NMC Revalidation Confirmation Form Review

This assignment involves reviewing a sample NMC (Nursing and Midwifery Council) revalidation confirmation form. The document outlines the required information and evidence for nurses and midwives undergoing revalidation. It includes details on practice hours, continuing professional development, practice-related feedback, reflective accounts, and reflective discussions. Reviewers must confirm that the individual has met all these requirements before their registration can be renewed.

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:

24/02
/16
Nursing and
Midwifery
Council, 23
Portland
place,
London,W1
B1PZ.
On the day
incident
took place I
was not on
duty, the
senior
nurse was
unable to
send the
resident to
the hospital
and the
nurse on
night shift
also did not
care to take
any action
to give
some relief
to the
resident till
morning.
The
manageme
nt did not
inform me
about the
seriousness
of the
incident, so
that I would
have taken
the possible
action.
There was
no action
taken by
the nurses
or no
response
was given
to the
resident till
3 hours, he
was
admitted in
the
hospital.
I registered
on the next
day of the
incident, I
was not
informed
by the
nurses
about the
seriousness
of the
resident
and was
handover
the case
due to
which I did
not check
the resident
till 11: 30
A.M. and
did not
inform the
managemen
t till 2 P.M.
The lack of communication
between the nurse and the
management made it difficult to
understand the seriousness of the
incident which lead to delay in the
treatment due to which the
resident was not cured in time.

18/01
/17
Nursing and
Midwifery
Council, 23
Portland
place,
London,W1
B1PZ.
I meat with
the nurse
and J.M
quality
manager
who
discussed
about their
two care
plans (H.H
and E.R).
When I was
looking to
one of the
plans the
nurse drew
one of the
care staff
attention,
why she
would not
wear rings
on duty.
The nurse
and J.M
made care
plans to
give the
proper
attention to
residents.
The nurse
went
straight
away
toward the
staff to
whom she
saw were
trying to
transfer the
resident
from
armchair to
wheelchair.
It was
around
2:30 P.M. I
meat J.M
quality
manager
and the
nurse for
some
discussion
on the two
care plans
(H.H and
E.R) and the
wound
audits of
the
residents.
I was there
to
understand
the care
plans and
how to
handle the
serious and
delicate
residents
for the
proper
treatment.
The care plans drawn by the nurse
was to give a proper treatment to
the residents when needed.

06/02
/17
Nursing and
Midwifery
Council, 23
Portland
place,
London,W1
B1PZ.
On the
medication
round I
noticed that
there was
no entry of
Fentanyl
patch on
05.02.2017
and was
signed in
MAR chart
by the
administrat
ion. I asked
V.A to
recheck it
from the CD
but there
was no
entry. I
directly
reported to
C.C (deputy
manager) in
the meeting
at 10.
There was
no entry of
the
medication
treatment
of Fentanyl
patch on
the
administrat
ion records.
The
resident
was marked
in MAR
chart.
I had a
meeting
with C.C
(deputy
manager) at
10 A.M.
about not
maintaining
the records
properly.
As I noticed
that the
entry of
Fentanyl
patch of Mr.
B.L is not in
the records,
I asked to
reconfirm it
with the CD.
The records
were not
found in the
CD so I
reported to
the deputy
manager in
the
meeting.
There should be proper record of
every resident for the better
treatment. The proper records
help the doctors to analyse the
actual situation of the resident.

25/02
/17
Nursing and
Midwifery
Council, 23
Portland
place,
London,W1
B1PZ.
In this I
wanted to
thank
everyone
for taking
care of the
resident.
The
resident
found all
the nurses
very caring
and the
staff was
very
helpful.
The care
taken by
the staff
during the
last months
of the
resident's
life made
her very
happy. She
wanted to
thank
everyone
but
specially to
the Dawn
and Vasilka.
The
resident
was here
till here last
days.
I found all
the nurses
and the
staff caring
and helpful
towards the
resident's.
They used
to attend
the
resident's
very well
and gave
the
medicine on
time.
I will ensure that the care and help
by the nurses and staff remains
the same for the resident's. The
proper care and help leads to
recover the resident's faster.

30.02.
17
Nursing and
Midwifery
Council, 23
Portland
place,
London,W1
B1PZ.
In this case
I have
highlighted
the
problems
faced by the
handicap
people. The
improper
care and
attention to
the people
suffering
from this
leads to
improper
treatment
by the
doctors.
I would
manage the
staff to pay
attention to
the
problems of
the
handicap
people.
They
should be
listen and
cured on
time. Their
problems
should be
taken
seriously .
The
manageme
nt should
take care of
the
seriousness
of the
incident, so
that I would
have taken
the possible
action.
The
resident
was under
observation
till 3 hours.
The
managemen
t was not
helpful and
caring
towards the
resident.
This lead to
improper
treatment
of the
resident
and
miscommu
nication
among the
staff and
the nurse.
I will make sure that the
management and staff members
should give proper attention to
these resident's for better
treatment. The proper response
and care given to these resident's
will let them fight with their
problems easily.

(Please add rows as necessary)

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.
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:
24/02/
16
To reduce the lack of communication skills
the hospital should enable the telephonic
services, so that the nurse can inform the
doctors about the seriousness of the
residents.
Lack of communication Case 1 3 hours
(11:30 Am –
2 Pm)
3 hours
(11:30 Am –
2 Pm)
18/01/
17
The two care plans (H.H and E.R) proposed
by the nurse and J.M should be used to in
the hospital by the staff for the better and
faster treatment.
Care plans Case 2 14:30:00 14:30:00

06/02/
17
The correct records with the timing for each
treatment should be kept in the CD's as well
as in the registers for further use.
No records Case 3 22:00:00 22:00:00
25/02/
17
There was a proper care and help to the
resident's from the staff and nurses. I will try
to maintain and to improve the lacking of
staff.
Loyalty Case 4 04:00:00 04:00:00
30.02.1
7
The improper treatment of the staff and the
nurses lead the level of confidence down of
the resident.
Ill-treatment Case 5 08:15:00 08:15:00
Total Total
(Please add rows as necessary)

Guide to completing a feedback log
Examples of sources of feedback
 Patients or service users
 Colleagues – nurses midwives, other
healthcare professionals
 Students
 Annual appraisal
 Team performance reports
 Serious event reviews
Examples of types of feedback
 Verbal
 Letter or card
 Survey
 Report
Please provide the following information for each of your five pieces of feedback. You should not record any information that
might identify an individual, whether that individual is alive or deceased. Guidance Sheet 1 in How to revalidate with the NMC
provides guidance on how to make sure that your notes do not contain any information that might identify an individual.
You might want to think about how your feedback relates to the Code, and how it could be used in your reflective accounts.
Date
Source of feedback
Where did this feedback
come from?
Type of feedback
How was the feedback received?
Content of feedback
What was the feedback about and how has it influenced your practice?
24/02/16 Resident Negative The feedback was about improper care and treatment of the
resident. He was not treated on time by the doctors due to the lack
of communication skills between the management and the nurses.
The feedback influenced in a adverse way in my practice because I
got a warning letter from the higher authority and witness were
needed to justify that I was not in the hospital at that time.

18/01/17 Resident Negative This feedback was negative because the care plans were still in
the process of application. The care plans were still been
discussed rather than implemented on time.
The nurse did not handle the resident in a proper way, which lead
the resident shout on her. This was adverse for the growth of the
hospital.
06/02/17 Resident Negative Keeping no or wrong records of the resident's treatment will lead
to adverse feedback.
There were no records of Mr. B.L about his treatment of Fentanyl
patch on 05.02.17 in CD and register and his was marked in MAR
chart which created a confusion in my mind for the further
treatments to be given.
25/02/16 Resident Positive The feedback was about the good services and care towards the
resident.
The resident was satisfied with the help and care of the resident. I
will try to continue this with more improvements for better
results.
30.02.17 Resident Negative The feedback was adverse because the resident who are handicap
were not treated properly by the staff. They were unable share
their problems with the management due to their rude behavior.
The resident was very unsatisfied with the management for their
avoidance and improper care towards the problem.

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.
Case 1
Reflective account:
What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?
Continuing professional development (CPD) activity is related to improve skills of
workers contributed in team work. It is online learning method for increasing working
efficiencies of hospital staff. In this regard, different tools and practices related to
health and social care are considered for effective treatment and hospitalization for
patients of the entity. However, feedback regarding services of hospital are achieved
through conducting survey with patients and analyzing their satisfaction level with
hospitalization. Including this, annual appraisal is provided to staff members which is
also able to encourage them for better quality work. Moreover, preparing team
performance report is also considers as one the essential tool for experiencing our
practices and hospitality of the organization. Therefore, by using these tools, proper
feedback regarding treatment services and team building can be identified that
generated variety of ideas for improving health and social care services at higher
level.
What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
Through conducting CPD activities, it is recognized that all staff members of the
hospital entity perform their work more efficiently. Including this, positive and
effective environment of the organization is created by effective coordination of all
team workers. As per analyzing my performance, I am feeling like improving in my
skills for building team and managing all staff members' performance effectively. In
addition to this, I improved my communication and listening skills which is helpful for
proper team building and creating peaceful environment of the entity. Moreover, I
learned to handle situations occur at workplace through motivating all members and
getting adjusted towards problems. In order to this, I feel improvement in my
performance as well skills which are favorable for personal and professional
development.

How did you change or improve your practice as a result?
For improving my skills and implementing professional development, I attend
seminars and events as well online learning through CPD activities. It helped me to
increase working efficiencies and better coordination in team work. Besides this, by
accessing online sites, I learned tips to building team more efficiently. Including this,
I improved my problem solving skills through analyzing critically and preparing
strategies to be reach out them in proper time schedule. Apart from this, I learned to
create effective and friendly environment of the hospital entity by using job rotation
and motivational tools among hospital staff. In this regard, I learned to making
understand all team members in one determined direction through expressing goals
and strategies to them that what activities are to be implemented and so on.
Therefore, I took advantages of different tools for improving my skills and emerging
positive feelings among hospital staff towards team building and treatment services
more efficiently.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
For conducting development programs, several themes has been used for effective
treatment services and better hospitalization. For example; prioritize people, practice
effectively, preserve safety etc. In accordance to this, our team's main motto was to
increase working efficiency of staff by which satisfaction level of patients can be
enhanced at maximum level. It is linked with promoting professionalism, emerging
positive feelings towards hospitalization and so on. Moreover, it also includes
practice more effectively and valuing patients of the hospital at most. It is able to
preserve safety and providing healthy as well secured medication and
hospitalization to them effectively. Thus, it is identified that the most relevant code
for planning strategies and hospitalization was to improve working efficiencies and
professional development of hospital staff that is able to increase their skills and
creating healthy environment of the workplace effectively.

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.
Case 2
Reflective account:
What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?
For improving the care plans in the hospital, I will take regular audits of the hospital
to confirm the implementation of care plans by the staff in the appropriate manner. I
will ask the nurse and quality manager J.M to draw more care plans for the
convenience of the residents. I will make sure that the care plans made by the nurse
and manger helps to heal the wounds as well as the residents faster. I will also
make sure that the residents are handle with care while transferring from armchair to
wheelchair. I observed the nurse taking care of the resident despite of his rude
behavior. In this context, there are also many of the plans which are implying in the
hospital for longer time such as any type of Jewelry like rings and other asses-
caries are not allowed to wear at the hospital by any of the staff member. It is
required for to carry out other training activities to the care staff by which they would
be able to deal patients of the hospital with more delicacy.
What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
I learned how to manage and handle a loud behavior of the resident in a calm way. I
learned not to wear rings on duty to avoid harm to the resident's. Regular audits are
must, to ensure that the treatment given to the residents are appropriate. The
regular audits also helps to know the recovery speed of the resident's wound, this
will provide us about what are further requirement in addition for the better recovery
of the wounds. This regular audit will also reduce the chances to any type of
question arising against the hospital and develop the quality trust in the market
about the hospital. In addition to this it will also reduce the chances of any type of
risk regarding to the causing of infection in the wound of patients, this will also
increase the rate of recovery to the patient.
How did you change or improve your practice as a result?

In context to this many of the progressive steps were taken by me in order for the
development. Such as by the creation of several rules like staff member are not
allowed to were any Jewelry at the work place like Rings and other ornaments. In
addition to this I had also organized various activities such as care staff training
which will unable the staff members to treat patients with more handling and care.
Along with all this it develops the working environment in the staff and motivates
them to treat patient better.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
Practicing activities to the staff member will allow them to better treat the patient, performing
and teaching them about various physiotherapy activities would enable them to take care
about how they should transfer patients such as from the case, in which they were
transferring the patient In wrong manner from the armchair to the wheel chair.

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.
Case 3
Reflective account:
What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?
CPD activities are continuous professional development activities. It is essential for the
medical professionals that to keep records of all patients and their related medical issue. If
they do not maintain records properly then they are unable to perform well in their work area.
In the case 3, I noticed that there was no records of Mrs. B.L. Administrator has not recorded
any entry of B.L. The incident was verbally reported to Mr. C.C. This activity is not included in
professional work ethics according to me. The nature of CPD activity was casual. There was
chances that Mrs B.L can not get timely treatment next time that may impact on her health as
well. It was asked to double check the CD register book but stile there was no record of the
lady.
What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
I learned that it is the duty of professionals that to maintain record properly. It is essential to
maintain CD register book. In this absence of this record maintenance patients become
unable to get proper and timely care. I learned about professional activities that are needed
to be performed by professionals. I learned that if people do not perform their duties well
then it may create huge trouble for users and providers as well. I learned about
effectiveness of proper communication. I got to know that if there is communication gap then
people can not be able to express their views properly. I learned that administrative staff
members do not perform their duties well so they need to improve their working
performance.
How did you change or improve your practice as a result?
For making changes in practices, professionals have to give training to its junior staff
members about working practices. That may help them in knowing about their
responsibilities, by this way they will not ignore maintaining records properly. Proper
guidance about roles and responsibilities, work ethics and standards can help in
improving practices. By this way such type of issues will not take place in the

workplace.
Authorities are required to monitor activities of the hospitals effectively, by this way loop fall
will be identified soon, and they will be able to make strategies so that such type of ignorance
issues can be minimized in the care homes. Verbal reporting need to be stopped which is
only possible when authorities maintain each record effectively.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
The present case is relevant with prioritize people and promote professionalism. By
giving priorities to people medical professional will be able to provide quality care to
patients thus, such type of ignorance issues and non maintenance of records will not
take place in the hospitals. Main issue in the case was that there was no written
record of Mrs. B.L which has caused difficulty. It was not professional attitude of
medical persons and administrator. That is why promote professionalism and
prioritize people are relevant codes.

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.
Case 4
Reflective account:
What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?
In this case, resident very happy due to proper care of him with several nurses and
doctors as well. It creates positive impact on the performances and functions of
NMC. Therefore, it assists to enhance outcomes and results in significant manner to
ensure sustainability of people in business unit. With the help of positive results of
patient care, the selected enterprise can also enhance their activities which need to
be performed for organizational patients. With the help of different activities, CPD
can be develops which required to undertake several practices that would be
beneficial to make proper treatments of people. Further, it also ascertains more
relevant example which can impact positively on other residents.
What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
Residents gives positive feedback towards activities which perform by nurses.
Therefore, it makes effective results to solve issues of them in significant manner. It
also ascertains effective learning which would be required to undertake different
activities at workplace. With the help of positively impact, NMC has chances to
develop effective functioning in business unit. Therefore, expansion of different
activities can be made at workplace to assess outcomes. With the help of patient
feedback, activities can be developed in significant manner that required for
undertake several elements that assists to take care of residents.
How did you change or improve your practice as a result?
In this way, changes are not required but improvements can be made in significant
manner. Therefore, it assists to enhance practices that needed for develop results in
enterprise. There are several residents exists who took care for them and nurses
required to take guidance from their senior to improves it in significant manner. It will
be helpful to make sure that proper functioning and caring taken easily for further

improvement and making large loyalty of patient group. In addition to this,
improvement also enhance through continuing practices which need to be
implemented in significant manner.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
This case relevant for several things such as priorities people and making safety for
them as well. Therefore, it will be helpful to undertake effective functioning and
outcomes in business unit. In addition to this, there are several elements relevant for
present code and also helpful to make increasing power of people. Therefore, it will
be helpful to make proper and effective outcomes in business.

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.
Case 5
In the NMC, there is no effective proper solution for dealing with handicap people.
Therefore, residents demotivated due to no effective solution made for patients. It creates
negative impact on the performances of chosen healthcare enterprise. Therefore, it is
essentially deals required by C.C. To take care of that residents. Further, management not
effectively communicate about patient requirements to doctor so that C.C unable to
understand problems and issue of each person in business unit. In this case, practice need
to be made with each person so that objectives could be undertake in significant manner to
deals with different issues.
Reflective account:
What was the nature of the CPD activity and/or practice-related feedback
and/or event or experience in your practice?
Continuing professional development has activity to assess participation of doctors
in taking care of different people. Therefore, proper care undertake for each patient
who has problem to working in life. Further, patients also giving their feedback
toward problem which they face to communicate with management. In this way,
management not taking proper facility to undertake their queries so that loyalty of
patients also reduce gradually. Also, there nurse no actively participate so that I also
experience in the work practices to take services from NMC.
What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
From the CPD activity, I have learned that at NMC there is no proper management
exist so that it create problem to understand each other understanding. Further, take
care are not effectively participate in patients queries so that it make proper
understanding among several people in effective manner. With the help of proper
caring and solving queries, the selected enterprise can easily make loyalty towards
people in significant manner. Therefore, it assists to gather relevant information
towards customer data. In addition to this, there is no effective technology
implemented which required to make proper functions and operations in business
unit. In this way, advance technology required in the selected healthcare enterprise.

How did you change or improve your practice as a result?
In order to solve this issue, NMC need to implement advance technology
equipment's so that it would be beneficial to attain overall growth and effective
results in business unit. With the help of changes and improvement in this facility,
the selected enterprise can enhance overall outcomes to deal with patients in
significant manner. Therefore, it will be beneficial to make proper and effective
results in NMC. Therefore, it required understand problem and issues of the person
in significant manner. Therefore, professionalism and trust will be managed in
significant aspect that required to make effective functioning.
How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
This problem relate with enhancement of professionalism and trust to develop
effective functioning at workplace. Therefore, advance technology implementation
assists to keep relevancy of different outcomes that are related to the patient care.
In this way, promotion can be made for ascertain effective outcomes in significant
manner. Therefore, NMC required to implement advance technology system in
business unit with equipment's as well.

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: Olivia
NMC Pin: W1B1PZ
To be completed by the nurse or midwife with whom you had the discussion:
Name: Olivia
NMC Pin: W1B1PZ
Email address: [e-mail]
Professional address including
postcode:
Nursing and Midwifery Council, 23 Portland place,
London,W1B1PZ.
Contact number: 02073339333,02073336600
Date of discussion: 24/02/16
Short summary of discussion: The resident had a serious incident and was not
treated on time due to lack of communication.
I have discussed five written
reflective accounts with the
named nurse or midwife as part
of a reflective discussion.
I agree to be contacted by the
NMC to provide further
information if necessary for
verification purposes.
Signature:
Date: 26.02.16

You must use this form to record your confirmation.
To be completed by the nurse or midwife:
Name: Olivia
NMC Pin: W1B1PZ
Date of last renewal of registration or
joined the register: 24/02/16
I have received confirmation from (select applicable):
Yes A line manager who is also an NMC-registered nurse or midwife
No A line manager who is not an NMC-registered nurse or midwife
Yes Another NMC-registered nurse or midwife
No A regulated healthcare professional
No An overseas regulated healthcare professional
No Other professional in accordance with the NMC’s online confirmation tool
To be completed by the confirmer:
Name: Olivia
Job title: Nurse
Email address: [e-mail]
Professional address
including postcode:
Nursing and Midwifery Council, 23 Portland place,
London,W1B1PZ.
Contact number: 02073339333,02073336600
Date of confirmation discussion: 26/02/16
If you are an NMC-registered nurse or midwife please provide:
NMC Pin: W1B1PZ

If you are a regulated healthcare professional please provide:
Profession: Health Care
Registration number for regulatory body: 99A9999A
If you are an overseas regulated healthcare professional please provide:
Country: United Kingdom
Profession: Health Care
Registration number for regulatory body: 99A9999A
If you are another professional please provide:
Profession: Health Care
Registration number for regulatory body (if relevant): 99A9999A
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 satisfies 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
N
o
N
o
N
o
Yes

You are satisfied that the nurse or midwife has obtained five
pieces of practice-related feedback.
Written reflective accounts
You have seen five written reflective accounts on the nurse 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 and signed form showing that the nurse or midwife
has discussed their reflective accounts with another NMC-registered 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, and that the above named 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 respond to a request for verification
information I may put the nurse or midwife’s revalidation application at risk.
Signature:
Date: 24.02.16
Yes
Yes
Yes