Matt’s Masterclass: the ‘modern veterinary family’

When I first started my veterinary nursing journey in 1989, working in a large mixed practice, it was expected I would address the senior vets formally; in my case, it was Mr Johnson and Mr Daniels.

To be honest, it made me slightly fearful of occasions where I would have to engage with them, and I am not sure how suggesting having a “clinical discussion” would have been received at the time, but I suggest my request would have been met with some confusion due to a lack of understanding of what a trainee VN could possibly bring to such a discussion.

Fast forward to 2020 and, thankfully, a much greater understanding exists of the amazing knowledge, experience and skill within veterinary nursing.

I work in a team that actively encourages clinical engagement and input from all levels of the nursing team, including veterinary care assistants (VCAs). I know this tangibly improves the welfare and standard of veterinary care we provide for our patients. For me, this is progression that needs to continue as it’s of paramount importance in helping create the modern veterinary family.

We still have a long way to go, and I am sad when I hear of extremely experienced and knowledgeable VNs not being allowed the opportunity to give their clinical input and guidance to less experienced vets.

This detracts from our role as veterinary nurses, causes disillusionment in the profession and, ultimately, detracts from the care and welfare of the patients under our care. I believe some things exist that we can do to improve this situation.

Clinical guidance, not clinical governance?

A lack of clarity exists in both professions as to what level of clinical input is appropriate for veterinary nurses to have in patient care – we need to be very clear with each other on how this needs to work.

For me, the key thing is only veterinary surgeons ever have clinical governance. However, RVNs, SVNs and VCAs should be afforded an opportunity for offering opinions on a patient’s care, and the level of that clinical input should reflect their experience and the amount of time they have spent with that patient; therefore, clinical guidance.

Clinical communication

Nurses should be actively encouraged to give clinical guidance. We need to be mindful that we can offer suggestions and guidance to vets – it’s completely up to them if they choose to take that on board – but, as nurses, we can significantly improve the likelihood of our suggestions being instigated by how we deliver them:

• Timing is key – don’t brain dump a lot of clinical information at an extremely busy time.
• Be concise – don’t waffle and take up lots of clinical time; it detracts from the facts.
• Base your suggestions on sound clinical experience and, ideally, evidence-base them.
• It needs to be a clinical discussion, not an argument. Both parties need to be professional.
• Don’t be a “know-it-all nurse” – reflect on these clinical discussions and learn from them.
• No one likes to be made to feel they lack knowledge; consider the feelings of your vets. Be encouraging, supportive and positive, not judgemental or negative about their abilities. If you make your veterinary surgeons feel they are not doing a good job, they will not ask for your clinical guidance again.

When we are empowered to carry out a clinical procedure by a vet, it’s really important we make a really good job of it. Make sure your nursing is to a really high standard. If you’re not comfortable with something you are being asked to do, ask for some help from the more experienced RVNs around you or ask for some external CPD on the matter.

If you don’t do a really good job when a vet delegates a clinical procedure to you (especially the first time), that vet will lose confidence in your nursing abilities and will be less likely to delegate to you again. Moreover, do ask for constructive feedback from your vets, so you can improve and grow as a nurse. For example, a vet says to you:

“Can you please admit ‘Olive Rendle’. She has a possible foreign body and has been vomiting repeatedly for 48 hours. Can we get informed consent for permission to blood sample for a full in-house screen, IV fluid therapy with Hartmann’s solution at twice maintenance, and lateral and ventrodorsal abdominal radiographs. Can you get this done and let me have the results ASAP, and then we can discuss a treatment plan.”

Can you say you are 100% confident in your nursing abilities that you can carry out every element of this clinical procedure to a high standard? If not, please do ask for that additional support.

Make sure your team is all on the same page. I have never really considered this until a clinical situation occurred recently.

I was working in the referral centre on a very busy day and a vet new to our hospital had an African grey parrot booked in for a microchip. The vet had concerns about this procedure, but especially the handling of the parrot.

She found me and asked if I had any experience of handling birds, which made me smile. However, it seriously highlighted to me that, as nurses, we need to take the time to have a pre-clinical discussion with new vets (and nurses) joining the team about what we can do for them clinically and our clinical experience. They can tell us the same and this can only improve the clinical efficiency of your team, let’s take the time to do it.

Future

The level of the knowledge and ability within veterinary nursing is increasing steadily every year. Some clinical areas will not exist in which some nurses will have more knowledge and skill than some vets. It’s really important we don’t panic our fellow professionals, but encourage them to use our skills and optimise the clinical service we provide.

The whole veterinary family needs to use this knowledge in the nurses, and not feel unnerved or feel undermined by us. We are a key part of the veterinary team and we all want the same thing, and that is always to improve the veterinary care and welfare of our patients.

“Since the earliest days of my career, nursing colleagues have taught me more than I can possibly say. Patient care is at the core of both our professions, and is best served when we both bring our complementary skills together and work closely as a team” – Amanda Boag.