Jill Macdonald RVN DipAVN (Surgical) FHEA

Whilst veterinary nurses hold a key position in primary care, referral and emergency practice, it is felt that their role is still often not recognised or understood by the public and clients who use veterinary services. This has been highlighted in surveys comissioned by the Royal College of Veterinary Surgeons (RCVS) over a number of years. The two most recent surveys (held in 2014 and 2019) demonstrate that nearly half of respondents feel that the profession would benefit from more respect and recognition from the public. (Robinson et al, 2019).

9.4.2 Things that would make the VN profession a better place to work

The top eight things that would make the profession a better place in which to work, listed below with the percentage selecting them, were all chosen by over 600 respondents:

  • Better financial reward: 86.3%
  • Better work-life balance:41.6%
  • More respect/recognition from the public: 40.9%
  • Better opportunities for career progression: 32.3%
  • More responsibility: 18.9%
  • Less workload pressure: 18.7%
  • More flexibility of working hours: 15.5%
  • More support staff: 12.6%

(Robinson et al 2019, 2019 Survey of the veterinary nursing profession)

The VN Futures project, and initiatives such as BVNA’s Veterinary Nursing Awareness Month, have done a great deal to increase awareness of the veterinary nurse’s impact and contribution to veterinary care, however it is clear that there is still more to be done.

There are many factors which feed into recognition and value, and this short piece will take a look at some key areas, with the aim of reinitiating discussion within the veterinary profession.

Why should the veterinary nursing role be recognised?

Some may ask, why is it that veterinary nurses feel that they should be respected and recognised? Many people perform roles which are integral to day-to-day life (and this has been strongly highlighted with the COVID-19 pandemic – for example delivery drivers, refuse collectors and supermarket staff) and yet do not seek the recognition that veterinary nurses do.

Well, the veterinary nurse’s role has evolved considerably over the past few years. It was only in 2015, through the RCVS’s work to amend its Royal Charter, that the Register of Veterinary Nurses became mandatory, (RCVS, n.d.) and veterinary nursing became a recognised profession, with nurses held accountable for their work, actions and decisions through a regulatory process.  This brings with it a higher level of professional responsibility, plus the need, for example, to perform a statutory amount of continuing professional development (CPD) every year.

Nurses undertake significant training in order to become registered, often with significant associated financial costs. They play a key role in the vet-led team and in patient and client care (BVA, 2019). They work long and hard hours, are frequently responsible for many of the daily administrative duties that enable practices to operate efficiently, and often undertake practice and personnel management roles.

Veterinary nursing can also be incredibly stressful, with life and death situations, client emotions and bereavement, and the ongoing pressures that nursing brings being an every-day occurrence. Veterinary nursing is both emotionally and physically challenging.

These are just some of the reasons that nurses wish for their role to be respected and recognised, and I’m sure anyone reading this can think of many more.

So what activities can we encourage and support in order to achieve a greater level of recognition?

Client-facing roles

Many veterinary nurses in practice perform nursing clinics (Robinson et al, 2019), but often these are delivered (and therefore seen by clients and possibly the profession itself) as an ‘add-on’ service to help promote client loyalty, rather than being the integral part of veterinary care that they should be.

Moreover, many of these clinics are delivered as a ‘free’ service, further imapcting on the view that clients may have of the role nurses perform. (Writer-Davies, 2019).

Are nurses receiving adequate training to deliver the highest level of support and advice that would empower them to deliver a high level of care? For example, have nurses performing weight management clinics received specific training in nutrition, communication skills, behavioural change – which are fundamental to successful weight management discussions – to enable them to effectively manage these clinics?

Should investment in nurses provide access to professional development in specific areas, such as osteo-arthritis, diabetes mellitus, thyroid disease, and renal disease, and if practice culture change supported veterinary nurses possessing more autonomy and responsibility in consulting work, then this would enable veterinary nurses to support veterinary surgeons in managing these patients on a long-term basis, and become fundamental in delivering care to patients suffering from chroinc disease as a chargeable service.

Post-registration qualifications

The Certificate in Advanced Veterinary Nursing (CertAVN) – the framework that was developed through the work of VN Futures – offers veterinary nurses with an opportunity to achieve level 6 and 7 post-registration qualifications in differing areas of expertise (RCVS, 2019). Over the coming months and years, it is envisaged that many providers will offer these qualifications in a variety of disciplines. This level of education will equip veterinary nurses with the knowledge to demonstrate a higher level of expertise, with corresponding responsibility in patient care.

Delegation

Improved delegation within practice is also a key component. Veterinary nurses should be performing the tasks that they were trained for, within the RCVS Code of Professional Conduct and the law, but all too often this may not be happening. The 2017 Schedule 3 survey (Robinson D, Edwards M, Williams M., 2017) highlighted that both veterinary surgeons and veterinary nurses have a lack of understanding of what can and should be delegated, which creates confidence issues in this area, and this will impact on the occurrence and level of effective delegation, despite support for nurses performing an expanded role (RCVS 2017).

The Schedule 3 working party (now the RCVS Legislation Working Party [LWP]) developed a variety of resources to support delegation, including a series of case studies, and the SUPERB poster (RCVS 2017). The LWP has since developed a comprehensive report outlining potential changes to the legislation governing veterinary practice, which was approved by RCVS Council in June 2020 (RCVS, 2020). A consultation to the profession is expected to start later in 2020.

Whilst legislative changes do of course take time, and the process involves bodies such as the Department for Environment, Food and Rural Affairs (DEFRA) before it reaches the stage of discussion by parliament, this gives us an opportunity to ensure we are working as best we can within existing legislation, and prepare the profession for future changes and developments.

Communicate nursing input

The input that veterinary nurses have to any patient’s care should also be communicated to the client. If we don’t tell them, they don’t know. If we take any admitted case, the proportion of the ‘work’ for that patient performed by a nurse is often hugely significant – but the client may only see a nurse at the discharge appointment, or maybe not at all. Do they appreciate and understand the contribution the nursing team had? Did the veterinary surgeon highlight this? Was it clearly outlined on the detailed invoice?

Culture change

Will this take a culture change in our profession? Maybe. There are some practices who are utilising their nurses incredibly effectively, and those nurses are remunerated well, have enhanced role satisfaction, and tend to stay within that practice. So how can we take learning from these practices? We need to find out how they work effectively as a vet-led team, utilise their nurses’ skills and abilities, encourage and support career progression, and increase recognition of the nursing role within society.

The VN Futures Project will soon be entering its second phase, and it is likely that work to enhance role recognition and the value of veterinary nurses will carry forward into this next stage. So let’s consider now how we can most effectively achieve our goals through future initiatives, and get involved in the work to promote our profession.

This blog was created to support a session that VN Futures provided at the BVNA This Is Us 2020 online event. The session on Role Recognition, chaired by the blog author, Jill Macdonald, was held on Sunday 11th October, and asked the question: “What activities or initiatives in practice feed into increasing the ‘value of veterinary nurses’ and recognition from the public and the profession?”

We welcome your thoughts on this topic below.

References

British Veterinary Association. (2019). BVA policy position on the vet-led team.
Download at: https://www.bva.co.uk/media/2786/vet-led-team-policy-position-final.pdf

RCVS, (n.d.) About the VN Register. [Online] Available at: https://www.rcvs.org.uk/registration/check-the-register/about-the-vn-register/

RCVS (n.d.) Advice on Schedule 3. [Online] Available at: https://www.rcvs.org.uk/setting-standards/advice-and-guidance/advice-on-schedule-3/

RCVS (n.d.) Certificate in Advanced Veterinary Nursing. [Online] Available at: https://www.rcvs.org.uk/lifelong-learning/postgraduate-qualifications/certificate-in-advanced-veterinary-nursing/

RCVS (2017) Professions overwhelmingly support expanded role for VNs [Online] Available at: https://www.rcvs.org.uk/news-and-views/news/professions-overwhelmingly-support-expanded-role-for-veterinary/

RCVS (2020) RCVS Council agrees in principle to wide-scale legislative changes.
Available at: https://www.rcvs.org.uk/news-and-views/news/rcvs-council-agrees-in-principle-to-wide-scale-legislative/ (includes access to the LWP report to Council)

Robinson. D., et al (2019). The 2019 Survey of the Veterinary Nurse Profession. A report for the Royal College of Veterinary Surgeons. [Online] Available at: https://www.rcvs.org.uk/news-and-views/publications/the-2019-survey-of-the-veterinary-nursing-profession/

Robinson D, Edwards M, Williams M. (2017) The future role of the veterinary nurse: 2017 Schedule 3 survey. A report for the Royal College of Veterinary Surgeons. [Online] Available at: https://www.employment-studies.co.uk/resource/future-role-veterinary-nurse-2017-schedule-3-survey

Writer-Davies, S. (2019) The value of veterinary nurses to practice – changing the mind-set [Online] Available at: https://www.vnfutures.org.uk/the-value-of-veterinary-nurses-to-practice-changing-the-mind-set/

Jill Macdonald