Venepuncture (Phlebotomy) and Cannulation Training

Completed forms and templates

Contents

The forms and templates in this pack are examples of how a nurse or midwife may record how they meet the requirements of revalidation. These include real life examples taken from nurses or midwives who have already revalidated.

This is not a sample portfolio of one individual nurse or midwife. The pack includes a variety of forms and templates, designed to reflect multiple practice settings and different ways of approaching the process.

1. Practice hours log
Secondary care – Dual registered nurse and midwife	3
University – Nursing lecturer	4
Primary care – Practice nurse	5

2.	Continuing professional development log
	Secondary care – Staff nurse	6
3.	Feedback log
	Secondary care – Midwife	8
4.	Reflective accounts form (mandatory)
	Community – District nurse	10
	Community – Health visitor	12
	Cosmetic sector – self-employed aesthetic nurse	14
5.	Reflective discussion form (mandatory)
	Care home – Staff nurse	16

Confirmation form (mandatory)

Care home – Staff nurse

The reflective accounts, reflective discussion and confirmation forms are all mandatory for revalidation.

Guide to completing practice hours log

To record your hours of practice as a registered nurse, midwife and nursing associate, 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 can only count practice hours during the three year period since your last registration renewal or initial registration. 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 a midwife or a nursing associate and nurse 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 practice¹,²

Direct clinical care

Education

Research

Management

Leadership

Policy

Commissioning

Consultancy

Quality assurance or inspection

Registration

Registered Nurse

Midwife

Nursing Associate

Registered Nurse/SCPHN

Midwife/SCPHN Registered Nurse and Midwife (including Registered Nurse/SCHPN and Midwife/SCPHN)

Dates:	Name and	Your work	Your scope	Number	Your	Brief description of your work:
	address of	setting	of practice	of hours:	registration
	organisation:	(choose from list above):	(choose from list above):		(choose from list above):

1	The Code (NMC 2018) https://www.nmc.org.uk/standards/code/
2	Standards of proficiency for: registered nurses (NMC 2018), nursing associates (NMC 2018) and midwives (NMC 2019): https://www.nmc.org.uk/standards/	Page 3 of 19

10/12/2010	London Hospital,	Hospital	Direct patient	Full time 37.5	Nurse and	Midwife on labour and PN ward, also rely
– Current	London Road,		care	hours per week	midwife	on nursing skills, knowledge &
	London.					experience every day. Caring for women
						and babies in labour and postpartum
						period; caring for women post-
						operatively; CTG monitoring; suturing;
						breastfeeding support; examination of
						the new born.

Page 4 of 19

Guide to completing practice hours log

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 practice³,⁴

Direct clinical care

Education

Research

Management

Leadership

Policy

Commissioning

Consultancy

Quality assurance or inspection

Registration

Registered Nurse

Midwife

Nursing Associate

Registered Nurse/SCPHN

Midwife/SCPHN Registered Nurse and Midwife (including Registered Nurse/SCHPN and Midwife/SCPHN)

Dates:	Name and	Your work	Your scope	Number	Your	Brief description of your work:
	address of	setting	of practice	of hours:	registration
	organisation:	(choose from list above):	(choose from list above):		(choose from list above):

June 2013 –	Norwich	University	Education	1600 hrs per year	Nurse	Teaching pre-registration nurses, and
June 2016	University,					teaching post qualifying courses at under
	Norwich Road,					and post graduate level.
	Norwich.					Link lecturer, practice liaison and
						associated activities, marking.

3	The Code (NMC 2018) https://www.nmc.org.uk/standards/code/
4	Standards of proficiency for: registered nurses (NMC 2018), nursing associates (NMC 2018) and midwives (NMC 2019): https://www.nmc.org.uk/standards/	Page 5 of 19

Guide to completing practice hours log

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 practice⁵,⁶

Direct clinical care

Education

Research

Management

Leadership

Policy

Commissioning

Consultancy

Quality assurance or inspection

Registration

Registered Nurse

Midwife

Nursing Associate

Registered Nurse/SCPHN

Midwife/SCPHN Registered Nurse and Midwife (including Registered Nurse/SCHPN and Midwife/SCPHN)

Dates:	Name and	Your work	Your scope	Number	Your	Brief description of your work:
	address of	setting	of practice	of hours:	registration
	organisation:	(choose from list above):	(choose from list above):		(choose from list
					above):

5	The Code (NMC 2018) https://www.nmc.org.uk/standards/code/
6	Standards of proficiency for: registered nurses (NMC 2018), nursing associates (NMC 2018) and midwives (NMC 2019): https://www.nmc.org.uk/standards/	Page 6 of 19

6 January	Heatherfield GP	GP practice	Direct patient	12 hours per	Nurse	Part of primary healthcare team, with duties
2008 –	Practice, Leeds		care	week = approx.		including:
Current	Road, Leeds.			560 hours per		–	Venepuncture
				year		–	Travel health advice and vaccinations
						–	Smoking cessation
						–	Family planning & women’s health

Page 7 of 19

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 practice7,8, 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 your CPD.

Prioritise people

Practise effectively

Preserve safety

Promote professionalism and trust

Link to Standards of proficiency

Please identify the part or parts of the relevant standards that you used to inform your CPD

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 types of evidence you could retain, refer to our guidance sheet at www.revalidation.nmc.org.uk/download-resources/guidance-and-information.

Dates:	Method:	Topic(s):	Link to Code:	Link to	Number of	Number of
	Please describe the methods you			Standards of	hours:	participatory
	used for the activity:			proficiency:		hours:

The Code (NMC 2018) https://www.nmc.org.uk/standards/code/

Standards of proficiency for: registered nurses (NMC 2018), nursing associates (NMC 2018) and midwives (NMC 2019): https://www.nmc.org.uk/standards/

Page 8 of 19

4.4.14	Independent learning –	Clinical mandatory training	Practise	Being an	7.5	0
	online course	effectively	accountable
	Update for all clinical aspects relevant
		to my role, including blood transfusion,	Preserve	professional
		manual handling and safeguarding.	safety	Improving safety
		Some of what we covered I already
			and quality
		knew, but it was good to refresh. I
			of care
		learned that there was a new blood

		transfusion policy and a new procedure
		for collecting blood from the fridge. I
		haven’t done this in practice for a while
		so it was important that I learnt this.

27.5.14	Course attendance	IV Therapy. This course enabled me	Practise	Assessing needs	7.5	7.5
		effectively	and planning
		to learn the theory and practice
		behind IV therapy. Also got to practise	Preserve	care
		aseptic non touch technique (ANTT). I	safety
		have increased my knowledge and	providing and

		am now able to deliver IV therapy
			evaluating
		safely.
			care


3.6.201	Independent learning –	Caring for people who are dying:	Prioritise	Being an	2	0
5	reading article	people	accountable
priorities at the end of life. Read
		CPD article in Nursing Standard.		professional
		Gained new ideas which I will reflect
		on and discuss with my team, with a		Improving safety
		view to making changes to our
			and quality
		practice.
			of care

Page 9 of 19

16.6.14	Meeting attendance	Mentor update. Face to face	Prioritise	Being an	3	3
		people	accountable
		session which informed me of recent
		changes to student nurse training		professional
		and reminded me of the standards I
		need to achieve as a mentor.		Improving safety
		Allowed me to reflect on my role as a
			and quality
		mentor and role model to students in
			of care
		the last six months.

1.3.16	Conference attendance	RCN Education Conference.	Practise	Improving safety	15	15
		effectively	and quality
		Attended two-day conference.
		Presentations on quality surgical	Preserve	of care
		nursing and its impact on clinical	safety
		practice were particularly relevant to	Leading and

		me. I will present these ideas to the
			Managing Nursing
		team at our next meeting, and have
			care and
		gained some ideas on implementing
		more training in my area.		Working in
				teams


					Total: 35	Total: 25.5

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Guide to completing a feedback log

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 thatyour 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.

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

Date	Source of feedback	Type of feedback	Content of feedback
Where did this feedback	How was the feedback
What was the feedback about and how has it influenced your practice?
	come from?	received?


			The student found it valuable when I let her take the lead in a
1.7.2015	Student	Verbal, in a meeting to review	postnatal baby check. I will encourage my students to take the lead
		placement documentation	more often and try to only provide direction when they need it.
			Linked to ‘promote professionalism and trust’ in the Code.

			Thanking me for supporting her and her partner throughout the
	Woman I looked after on PN	Thank you letter	discharge process. Highlighted the importance of taking time to make
10.8.2015	ward		sure women feel confident and comfortable before they are sent
			home with their new baby. Linked to ‘prioritise people’ in the Code.

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			Gave me feedback on my leadership style. We discussed what works
12.11.2015	Annual appraisal	Verbal	well, and areas where I could improve. We also talked about a
			leadership course which I am going to attend next month.

			A complaint was received about the ward, from a woman who felt she
3.2.2016	Patient	Written complaint	received poor care, inadequate support with breastfeeding and was
			not kept in the loop about discharge process. Will reflect on this in one
			of my reflective accounts. Linked to ‘prioritise people’ in the Code.

			I asked a more experienced midwife on the ward to observe a
7.5.2016	Colleague	Verbal	breastfeeding support session I lead, and give me feedback. We
			talked about what I did well, and some new ideas and techniques I
			could include in my session. Will reflect on this in one of my reflective
			accounts.

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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: Community – District nurse

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

CPD participatory activity. Attending a Manual Handler Transfer Specialist course.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

As an experienced community nurse I have had to adapt to various environments to deliver care safely and effectively. Working within the community team we provide care for patients with complex health care needs at home, most presenting with limited ability to mobilise and transfer independently. I participated in the manual handling transfer specialist training course to develop the team’s knowledge and skills in patient handling. The role of transfer specialist will also promote the team’s compliance with the Trust’s mandatory training programme.

The statistics highlighting that 24% of NHS staff are injured through poor manual handling practice, and that poor practice contributes to 40% of sickness and absence, emphasise the need for raising awareness of the consequences of poor practice. The cost to the NHS for compensation claims is approximately £150 million a year; money that should go directly to patient care.

The role of transfer specialist will focus on organisational and individual training needs to move safer handling practice forward across the organisation, in line with current best practice. Each trainer will be expected to attend a minimum of one update training session every year facilitated by a board manual handling advisor.

Staff will complete a structured manual handling passport and will be assessed carrying out practical modules relevant to their workplace. For new staff an induction will be carried out and a checklist of training needs must be met prior to commencement of work. Self-assessments will be carried out every two years and, if required, training will be provided by the transfer specialist.

The legislation regarding risk assessments and safety at work was discussed and the importance of assessment prior to performing any task was reinforced, with the aim to reduce risk of injury to both patient and staff member.

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How did you change or improve your practice as a result?

We have arranged a teaching programme which includes individual task assessments, control measures, risk assessments, care plans and review dates. We have offered to accompany colleagues on home visits to carry out complex assessments, enabling us to initiate safer handling principles. We will act as a resource to the team in relation to the ordering of equipment, with the purpose of reducing the risk of injury to colleagues and patients as a result of poor manual handling practice.

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

All four themes of the NMC Code are linked to this CPD activity:

Prioritise people – the majority of people referred to the CRT are older with chronic limitations including social needs. For some patients to remain at home safely, functional assessments are necessary to perform the fundamentals of care safely. The extended knowledge and skills in identifying appropriate aids for transferring patients enables them to remain independent with formal support at home.

Practise effectively – the ongoing manual handling updates enables staff members to maintain the knowledge and skills needed for safe and effective practice.

Preserve safety – As a transfer specialist I am to be a resource for the team, supporting colleagues to take account of their own personal safety as well as patient safety by attending manual handling training sessions.

Promote professionalism and trust – I intend to be a model of integrity and leadership by being committed to the standards of safer handling practice.

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Reflective account: Community – Health visitor

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

I received written feedback on a record keeping and documentation and train the trainer training day that I delivered with a colleague. The audience included health visitors, student health visitors and managers. The organisation was in the process of moving to a new record keeping system and had concerns about the quality of their practitioner’s records. There had been a number of serious case reviews where poor record keeping was highlighted as a contributing factor. My colleague and I delivered the record keeping session and I delivered the train the trainer session. Feedback was received from participants who completed an evaluation form. I also received a thank you email from the manager who commissioned the session.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

The feedback from participants was positive and demonstrated that expectations of the session had been met. The content, materials and delivery of the session were rated excellent or very good, indicating it had been well received and was beneficial. There were a number of additional comments. It was suggested there could have been more focus on the how participants themselves could deliver the training, more on the basics of record keeping in relation to current NMC guidelines and, rather than maintaining the same members of a group within the different interactive sessions, it would have been beneficial if members were moved around.

I was pleased with the feedback, in particular the additional comments from participants that would enable me to improve future sessions.

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How did you change or improve your practice as a result?

I reviewed the training package based on the feedback provided and the programme for future sessions was amended, addressing the suggestions made.

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

It is relevant to the theme ‘prioritise people’ in terms of listening to people and responding to their preferences and concerns. I had a number of meetings and communications with the management team and representatives to ensure the training day would meet their requirements, and I made changes based on the feedback received.

It is also relevant to the themes ‘practise effectively’ and ‘promote professionalism

and trust’ in terms of practising in line with the best available evidence, working cooperatively, communicating clearly, and sharing skills and knowledge. It was important that the best available evidence was used in the presentation, which required me to research the subject area and ensure I was confident in my knowledge. I also had to ensure that I communicated clearly and varied the teaching methods to facilitate participants’ engagement, recognising that people learn in different ways. The session encouraged participants to uphold the standards and values set out in the Code.

Page 13 of 19

Reflective account: Cosmetic sector – self-employed aesthetic nurse

What was the nature of the CPD activity and/or practice-related feedback and/or event or experience in your practice?

An experience from a clinic treatment day, during the pre-treatment discussion with a patient.
When I asked if there were any changes to medical or drug history, the patient said there had been no changes. T
Patient did not consider that taking oral low dose aspirin was a medical or drug related issue, and therefore did not inform us that six weeks ago she’d commenced prophylactic oral low dose aspirin after reading an article in a newspaper.
This resulted in her subsequent bleeding during the elective procedure which had to be abandoned.

What did you learn from the CPD activity and/or feedback and/or event or experience in your practice?

Learnt that patients do not always have a clear understanding of the information we are requesting from them.
I reflected on how we asked patients for general information – it is quite possible that patients do not consult with Health Care Professionals when making choices – in this case they read an article, purchased an OTC medication and commenced self-medication.
This highlights that patients may not consider self-medication either a ‘medical’ or ‘drug’ change and therefore would not report a change to us.

How did you change or improve your practice as a result?

Reviewed the written information we give to patients prior to treatment
Introduced a risk assessment for bruising
This risk assessment includes a list of possible medications they may be taking and might not think to mention, such as low dose Aspirin, Vitamin E supplements, cod liver oil capsules etc.

Page 14 of 19

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote professionalism and trust

This is relevant to all principles of the Code, but in particular:

Practising effectively – this experience is about communicating clearly, and taking steps to ensure people understand what is being asked of them.

Preserving safety – I took steps to reduce as far as possible any potential for harm associated with my practice by introducing a new risk assessment for bruising.

Page 15 of 19

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:

A.Nurse

12A1234B

To be completed by the nurse or midwife with whom you had the discussion:

Name:	L. Manager


NMC Pin:	13A1234B


Email address:	l.manager@nurse.com


Professional address including	London
Hospital
postcode:
	Jones Road
	London
	LN1 2NM
Contact number:	020 1232 1234


Date of discussion:	30/01/2016


Short summary of discussion:	We discussed all five of Amy’s reflective
accounts and linked them back to the Code. We

	had a very beneficial discussion about some of
	the issues raised, and shared our different
	perspectives. We also identified some
	professional development objectives for Amy,
	and she is now going to write an action plan for
	the future.

Page 16 of 19

I have discussed five written reflective accounts with the named nurse, midwife or nursing associate 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: 30/01/2016

Page 17 of 19

You must use this form to record your confirmation.

To be completed by the nurse, midwife or nursing associate:

Name:	A.Nurse

NMC Pin:	12A1234B

Date of last renewal of registration or	01/01/2013
joined the register:

I have received confirmation from (select applicable):

A line manager who is also an NMC-registered nurse, midwife or nursing associate

A line manager who is not an NMC-registered nurse, midwife or nursing associate

Another NMC-registered nurse, midwife or nursing associate

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:	L.Manager

Job title:	Ward Manager

Email address:	l.manager@nurse.com

Professional address	London
including postcode:	Hospital
	Jones Road
	London
	LN1 2NM
Contact number:	020 1232 1234


Date of confirmation discussion:	30/01/2016

If you are an NMC-registered nurse, midwife or nursing associate please provide:

Page 18 of 19

NMC Pin: 13A1234B

If you are a regulated healthcare professional please provide:

Profession: Nurse

Registration number for regulatory body: 13A1234B

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 (if relevant):

Confirmation checklist of revalidation requirements

Practice hours

You have seen written evidence that satisfies you that the nurse, midwife or nursing associate 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, midwife or nursing associate has undertaken 35 hours of CPD relevant to their practice as a nurse, midwife or nursing associate

You have seen evidence that at least 20 of the 35 hours include participatory learning relevant to their practice as a nurse, midwife or nursing associate. You have seen accurate records of the CPD undertaken.

Practice-related feedback

You are satisfied that the nurse, midwife or nursing associate has obtained five pieces of practice-related feedback.

Page 19 of 19

Written reflective accounts

You have seen five written reflective accounts on the nurse, midwife or nursing associate’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, midwife or nursing associate has discussed their reflective accounts with another NMC-registered individual(or you are an NMC-registered individual who has discussed these with the nurse, midwife or nursing associate yourself).

I confirm that I have read Information for confirmers, and that the above named NMC-registered nurse, midwife or nursing associate has demonstrated to me that they have met all of the NMC revalidation requirements listed above during 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, midwife or nursing associate’s registration application at risk.

Signature:

Date: 30/01/2016

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