Advice needed please

Re: Advice needed please

Gillian Mostyn — Fri, 13 May 2011 22:43:24 GMT

Agreed. But they are an unqualified member of the profession so their opinion (no offence intended) is less, erm, weighty. A qualified VN needs to be a lot more careful with their comments - as your GtoPC also states.

Re: Advice needed please

Mrs Dot Dot — Fri, 13 May 2011 19:03:43 GMT

[quote user="Gillian Mostyn"]

[quote user="SmegSlayer"]As for vets not willing to go ahead if they didn't feel the nurses were competant- they're out there (unfortunately), mostly just seeing £££££ instead of an animals life.[/quote]

A little more professsionalism on a public forum would be a good idea.

[/quote]

Then going by that, we had better not mention that someone is expected to monitor anaesthetics with little training and only being in practice for 6 weeks... I don't think that is professional either really...........

Re: Advice needed please

Gillian Mostyn — Fri, 13 May 2011 13:12:49 GMT

A little more professsionalism on a public forum would be a good idea.

Re: Advice needed please

Steph Phillips — Thu, 12 May 2011 22:19:15 GMT

I actually agree with both of you (Sal & SmegSlayer)..

Nicola: - I think introducing more monitoring (i.e heart rate to start with) is a fab idea - I think it will prompt other nurses to follow suit, seeing you taking an interest in the animals condition might also make the vet realise that actually it IS important!! (might even shame them into doing the same!)

Like sal says, rather than pile the load on yourself with monitoring, ask the vet to teach you how to monitior the heart rate, then when your comfortable, move on to the mucous membrane, then jaw tone etc... little steps rather than a giant leap! Ideally, you should have someone experienced watching over you while you monitor - and explaining the potential complications if an animal gets 'too deep or too light' etc.. but, not every practice can cater that - which is why in my opinion, the vet should be doing more to avoid such complications and explain, and teach to you.. after all, the vet helping you, is actually helping him/herself also!

Re: Advice needed please

Sal the 1st — Thu, 12 May 2011 11:19:28 GMT

Nicola - if you really dont think you are going to be able to cope you need to be making this clear at work now so that there is a bit of a chance of doing something about this before you find yourself alone next week

Re: Advice needed please

SmegSlayer — Thu, 12 May 2011 10:10:18 GMT

I do actually know what you mean- the practice I am currently locuming in has a permenant nurse who is an ANA and me. Previous nurses didn't teach her much and she watched the chest move till I came along. I have also bought oesophageal stethoscopes and she used one for the first time yesterday and ws thrilled.

The only reason I mention qualifieds is because they have at least done the training, theory and exams so would have a more detailed understanding. I agree that qualification isn't everything, but at least it (supposedly) sets a standard.

As for vets not willing to go ahead if they didn't feel the nurses were competant- they're out there (unfortunately), mostly just seeing £££££ instead of an animals life.

Adding one piece of monitoring at a time is fine but only if there is a more senior nurse present as well to do the rest.

As for making changes, all she has to say is that she's been doing some reading and has found mention of other parameters to monitor and see what the staff say.

Re: Advice needed please

Sal the 1st — Thu, 12 May 2011 09:38:59 GMT

[quote user="SmegSlayer"]

[quote user="Nicola Russell"]

[quote user="Steph Phillips"]Are you now monitoring all the vitals? heart, resp, temp, BP, etc[/quote]

No, all we do is watch the bag move, on long ops they check gums but thats all.

[/quote]

well that is complete;y unacceptable in my eyes, i don't know any vet i have worked with who would be happy with that lack of monitoring while they were operating.

Maybe you can implement a change- listening to the heart rate alerts you to potential problems before they happen e.g. rhythm changes etc, listening to breathing, especially in cats can alert you to blockages of mucus etc happening in the tube- if ur only looking at the bag and the bag stops moving it can be too late by that point to do anything about it. checking gum colour and refill time is very important, need to check eye position- up with a normal pupil and possible blink reflex = awake and in pain, down= nicely asleep, up with fixed/dilated pupil= too deep and needs addressing asap. checking jaw tone and blink reflexes is also important. If you have a pulse oximeter you can check your o2 concentration, a capnograph can check ur CO2 concentration. If you can do temp and BP during procedures then do this as well. Don't forget to use blankets and heat pads to keep the animal warm as hypothermia is one of the biggest causes of post op death.

I don't want to scare you, but anaesthesia is big business and having been in a position where I got fired from a position for 'not picking it up quick enough' when nobody trained me has made me anal about it now.

Perhaps ur practice could employ a qualified nurse or at least borrow one from another practice for a day to do some training with everyone, coz if the other urses are monitoring this way, i can't see how they have a good understanding of anaesthesia.

[/quote]

with the deepest of respect this is somebody who is only 6 weeks into a job - a new job which they have not done before if my understanding is correct. To be suggesting to them that at this early stage in their career that they can maybe implement change when they are yet to fully understand the principles of anaesthesia and they havn't been in the job 2 minutes

I completely agree that just watching the bag isnt sufficient but its a start. The way I was taught and indeed the way I have taught students is one feature at a time. So for me yes for the first little while yes I would say get used to watching the bag and the animals breathing, the rate and the depth, when they are happy with that then I introduce pulse and mms and listening to the heart , then we bring in eye position and jaw tone - we just build on it rather than swamping somebody with so much information all at once they panic - but I will say that they do have somebody experienced with them until they are comfortable to fly solo.

Not every practice has the benefit of loads of staff and not everybody has the benefit of gadgets and toys and many practices do not have qualified staff - that doesnt by default make them bad practices there are plenty of places that work very well with non qualified staff and there are quite a high number of non qualified staff who have greater experience than those that have qualified. I dont imagine the vet would be starting any surgical procedure if they werent confident that the nursing staff were able to spot a potential problem and alert them to it or that they could deal with what was happening.

I am sorry if this comes across snappy but this is the sort of thing that really gets my hackles up at the moment, I am not directing this at you but more the culture that has developed which is so quick to condemn and shout down others - there is too much dictating being done about what should or shouldnt be happening but with little understanding sometimes of facilities/staff available in smaller practices.

Re: Advice needed please

Nicola Russell — Thu, 12 May 2011 09:12:36 GMT

I think if I understood anaesthesia more, i may be more happy, but when i asked about textbooks on anaesthesia was told I don't need to know the theory.

Up to now there's been another girl there as backup but next week i'm completely on my own

Re: Advice needed please

SmegSlayer — Thu, 12 May 2011 08:53:54 GMT

[quote user="Nicola Russell"]

[quote user="Steph Phillips"]Are you now monitoring all the vitals? heart, resp, temp, BP, etc[/quote]

No, all we do is watch the bag move, on long ops they check gums but thats all.

[/quote]

well that is complete;y unacceptable in my eyes, i don't know any vet i have worked with who would be happy with that lack of monitoring while they were operating.

Re: Advice needed please

Nicola Russell — Thu, 12 May 2011 08:38:59 GMT

[quote user="Steph Phillips"]Are you now monitoring all the vitals? heart, resp, temp, BP, etc[/quote]

No, all we do is watch the bag move, on long ops they check gums but thats all.

Re: Advice needed please

Steph Phillips — Thu, 12 May 2011 08:08:35 GMT

[quote user="Sal the 1st"]

pleased to hear you are a bit happier. Dont let anybody put you off if this is what you have chosen to do - you will get a lot of opinions (a lot of them on here too) saying that this or that isnt legal, my advice is check it out for yourself before taking anything as gospel because some of them are just that opinions not law.

work out for yourself what your strengths and weaknesses are - in the early days the more you find yourself in areas you feel uncomfortable the more you will learn from the experience

[/quote]

AMEN!! lol

Re: Advice needed please

Steph Phillips — Thu, 12 May 2011 08:07:11 GMT

[quote user="Nicola Russell"] My first week there I was monitoring anaesthetics (just watching breathing, no monitoring of heart rate etc)[/quote]

Are you now monitoring all the vitals? heart, resp, temp, BP, etc?

I agree with the others.. don't feel pressured into doing something your not comfortable with.. I'm not qualified and was expected to work in theater almost straight away.. told them i'm no where near confident and need more time.. they should respect that.. after all, it's the vets butt on the line if you mess up!

Hope things get easier for you hun.. xxx

Re: Advice needed please

Sal the 1st — Wed, 11 May 2011 12:26:39 GMT

work out for yourself what your strengths and weaknesses are - in the early days the more you find yourself in areas you feel uncomfortable the more you will learn from the experience

Re: Advice needed please

Nicola Russell — Wed, 11 May 2011 12:09:22 GMT

Thanks for the replies, I was misinformed that it was a legality issue. I have been there 6 weeks, I have spoken to someone at work (non of us are qualified) and it has made things a bit easier . I will be in sole charge next week as covering holiday so am bit worried about doing ops plus having to answer phones and dealing with clients coming in.

Re: Advice needed please

Elvira — Wed, 11 May 2011 11:58:47 GMT

Agree wholeheartedly with Sal's comments above. There is nothing there that you are not 'allowed' to do as an 'unqualified' person (rightly or wrongly is not the question here) but you should be suitably trained before being expected to do it all confidently and on your own. Do discuss it with someone - I know all about loss of confidence (sadly) and it would be such a shame not to give the job a reasonable go.

Re: Advice needed please

Sal the 1st — Wed, 11 May 2011 11:41:25 GMT

How long is it since you started the job?

If it is making you feel this upset then maybe speak to somebody within the practice - head nurse maybe.

This is quite a common problem - the thing is everybody has a settling in period and when its your first job its difficult to know what to expect and taking everything in can be a bit overwhelming. I dont feel that many people coming fresh into this job are adequately prepared for what they might encounter because there are so many differences between practices (and there always will be which in my mind is not a bad thing).

If you are uncomfortable doing things - you need to look at your reasons for being uncomfortable - ie for some like you say it is because they feel out of their depth or they feel they lack support, and then speak to your head nurse. See if talking it through with somebody at work makes you feel any happier.

What is it exactly that you feel you shouldnt be doing? is it because you dont feel you are experienced enough to be doing things or you dont legally feel you should be doing stuff?

microchips - you dont need to be qualified; pet shops, rescue centres and dog wardens among others do their own microchips in many cases. I am aware there is a training course for the correct implantation of a microchip but to be honest it is just another course and another little bit of paper in the gravy train that is now nurse training that makes money for other people, benefits the learner very little and as far as I am aware is not a legal requirement (yet). How about next time you have a patient in for an op who also wants a microchip you ask if you can do it? it might help you to get used to this

monitoring anaesthetics - well again there is no requirement for you to be qualified (and no I am not commenting on the rights or wrongs of this). Maybe ask if you can shadow somebody else for a while until your confidence increases - dont be afraid to ask questions, and dont be afraid to speak up if you are worried

dentals - I am assuming you are meaning scale and polish as opposed to dental extractions, even as a qualified nurse I am not allowed to remove teeth, but for scale and polish again there is no legal requirement that you have to be qualified to do this. Maybe you just need a bit more training?

discharging spays and castrates - practise this with a colleague until you are happier with it - sometimes its just a case of building up a bit of confidence.

You could leave this job and be lucky enough to find another and then find the situation may be the same or worse. How about having a chat and giving it a bit longer?

Or if it is really that bad consider that much as your heart tells you you would love to do this job it just isnt for you - and there is no shame in that

Have you thought that the person who will carry the can for any mistake you make will ultimately be your boss - if your boss isnt happy or confident to let you do things would they be letting you do them?