As a profession, veterinary nursing is a relatively new contender in the animal care industry. In 1963, Pamela Pitcher was the first Registered Animal Nursing Auxiliary (RANA) to qualify, however back then there was no legal framework to abide by, no textbooks or a syllabus to refer to and no support or guidelines to follow. Since the sixties, there have been many schemes aiming to improve the veterinary nursing profession; such as putting together an academic syllabus, having a guide to professional conduct and most importantly creating a legal and professional framework.
Despite such advances, veterinary nurses (VNs) still continue to encounter limitations in their profession and new challenges are constantly being faced (and some overcome) in order to achieve the ultimate goal of professional autonomy (Gray & Pullen 2006). In the United Kingdom, bearing the title of a Veterinary Nurse means, having a recognized qualification and being registered with the Royal College of Veterinary Surgeons (RCVS). The RCVS is a regulatory body in the UK who make sure that the standards of the veterinary profession are being adhered to; and by doing so they ensure the health and safety of animals and the public (RCVS 2010a).
Whilst a registration process exists for veterinary nurses it is not yet a legal requirement. This has created four types of veterinary nurse: listed VNs, student VNs, unlisted VNs, and VN assistants. Listed VNs are qualified and registered on the RCVS List of Veterinary Nurses. They are also able to perform tasks under Schedule 3 of the Veterinary Surgeons Act, which will be discussed later on. These tasks must be executed under the direction of the veterinary surgeon. Student VNs are nurses in training and must be enrolled with the RCVS as a student nurse.
They too are able to perform tasks under Schedule 3; however they must be directly supervised by a veterinary surgeon (VS) or a qualified and listed VN. An unlisted VN is a nurse who is qualified but not registered on the RCVS List. Finally, a veterinary nursing assistant is someone who has not gone through professional nursing training and is also not registered with the RCVS. They might however have some type of formal training and be perfectly capable to help out with veterinary nursing duties. Like student nurses and unlisted nurses, they are not allowed to perform any tasks under Schedule 3 (Earle 2007).
Veterinary nurses have numerous roles within a veterinary practice; however the most significant of these is their role in providing nursing care to animals receiving veterinary treatment (Earle 2007). Observation and assessment of the patient is a determining factor in this process, and includes the constant monitoring of the animal and response to any ‘out of the ordinary’ symptoms. Recording temperature, pulse, respiration rate, demeanor, rates of elimination and responsiveness are some of the few factors that are being documented as part of the in-patient care process (Seymour 2007).
However there is only so much a VN can do in terms of treatment to patients showing signs of abnormal behavior. If a patient is clearly in pain despite being given medication, or if more fluid therapy is needed during their recovery period, a VN is unable to change or add any medication/fluid given to the patient based only upon his/her judgment, and therefore must consult a VS. This sheds some light on the limitations presented in this profession; in terms of the influence the VS exerts on the role of the VN.
To verify this point, there are specific roles of a VN which are highly regulated and require direction and supervision of a VS. These roles are clearly explained under Schedule 3 in The Veterinary Surgeons Act 1966. The purpose of this Act is “…to maintain a register of veterinary surgeons eligible to practice in the UK; to regulate veterinary education and to regulate professional conduct” (RCVS 2010b). In 1992, this Act was amended in order to include and recognize the role of the VN, and was again revised in 2002 to further increase the significance of the VN role (Gray & Pullen 2006).
Included in this Act is a section entitled Schedule 3 which explains what non-veterinary surgeons (which include VNs and laypersons) are allowed to provide in terms of medical treatment to animals. Under this legislation, listed/registered VNs are able to administer any medical treatment or minor surgery to a patient as long as this does not involve entry into a body cavity (Earle 2007). Minor surgery could include dental procedures such as scaling, and the removal of teeth which are loose and can be extracted by hand.
Dental extractions of relatively intact teeth using instruments are therefore not permitted as that would involve entry into a body cavity. With regards to medical treatment, a VN is able to administer medication orally, subcutaneously, intramuscularly, intravenously, rectally, topically and by inhalation. They are also able to treat patients via fluid therapy, catheterization, cleaning/dressing of surgical wounds, treatment of ulcers, application of external casts and handling of viscera when assisting in surgery.
Other roles of a VN described under this Act include, the preparation of animals for anesthesia: this involves the administration of pre-med and analgesia and the intubation of the patient; the collection of samples such as urine, blood, faeces, skin and hair; the taking and developing of X-Rays; and the adjustment of the dose of the anesthetic agent during surgery (Veterinary Surgeons Act 1966). Looking at all these different tasks, one would think that a VN has a great amount of responsibility within his/her role and with responsibility, professional autonomy pursues.
However this might be misleading. This is not to say that VNs are not responsible for any of their undertakings, nevertheless each of the procedures mentioned above can only be carried out under the direction of the VS. The animal that is being cared for by the VN must be under the care or a patient of the VS, who must also be the employer of the VN. Any treatment must be carried out by the VS’s consent.
With regards to minor surgery, any procedures must always be carried out under the direction and direct supervision (in the case of student VNs) of the VS. Since VNs are only allowed to act under the supervision of the veterinary surgeon, they are therefore unable to use their clinical judgment. Another example of this would be the monitoring and maintenance of anesthesia. This role plays a major part of a VNs day to day activity. In order to perform surgery on a patient, it must be anesthetized, and this requires a great deal of care and monitoring. It is the VN’s job to understand each individual patient’s requirements and the effects of the anesthetic agent upon the patient.
The process of anesthetization requires what is called the ‘triad of anesthesia’ which includes the provision of analgesia (pain relief), muscle relaxation and narcosis/unconsciousness. The VN is integrally involved in this process and would be instructed by the VS on the doses of agents administered in order to achieve a successful triad of anesthesia. From the point of admission, through the anesthetic process and until discharge, a VN is responsible for the patient’s monitoring (Brodbelt & Girling 2007).
What monitoring under anesthesia involves is the recording of vital signs of the patient such as pulse, heart rate, breathing rate, capillary refill time or CRT and pupil dilation. According to Peter Jinman, president of the RCVS, this part of the process is actually the VS’s responsibility but may be carried out on his/her behalf by a VN; provided the VN has proven to be capable of performing the designated task. When it comes to inducing anesthesia, this can be done by a VN under the direction of the VS.
During surgery, the course of maintaining anesthesia by moving dials of the anesthetic agent is technically the responsibility of the VS. However any suitable trained person, such as a VN, may assist by acting as ‘vet’s hands’ (Jinman 2010). This influential position that a VS has upon the VN is also reflected in the RCVS Guide to Professional Conduct for Veterinary Nurses. Codes of professional conduct are a set of expected standards of practice, guidance on ethical issues, and guidance to the courts of regulatory bodies such as the RCVS.
Particularly in the code of conduct for VNs, it is stated that VNs should co-operate fully with the VS when assisting them with veterinary care duties. As a general standard it also states that a VN should always act under the supervision of the VS (RCVS 2010c). According to the 2010 RCVS Survey of the UK Veterinary and Veterinary Nursing Professions, this has made many VNs feel rather restricted within their role, in particularly regarding the tasks that they are able to perform.
When asked if VNs are valued by the veterinary profession, the majority of VNs responded more towards the negative end of the scale (Robertson-Smith et al. 2010). This might be because VNs do not feel empowered within their roles, since the majority of their tasks must be overshadowed by a superior’s consent. There might also be other factors involved in the result of this data, such as salary and working conditions. Nonetheless, the absence of autonomy within this profession should not be ignored.
There is a major setback with regards the VNs code of conduct; it is only a guide, and therefore VNs are not obliged to any official code of conduct. This means that VNs are not at risk of any disciplinary proceedings. This lack of regulatory framework means that a client is not protected against negligent acts conducted by the VN which are not included under Schedule 3. Since nurses are therefore not accountable for their actions they might be more reluctant to consider the consequences of what they do.
The prospect of regulation should therefore be striking to a veterinary nurse in order to boost the status of the profession (Gray & Pullen 2006). So what is the way forward for the Veterinary Nursing Profession? Without a doubt it should be a focus on developing a professional identity through a more refined regulatory framework. A regulatory body for VNs must be established, which will require the nurse to be directly responsible for his/her own actions and omissions. Having this knowledge would enable the veterinary nurse to be more empowered and able to challenge or question his/her employer.
At its November meeting 2010, the RCVS Council have unanimously approved the introduction of a disciplinary system for registered VNs on the 1st of April 2011. As of this date, a registered veterinary nurse or RVN can be removed or suspended from the Register if found guilty of any serious professional misconduct, criminal offences or fraudulent registration. This will lead to an adverse affect on his/her ability to practice. The RCVS Council has also confirmed they will be making amendments to Schedule 3 in order to remove the names of nurses who are found guilty of any profession misdemeanor.
The RVN disciplinary system is on its way to mirror that for VS and would therefore have the same complaints-handling process, same investigations and also similar decision-making sanctions (RCVS 2010d). During the meeting, VN Council Chairman Liz Branscombe stated that the Council was committed to adopt a statutory regulation framework for VNs. This dedication, she continued, would be an opportunity to prove to the government and the public that VNs are willing to be regulated. This should enhance the profession’s autonomy in the future.
Until this legislation takes effect however, there is still a lot practices can do in order to promote the role of the VN. Using promotional tools such as flyers and posters in the waiting room would make people aware of the VN’s role, who they are and what they can achieve for the clients. Giving VNs more autonomous responsibilities such as new puppy/kitten consults, senior pet clinics, six monthly checks, general pet clinics; including nutrition, behavior and bereavement; and dedicated VN appointments would not only offer job satisfaction, but provide a greater definition to the role of a VN (McLaughlin 2008).
Being a relatively new profession, there is still a long way to go in terms of establishing the role of the VN. Within a practice, clients are still unaware of what the VN can offer and this can be detrimental to the appropriate recognition of the profession. A VN should be made to act as an ambassador to the practice, assisting with enquires and giving valuable advice to customers. The influence exerted by the VS should also be minimized. This will enable the VN to take on board and manage tasks on which they can exercise clinical judgment. And finally law and regulation should follow suit in providing structure, reference and guidance.