Advise please

RE: Advise please

enigmaticat-uk — Mon, 18 Jan 2016 17:41:31 GMT

I think it's not good practice to reprimand someone in front of colleagues, however, you are unclear as to the manner you 'refused' to give the metacam. I would never 'refuse' to give a medication prescribed by a vet but I certainly would query it with them. Once satisfied my concern has been considered, I would then follow the vet's instructions.

RE: Advise please

maylane — Sat, 16 Jan 2016 14:39:26 GMT

You did exactly the right thing. If your practice cant thank you for that and provide an environment where being able to stop and question the treatment plan, then go find a job somewhere else. The clinician should apologise to ensure you feel able and comfortable to raise your concerns without fear of the same thing happening next time. Shame on him and good for you.

RE: Advise please

Selena Carnell — Wed, 16 Dec 2015 20:00:33 GMT

i have worked with vets who have knowingly given steroids and Metacam together. Difficult, but wording always helps ease the situation. In mine though it would have made no difference.

RE: Advise please

Caro Laithwaite VN — Tue, 15 Dec 2015 22:08:38 GMT

I was in similar situation but in case of my vet he was really grateful as he said totally forgot it had steroids and said l saved him from a load of problems.

RE: Advise please

nikki.mits — Mon, 14 Dec 2015 18:37:24 GMT

I would personally have said something, but when questioning vets clinical decisions or instructions I am always careful with the way I word it. Stressed out vets act irrationally to 'mouthy' nurses (not meaning you are but I have seen some nurses and student nurses question vets in ways that would totally get my back up badly). As long as you have asked politely if they meant metacam in conjunction with steroids (sometimes this is done for quality of life) and they say yes, I would probably give it.

Speak to the VDS though as I would be interested in knowing what they say.

If the vet is an approachable person I would probably ask them to have a word and express your concerns with being told off in front of the entire team , as I don't agree with people doing that.#

Good luck

RE: Advise please

steph fursland — Mon, 14 Dec 2015 17:53:55 GMT

Definitely I would always want my nurses to flag up anything that they were unsure about or that didn't seem to make sense - I want the input of all the team, and it might be that a nurse has looked after ten similar patients, or just studied that illness at college, or whatever, or that I have made a mistake and another pair of eyes double checking picks it up. It's definitely not ideal that the vet reacted in that way to you just trying to help, and even if you had done something really wrong, confrontations in front of the staff are not the way to handle it. Is there a practice manager or senior nurse who could have a word with the vet in question?

On the flip side, my nurses would always phrase it more like 'but have you considered he is on steroids?' rather than 'refusing to give' a treatment (goes for all interactions between any staff regardless of job roles ideally!) - do you think you could have tackled it more 'gently'?

There are times you go against established wisdom, and if the vet is knowingly following that treatment plan after weighing up the risks, that is on them, so I think it is very unlikely an RVN would be in trouble for following directions like the situation you described.

RE: Advise please

Tania Ford — Mon, 14 Dec 2015 12:43:43 GMT

ALWAYS, ALWAYS, say if you are not happy doing something. AS RVN's we are now responsible for our own actions and as such are within our rights to question anything we are asked to do. I have, on many occasions refused to do something i am not happy with. The vet in question was out of order to reprimand you in front of anyone - regardless of being the boss or not! In future it would be best to air your concerns in private with the person concerned, so hopefully the matter can be settled without anyone else interfering. Obviously you may sometimes need to ask advice from your peers, but again this should be done in private. Try not to discuss things with lots of other members of staff before speaking to the vet first. I have known animals have NSAIDS and steroids together in the past, as sometimes its more a question of quality of life rather than contraindications, but having said this, you were still within your rights to question their use together and showed your knowledge of how medications should/should not be used - I have known many RVN's never question anything and and I see this as a lack of interest in their patients well being. As far as im concerned a nurse should put their morals and ethics towards their patients before any concern of upsetting someone - especially vets!

Good luck with your boss and I hope he apologises to you as publically as he did when he reprimanded you.

RE: Advise please

hobbits — Sun, 13 Dec 2015 20:29:56 GMT

It's possible that the vet felt embarrassed if it was an error eg he forgot the patient was on steroids and reacted poorly as a defensive reflex. Not good, but hopefully having reflected on it over the weekend they will have thought through the situation and be much more reasonable. I would always question these things as we are all human, and mistakes happen/things get forgotten even by vets! I think this is an important part of our role, but there are diplomatic ways of handling/approaching it. (Not to say you didn't, but worth considering how you may have been interpreted regardless of your intent)

RE: Advise please

fairy — Sun, 13 Dec 2015 18:15:41 GMT

I think you should never feel uncomfortable in questioning something that doesn't sit right with you. You have just as much responsibility for patient care as the vet and therefore you have the right to understand the reasoning for a vet making a certain decision without being spoken to in a disrespectful way.

RE: Advise please

Nicola Smith — Sun, 13 Dec 2015 17:26:57 GMT

If in doubt I would always question as I know that I will feel guilty if I dont speak up and it is to the detriment of the patient. Not all vets take kindly to this but I would still do it. The vet should appreciate having a nurse that actually thinks and uses their common sense and gut feeling to question if they feel its wrong. Everyone makes mistakes or overlooks things sometimes so they should appreciate the back up of a safety net.