Qualified veterinary nurses (VNs) are a valuable asset to the efficient running of any veterinary practice or hospital.

The specific role of a nurse can vary within each independent practice, but the same level of training and high standards have been achieved, whether it be a small surgery or a larger veterinary hospital. Traditionally, they helped feed and exercise patients, clean the surgery and generally be a helping hand. However with an intense theoretical and practical training course, veterinary nurses now hold a position of respect with both veterinary surgeons and pet owners.

The first official recognition for veterinary nurses was in 1965, with the formation of the British Veterinary Nursing Association. Discussion with Royal College of Veterinary Surgeons led to the creation of a training course, enabling 'lay staff' to take a written and practical examination to become a RANA (Registered Animal Nursing Auxiliary), the title later changed to Veterinary Nurse (VN).

Uniforms

The standard colour of student nurses uniforms is striped mint, with bottle green piping on the sleeves and collar, and the qualified nurses wear bottle green colour with white piping. Traditionally, dresses were worn with cardigans but these have become fairly unpopular for practical reasons (such as laddering of tights), so trousers and tunic tops have become the much-preferred option for comfort and practicality. Jewellery and make-up is discouraged, and comfortable shoes are a must. Many practices prefer a more informal look, with polo shirts and sweatshirts, even having a 'practice colour' where both student veterinary nurses (SVNs) and VNs will dress the same, using name badges to identify the staff and their positions within the practice.

RCVS Veterinary Nursing Certificate

This exam structure was retained until 1991/92 when multiple-choice questions replaced the written examination paper. The training course has seen many changes over the years, perhaps the greatest was in 1999 to the current S/NVQ based format¹.

Examinations take place in the summer and in autumn, with an average pass rate over the last three years being 62%.

Many veterinary practices (particularly the smaller one-man surgeries) still employ lay staff to help out with animal husbandry and general duties. However, employing a qualified veterinary nurse has many benefits. The course ensures that nurses are trained on a practical level to an extremely high standard as well as having knowledge in the science of veterinary medicine.

Course Requirements

To enrol on the course you must be at least 17 years of age, have secured employment as a student veterinary nurse within a veterinary practice and have one of the following:

• 5 GCSEs - grade C or above²
• 5 Scottish Standard Grades - grade 3 or above (see footnote 2)
• BVNA Animal Nursing Assistant Course - pass

These may also be considered as suitable entry qualifications to the veterinary nursing course, subject to certain modules being attained with a 'pass' or 'distinction'.

• BTEC National Diploma or Certificate in Animal Care
• GNVQ in Health and Social Care
• GNVQ Intermediate in Science
• BTEC First Diploma in Animal Care

To ensure that a national standard is achieved, training centres are regulated by the RCVS who use qualified Assessors and Verifiers to monitor the level of practical tuition, assessment as well as facilities available within a practice. Although S/NVQ modules are used as part of VN training, the RCVS stipulates that a higher supervision level by assessors is required than standard S/NVQ courses.

College Based Courses

*****The training is provided by two separate courses:
Year 1 (RCVS Part 1): 1 year full-time (44 Weeks) August ­ July
Year 2 (RCVS Part 2): full-time (56 Weeks) September ­ December.
*In addition students must have a minimum of 10 days work experience in a veterinary practice and general experience with small animals. ****

Work Placements

In combination with a structured tutoring course and a series of practical assessments, student veterinary nurses must complete a minimum of 35 hours per week, for 94 weeks (excluding holiday leave and sickness absence), in full time employment. Alternatively 20 hours per week part time employment is equally acceptable, providing that a total of 3,290 hours is worked within a five-year period. Only those hours worked in an approved training centre, after enrolling as an SVN, will be accepted by the RCVS.

List of Veterinary Nurses

Over the last decade, nurses have become increasingly respected for their skills and knowledge, which has been formerly recognised by the Royal College of Veterinary Surgeons. Working with the British Veterinary Nursing Association changes in legislation were approved, as well as the compilation and publication of the List of Veterinary Nurses.

Listed veterinary nurses may take on increased responsibilities, in addition to their basic nursing duties. Once they have passed the final examinations and have completed the required training period, newly qualified nurses must register with the RCVS to obtain their certificate and nursing badge. They will be added to the list of veterinary nurses and entitled to perform all duties that qualified nurses can.

Only those nurses who have passed the RCVS Certificate in Veterinary Nursing may call themselves Veterinary Nurses or VNs.

The list is maintained by the RCVS and updated yearly to include those recently qualified. There are over 4000 listed veterinary nurses, however over a 1000 qualified veterinary nurses are currently working in practices that have not renewed their status. It is the responsibility of the individual nurse to maintain their listed status each year, and the responsibility of the senior veterinary surgeon to ensure that nurses he does employ are legally qualified to perform the tasks he expects of them.

The RCVS now issues annual registration cards to listed veterinary nurses. This is to provide proof that you are legally entitled to perform duties, according to the provisions of the Veterinary Surgeons Act, as a listed veterinary nurse.

The Schedule 3 Ammendment - June 2002³

Under the Veterinary Surgeons Act 1966 only a veterinary surgeon may practise veterinary surgery. There are some exceptions to this rule that are of relevance to veterinary nurses. This is a very complicated ruling and a fuller explanation of this can be found at the RCVS website -
Schedule 3.

The Role of a Veterinary Nurse

The role of the veterinary practice and its nurses is constantly changing, the modern veterinary practice is not just a treatment centre for the sick and injured, but also a healthcare centre with the emphasis on prevention and advice. Nurses' profiles within a practice have been raised, so much so that they are now recognised as being able to fulfil a role that veterinary surgeons cannot - that of the 'Veterinary Healthcare Advisor'.

Nurses have their own appointments and run specialist advice clinics for a variety of conditions. These include:

• Post-operative and suture removal examinations, dressing changes and wound management reviews
• Calculating weight management programmes for obese patients
• Oral hygiene and prophylactic dental care
• 6 monthly health examinations from 'puppy hood' through to geriatric pets
• Puppy parties
• Nutrition and dietary management
• Basic training
• Choosing a Pet
• Flea, worming control, neutering and vaccination advice

Emergency Work

Veterinary nursing is not a 9-5 job. Practices provide out-of-hours emergency cover by participating in a shared rota with other practices, subscribing to a dedicated emergency team or by relying on their own staff. Nurses may need to cover 'on call' as well as their normal day shifts and be either required to stay overnight and at weekends, be given a pager, or live onsite as part of their contract agreement and share on call duties with other nurses. Senior nurses are often exempt from on call duties but will provide cover in the case of staffing shortages.

Nurses covering nights and weekends are expected to not only take care of the hospitalised patients, but also assist the duty veterinary surgeon with any emergency consultations. Just as in a hospital accident and emergency department, the range of cases seen varies, from pain relief for an arthritic dog to cats involved in a road traffic accident (RTA).

RTAs, falls from windows, caesareans, gastric torsions⁴ and status epilepticus are conditions that need urgent treatment to save the animals life. The vet and the nurse have to work as a team to get the patient stabilised, whilst running tests, taking x-rays or ultrasounds and preparing theatre when necessary. In what can be a very distressing situation for the owners, the veterinary nurse needs to focus and stay calm, be able to multi-task and anticipate the surgeon's requirements, in order to efficiently provide nursing support.

Laboratory Work

Most veterinary practices are able to provide basic in-house analysis. The range of tests available will depend on the individual practice, but some samples will automatically need to be sent to an external specialist laboratory - such as rabies antibody titres and hormone assays. However, modern practices have the facilities to perform a wide range of tests, and it falls to veterinary nurses to obtain the samples, run the appropriate tests, then prepare and report the results for the veterinary surgeon to assess. Although only the veterinary surgeon can diagnose a condition, nurses are taught to recognise the changes in test results and the implications of them.

Collecting a urine sample and testing by use of an indicating strip is probably the simplest of tests, but the most frequently performed test is a blood test. Nurses take blood samples from the jugular vein in the neck, or the cephalic vein in the front leg of dogs and cats, or the ear vein in rabbits. (The more exotic species, such as lizards or snakes, usually requires a specialist veterinary surgeon to take the sample.)

Blood samples are than analysed for liver function, kidney function, pancreatic disorders,
Diabetes Mellitus, infection, Anaemia, leukaemia, Total T4 levels for the diagnosing of Hyperthyroidism, antibody levels for Feline Leukaemia Virus and FIV (the feline equivalent of HIV), electrolyte (sodium, chloride and potassium) imbalance

Veterinary nurses are trained to take skin scrapes for microscopic examination and identify the many different types of parasites found on or burrowing into the skin. Microscopy is also used on urine samples to identify calculi, and bacteria, as well as on blood smears, which are stained to identify the different types of cells, making it easier to recognise changes in the cells. The latter is usually something the more experienced nurses will do. Larger practices have incubators, and nurses will do cultures for bacteria and antibiotic resistance and sensitivity with petri dishes.

The equipment in a lab is very sensitive and requires daily control checks. Nurses make sure that all equipment is functioning correctly and are responsible for running quality control checks and the maintenance of the equipment.

Radiography

Veterinary nurses are trained to operate x-ray machines and take radiographs of different areas of animal's bodies including the limbs, heart and lungs, abdomen, bladder, skull, pelvis and the spine. This involves the calculation of radiation exposures. Variables to be considered when calculating the correct exposure include the density of the area being x-rayed, the type of film being used, speed of the intensifying screen and the distance from the plate to the x-ray head. Unless an animal is very ill, patients will be sedated for x-ray to comply with health and safety guidelines. Badges worn on the body, and checked monthly by the National Radiation Protection Board, record radiation exposure levels.

Modern dark rooms may be equipped with an automatic processor to develop the x-rays, but it is not uncommon for nurses to manually develop x-rays using a 'wet processing' technique. In either case, the veterinary nurse must monitor the temperature and strength of the processing chemicals, replenishing or replacing them when necessary. Automatic processors need to be cleaned and the screens washed, usually after 30 to 40 films have been processed, but this can vary with the type of processor used. The x-ray plates containing the film must be checked for flaws and the delicate intensifying screens wiped with a cleaning agent regularly to prevent artefacts such as hair, dirt or debris, which appear as white marks on the developed films.

Additional Duties

Marketing

Marketing and practice management are some of the career opportunities available to nurses. However, some nurses enjoy having a small involvement in this area whilst continuing their regular nursing duties.

As part of a 'marketing team', nurses can help ensure that clients not only receive up to date information on all products and treatments, but that all services and facilities are meeting the needs of patient and owner. Organising open days and contributing to websites, creating practice brochures, information leaflets and a monthly or quarterly newsletter are all part of this.

Reception

Other additional duties can mean providing cover on the reception desk. This involves, booking appointments, filing case records, handling money, cashing up, book keeping, answering routine enquiries and organising consultations. Most practices are updating to at least a partial, if not a fully, computerised system, so familiarisation with a PC system can be necessary.

Insurance Claims Assessor

More and more people are taking out pet insurance for their animals. This covers emergency treatment, as well as ongoing medical conditions, and any surgery that may be required. Each treatment fee is claimed from the
pet insurance providers but requires comprehensive reports from the veterinary practice on the nature of the treatment as well as an itemised breakdown of the cost of individual examinations and medications. If the animal has more than one condition then the claim lists the treatment for each condition separately. Claim forms, in the past, were completed by veterinary surgeons but veterinary nurses are now authorised to sign and complete these time-consuming and complicated forms. Because of the experience nurses have gained in dealing with insurance forms, nurses are now ideal for working as a veterinary insurance claims assessors

Cleaning

Some practices employ a cleaner to maintain hygiene levels in the public areas, such as the waiting room, offices, consultation rooms and corridors. However many don't (due to financial restrictions), and these areas are added to the cleaning of the wards, theatres, and clinical areas that nurses must do, (assisted by an animal care assistant if the practice has one). Whilst it is not one of the aspects of the job that nurses enjoy doing, it is vitally important that a high standard of cleanliness, with a good disinfection routine, is maintained to reduce the risk of infection.

Dispensing and pharmacy

Unlike a doctor's surgery, veterinary practices have their own onsite pharmacy for use with the treatment of both inpatients and outpatients. Veterinary surgeons will authorise dispensing of the appropriate medicine and nurses will prepare the medication and advice the owner on how to administer the treatment. They must ensure that they are labelled correctly and dispensed in the correct container (such as 'ribbed' bottles for external treatments and smooth bottles for internal treatments). Some medicines are controlled drugs and need to be signed for each time, with the quantity dispensed, the date and the patient's owner details. Some may have health and safety requirements such as the wearing of gloves when handling them or have common side effects that the owner should be aware of. The nurses need to be familiar with the uses of the drugs, any special requirements as well as the Medicines Act 1968 and the Medicines (Restrictions on Administration of Veterinary Medicinal Products) Regulations 1994.

The nurses manage the pharmacy. The stock taking and re-ordering, monitoring the expiry dates, storage conditions of the drugs. The nurses handle all any associated paperwork. Senior nurses can even be involved in discussions with drug company representatives who may have new products available.

Veterinary surgeons have the responsibility to prescribe treatment for patients, and unlike doctors, have their own 'in-house' pharmacy⁵.

SURGICAL

Permits listed VNs with appropriate training to carry out minor acts of medical treatment and minor surgery (not involving entry into a body cavity) to any species, provided that the directing veterinary surgeon is satisfied that the VN is qualified to do so.

This allows those (but only those) that have attained the RCVS Equine VN Certificate to treat horses, and all VNs to treat exotic species.

Allows student veterinary nurses to give medical treatment and carry out minor surgery, (not involving entry into a body cavity) under direct supervision of a veterinary surgeon or listed VN⁶

This ensures that SVNs have become competent during training in all aspects of Schedule 3 procedures, and ensures they are fully able to perform them competently once qualified.

Surgical Nursing

Instruments and sterilisation

Theatre preperation

Pre op assessments

Anaesthesia

Post op assessments

Discharge

Theatre Clean Up

Instrument Care

Pain management

Monitoring

Crash Trolley

Dentistry

MEDICAL

Nutrition

Fluid Therapy

Monitoring

Recumbancy/Geriatric Care

Intensive Care

Medical Charts

Blood Transfusions

Treatments/Medications

Physiotherapy

Specialised Nursing

Ward Rounds

General

Bandaging

Medical Nursing