Self-tracking, governmentality, and Nursing and Midwifery Council's (2016) revalidation policy
Introduction
Continuous professional development (CPD) is a familiar term to nurses and midwives, as it is an integral part of nursing and midwifery professional education and practice development. The concept of CPD has been widely explored in nursing and midwifery literature and CPD is synonymous with continuing professional education, staff development, continuing professional development, continuing education, and lifelong learning (Gallagher, 2007; Quinn, 2005).
In the UK, the importance of CPD as a contributory factor for the retention of well-qualified staff in the National Health Service (NHS) has been widely debated in the literature (Drey et al., 2009), and CPD is recognised as one aspect of lifelong learning. In addition, it is described as the commitment to developing professional skills, knowledge, and learning for the duration of a chosen profession (Nursing and Midwifery Council Revalidation, 2016a, Nursing and Midwifery Council Revalidation, 2016b).
It is because of the importance of CPD to patient care and safety that the NMC has constantly revisited the policy for nurses and midwives. The NMC defines the revalidation process as:
A process that allows you to maintain your registration with the NMC; builds on existing renewal requirements; demonstrates your continued ability to practise safely and effectively, and is a continuous process that you will engage with throughout your career.
Revalidation is the responsibility of nurses and midwives themselves. You are the owner of your own revalidation process (Nursing and Midwifery Council Revalidation, 2016a, Nursing and Midwifery Council Revalidation, 2016b).
In 1994 the first post-registration education and practice standards (Prep) were published by the United Kingdom Central Council, and the policy took effect in 1995 (United Kingdom Central Council, 1995; Nursing and Midwifery Council Revalidation, 2016a, Nursing and Midwifery Council Revalidation, 2016b; Royal College of Nursing [RCN], 2016). The difference between the old Prep standards and the new revalidation policy for nursing and midwifery is that there is now greater responsibility and accountability on the part of nursing and midwifery professionals to complete all the required activities. In addition to completing the relevant clinical hours and signing health and character declarations, nurses and midwives are required to self-track their learning and teaching activities through a portfolio system. Unlike the Prep standards, the new revalidation portfolio must be approved and verified by a senior colleague or mentor, prior to the online submission to the NMC for revalidation. In other words, not only are nurses and midwives required to self-track their own professional development, once the revalidation portfolio has been completed by these professionals a senior member of staff must approve their portfolio before the professional uploads the information onto the NMC website to await their approval.
There are two issues highlighted here; the NMC expects nurses and midwives to self-track their own professional development, yet the employer is not compelled to fund or provide study days for professional development, with the portfolio required to be signed off by a senior colleague before the professional submits it on the NMC website. If these conditions are not met, the portfolio will not be approved by the NMC.
According to William (2002), the intentions of professional development practices are neither neutral nor innocent and what counts as knowledge and the processes by which knowledge occurs are sometimes questionable. Foucault noted:
[….] The contact point, where the individuals are driven by others is tied to the way they conduct themselves, is what we can call, I think, government. Governing people, in the broad meaning of the word, governing people is not a way to force people to do what the governor wants; it is always a versatile equilibrium, with complementarity and conflicts between techniques which assure coercion and processes through which the self is constructed or modified by himself. (Foucault, 1993, pp.203-4)
Foucault's (1978) concept of governmentality focussed on how people were governed, the rationalities of government, and the technologies employed to regulate the conduct of the people being governed, while Hindess defined government as ‘the regulation of conduct by the more or less rational application of the appropriate technical means’ (1996, p.106). Foucault explored the connections between ‘forms of government, and rationalities or modes of thoughts (about governing) which justify, legitimise and make the exercise of government deem rational’ (Fimyar, 2008, p. 4). Lemke (2002) stated that power is exercised in modern society through technologies that are used to regulate conduct, but Foucault's concept of governmentality differentiated between domination and power (Fendler, 2010). Domination was referred to as an unequal power relation, where one party is weak and defenceless, while in contrast power enables all parties to act, respond, or react, ‘even if the only options for action are extreme’ (Fendler, 2010, p.115). Trowler (2003) noted that policymakers' discourses may not represent the needs of the recipients and consequently the intention and rationale behind a policy may not be readily understood by the recipients.
In this paper, by drawing on Foucault's (1978) discourse of governmentality, I will argue that the Nursing and Midwifery Council Revalidation, 2016a, Nursing and Midwifery Council Revalidation, 2016b revalidation policy has employed the technology of self-tracking and the self-funding of professional development as forms of governing in order to enhance a neoliberal policy of self-governing and self-funding on the part of nurse and midwife professionals. The new revalidation policy has not been forced on nurses and midwives, but those who wish to remain registered with the NMC must undergo the revalidation process. Although this revalidation policy should bring about an improvement in skills and knowledge, I will argue that the process may not necessarily meet the development needs of nurses and midwives, because the time and funds required for the revalidation process are not provided by employers, since it is not compulsory for employers to allocate such support. Thus this situation defeats the purpose of revalidation, which is to protect public safety. The following question will be addressed: Does self-tracking and self-funding professional development facilitate or hinder the professional development of nurses and midwives? William (2002) argued that professional development has the tendency to become a powerful tool in the hands of those who set the standards for professional development, and sometimes also those who are undertaking professional development in order to advance their careers. It is recognised by William (2002) that professional development may not always serve the purpose it was designed for, such as when the ideology behind a professional development policy limits the application of the policy in practice.
Rose (1989) described personal freedom as a natural state of humankind with a minimal form of government, while Lupton (2014) suggested that while citizens are encouraged to engage in certain practices voluntarily, it is also an effective and non-coercive way of rendering them to be manageable and productive citizens. However, Lupton argued that self-interests and outcomes should be aligned to the rationales and interests of the state. Ball (2012, p.3) urged the critical examination of important issues, such as ‘whose values are validated in a policy and whose are not’. In nursing and midwifery, governmentality and autonomy over professional development, professionalism, and lifelong learning have been incorporated into the undergraduate and postgraduate curricula through module assessment and yearly mandatory training (Ryan, 2003). Health professionals, such as nurses and midwives, are intrinsically willing and expected to learn, develop their skills and knowledge, and provide safe care. Therefore, understanding the values behind the revalidation policy is important for the professional development of nurses and midwives. While nurses and midwives have always complied with professional governing requirements or policies, such as the new self-tracking technology for CPD activities, it is important that these policies continue to enhance professional practice and professional knowledge. The NMC revalidation governing technologies were established to maintain public safety needs and the policy should also serve the professional and self-interest of nurses and midwives.
Section snippets
Self-tracking Technology and Governmentality
Self-tracking as tool for understanding the self through data collection has gained recognition in both the health sector and public domain. The term “quantified self” was coined by Wolf and Kelly to describe the behaviour they observed among their colleagues who used digital technologies, such as mobile phones and apps, to generate personal data about their day-to-day life (Lupton, 2013). Foucault (1988) described one of the principal techniques for self-understanding as possessing knowledge
Conclusions
This paper has primarily focused on the constraints faced by nurses and midwives and the lack of proper consideration for how they undertake self-tracking, together with how this prevents the enhancement of professional development. In response to whether self-tracking professional development facilitates or hinders the professional development of nurses and midwives, it is clear from this discussion that the act of governing as described by Foucault is not limited only to politics, but also
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