Vet Legislation Reform: 2. Enhancing the VN Role

RE: Vet Legislation Reform: 2. Enhancing the VN Role

Ben Ogden — Thu, 19 Aug 2021 13:54:09 GMT

The reform will be like pushing water up hill. The RVC isn’t brave enough to push radical changes, it’s part of the reason the profession is in the shambolic state it’s in now.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

Cyonica — Fri, 05 Mar 2021 02:04:20 GMT

Whilst it does feel like there's an unspoken idea that nurses are not clever enough to be trusted with anything, I feel like that's caused by the restrictive legislation, and that it probably stems from where nursing started. Originally we were just there to hold animals and fetch things. We weren't professionals and weren't ever supposed to be; vets at the time would have laughed at the idea. The world's moved on since then and the very fact that our qualification exists means that there is a place for nursing as a profession, otherwise it wouldn't have needed to happen.

We may be governed by mesozoic legislation, but the fact that forward thinking changes are being proposed is hugely positive in my opinion. It means that the veterinary world is starting to recognise the professional position that nurses fill in modern day practice, rather than the historic assistant position. By this, I mean that you're right Arlo in thinking that nurses already assist in all aspects of anaesthesia, and are often responsible for much of the decision making. The legislation wants to say otherwise, but it's just not practical or safe for a vet to simultaneously carry out a delicate and invasive surgical procedure and also continuously make decisions about anaesthesia management.

I think the issue with vets struggling to delegate is exacerbated by the fact that although we may be accountable for our actions, the vet is still responsible. Because of this, I'm not surprised that many vets are uncomfortable about delegating tasks that have the potential to go badly wrong. It also doesn't help that there are no standardised accredited qualifications for nurses that demonstrate a recognised higher level of ability.

This is starting to happen though, with the RVC and other institutions creating advanced courses for nurses that they hope will open doors for us later on once legislation has been modernised. I don't think that we should be automatically given any more professional responsibility than we currently have once new legislation comes through, but I do think that top up training should be made available to give us the underpinning knowledge we'll need to take on additional responsibilities, and to gain the qualification to enable us to do more. Many advanced qualifications already exist, which could be assessed on a case by case basis and accredited where appropriate. This would also allow those who are content with the role RVNs currently have to remain as they are.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

Arlo Guthrie — Thu, 04 Mar 2021 17:02:52 GMT

[quote userid="16211" url="~/001/nonclinical/f/life-in-veterinary-practice/32156/vet-legislation-reform-2-enhancing-the-vn-role/176893#176893"]Sadly I think the proposals are very poor. The RCVS still see Vet Nurses as second class citizens.[/quote][quote userid="16211" url="~/001/nonclinical/f/life-in-veterinary-practice/32156/vet-legislation-reform-2-enhancing-the-vn-role/176893#176893"]There seems an unspoken assumption in the veterinary profession that Vet Nurses aren't very bright, otherwise we would have been Vets. People may disagree but I have sadly encountered many Vets and managers who think this way.[/quote][quote userid="55000" url="~/001/nonclinical/f/life-in-veterinary-practice/32156/vet-legislation-reform-2-enhancing-the-vn-role/176896#176896"]It's a real shame that RVNs are still finding that vets trust in them is lacking.[/quote]

annaka lee - Hi. Interesting post, and quite a tricky one to discuss without putting my foot in it! And David Inglis, your post ties in.

I think the most important thing here is to split those two different things ... ie the RCVS proposals and how you think the RCVS views vet nurses, and how vets view vet nurses. They are two very different things.

In my (limited) experience, I've only met nice vets who speak highly of their nurses and how they couldn't do without them. But I am sure you are right and there are others that don't. I just haven't met 'em.

But I think one of the biggest challenges may be in overcoming the mental block to delegating. In other words, some people find it really, really hard to delegate (I'm one of them!). That doesn't mean that I look at other people as second class citizens, just that I am a perfectionist and want to do everything to my own exacting standards myself. I think probably a lot of vets are like that - trained to a very high standard and finding it very hard to delegate to someone with a lower level of training (and I don't mean that disparagingly at all).

And then there's the question of responsibility. It takes a huge amount of trust to delegate when ultimately the responsibility rests on your shoulders. And yes, I know vet nurses are now held responsible, but at the end of the day it will, in most cases, be the vet that has to face the owner.

The College can't legislate a requirement to delegate. I suppose what it can do is help create an environment in which teamwork thrives, part of which is delegation.

[quote userid="16211" url="~/001/nonclinical/f/life-in-veterinary-practice/32156/vet-legislation-reform-2-enhancing-the-vn-role/176893#176893"]We would be happy to be trusted to actually do schedule 3 procedures. I have met plenty of vets who can't suture properly and many nurses who can do an excellent job. Yet most vets won't let us do that even if we have paid for and undergone specific training. A lot of practices won't even trust nurses to give second vaccinations, yet in human medicine it is the practice nurse that usually gives the vaccination.[/quote]

That's kind of what I mean. The law already allows you to do schedule 3, yet lots of you aren't allowed to. In that sense, these proposals may be more symbolic than anything else. Nurses being allowed to do cat castrates sends a message to the profession.

On that note, I would love to run a campaign to highlight the benefit of making the most of vet nurses ... by asking you all to email photographs of yourselves which demonstrate the breadth of what you do in practice, and also send an example to those who are not using their nurses effectively. Then I can share them via these websites and elsewhere on social media. Does anyone think that would be a good idea / like that idea?

In the bigger picture, I wonder too if the likelihood of vets delegating to nurses is being eroded somewhat by the referral culture. ie all the interesting stuff being referred away, leaving GP vets to dispense flea treatments. Just a thought.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

hollybush — Thu, 04 Mar 2021 15:50:13 GMT

If they decide to make an advance nursing qualification that is recognised by the RCVS and is on par with the the vet advance practitioner certificate then I think the worry about gaps on knowledge would go away. Nurses don't need to do to cat castrations... when will they move away from this old school approach. In my opinion nurses would like advance quals to be recognised so we can be paid appropriately, have advance quals taught by actual advance nurses who have to maintain their specialist status (VTS holders) and nurses would like to do stuff like administer a fluid bolus and assign fluid rates, place an IV an and take bloods without permission from a vet so they can run/interpret a blood gas or other bloods so the vet can interpret later. Give drugs that aren't exciting but also are not rocket science to understand the pharmacology i.e. paracetamol, broad spectrum antibiotics. I work in a place where I have residents asking me to work out their CRIs for them that they have prescribed as they are unfamiliar with it... i.e. vasopressors, sodium nitroprusside, calcium and phosphate CRI's Or being able to do POCUS just report what you see to the vet, doesn't mean you are diagnosing like taking an x-ray (some vets are cool with this already but some aren't). I am not allowed to place chest drains yet I am being asked to supervise vets placing them for the first or second time...! We need to go down the similar route as human advance practitioners. I have also had vets who know nothing about some drugs trying to administer a bolus when its contraindicated and would cause patient harm.. I am an experienced nurse but I am getting to the point where we need to stop thinking of nurses as lesser (already pointed out above), I know nurses who got better grades than the vets and they chose vet nursing! The vets and nurses who are at the top at RCVS/BVNA need to come to visit places where nurses are utilised well, respected and have amazing skills in their area of expertise. Then I think some eye would be opened, sometimes people are just obvious to actually what is current and which nurses are trying to push the proffesion forward but are just not being heard or they don't want to listen as it to much work at their end to "fix" the issues we have, we can't even protect our title of RVN..!

RE: Vet Legislation Reform: 2. Enhancing the VN Role

David Inglis — Thu, 04 Mar 2021 15:23:31 GMT

That is a very valid point. More workload with no change in pay is not a positive.

Some employers, especially some corporates, really do pay their nurses badly so it certainly needs to improve, or at least have what teachers (in Scotland) have where they have a tiered payment system whereby your pay goes up with the number of years qualified.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

annette454 — Thu, 04 Mar 2021 14:30:48 GMT

I think the proposals are all good and positive. My only issue would be that if nurses are given more responsibility and tasks then they be paid appropriately to reflect this. If a nurse does not want the extra responsibility it may be worth considering why? is this because it will be more stress and work load which they might feel they don’t get paid enough to do. Many nurses get paid the same or less in some cases as “unskilled” workers. Think pay also has to improve if nurses are to take a more active role. It has improved slowly but still has a long way to go.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

Julip21 — Thu, 04 Mar 2021 13:56:46 GMT

I'm currently an SVN but agree that from what I have seen, many practices do not allow nurses to use their abilities to the fullest. I have even met some vets who are wary about allowing nurses to implant microchips, do not allow nurses to perform second vaccinations and many other tasks. I think allowing nurses to do more will not only utilise our training and abilities better but would also help the vets who already have a huge responsibility to patients and their care.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

David Inglis — Thu, 04 Mar 2021 13:20:03 GMT

It's a real shame that RVNs are still finding that vets trust in them is lacking. I've only ever worked in one practice, and am currently an SVN, but I've been lucky enough to work with vets who trust myself and the rest of the nursing team and use us to the fullest of our abilities. One of our nurses loves surgical procedures so does much of the closing up after ops and does the odd mass removal of it falls out with a body cavity.

I have heard of some vets not even allowing nurses to draw up meds, which is scary.

It may well come down to the team dynamics of course. If there is a clear division between the vet team and the nurse team with little in the way of team interaction then the types of jobs each does will likely also be unfairly divided. Working as one solid team is always the better option.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

annaka lee — Thu, 04 Mar 2021 10:19:04 GMT

Sadly I think the proposals are very poor. The RCVS still see Vet Nurses as second class citizens. I have contacted them several times to recommend changes to the role which sadly they never bothered to respond to. There seems an unspoken assumption in the veterinary profession that Vet Nurses aren't very bright, otherwise we would have been Vets. People may disagree but I have sadly encountered many Vets and managers who think this way. Why not look at the human model and see routes to really progress the role of veterinary nurses. We would be happy to be trusted to actually do schedule 3 procedures. I have met plenty of vets who can't suture properly and many nurses who can do an excellent job. Yet most vets won't let us do that even if we have paid for and undergone specific training. A lot of practices won't even trust nurses to give second vaccinations, yet in human medicine it is the practice nurse that usually gives the vaccination. Put simply until Vets give nurses the respect they deserve and see them as more than restrainers and kennel maids the 'profession' of veterinary nursing won't move forward at all. How many nurses at practice principals? A simple example of how nurses are viewed as not worthy of extended responsibility.

RE: Vet Legislation Reform: 2. Enhancing the VN Role

Arlo Guthrie — Thu, 04 Mar 2021 09:35:16 GMT

I'd be really interested to know what you all make of these proposals in particular. Do you think that nurses in general are keen to do more, ie have a greater role in anaesthesia and doing cat castrates and having a prescriber role? Or would you rather not have the additional responsibility?