the nurse has practised for the minimum number of hours Evidence may include a contract of employment; timesheets, job specification and role profiles Only hours relating to nursing count but this can include non clinical roles such as management, education and policy If a nurse has not practised for the required number of hours the confirmer must be satisfied that they successfully Northumberland, Tyne and Wear NHS Foundation Trust 6 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Practice Hours Log Template Guide to completing practice hours log To record your hours of practice as a registered nurse and/or midwife, please fill in a page for each of your periods of practice. Please enter your most recent practice first and then any other practice until you reach 450 hours. You do not necessarily need to record individual practice hours. You can describe your practice hours in terms of standard working days or weeks. For example if you work full time, please just make one entry of hours. If you have worked in a range of settings please set these out individually. You may need to print additional pages to add more periods of practice. If you are both a nurse and midwife you will need to provide information to cover 450 hours of practice for each of these registrations. Work setting Ambulance service Care home sector Community setting (including district nursing and community psychiatric nursing) Consultancy Cosmetic or aesthetic sector Governing body or other leadership GP practice or other primary care Hospital or other secondary care Inspectorate or regulator Insurance or legal Maternity unit or birth centre Military Occupational health Police Policy organisation Prison Private domestic setting Public health organisation School Specialist or other tertiary care including hospice Telephone or e-health advice Trade union or professional body University or other research facility Voluntary or charity sector Other Scope of practice Commissioning Consultancy Education Management Policy Direct patient care Quality assurance or inspection Registration Nurse Midwife Nurse/SCPHN Midwife/SCPHN Nurse and Midwife (including Nurse/SCHPN and Midwife/SCPHN) Dates: Name and address of organisation: Your work setting (choose from list above): Your scope of practice (choose from list above): Number of hours: Your registration (choose from list above): Brief description of your work: (Please add rows as necessary) Northumberland, Tyne and Wear NHS Foundation Trust 7 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Four: Continuing Professional Development Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see As a professional you have a duty to keep your professional knowledge and skills up to date through continuous process of learning and reflection. The CPD requirements are designed to help nurses and midwives to maintain safe and effective practice, to improve practice or develop new skills where a gap has been identified and to respond to changes and advances in nursing. Participatory learning reduces professional isolation through engagement while increasing skills and awareness The NMC does not prescribe the particular type of CPD activity as they believe registrants are best placed to decide what learning activity is beneficial to their scope of practice. Participatory learning must be face to face Types of learning activity could be; Structured learning Accredited higher education or training Masterclass Mandatory training must be relevant to the individuals scope of practice i.e. mental health act ; safeguarding ; child protection not Fire/Health and Safety Learning events such as conferences Reading and reviewing publication Enquiry based research/clinical audit Peer review activities Coaching and mentoring You must maintain accurate records of your CPD activities as this will form part of your discussion with your confirmer and you will also need to have this information available should the NMC wish to see it for verification. You need to declare that you have met the CPD requirement Suggested evidence to retain Certificate of completion, notes, learning outcomes Evidence of application to practice Copies of publications read, review notes including practice related outcomes Evidence of peer review including notes, observations and outcomes Evidence of mentoring /coaching including notes, observations and outcomes NMC have provided a CPD template The Confirmer will need to see evidence that you have undertaken at least 35 hrs of CPD including 20 hours of participatory learning All CPD must be relevant to your scope of practice A Confirmer must see accurate records of ; CPD method A description of the topic and how it relates to your practice Number of hours Which part of the Code it relates to The Confirmer is not being asked to assess the quality of the CPD undertaken Northumberland, Tyne and Wear NHS Foundation Trust 8 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

CPD LOG TEMPLATE Guide to completing CPD record log Examples of learning method Online learning Course attendance Independent learning What was the topic? Please give a brief outline of the key points of the learning activity, how it is linked to your scope of practice, what you learnt, and how you have applied what you learnt to your practice. You may wish to use the reflective accounts format to record as you go the way in which you have used CPD to inform and improve your practice Link to Code Please identify the part or parts of the Code relevant to the CPD. Prioritise people Practise effectively Preserve safety Promote professionalism and trust Please provide the following information for each learning activity, until you reach 35 hours of CPD (of which 20 hours must be participatory). For examples of the types of CPD activities you could undertake, and the types of evidence you could retain, please refer to Guidance sheet 3 in How to revalidate with the NMC. Dates: Method Please describe the methods you used for the activity: Topic(s): Link to Code: Number of hours: Number of participatory hours: Total: Total: (Please add rows as necessary) Northumberland, Tyne and Wear NHS Foundation Trust 9 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 5: Practice Related Feedback Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see Practice related feedback is intended to encourage nurses to be more responsive to the needs of patients and service users, and those who care for them, by seeking feedback from those they work with and care for, and using that feedback to make improvements to their practice The NMC recommend registrants obtain feedback from a variety of sources for example; Feedback from service users, carers, or students as part of your day to day practice Feedback from colleagues Complaints Team performance reports Serious event reviews Feedback through annual appraisal Types of feedback Feedback can be about your individual practice or about team, ward or organisational practice you need to be clear about the impact the feedback had on your practice Formal or informal Written or verbal Positive or constructive You need to declare that you have met the feedback requirement in your online application You are advised to maintain notes of the content of the feedback and how it has been used to improve practice. This is also helpful when preparing the reflective accounts requirement You may wish to use the reflective accounts format to record as you go the way in which you have used CPD to inform and improve your practice Evidence that satisfies the Confirmer that you have obtained five pieces of practice related feedback and the way you have used this to improve your practice The NMC recognise that organisations already collate feedback in a variety of ways. You must seek consent to access or use employer s information. If you chose to solicit feedback directly from colleagues; service users or carers you must make clear how you intend to use this information and that no information used will identify individuals Northumberland, Tyne and Wear NHS Foundation Trust 10 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 6: Written Reflective Accounts Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see Encourages registrants to engage in reflective practice so that they can identify any changes or improvements they can make to their practice based on what they have learnt. Raises awareness of the Code and encourages nurses to consider the role of the Code in their practice and professional development The NMC have provided a form which must be used to record your five reflective accounts. You are asked to gather and reflect on feedback from a variety of sources, using it to improve your practice and performance. You must have prepared five written reflective accounts in total, in the three year period since your registration as last renewed or you joined the register They should be based on CPD/feedback/event or experience in practice ( or combination of each) and how they relate to the Code The written reflective account should include; What did you learn from CPD activity, feedback or experience How have you changed or improved your practice as a result How is it relevant to the Code Please note see Guidance Sheet 1 NMC How to Revalidate for advice on how to ensure notes do not contain any information that might identify individuals (patients or colleagues) You need to declare that you have met the requirement for written reflective accounts You are not required to submit a copy to the NMC however you must retain a copy and evidence to inform your reflective discussion and to show your confirmer Five written accounts as described in requirements recorded on the NMC form Northumberland, Tyne and Wear NHS Foundation Trust 11 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Reflective Accounts Form You must use this form to record five written reflective accounts on your CPD and/or practice-related feedback and/or an event or experience in your practice and how this relates to the Code. Please fill in a page for each of your reflective accounts, making sure you do not include any information that might identify a specific patient, service user or colleague. Please refer to our guidance on preserving anonymity in Guidance sheet 1 in How to revalidate with the NMC Reflective account: What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice? What did you learn from the CPD activity and/or feedback and/or event or experience in your practice? How did you change or improve your practice as a result? How is this relevant to the Code? Select one or more themes: Prioritise people Practise effectively Preserve safety Promote professionalism and Trust Northumberland, Tyne and Wear NHS Foundation Trust 12 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 7: Reflective Discussion Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see Cultivates a sharing reflective culture that focuses on improvement by requiring registrants to discuss their professional development and improvement and by ensuring that registrants do not practise in professional isolation You must discuss your written reflective accounts with an NMC registrant as part of a reflective discussion This should be someone you frequently work with or someone from a professional network or learning group. You do not need to work with them on a daily basis and you do not need to undertake the same type of practice or the same part of the register. It is up to you to decide the most appropriate person. If your confirmer is a NMC registrant your reflective discussion can form part of your confirmation discussion. If your confirmer is not a Registered Nurse you will need to have a reflective discussion with an NMC registrant before your confirmation discussion with your confirmer Discussions should be face to face and you should not discuss patients, service users or colleagues in a way which can identify them without their express consent. Visit www.nmc.org.uk/revalidation for further information of reflective discussions. You need to declare that you have had a reflective discussion with another NMC registered nurse You must ensure that the nurse with whom you had the reflective discussion signs the NMC form and records their name, PIN number and email, the date the discussion took place and a summary of the discussion. Your confirmer will need to see a completed and signed NMC form showing that you have discussed your reflective accounts with another NMC registered nurse The Confirmer can be the reflective discussion partner if they are a registered nurse The Confirmer is not making a judgement as to the quality of the reflective discussion they are confirming that they have seen the completed NMC form which demonstrates that this has taken place This completed form must be signed by both yourself and your reflective discussion partner Northumberland, Tyne and Wear NHS Foundation Trust 13 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Reflective Discussion Form You must use this form to record your reflective discussion with another NMC-registered nurse or midwife about your five written reflective accounts. During your discussion you should not discuss patients, service users or colleagues in a way that could identify them unless they expressly agree, and in the discussion summary section below make sure you do not include any information that might identify a specific patient or service user. Please refer to Guidance sheet 1 in How to revalidate with the NMC for further information. To be completed by the nurse or midwife: Name: NMC Pin: To be completed by the nurse or midwife with whom you had the discussion: Name NMC PIN Email address Professional address including postcode: Contact Number Date of Discussion Short summary of discussion: I have discussed five written reflective accounts with the named nurse or midwife as part of a reflective discussions Signature: Date: I agree to be contacted by the NMC to provide further information if necessary for verification purposes Northumberland, Tyne and Wear NHS Foundation Trust 14 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 8: Confirmation Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see Encourages line managers to regularly consider and discuss how their staff are maintaining and developing their competence and improving their practice Increases professionalism by making nurses more accountable for their practice Provides additional assurance that the registrant has met the revalidation requirements Encourages a culture of sharing, reflection and improvement Helps reduce professional isolation The confirmation process involves having a face to face discussion about your revalidation with an appropriate confirmer. The NMC strongly recommends this is your line manager. If your line manager is not an NMC Registered Nurse you can seek confirmation from another healthcare professional that you work with and who is regulated in the UK i.e. a Doctor; Pharmacist. However the NMC recommend where ever possible registrants should seek to obtain confirmation from another NMC registered nurse. If your confirmer is an NMC registrant your reflective discussion can form part of the confirmation discussion. If they are not you will need to have your reflective discussion with an NMC registered nurse before your confirmation discussion with your confirmer The NMC have provided a form you must use to record your confirmation. Your confirmer will need to complete and sign this form You are required to keep the completed and signed form. You need to declare that you have obtained confirmation from an appropriate confirmer who has agreed to be contacted by the NMC if necessary for verification purposes. You will be asked to enter the name, NMC PIN number, email, professional address and postcode of your confirmer. You will be asked to confirm you have regular appraisal and whether you have a line manager who is an NMC registered nurse so that the NMC can understand the level of support which was available to you in completing your revalidation application Where the confirmer is not an NMC registrant you will need to provide details of their profession and registration and their regulatory body You will need to meet with your confirmer and have a face to face discussion about your revalidation. As part of the discussion you will need to provide evidence that you have met the revalidation requirements This can form part of your annual appraisal Northumberland, Tyne and Wear NHS Foundation Trust 15 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Purpose How to meet requirements What you need to tell the NMC in your online application What your Confirmer will need to see As part of the discussion you will demonstrate to the confirmer that you have complied with all of the revalidation requirements; except professional indemnity arrangement and health and character as set out in the guidance The NMC recommend that registrants obtain their confirmation during the final 12 months of the three year registration period to ensure that it is recent. If your confirmation was obtained earlier the NMC may ask you to explain why The NMC have provided further guidance for confirmers which can be found in the Trust Nursing SharePoint or by going to www.nmc.org.uk Northumberland, Tyne and Wear NHS Foundation Trust 16 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

CONFIRMATION FORM You must use this form to record your confirmation To be completed by the nurse or midwife: Name: NMC Pin: Date of last renewal of registration or joined the register: I have received confirmation from (select applicable): A line manager who is also an NMC-registered nurse or midwife A line manager who is not an NMC-registered nurse or midwife Another NMC-registered nurse or midwife A regulated healthcare professional An overseas regulated healthcare professional Other professional in accordance with the NMC s online confirmation tool To be completed by the confirmer: Name: Job Title: Email address: Professional address including postcode: Contact number: Date of confirmation discussion: Northumberland, Tyne and Wear NHS Foundation Trust 17 Part of SC-PGN-03 - Nursing Revalidation and Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

If you are an NMC-registered nurse or midwife please provide: NMC Pin: If you are a regulated healthcare professional please provide: Profession: Registration Number for regulatory body: If you are an overseas regulated healthcare professional please provide: Country: Profession: Registration number for regulatory body: If you are another professional please provide: Profession: Registration Number for regulatory body: Northumberland, Tyne and Wear NHS Foundation Trust 18 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Confirmation Checklist of Revalidation Requirements Practice Hours You have seen written evidence that satisfies you that the nurse or midwife has practised the minimum number of hours required for their registration Continuing Professional Development You have seen written evidence that satisfied you that the nurse or midwife has undertaken 35 hours of CPD relevant to their practice as a nurse or midwife You have seen evidence that at least 20 of the 35 hours include participatory learning relevant to their practice as a nurse or midwife You have seen accurate records of the CPD undertaken Practice-Related feedback You are satisfied that the nurse or midwife has obtained five pieces of practicerelated feedback Written Reflective Accounts You have seen five written reflective accounts on the nurses or midwife s CPD and/or practice-related feedback and/or an event or experience in their practice and how this relates to the Code, recorded on the NMC form Reflective Discussion You have seen a completed signed form showing that a completed and signed form showing that the nurse or midwife has discussed their reflective accounts with another NMCregistered nurse or midwife (or you are an NMC-registered nurse or midwife who has discussed these with the nurse or midwife yourself). I confirm that I have read Information for Confirmers; NMC-registered nurse or midwife has demonstrated to me that they have complied with all of the NMC revalidation requirements listed above over the three years since their registration was last renewed or they joined the register as set out in Information for Confirmers I agree to be contacted by the NMC to provide further information if necessary for verification purposes. I am aware that if I do not response to a request for verification information I may put the nurse or midwife s revalidation application at risk Signature Date Northumberland, Tyne and Wear NHS Foundation Trust 19 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Nine Triennial Review Checklist of Requirements and Supporting Evidence The Trust is required by the NMC to meet the Standards to Support Learning and Assessment in Practice (NMC 2008) which include: Placement providers are responsible for triennial review of mentors to ensure that those who continue to meet the NMC s mentor requirements remain on the local register (NMC 2008) To be maintained on the local register the individual must have evidence of having: Mentored at least two students within the three year period/and or demonstrate equivalent experience with other learners Participated in annual updating - to include an opportunity to meet and explore issues with other mentors. Mapped ongoing development in their role against the current NMC mentor/practice teacher standards. Therefore, to be deemed to have met all requirements needed to be maintained on the local register as a mentor, sign-off mentor or practice teacher, evidence that demonstrates completion of the above is required. In meeting the NMC requirements and keeping your evidence you must not record any information that might identify an individual, whether that individual is alive or deceased. This means that all information recorded must be recorded in a way that no patient, service user, colleague or other individuals can be identified from the information. For example any notes or reflections must not include; The name of any individual The date of any incident or event referred to The particular ward or place where the event occurred or Descriptions of unique circumstances where an individual could be identified from the circumstances Northumberland, Tyne and Wear NHS Foundation Trust 20 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Triennial Review Checklist of Requirements and Supporting Evidence Requirement Mentored at least two students within the three year period. Participated in annual updating Mapped ongoing development in their role against the current NMC mentor/practice teacher standards Supporting Evidence Completion of mentor activity record or equivalent. Evidence of summative or formative assessment, in a mentor or co mentor capacity with a variety of students/staff including: Nursing students from all fields (specific placements or supervised visits) Allied health students including Occupational Therapists, physiotherapists etc. Foundation degree students, preceptee s medical students, paramedic students, appraisals etc. Dashboard evidence/ certificate of attendance. CPD hours As outlined in the mentor /practice teachers standards please see below which includes examples of appropriate evidence Mentor/Practice Teacher Standards Competency Domain Establishing effective working relationships a) Demonstrate an understanding of factors that influence how students integrate into practice settings b) Provide ongoing and constructive support to facilitate transition from one learning environment to another c) Have effective professional and interprofessional working relationships to support learning for entry to the register Facilitation of learning a) Use knowledge of the student s stage of learning to select appropriate learning opportunities to meet their individual needs b) Facilitate the selection of appropriate learning strategies to integrate learning from practice and academic experiences c) Support students in critically reflecting upon their learning experiences in order to enhance future learning Examples of evidence Written evaluation of involvement of PLT. Attendance at mentor development sessions Witness testimony that confirms team working and relationship building skills Preparation of students experience on placement Induction/ Orientation within 1 st week Working groups or meetings eg practice learning team Student evaluations of mentor Strategy for achievement in different stages of students mentored Implementation of timetables/pathways to maximise the amount of students within the placement Enhancing the quality of the learning available. Witness testimony/mentor reflective accounts re progression of student. Schedule for reviewing progress Evidence on assisting with critical reflection Inductions Anonymised learning contracts and timetables Account of how mentor encouraged the learner to manage their own learning, incorporating different learning styles at different stages Details of learning outcomes Northumberland, Tyne and Wear NHS Foundation Trust 21 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Mentor/Practice Teacher Standards continued Competency Domain Examples of evidence Assessment and accountability a) Foster professional growth, personal development and accountability through support of students in practice b) Demonstrate a breadth of understanding of assessment strategies and the ability to contribute to the total assessment process as part of the teaching team c) Provide constructive feedback to students and assist them in identifying future learning needs and actions. Manage failing students so that they may enhance their performance and capabilities for safe and effective practice or be able to understand their failure and the implications of this for their future d) Be accountable for confirming that students have met, or not met, the NMC competencies in practice. As a sign-off mentor confirm that students have met, or not met, the NMC standards of proficiency in practice and are capable of safe and effective practice Evaluation of learning a) Contribute to evaluation of student learning and assessment experiences - proposing aspects for change resulting from such evaluation b) Participate in self and peer evaluation to facilitate personal development, and contribute to the development of others Examples of action plans which address particular learning needs Reflective account of dealing with a challenging learner or one with additional support needs Witness Testimony from colleague or student Record of discussion with students to achieve evidence of their learning through use of simulation/examples Attendance at and reflection on mentor related activities that focus on assessment Range of evidence produced by student Anonymised assessment documentation demonstrating feedback Witness testimony of meetings with learners, other mentors Anonymised assessment tools, e.g. T.C.C. L.M.C., DOPS etc Record of observation of clinical skills practice Records of assessment of the underpinning knowledge of the competencies Support and WT from PPF re action plans Other: Through 1:1discussion demonstrates knowledge of the course requirements and assessment strategies Review of their role for a particular student Involvement in developing and using local evaluation tools relating to the placement Reviewing evaluation data and, where required, implementing changes Action plans to address concerns re the quality of placement/learning opportunities Action plan review Application of quality standards to the placement Involvement with E.A.P. placement Northumberland, Tyne and Wear NHS Foundation Trust 22 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Mentor/Practice Teacher Standards continued Competency Domain Create an environment for learning a) a) Support students to identify both learning needs and experiences that are appropriate to their level of learning b) Use a range of learning experiences involving patients, clients, carers and the professional team, to meet defined learning needs c) Identify aspects of the learning environment which could be enhanced - negotiating with others to make appropriate changes d) Act as a resource to facilitate personal and professional development of others Examples of evidence A WT from manager, student or colleague Student evaluations how could future learning be enhanced Teaching formal or informal (PLT). Inductions Development and examples of teaching/ learning resources Facilitation of inter-disciplinary learning Involvement in Educational audits Context of practice a) Contribute to the development of an environment in which effective practice is fostered, implemented, evaluated and disseminated b) Set and maintain professional boundaries that are sufficiently flexible for providing interprofessional car c) Initiate and respond to practice developments to ensure safe and effective care is achieved and an effective learning environment is maintained Attendance at and reflection on mentor related activities, e.g. Mentor development sessions, link mentor meetings, mentor updates Attendance at and reflection on study days, training events, conferences or seminars that focus on learning and development or are pertinent to the role of the mentor Written report, reflective account or witness testimony of involvement in the management of change within the placement area, particularly in relation to learning Discussion or reflective account demonstrating knowledge and understanding of current healthcare and educational policies e.g. Standards to support learning and assessment in practice (2010), Mentor Policy etc Involvement with practice/ learning development Reading newsletters or e-bulletins from NMC or NTWFT Annotated documents related to learning and development Northumberland, Tyne and Wear NHS Foundation Trust 23 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Competency Domain Evidence-based practice a) Identify and apply research and evidencebased practice to their area of practice b) Contribute to strategies to increase or review the evidence-base used to support practice c) Support students in applying an evidence base to their own practice Examples of evidence Witness testimony of application of EBP Membership of clinical groups Participation in research and/or audit Literature search and review, relevant to area Presentation or attendance and reflection on study days, conferences or seminars/journal Club Demonstration of use of web-based learning resources Leadership a) Plan a series of learning experiences that will meet students defined learning needs b) Be an advocate for students to support them accessing learning opportunities that meet their individual needs - involving a range of other professionals, patients, clients and carers c) Prioritise work to accommodate support of students within their practice roles d) Provide feedback about the effectiveness of learning and assessment in practice Clinical/Education meetings etc. Evidence of cascading information related to learning and development within or across departments Evidence of planning/organisation student placement Witness testimony of mentor acting as an advocate for learners Critical Incident related to learning and development Organisation of training events to meet the needs of students and other mentors Northumberland, Tyne and Wear NHS Foundation Trust 24 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section 10 Index of Evidence Please use to identify individual pieces of evidence you wish to use to demonstrate achievement of mentor/practice teachers standards. The evidence can be cross referenced to demonstrate achievement of both revalidation and triennial review. It is helpful to order evidence chronologically to aid cross referencing. For example if using witness testimony number 7 in index it may look like WT. Revalidation Requirements Evidence location Evidence location Evidence location Evidence location Evidence location Confirmer Signature Practice hours CPD 35hrs Total Practice related Feedback Written reflective accounts Reflective discussion Mentor standards Evidence location Evidence location Evidence location Evidence location Evidence location Peer mentor Signature 1 a) b) c) 2 a) b) c) 3 a) b) c) d) Northumberland, Tyne and Wear NHS Foundation Trust 25 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Mentor standards Evidence location Evidence location Evidence location Evidence location Evidence location Peer mentor Signature 4 a) b) c) d) 5 a) b) c) d) 6 a) b) c) 7 a) b) c) 8 a) b) c) d) Appraiser/Line Manager Signature Date Northumberland, Tyne and Wear NHS Foundation Trust 26 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Eleven Witness Testimony Witness testimony can be used to demonstrate achievement of requirements Date Location Testimony/Evidence gathered Related Competencies Witness Name Signature Mentor Name Signature Northumberland, Tyne and Wear NHS Foundation Trust 27 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Twelve Miscellaneous Please place other evidence collected for Revalidation or triennial review in this section in, chronological order and numbered; for example - attendance at or minutes of meetings etc. In meeting the NMC requirements and keeping your evidence you must not record any information that might identify an individual, whether that individual is alive or deceased. This means that all information recorded must be recorded in a way that no patient, service user, colleague or other individuals can be identified from the information. For example any notes or reflections must not include; The name of any individual The date of any incident or event referred to The particular ward or place where the event occurred or Descriptions of unique circumstances where an individual could be identified from the circumstances Any information extracted from employer data (such as complaints logs) must be extracted in a way that no information identifying an individual is obtained, used or recorded. For example you must not forward works emails to your personal account or download and take copies of Trust s records. Northumberland, Tyne and Wear NHS Foundation Trust 28 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)

Section Thirteen Annual/Triennial Review of Mentor Qualifications and Performance Name Mentor Sign-off Mentor Review Date The mentor: Requirement 1. Can demonstrate development mapped against current NMC mentor standards Suggested Evidence of Achievement Record of mapping exercise self-assessment documentation peer review documentation personal development plan Achieved? Yes No 2. Has attended an annual update which Included: - discussion of assessment and supervision issues - validity and reliability of judgements made in challenging circumstances - programme requirements - NMC registration requirements - mentor accountability 3. Has mentored a minimum of two students in preceding three years Action Plan (if required): Mentor passport attendance record mentor update attendance at moderation peer review Peer review documentation record of mentor activity reflective diary Detail of action(s) to be taken (to include completion dates): Example: mentor had not attended an update within the previous twelve months action: attend annual update within two months. To be reviewed 20.06.07. Reviewed on (date) Review result 20.06.07 Attended on 30.05.07, evidence available. PPF informed -to reinstate on database. Reviewer signature Mentor Name Mentor Signature Reviewer Name Reviewer Signature Designation Northumberland, Tyne and Wear NHS Foundation Trust 29 Part of SA-PGN-03 (NTW(HR)09) Nursing Revalidation-Triennial Review (NMC)-(NTW(HR)09 Staff Appraisal Policy)