The views of Gil Ramsden, Lead Nurse for NHS Leeds West Clinical Commissioning Group (CCG)
The introduction of revalidation (NMC 2016) has created concern amongst some nurses currently practicing in non-patient-facing roles or who do not specifically have reference to active registration within their role title, job description or contract of employment. This paper serves to allay fears and reassure active registrants of their significant contribution to nursing, highlighting reliance of others on their roles, particularly but not exclusively within commissioning and directorships. The table below highlights the potential scope of non-clinical contributions; the NMC does not prescribe any particular type of continuing professional development so contents are for illustrative purposes only.
| Work setting | Scope of practice | Some examples of non-clinical nursing contributions: |
| Governing body or other leadership
GP practice or other primary care Inspectorate or regulator
|
Commissioning
Policy Education Consultancy Management Quality assurance or inspection Direct patient care |
Those working in roles such as Commissioning, policy or education may contribute towards nursing or midwifery by:
|
| Clinical role | ||
| For example:
Caring for, observing or treating patients |
Strategic nursing practice requires an inclusive set of skills for different kinds of work across different settings and contexts. It requires us to see beyond the biomedical model of nursing practice and associate ourselves with a more abstract concept of ‘nursing’. Nursing carries its own ontology; its scope is essential within such a diverse healthcare spectrum. In the context of non-clinical or non-patient-facing roles this can expose anxiety around a ‘clinical practice gap’, but nurses can reassure themselves by asking and answering ‘how did I contribute as a nurse today?’
The answer may call for a change in thinking at different levels about our relationship with nursing, and how we can develop nursing to meet the significant level of change demanded within healthcare. Those in strategic positions are therefore well placed to actively engage in new ways of thinking, working and developing political insight regarding future nursing delivery and direction.
By virtue of their career longevity and complexity those in strategic positions acknowledge and understand the profession. Improving and developing it relies on their much wider skill set, and ability to adapt and survive in a constantly evolving healthcare system. In that context leaders with a nursing background can continue to serve as effective role models; they consider in detail how they champion health within organisations, and demonstrate vision and skill to effect required change. Consequently those in strategic roles need to value their importance and ability to teach and inspire those with responsibility for the health of others. The skilful and scientific application of ‘nursing’ in its widest sense by more junior colleagues is dependent on how senior non-clinical and non-patient-facing colleagues are viewed as role models delivering the art of nursing.
Revalidation supports individual development needs, affirming fitness to practice and professionalism. The process requires us to reflect on the Code (NMC 2015) and standards of practice with a specific aim to improve practice. Considering the significance of strategic roles as outlined above, nurses in commissioning and corporate roles significantly relying on their nursing or midwifery skills, knowledge and experience can apply every-day non patient-facing activity to meet the practice hours requirement when they can answer with personal and professional integrity how they ‘contributed to nursing today’.
The revalidation process clarifies how to calculate practice hours and the NMC has provided assurance that non-clinical and non-patient-facing registrants can use the same evidence of hours as if working in a clinical role (e.g. a rota, a job description, a contract of employment, time sheets etc…). Registrants are able to define their role as non-clinical, delivered through a range of work settings, clarifying their scope of practice as (briefly) outlined in the table above.
References:
Revalidation. How to revalidate with the NMC; requirements for renewing your registration. NMC (2016) www.nmc.org.uk/globalassets/sitedocuments/revalidation/how-to-revalidate-booklet.pdf
The Code: Professional standards of practice and behaviour for nurses and midwives NMC (2015)