The 'How You Changed Practice' Field on the NMC Form 6

Field 3 of the Form 6 is where the learning shows up in real behaviour. The wording on the form asks how you have changed or improved practice. The audit reads this field looking for concrete change, not stated intention.

The basic test

Reread your Field 3 and ask: could the audit, watching me work next week, see this change in action?

If yes, the field works. If no, if the change is internal, intentional, or aspirational, the field needs strengthening.

Three failure modes

1. Future tense. “I will be more careful with drug calculations in future.” This is intention, not change. The Form 6 expects past or present tense: what you have changed, not what you intend.

2. Awareness without behaviour. “I am now more aware of the importance of handover quality.” Awareness is a precondition for change, not a change. Pair any awareness statement with a concrete behaviour.

3. Repetition across accounts. The same practice change cited in three of your five reflections suggests either a very narrow learning record or that the change wasn’t really specific to each event.

Three patterns that work

1. The new behaviour. A specific thing you now do that you didn’t before.

“I now check the patient’s stated allergies against the prescription before drawing up any medication, even when the trust’s electronic system has already flagged compatibility. The check adds 20 seconds per round and has caught one prescription error in the eight weeks since the change.”

2. The removed behaviour. A specific thing you stopped doing.

“I no longer use family members as informal interpreters for consent conversations. Since the September training, I have requested a professional interpreter on three occasions where previously I would have used the family member who was already present.”

3. The modified routine. A change to how you do something familiar.

“My SBAR handover for complex patients now starts with ‘I need to give you a fuller Background than usual’ and uses two or three sentences for the medical context rather than one. I have used the expanded format on four handovers since the feedback in March; the receiving nurse has not had to ask clarifying questions on any of them.”

The “when did it start, how has it held” structure

Strong Field 3 entries include two time references:

• When the change started, usually shortly after the event in Field 1.
• How it has held since, usually a brief example of the change being applied.

This double-stamp gives the audit confidence that the change is real and embedded, not just claimed.

Worked example with both stamps:

“Following the near-miss in November, I changed my approach to wristband identity checks. From the next shift onwards, I have read the band aloud rather than glancing at it (name, DOB, hospital number) and asked the patient to confirm before proceeding. In a busy shift last week I noticed I was tempted to revert to a glance under pressure; I caught myself and used the aloud-read for all four patients on that round. The change has stuck.”

How long the field should be

The form has space for around 100 to 250 words on Field 3.

• Under 75 words usually means the change isn’t well described.
• 100 to 200 words is the typical strong range.
• Over 300 words suggests you’ve put descriptive narrative in that belongs in Field 1.

Common edge cases

Change in a senior or strategic capacity. If the event led to a wider service change rather than a personal behaviour change, write the change at the level you led it. “I now lead the monthly drug safety review meeting” is a valid change for a senior nurse.

Change that’s organisational rather than personal. If your trust adopted a new policy and you simply follow it, that’s compliance, not personal practice change. Form 6 expects a change attributable to your reflection.

Change that hasn’t held. If you tried a change and reverted, the honest account is that you didn’t change practice. Pick a different event for the reflection. (The reverted attempt may be its own learning event later.)

The next chapter covers Field 4 (the Code link) and how to make sure the section number you pick actually fits the content of the reflection.