Nurses Involvement in Surgical Wound Closure.

RE: Nurses Involvement in Surgical Wound Closure.

raggydoll — Mon, 06 Jul 2020 20:05:43 GMT

[quote userid="60272" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/31994/nurses-involvement-in-surgical-wound-closure/176178"]I don't believe it is "in the realm of the vets," I think that anything nurses can competently do within our remit, we absolutely should do[/quote]

I wholeheartedly agree with this! I worked very hard, often outwith my working hours, practicing suturing, timing myself to get competent on cadavers before beginning to suture live patients and did so only when both myself and my boss felt I was ready to do so. I agree that initially a vet may be a little quicker to do the stitch up that arrives at end of shift but with practice, nurses can be equally as quick and proficient as vets. If we say that nurses should not do stitch ups etc because vets will be quicker at the procedure, what about new grads? Everyone has to learn, within reason, this is an ever changing profession and I think we have to be open minded.

[quote userid="60272" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/31994/nurses-involvement-in-surgical-wound-closure/176178"] We can be so much more, and there's nothing wrong with specialising in a niche, so long as that niche needs to be filled[/quote]

This is very true, my practice is a large teir 3 veterinary hospital, many of us have a special interest within certain areas of nursing and this works well, we all seek each others opinion if and when required.

[quote userid="60272" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/31994/nurses-involvement-in-surgical-wound-closure/176178"]I think there also needs to be a shift in professional responsibility onto us for tasks that have been delegated to us by the veterinary surgeon[/quote]

This is an excellent idea! I do agree with the "entitled" attitude of some and this does need to be addressed, this idea could hopefully help with this?

RE: Nurses Involvement in Surgical Wound Closure.

Cyonica — Mon, 06 Jul 2020 15:05:06 GMT

This is a really interesting discussion! It's interesting to hear the perspective of someone who does/did this against their preference. I personally love doing surgical work within Schedule 3, but maybe because it fits so well with my out of work hobbies, and the skills I use for both are very similar. I totally agree that we should only be doing it when it makes sense to, and when we've had the proper training and support. It was a real struggle for me to push into it as we're overrun with nurses but have next to no vets. This is the main reason I wanted to do it (to give vets more time for other things), but made it really hard to get the support and find the time to learn. I do think that in my practice it is needed though, despite that the vets are far more experienced and faster than me, because practice is the only way I will learn and speed up, and I believe I can at least work to the standard of a relatively new vet.

I don't believe it is "in the realm of the vets," I think that anything nurses can competently do within our remit, we absolutely should do (in my situation at least, where vets are skipping lunch every day and us nurses are fitting in work between tea breaks). I also don't think that we should limit ourselves to our base role and initial training. We can be so much more, and there's nothing wrong with specialising in a niche, so long as that niche needs to be filled. If everyone does one thing well, and between us we're covering everything, I think we've got a great team. I equally respect and very much value people who want to keep a balanced skillset; those people are far more adaptable than people like me and far less likely to be found crying in the corner on a busy inpatient shift. I think there's a place for both types of nurse.

In answer to the original questions, I perform surgical closures and small mass removals as well as a few other minor procedures like removing torn nails, and I used to do aural haematoma repairs though they tend to be treated medically now. I've been watching vets do tail and digit amputations, but I want to take a course in it as I don't think these procedures should be learned on the go. I strongly believe that anyone performing minor surgery should take a proper course to give them the surgical understanding and anatomy knowledge they need in order to carry it out safely. There's far more to it than knowing suture patterns! Sal is absolutely spot on about people feeling "entitled," and I think it's a dangerous attitude to put pride ahead of patient care. I put a LOT of time and work into making sure I was ready to do this.

What I would like to see is standardised and recognised courses for nurses that build our knowledge and understanding up from where we leave off at college to where we need to be to perform advanced tasks safely and competently with minimal support from the vet (obviously support will always be needed whilst building up new practical skills). I think there also needs to be a shift in professional responsibility onto us for tasks that have been delegated to us by the veterinary surgeon, but hopefully that's in the works with the Schedule 3 talks. This will mean that vets no longer have to worry about risking their own registration on our competence, and we will have to consider whether we are competent enough to take responsibility for what we're doing (less entitlement, more accountability).

RE: Nurses Involvement in Surgical Wound Closure.

Sal the 1st — Fri, 03 Jul 2020 16:36:43 GMT

Definitely agree with you there and also this

[quote userid="12003" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/31994/nurses-involvement-in-surgical-wound-closure/176158"]I think it is important for nurses to further their knowledge and education and look to carve out roles for themselves, such as wound nurse or consulting nurse to provide career progressions and in some cases a better level of nursing care. [/quote]

there is so much that nurses can do to improve life for their patients. Over the years I have concentrated on different aspects at various times and once I have got to be where I need to be with them somehow, and they cease to hold my interest, I have moved onto something else until that too ceases to be a challenge - but sometimes the most satisfying challenge for the day for me might simply just be getting that crabby attitude, hunger striking cat, down in the kennels to take some food voluntarily after a bit of a groom and a bit of a chat. I don't think I will ever be a specialist in any thing (and after 3 plus decades its probably far too late) as to me that is too limiting but I would like to think I could be a good all rounder sometimes

RE: Nurses Involvement in Surgical Wound Closure.

Arlo Guthrie — Fri, 03 Jul 2020 10:58:56 GMT

Just what I was thinking, and very much the direction of travel for vetnurse.co.uk - ie a high standard of clinical discussion with proper recognition of expert opinion - something I am SO excited about having the Veterinary Wound Library Bandaging Angels involved with

RE: Nurses Involvement in Surgical Wound Closure.

shelly jefferies — Fri, 03 Jul 2020 09:44:50 GMT

This is a great discussion, Sal I can completely understand where you are coming from and I agree with the whole sentiment of a better collaboration of vets and nurses.

I think we should all remember the reason we became nurses and that was for the care of the animals, and this includes all the basic but vitally essential tasks. I think it is important for nurses to further their knowledge and education and look to carve out roles for themselves, such as wound nurse or consulting nurse to provide career progressions and in some cases a better level of nursing care.

I do think the type of practice you work in also influences the 'tasks' allocated - for example like myself in a busy, mixed animal, independent practice I have loads to do with the wound management and bandaging and dressing choices, but from a schedule 3 point of view I don't currently perform surgical debriding or suturing of wounds due partly to staffing constraints i.e not enough RVN's to allow for one to be performing procedure and one to be monitoring patient, with another to be able to assist the vet doing whatever they are doing, and partly because we have a lot of younger vets, who need the experience and opportunities to do these things themselves, and I provide guidance for these if needed. I have in previous larger/referral hospitals performed wound sutures, and a couple of comments here seem to shadow that.

RE: Nurses Involvement in Surgical Wound Closure.

Sal the 1st — Thu, 02 Jul 2020 20:25:27 GMT

[quote userid="2329" url="~/001/veterinary-nurse-clinical/small-animal/animal-wound-management/f/discussions/31994/nurses-involvement-in-surgical-wound-closure/176152"]so what you are saying is that deferral of tasks through schedule 3 could risks the same kind of issue, or that animals may suffer due to the time taken to perform tasks by less experienced staff? [/quote]

that is exactly what I meant. I know some think people like me are holding back the progression of the profession but really that isn't and never has been my intent - I just want what is best for my patient and I know how ever good I was or am with a suture needle a vet will be faster . I also know that when it comes down to the nursing side I am probably going to pick up on the subtlest of changes in my patient and be able to work out the best intervention ie the dog whining and creating in the kennel post op is it really in pain? or does it have anything to do with the fact it has been on maintenance plus fluids and needs a pee and really doesn't want to soil its kennel. At first glance somebody going through the kennels might think yep that dog needs its pain relief upping when the truth is it just needs an opportunity to relieve itself. I guess I just worry sometimes that it is easy to neglect the basics. However 'specialist' somebody may become in whatever area never forget your nursing roots - the basics are important.I'm not against anybody learning and developing new skills so long as they are in addition not instead of the skills they already have.

You ask how we can best ask what nurses really want but I wonder would it be better to ask for a collaboration of vets and nurses and try and hit a compromise somewhere between the two that satisfies both. If I was allowed one wish what I would ask for is serious engagement from both vets and nurses together to achieve this. And there lies the problem, its like trying to herd cats, I have managed it a few times in various places I have been employed but honestly its really hard work

RE: Nurses Involvement in Surgical Wound Closure.

Georgie Hollis — Thu, 02 Jul 2020 09:18:40 GMT

I am so glad to see this side of the discussion. Thank you for saying this. It's refreshing to hear and definitely the same view in human healthcare from my experience. In human healthcare there is a definitely feeling among nurses - and now health care assistants that there is a top down deferral of tasks to less qualified people who are less 'expensive' in terms of health economy. So the NHS saves money by asking healthcare assistants to change dressings instead of using the time of the district nurses. (sorry this is an area i know well from experience - so using the analogy). In the process of doing this, the patients don't benefit from the deeper knowledge/physical exam (even subconscious awareness of complications) that will quickly enable a change or intervention when needed. I've seen first hand months of mismanagement prolonged as a result - so what you are saying is that deferral of tasks through schedule 3 could risks the same kind of issue, or that animals may suffer due to the time taken to perform tasks by less experienced staff?

That's important and we should look at this from a wound perspective. TIME is really important especially in terms of surgical site infection risk.

I admit in human healthcare when teaching about wound dressings i was very slow to cotton on that some people just want a crib sheet and to go home! Not everyone wants to be 'experts' and understand the physiology behind this stuff, just that they know who to call when they have a problem and can just get on with their day to day care of patients in the meantime. I mean, God forbid, if people actually want to go home and have a life rather than studying a subject in depth!!! (i'm saying it is GOOD to have a life and have you time - we are all too tied up in what we should know and could do better at, and that is bad for us!)

Its a very important point about the training giving a sense of entitlement - i definitely think this happens in the NHS - nurses become 'lead' nurses in each area and then defer tasks downwards - or feel that they are entitled to. How individuals handle that 'entitlement' must be challenging in practice and we need to consider this when teaching. You've really got me thinking, its good to be challenged and i don't' think your comment is negative, it's a really important perspective that is real. Thank you!

Can i ask, and because i'd really like to explore this generically - how can we best ask what nurses really want? Are any of the associations, groups approaching this well at the moment? what would you ask for?

RE: Nurses Involvement in Surgical Wound Closure.

Sal the 1st — Thu, 02 Jul 2020 07:35:24 GMT

did sutures and surgery allowed under sched 3 for years at previous practice. Was bored by it if I'm honest. Wasn't what I came into the job for and at the end of the day. If a vet is available and able to complete the procedure faster then that has to be safer for the patient as it gets them off anaesthetic and off the table faster. If we have to use the dreaded 'gold standard' label surely that is 'gold standard'.

I realise that people only become proficient with practice but the problem is many practices cannot spare a vet/time to supervise a nurse until they become proficient if that makes sense.

If you have enough nurses/vets in practice for one of them to become proficient and the practice has a definite need for these skills then great and I'm all for it - but if the practice has no need for these skills to me its pointless investing time and money learning unless you plan to move to a practice that does as it will just cause further frustration having skills with no opportunity to use them. For many nurses now, once they have received training in certain areas (however superficial that training may be) they then develop a sense of 'entitlement' to carry out that procedure and that isn't always in the best interests of the patient for this to happen. There are so many areas where nurses can make a real difference to patient care without encroaching on what is seen by many to be the vets preserve.

Sorry not wanting to be negative but I think somewhere along the line the whole sched 3 thing needs a rethink we have to sort out the difference between what is wanted by the nurses and what is actually needed by the vets/practices.

But if the training is relevant to others then I would say best sutures and suture material to use in various wound closures would be a good start

RE: Nurses Involvement in Surgical Wound Closure.

Nick Shackleton — Mon, 29 Jun 2020 12:19:38 GMT

In previous role at referral centre scrub nurse used to close skin after routine ortho procedures such as tplo and patellas allowing vet to go and get on with next case

RE: Nurses Involvement in Surgical Wound Closure.

Selena Carnell — Sun, 28 Jun 2020 17:03:23 GMT

i would love to be able to do more suturing etc but often dont have staff to enable it. but would free up a vet if i could close up something like after a TTA or ex lap.

RE: Nurses Involvement in Surgical Wound Closure.

raggydoll — Sun, 28 Jun 2020 15:35:54 GMT

Our practice allows us to do stitch ups when not entering a body cavity, only if and when we have enough staff to allow us to do so which unfortunately is not that often. It also greatly depends on which vet is in charge as some are more willing than others to allow us to carry out these procedures!

We are never allowed to do lumpectomys, tail/digit amputations or aural haematoma sx because we do not have enough staff to allow us to learn. Some of our vets are not even aware that we are allowed to do such sx!

I myself am pretty confident with stitch ups including various stitch patterns but would love to learn how to do lumpectomys (we did briefly have some practical sessions at college) as well as digit/tail amputations. I do feel we are strongly underutilised in schedule 3 procedures.