Demonstrating Your Clinical Competence

Depression, Dementia, Alcoholism, Palliative Care and Osteoperosis

Jane Higgs, Gill Wakley, Ruth Chambers, Clare Gerada

• Publisher: CRC Press
• Year: 2018
• ISBN:
  9781315345062
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

This work is intended for those already in working in community care, including nurses, nursing students and social workers. It is aimed at those who have to provide palliative care from time to time, and at those who are considering a career shift into this field.

1

Making the link: personal development plans, post-registration education and practice (PREP) and portfolios

The process of lifelong learning

The professional regulatory body for nursing, the Nursing and Midwifery Council (NMC), has stated within the Professional Code of Conduct (2002) that all registered nurses must maintain their professional knowledge and competence.¹ The code states ‘you should take part regularly in learning activities that develop your competence and performance’. This means that learning should be lifelong and encompass continuing professional development (CPD). The formal requirements for nurses to re-register state that nurses must meet the post-registration education and practice standards (PREP). This includes completion of 750 hours in practice during the five years prior to renewal of registration, together with evidence that the nurse has met the professional standards for CPD. This standard comprises a minimum of five days’ (or 35 hours’) learning activity relevant to the nurse’s clinical practice in the three years prior to renewal of professional registration.² This requirement is seen as minimal by many nurses who would profess to undertake much more CPD than this in order to keep themselves abreast of current changes in practice. However, many nurses pay little attention to the recording of their CPD activity. This chapter will help you to identify a suitable format for recording learning that occurs in both clinical and educational settings.

Learning involves many steps. It includes the acquisition of information, its retention, the ability to retrieve the information when needed and how to use that information for best practice. Demonstrating your learning involves being able to show the steps you have taken. CPD takes time. It makes sense to utilise the time spent by overlapping learning undertaken to meet your personal and professional needs with that required for the performance of your role in the health service.

All nurses are required to maintain a personal professional portfolio of their learning activity. This is essential to maintain registration with the NMC.² Many nurses have drawn up a personal development plan (PDP) that is agreed with their line manager. Some nurses have constructed their PDP in a systematic way and identified the priorities within it, or gathered evidence to demonstrate that what they learnt about was subsequently applied in practice. The NMC does not have a uniform approach to the style of a PDP. Some nurse tutors or managers are content to see that a plan has been drawn up, while others encourage the nurse to develop a systematic approach to identifying and addressing their learning and service needs, in order of importance or urgency.

The new emphasis on lifelong learning for nurses has given the PDP a higher profile. Nurse educationalists view a PDP as a tool to encourage nurses to plan their own learning activities. Managers may view it as a tool that allows quality assurance of the nurse’s performance. Nurses, striving to improve the quality of the care that they deliver to patients, may want to use a PDP to guide them on their way, perhaps towards post-registration awards or towards gaining promotion opportunities.

Your personal development plan

Your PDP will be an integral part of your annual appraisal (sometimes referred to as an individual performance review) and your portfolio that is required by the NMC to demonstrate your fitness to practise as a nurse.

Your initial plan should:

• identify your gaps or weaknesses in knowledge, skills or attitudes

• specify topics for learning as a result of changes: in your role, responsibilities, the organisation in which you work

• link into the learning needs of others in your workplace or team of colleagues

• tie in with the service development priorities of your practice, the primary care organisation (PCO), hospital trust or the NHS as a whole

• describe how you identified your learning needs

• set your learning needs and associated goals in order of importance and urgency

• justify your selection of learning goals

• describe how you will achieve your goals and over what time period

• describe how you will evaluate learning outcomes.³

Each year you will continue to revise your personal development plan to support the development review process of The NHS Knowledge and Skills Framework (NHS KSF).⁴ It should demonstrate how you carried out your learning and evaluation plans, show that you have learnt what you set out to do (or why it was modified) and how you applied your new learning in practice. In addition, you will find that you have new priorities and fresh learning needs as circumstances change.

The main task is to capture what you have learnt, in a way that suits you. Then you can look back at what you have done and:

• reflect on it later, to decide to learn more, or to make changes as a result, and identify further needs

• demonstrate to others that you are fit to practise or work through:

– what you have done

– what you have learnt

– what changes you have made as a result

– the standards of work you have achieved and are maintaining

– how you monitor your performance at work

• use it to show how your personal learning fits in with the requirements of your practice or the NHS, and other people’s personal and professional development plans.

Incorporate all the evidence of your learning into your personal professional profile (PPP). Evidence from this document will be needed if you are asked to take part in the NMC audit, which is designed to ensure that all nurses are complying with the PREP standard. It is up to you how you keep this record of your learning. Examples are:

•an ongoing learning journal in which you draw up and describe your plan, record how you determined your needs and prioritised them, report why you attended particular educational meetings or courses and what you got out of them as well as the continuing cycle of review, making changes and evaluating them

•an A4 file with lots of plastic sleeves into which you build up a systematic record of your educational activities in line with your plan

•a box: chuck in everything to do with your learning plan as you do it and sort it out into a sensible order every few months with a good review once a year.

Using portfolios for appraisal/individual performance review, KSF and PREP

Appraisal is widely accepted in the NHS as a formative process that should be concerned with the professional development and personal fulfilment of the individual, leading to an improvement in their performance at work. It is a formal structured opportunity whereby the person being appraised has the opportunity to reflect on their work and to consider how their effectiveness might be improved. This positive interpretation of the appraisal process supports the delivery of high-quality patient care and drive to improve clinical standards. Appraisal has been in place in industry, commerce and public sectors for decades. In the NHS, nurses and other health professionals, managers and administrative staff are now all expected to undergo annual appraisals.

Nurses working in the health service should receive an appraisal or individual performance review at least once a year. This appraisal should include two main functions. Firstly there should be an assessment of fitness to practise in the current role, and secondly there should be a review of the CPD that has taken place and that is needed for the future. This should focus on the needs of the individual together with the needs of the organisation for which the nurse works.

Details of how annual appraisals are structured will vary from one organisation to another, but the educational principles remain the same. The aims are to give nurses an opportunity to discuss and receive regular feedback on their previous and continuing performance and identify education and development needs.

With the introduction of the Agenda for Change Knowledge and Skills Framework (KSF),⁴ nurses may find their appraisal incorporated into the KSF development review process, which has been designed to identify the knowledge and skills that individuals need to apply in their post; to help guide their development; to provide a fair and objective framework to base review and development of all staff; and to provide the basis of pay progression in the service. The main purpose of the development review is to look at the way an individual member of staff is developing in relation to the duties and responsibilities of their post, their application of knowledge and skills and the consequent dev...