Guide to completing practice hours log Work setting • Maternity unit or birth cent

• Ambulance service • Military

To record your hours of practice as a registered nurse,
• Care home sector • Occupational health
midwife and nursing associate, please fill in a page • Police
• Community setting (including
for each of your periods of practice. Please enter your district nursing and community • Policy organisation
most recent practice first and then any other practice psychiatric nursing) • Prison
until you reach 450 hours. You can only count practice • Consultancy • Private domestic setting
• Cosmetic or aesthetic sector • Public health organisation
hours during the three year period since your last
• Governing body or other • School
registration renewal or initial registration. You • Specialist or other tertiary
leadership
do not necessarily need to record individual practice • GP practice or other primary including hospice
hours. You can describe your practice hours in terms of care • Telephone or e-health adv
standard working days or weeks. For example if you • Hospital or other secondary • Trade union or professiona
care body
work full time, please just make one entry of hours. If
• Inspectorate or regulator • University or other researc
you have worked in a range of settings please set these facility
• Insurance or legal
out individually. You may need to print additional pages • Voluntary or charity sector
to add more periods of practice. If you are both a nurse • Other
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.

Dates: Name and Your work Your scope Number Your

address of setting of practice of hours: registration
organisation: (choose from list above): (choose from list above): (choose from list abo

(Please add rows as necessary)

Guide to completing CPD record log

Examples of learning method What was the topic? Link to Code
• Online learning Please give a brief outline of the key points of the Please identify the part or parts of the Code re
• Course attendance learning activity, how it is linked to your scope of • Prioritise people
• Independent learning practice, what you learnt, and how you have • Practise effectively
applied what you learnt to your practice. • 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 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): L
Please describe the methods you used for the activity: C

(Please add rows as necessary)

Guide to completing a feedback log

Examples of sources of feedback Examples of types of feedback

• Patients or service users • Verbal
• Colleagues – nurses, midwives, nursing • Letter or card
associates, other healthcare professionals • Survey
• Students • Report
• Annual appraisal
• Team performance reports
• Serious event reviews

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. The section on non-identifiable information 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.

Source of feedback
Type of feedback Content of feedback
Date Where did this feedback
How was the feedback received? What was the feedback about
come from?
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, colleague or other individuals. Please refer to our guidance on
preserving anonymity in the section on non-identifiable information in How to revalidate with the NMC.

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

What did you learn from the CPD activity and/or feedback and/or event or
experience in your practice?
 How did you change or improve your practice as a result?

How is this relevant to the Code?

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

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, colleague or other individuals. Please refer to our guidance on
preserving anonymity in the section on non-identifiable information in How to revalidate with the NMC.

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

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

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

 How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust

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, colleague or other individuals. Please refer to our guidance on
preserving anonymity in the section on non-identifiable information in How to revalidate with the NMC.

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

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

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

 How is this relevant to the Code?
Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust

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, colleague or other individuals. Please refer to our guidance on
preserving anonymity in the section on non-identifiable information in How to revalidate with the NMC.

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

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

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

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
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, colleague or other individuals. Please refer to our guidance on
preserving anonymity in the section on non-identifiable information in How to revalidate with the NMC.

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

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

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

How is this relevant to the Code?

Select one or more themes: Prioritise people – Practise effectively – Preserve safety – Promote
professionalism and trust
You must use this form to record your reflective discussion with another NMC-registered nurse, midwife or
nursing associate about your five written reflective accounts. During your discussion you should not
discuss patients, service users, 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 an individual. Please refer to the section on non-identifiable information in How to revalidate with
the NMC for further information. For more information about reflective discussion, please refer to our
guidance sheet on reflective practice for revalidation.
.

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

Name:

NMC Pin:

To be completed by the nurse, midwife or nursing associate with whom you had the
discussion:
Name:

NMC Pin:

Email address:

Professional address including

postcode:

Contact number:

Date of discussion:

Short summary of discussion:

Signature:
 I have discussed five written
reflective accounts with the Date:
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.

You must use this form to record your confirmation.

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

Name:

NMC Pin:

Date of last renewal of registration or

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:
Job title:
Email address:
 Professional address
including postcode:

Contact number:
Date of confirmation discussion:

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

NMC Pin:

If you are a regulated healthcare professional please provide:

Profession:

Registration number for regulatory body:

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.

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: