Provisional/Confidential
Template pack
This is a pack of templates to support the revalidation process, including:
Template: Practice hours record log 2
Template Continuing Professional Development (CPD) record log 3
Template: Reflective accounts record log 5
Professional development discussion (PDD) form 6
Confirmation from a third party form 7
Author (if required) DD month YYYY (if required) Page 2 of 8
Provisional/Confidential
Template: Practice hours record log
Dates / Name and address of organisation / Type of organisationPrimary care
Secondary care
Tertiary hospital
Public health
Care home sector
Ambulance service
Military
Prison
Schools
Policy
Education
Research
E-health
Other / Scope of practice
Direct patient care
Management
Education
Policy
Research
Other / Number of hours / Registration
Nurse
Midwife
Nurse/SCPHN
Midwife/SCPHN / Brief description of work
Sept 2014-Sept -2015
Sept 2014-Sept 2015 / Chesterfield Medical Partnership
Ashgate Manor
Ashgate Road
Chesterfield
S404AA
North Derbyshire
CCG
CCG Headquarters
Nightingale Close
Off Newbold Road
Chesterfield
S41 7PF / GP practice – primary care
Primary care nurse
representative / Nurse practioner
Direct patient care
Engagement
Education / 1,288
192 / RGN
RGN / Assessment diagnosis and treatment of minor illness and injuries.
Management and support of patients on insulin therapy
Chronic disease management
Attendance at meetings.
Resource and communications with primary care nurses.
Dissemination of education opportunities and information.
Setting up and delivery of education ssessions
EVIDENCE: P60 and payslips
To confirm your hours of practice as a registered nurse and/or midwife, please fill in a page for each of your periods of practice, in line with ‘How to revalidate with the NMC’. Please enter your most recent practice first. You may need to print additional pages to add more periods of practice until you reach 450 hours. 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.
Template: Continuing Professional Development (CPD) record log
Please provide the following information for each learning activity. You may be required to upload additional evidence in relation to your record of CPD.
For examples of the types of CPD activities you could undertake and the types of evidence you could keep in your portfolio please refer to Annex 2 of ‘How to revalidate with the NMC’.
Dates / MethodPlease describe the methods you used for the activity.
For example:
Online learning
Course attendance
Independent learning / Topic(s)
Please give a brief outline of the key points of the learning activity, how they are linked to your scope of practice, what you learnt, and how you have applied what you learnt to your practice / Link to Code
Prioritise people
Practise effectively
Preserve safety
Promote professional ism and trust / Number of hours / Number of participatory hours
March 2015 / Course Attendance / As per my role in delivering cytology screening: Smear Update
Systems and process of national screening programme, failsafe etc
Reiteration of LBC technique
Sharing of good practice and pitfalls
Better understanding of risk especially in women who have never been sexually active.
EVIDENCE: Certificate of attendance / Preserve safety- ensuring ongoing competence
Prioritise people- able to better inform women of their risks and the process. / 3 / 3
Feb 2015
April 2015
March 2015
June 2015 / Quest Attendance
AF management
Online Learning
Attendance at GPN conference
Independent learning / As per my role as AC lead within the practice: Update on atrial fibrillation- and the need for effective anticoagulation.
Learned that aspirin is worse than placebo
Understood the impact of stroke on N D
Learned how to prioritise care for those patients most at risk
Learned how to use screening tools such as Has Bled and ChadsVasc.
As AC lead have adapted practice, and ensuring safe effective care for patients within the practice with AF.
EVIDENCE: Slide set of course /email of confirmation
As part of my role in managing patients with IDDM: BDEC: Online training aimed at patients with IDDM teaching them about carbohydrates in diabetes and how to calculate their carbohydrate ratios.
EVIDENCE: link to course and some of the course materials
In my role as CCG nurse representative: Revalidation/reflection what is indicated how to find resources timescales etc- used as a basis for sharing knowledge and resources with GPN’s.
Use of social media risks/benefits- better understanding of how to remain safe using these platforms.
Student placement in general practice- inspired to put together a resource to encourage greater uptake of students
The future of GPN nursing- a great steer on the 5YFW , impact on general practice and workforce needs
EVIDENCE: Confirmation email of my attendance/course materials/certificate of attendance
As part of my CCG role: Reading literature and articles on student placement requirements in general and some specifically related to general practice, learned the requirements benefits and barriers plus identified the key personnel in my area.
EVIDENCE: links to articles/example of article / Prioritise patients: ensuring they can access effective preventative care
Practise effectively-improved my understanding of anticoagulants especially NOACS and risk/benefits
Promote professionalism and trust- enabled close liaison with colleagues GP/Pharmacists to work together in delivering changes in the service.
Prioritise patients-
Able to effectively signpost patients to the course
Preserve safety- improved my own understanding of CHO and insulin ratios
Promote professionalism and trust- able to develop a resource and share with colleagues
Prioritise people- enabled me to offer resources to other nurses.
Preserve safety- my own in running a twitter account.
Promote professionalism and trust- to develop a resource for practice nurses /PM ‘s/Gp’s ; to encourage uptake of student placements in general practice- improve students understanding of our role and improve recruitment opportunities plus enable CCG priority of care delivered closer to home. / 4
2
14
3 / 4
0
14
0
Dates / Method / Topic(s) / Link to Code / Number of hours / Number of participatory hours
May 2015 / Independent learning: twitter chat / Twitter chat #weGPNs on student placement in general practice, networking sharing ideas and exploring barriers
EVIDENCE: screenshot of twitter chat and tweet / Promote professionalism and trust- sharing ideas and resources with GPN’s in the wider community / 1 / 0
June 2015 / Attendance at MDT meeting / As part of my NP/CM role: Community matron/virtual ward MDT meeting to discuss care and management of patients on our caseload,
EVIDENCE: meeting minutes / Prioritise people- identify patient needs and how best they can be met.
Practice effectively- liaising directly with other members of HC team involved in that patients care.
Preserve safety- ensure that the patient has his/her needs met
Promote professionalism and trust- effective liason with other AHP better understanding of their roles and sharing expertise. / 1 / 1
Total:
28 / Total:
21
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Provisional/Confidential
Template: Reflective accounts record log
You are required to record a minimum of five written reflections on the Code, your CPD and practice-related feedback, as outlined in ‘How to revalidate with the NMC’. Please fill in a page for each of your reflections, ensuring you do not include any information that might identify a specific patient or service user. You must also discuss these reflections as part of a professional development discussion (PDD) with another NMC registrant and may be required to upload a signed PDD form.
Reflective account:What was the nature of the CPD activity/ practice-related feedback?
Complaint from a patient (a professional dancer) I diagnosed with gout whom was subsequently found to have an infection requiring surgery clearly impacting upon his employment and possible future aspirations.
NOTE: there is a longer history than this but I have removed it as this is going public and it is possible the patient could be identified from the history.
What did you learn from the CPD activity and/or feedback?
1 The importance of good safety netting and documentation: I have no real idea why the patient left his foot a further 9 days when it was clearly getting much worse and eventually looked nothing like the foot he presented to me, especially in view of the fact that it was his livelihood.
The photographs substantiated my diagnosis it may have been more difficult had there not been photographs.
2 That making a diagnosis very early in a disease process can be risky I did examine and consider the possibility of infection from the mosquito bite but there was an inch between sites and it looked healed and was not painful, but I could have informed the patient that infection may be a differential diagnosis and to monitor for further specific signs and symptoms rather than just saying if it is not improving or worsening ...seek further advice.
3 That patients sometimes do not do the obvious thing I guess for a multitude of reasons I had given him literature pertaining to gout which outlined what he could expect and I had informed him verbally i.e that pain and inflammation should settle over the next few days, he may or may not have read it, but clearly did not hear pay/ attention, he appeared articulate and intelligent and I perhaps assumed he would do the sensible thing.
4 It was very reassuring that my Gp colleagues said that I had done nothing wrong and that they would have done the same as I did.
5 I felt very supported by the Practice team and management.
6 Nevertheless I was devastated that this young gentleman had had to endure surgery and the worry about the impact upon his career and of course the impact of loss of earnings.
7 I learned that what seemed to be a very straightforward and clear diagnosis can on occasion wrong foot you and that it is important to be always vigilant, the main reason this happened was that the gentleman presented very early in the disease process and the infective process had simply not developed enough signs.
How did you change or improve your work as a result?
1 Improved safety netting.
2 Improved documentation, especially in view of why I chose a diagnosis over the differential one.
3 Ensure the patient goes away knowing exactly what they can expect over the next days and if things do not go as expected then further review is needed.
4 That patients do not always behave as you would expect.
How is this relevant to the Code?
Select a theme: Prioritise people - Practice effectively - Preserve safety - Promote professionalism and trust
Preserve safety: I am not entirely sure if I could have prevented this incident, I really cannot understand why the patient did not seek further advice and care when his condition was clearly worsening, but I now take pains to be absolutely sure that patients know exactly what to expect , and provide as much information as I can about their disease process, duration of symptoms, possible other diagnoses, and when they need further review.
Professional development discussion (PDD) form
You are required to have a PDD with another NMC registrant covering your written reflections on the Code, your CPD and practice-related feedback. Please refer to ‘How to revalidate with the NMC’ for further information.
This form should be completed by the registrant with whom you had the discussion:
Name:NMC Pin:
Email address:
Professional Address (including postcode):
Name of registrant: (with whom you had a PDD discussion)
NMC Pin of registrant: (with whom you had a PDD discussion)
Date that the discussion took place:
Number of reflections discussed:
I confirm that I have discussed the number of reflective accounts listed above, with the above named registrant, as part of a PDD and in line with the ‘How to revalidate with the NMC’. / Signature:
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Provisional/Confidential
Confirmation from a third party form
Name: / NMC pin number: / 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 health care professional
An overseas regulated health care professional
To be filled in by your confirmer:
Name / Job Title / Personal email / Professional email / Address including postcode / Date of confirmation discussionIf you are an NMC registered nurse or midwife please provide:
NMC Pin Number______
If you are a regulated health care professional please provide:
Profession______ ID of membership for regulatory body______
If you are an overseas regulated health care professional please provide:
Country______
Profession______ID of membership for regulatory body______
I confirm that the above named NMC registrant has demonstrated to me that they have complied with the NMC revalidation requirements as set out in ‘How to revalidate with the NMC’.By signing this document, I agree to be contacted by the NMC to provide further information and/or verification. / Signature:
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