Time to grasp the nettle for veterinary nurses?

01 July 2017, at 1:00am

PERISCOPE continues the series of reflections on issues of current concern

ON 3rd MAY THE RCVS launched a consultation as part of a review of Schedule 3 of the Veterinary Surgeons Act and some members of the veterinary profession will undoubtedly see this as the “thin end of the wedge” or the top of “the slippery slope”. I believe, however, that enhancing and expanding the role of veterinary nurses is essential to retaining the very best of them in clinical practice by giving them the responsibilities (and the rewards) that their expertise merits. The age-old arguments for keeping our veterinary nurses closely shackled to the vet are that we don’t want to produce mini-vets for fear of taking work away from ourselves; and that animal welfare could suffer as a result of less qualified personnel making clinical judgements. These are protectionist arguments that have little basis in fact and are more akin to the views frequently adopted by Trade Union leaders back in the Seventies. The route for qualifying as a VN is now an arduous one. It involves a lot of academic study as well as a large amount of training in practice under the watchful eye of a clinical coach. It is not something to be undertaken by the work-shy or faint-hearted, and to finally be registered with the RCVS as a VN shows a high level of dedication and skill. VNs graduating today are probably more highly trained and more rigorously examined than ever before. On top of that and as a result of being on the VN register, they are now responsible for their own actions and can be disciplined in the same way as us vets. Now those of us with more than a few years in veterinary practice under our belt will have worked with mediocre, excellent, and in some cases exceptional veterinary nurses (and fellow vets) during that time. And while some of those exceptional VNs will have remained in practice, others will have been lost to industry, education, or in some cases to a completely different career path. Retention of VNs within the practice environment is as difficult, or more so, as it is among veterinary surgeons. If by enhancing the role of VNs we can encourage them to stay within their chosen career, that is to be wholeheartedly welcomed. There have long been many grey areas concerning Schedule 3. Maintenance of gaseous anaesthesia is one that springs to mind whereby the VN is supposed to act as nothing more than “the veterinary surgeon’s hands… for example by moving dials”. Many veterinary nurses I have worked with have been exceptional at monitoring and maintaining anaesthesia. And how useful a skill is that when faced with a tricky surgery in a highrisk patient when concentrating on the said surgery takes up most of one’s effort? That’s not to say that one detaches oneself from the anaesthetic completely, but there have certainly been times when I’ve relied on the skill of the assisting VN beyond that which is strictly permitted under Schedule 3. Of course, in the scenario described above, the requirement for excellent communication between the vet and the VN goes without saying so that each knows what the other is doing and thinking concerning the animal’s anaesthetic and clinical state. But wouldn’t it be so much better if it was permitted for a suitably trained and experienced VN to both monitor and maintain anaesthesia? It would give added kudos to the role and remove that feeling that something underhand is being done when no such thing is intended. Likewise, the prescribing/dispensing of preventive POM-Vs to otherwise healthy animals is well within the capability of many VNs. Developing a demonstrable knowledge concerning external and internal parasites and the available control strategies is something that could be utilised to improve job satisfaction and also client care.

A question of time?

How often do we simply not have the time (and sometimes the inclination) to carefully explain the life cycles of the various parasites and how these can best be disrupted? A nurse with a keen interest in this field could make a significant impact on the uptake of effective treatment regimes with concurrent benefits to both animal health and practice profitability. Human medicine is currently far ahead of our own profession when it comes to utilising the skills of suitably trained nurses. Nurse practitioners regularly see clinical cases and can prescribe treatments such as antibiotics. Other trained nurses are performing such things as routine endoscopic examinations and of course vaccinations. Surely routine puppy vaccination could be safely delegated to the VN who would certainly be able to spot the “sick” puppy that needed to be
referred to the vet for careful clinical evaluation and diagnosis?
Clearly there are differences between the medical and veterinary professions, not least the huge turnover of the former in terms of patient numbers. The higher the throughput, the more justification there is for training nurses to carry out some of the more routine
procedures hitherto carried out by doctors. The current trend is for veterinary practices to get bigger and bigger. That must give greater opportunities (and a greater need) for VNs to be trained in
some of the roles hitherto performed solely by vets, thus freeing up the vets for the sort of work that can quite properly not be delegated to VNs. Is such a suggestion really that radical or
threatening to the vast majority of us? VNs have come a long way since the role of the RANA. We could not do our veterinary work without their expertise and assistance and that is likely to become increasingly true as the demands and complexities of small animal practice increase. We can wring our hands and lament the difficulty of motivating VNs to continue working within veterinary
practice as they become older and more experienced. Or we can grasp the nettle and support their desire to take on more responsibility and hopefully receive increased remuneration as a
result. Responding to the RCVS’ consultation document and urging
them to be bold and increase what a VN may do under Schedule 3 is a way of showing our commitment and support for an enhanced role for the VNs of the future. Is that too much to ask from our as-yet under-utilised veterinary nurse colleagues?