• Login
• Admin

Harrison, Joanne (2025) How do nurses experience and perceive the Nursing and Midwifery Council revalidation approach in relation to assurance of post-qualification maintenance of quality standards? PhD thesis, University of Nottingham.

PDF (corrections submission pdf) (Thesis - as examined) - Repository staff only until 30 September 2026. Subsequently available to Anyone - Requires a PDF viewer such as GSview, Xpdf or Adobe Acrobat Reader Available under Licence Creative Commons Attribution. Download (3MB)

Abstract

Background

The way in which healthcare professionals are held to account for their clinical care standards has received critical attention following the publication of several inquiries into failings within the United Kingdom’s (UK) National Health Service (NHS). This resulted in a parliamentary directive to strengthen the oversight arrangements of healthcare professionals’ regulation for education, practice standards and appropriateness for inclusion on professionally accredited registers. As a result, the Nursing and Midwifery Council (NMC), the regulator for nursing and midwifery, launched its ‘revalidation’ approach in April 2016.

Nursing and midwifery professional regulation continues to be scrutinised due to regulation challenges identified within the Coronavirus disease 2019 (Covid-19) pandemic and the identification of egregious criminal acts by a regulated healthcare worker. This has prompted further inquiry into NMC governance arrangements and called into question the rigour of its professional regulation.

Studies of healthcare professions’ revalidation approaches have focused

on the experience within medicine, which was the first UK healthcare

profession to commence with revalidation in 2012. These studies have

highlighted diverse findings, from positive reports such as revalidation

promoting professionalism through to concerns that revalidation

represents an infringement on professional autonomy. To date, limited

studies have focused on nurses’ experiences and perceptions of

revalidation. Although the medical and nursing professions share

commonalities, such as degree-level entry to each profession and the

provision of care and services within the health sector, significant

sociocultural, ethical and historical differences necessitate the

consideration of nursing separately. Nursing is the largest healthcare

professional group in the UK. However, limited studies have explored

nurses’ experience of revalidation, their views of its aims to promote

ii

patient safety and assure the quality of nursing care and how they

engage with it as a process.

This study aimed to develop an understanding of UK NMC registered

nurses’ experience and perceptions of revalidation, with specific

reference to its ambition of assuring its registrants post-qualification

maintenance of quality standards and nurses’ engagement with it as a

process. The theory of the sociology of the professions provided a

framework for this study. Sociology of the professions is a complex field

of study, one which is not linear in its discourse and traverses different

interpretations and concepts. This study has adopted the neo-Weberian

tradition from the sociology of the professions’ theory, specifically

Larson’s concept of the ‘professional project’, which has utility in

understanding how professions seek, develop and re-negotiate their

autonomy and social closure.

Methodology and Methods

This study adopted an interpretivist standpoint, utilising a social

constructionism approach. Through purposive sampling, participants

were recruited from across the UK using X (formally Twitter). Eligibility

was defined as nurses who were registered with the NMC and had

undergone at least one revalidation cycle. Data were collected using in�depth Microsoft Teams interviews (37 participants). Data were analysed

inductively using a thematic approach. Ethical approval was gained from

the University of Nottingham Faculty of Medicine and Health Sciences

Research Ethics Committee.

Findings

The findings suggest that participants did not value the assurance aim of

revalidation due to their belief that the process lacked rigour. However,

their commitment to revalidation was attributed to its gateway role in

maintaining nurses’ registration with the professional regulator and ability

iii

to work as a registered nurse. Participants described a spectrum of

engagement1

that portrayed their values and behaviours concerning

revalidation. These ranged from values and behaviours typified as

disingenuous (the gamers), tokenistic (the pragmatists) and explicit

engagement (the by the book), through to a more creative style of

engagement, pushing traditional approaches (the pirates). These values

translated into diverse operational styles in terms of revalidation

engagement. These included the positive perceptions of absorption,

normalisation and appropriation. These terms described how participants

understood revalidation as part of their professional work, made

revalidation part of their everyday professional activities and/or

repurposed it for broader professional purposes where appropriate.

Dissonance, as a negative perception of revalidation engagement, was

broadly attributed to participants’ assertion that revalidation lacked

processual rigour.

A further factor influencing engagement was the perceived availability (or

non-availability) of revalidation support from within the employing

organisations and the regulator. This study uniquely identified how

participants harnessed their agency to create opportunities within their

working activity to engage with revalidation, termed the permissive

space.

These findings align with the neo-Weberian scholarly concepts of social

agency and how professionals seek to preserve autonomy over their

work. Participants engaged with revalidation to maintain their registration

to work, but how and when it was engaged with was demonstrated in

individual ways.

1

Italics are used the first time a concept is referred to in either the abstract or the

body of the document

iv

Conclusions

The study supports the understanding of how nurses experience and

perceive the regulatory approach of revalidation through Larson’s

concept of the professional project. The requirement to engage with

revalidation is non-negotiable; to work as a nurse, revalidation is the

gateway which enables maintenance of the necessary registration. In

maintaining their registration, nurses demonstrated how revalidation was

engaged with, both individually and on behalf of teams they were

responsible for, as a professional project activity. Through revalidation

engagement, Larson’s professional project concept highlights how

nurses strived to attain the state-sanctioned monopoly of registration (the

economic order) and respectability, status, and trust of the public (the

social order). Recommendations support the strengthening of

revalidation as a regulatory process to benefit both the regulator and the

public. Recommendations that support nurses (and wider registrants) in

their experience of engaging with revalidation as a professional activity

are identified.

Item Type:	Thesis (University of Nottingham only) (PhD)
Supervisors:	Moffatt, Fiona Spendlove, Zoey
Keywords:	Nursing and Midwifery Council; Professional regulation; Revalidation engagement; Nurses; Quality of healthcare; Regulatory process
Subjects:	W Medicine and related subjects (NLM Classification) > WY Nursing
Faculties/Schools:	UK Campuses > Faculty of Medicine and Health Sciences > School of Health Sciences UK Campuses > Faculty of Medicine and Health Sciences > School of Nursing
Item ID:	82381
Depositing User:	Harrison, Joanne
Date Deposited:	31 Dec 2025 04:40
Last Modified:	31 Dec 2025 04:40
URI:	https://eprints.nottingham.ac.uk/id/eprint/82381

Actions (Archive Staff Only)

Edit View