Practice standards scheme/trainee nurses

Re: Practice standards scheme/trainee nurses

Rob Loxley — Thu, 29 May 2014 17:27:34 GMT

[quote user="Michael Woodhouse"]I' not convinced that it is illegal for a lay person to give injections (by any route)[/quote]

[quote user="Michael Woodhouse"]When schedule 3 of the VS act was amended to include VNs, no mention is made of phlebotomy, injections etc.

The only way we will find out is case law.[/quote]

The law is pretty clear about who can give Medical Treatment. I struggle to see how anyone could argue that giving an injection of a drug is not Medical Treatment.

The law is, however, inconsistent: allowing lay people over 18 to remove dew claws, for example; does giving a tablet constitute 'Medical Treatment'?Microchipping is another discussion...

Re: Practice standards scheme/trainee nurses

Michael Woodhouse — Wed, 28 May 2014 17:37:04 GMT

[quote user="An On MRCVS"]

This is my concern.

We have an excellent 'trainee' nurse but she cannot enrol in any official training until she gets the required GCSEs (not achieved at school at appropriate grade), which she is working towards. In the meantime she is employed as a trainee nurse - administering drugs, places IVCs, monitoring GAs etc etc - pretty much doing everything an RVN would be asked to undertake. As she's not enrolled in an official training course I assume that in the eyes of the RCVS she is a 'lay person' and should anything go wrong either myself (as a vet placing in patients in her care) or my boss (for requesting her to undertake these duties) would not be looked upon favourably...

[/quote]

The book stops with the vet. Simple. If she's a qualified VN the vet is in overall charge, especially if you are asking them to work outside their area of competence.

I'm not sure it's possible to mess up a s/c injection and cause harm.

Re: Practice standards scheme/trainee nurses

Kathryn Burton — Wed, 28 May 2014 15:46:46 GMT

I used to work at Budget Vets (don't judge me!). Due to the name we seemed to have more RCVS inspections then most so they were at least very up on doing everything according to the Code of Conduct. At my branch we had two VS and one lay staff member who monitored GAs under VS direction. Company were very strict that only VS (or VNs at branches than had one) could give injections by any route, so I presume this was based on something? Although frustrating when you realised after scrubbing you'd forgotten to give the metacam!

Re: Practice standards scheme/trainee nurses

Bob Russell — Wed, 28 May 2014 15:39:44 GMT

[quote user="An On MRCVS"]

This is my concern.

[/quote]

Do you have confidence in her abilities? If so why worry? If not, worry!

Re: Practice standards scheme/trainee nurses

An On MRCVS — Wed, 28 May 2014 15:36:00 GMT

This is my concern.

Re: Practice standards scheme/trainee nurses

Richard Carter — Mon, 26 May 2014 10:16:42 GMT

At the risk of re-opening the whole nurse training can of worms I think everyone can think of an experienced but unqualified nurse assistant that can run rings around most qualified RVNs. Do you trust them? Are you available if something goes wrong? Are you prepared to take the rap if what goes wrong is serious? You are the vet, you are responsible.

Re: Practice standards scheme/trainee nurses

Bob Russell — Sat, 24 May 2014 11:26:05 GMT

I tend to agree that it is the RCVS that has tried to define what an act of surgery is, rather than the law. Sadly they don't seem that interested in trying to enforce it (rodentology discussion). It is quite possibly legal and acceptable in law if adequate training has been given and an individual can be shown to be competent.

I have an extremely well trained, sensible and competent veterinary care assistant (College of Animal Welfare). I would trust her totally because she has the good sense to know what her limits are. With a sense of dread and doom (me!) she is determined to do her nurse training so we have all that fun and games to look forward too.

How else would it be legal for the local pet hairdresser to implant microchips!

Re: Practice standards scheme/trainee nurses

Michael Woodhouse — Fri, 23 May 2014 22:00:56 GMT

I've read and re read the Veterinary Surgeons Act 1966 with amendments. I' not convinced that it is illegal for a lay person to give injections (by any route) or even take blood or place IV cannuale. If you look at the human hospital situation phlebomomists do a short (few days) course and are let loose taking blood. Lower grades of staff may give injections once authorised and checked by a healthcare professional.

When schedule 3 of the VS act was amended to include VNs, no mention is made of phlebotomy, injections etc.

The only way we will find out is case law. Are we saying the owner of the boarding kennel should be arrested for injecting the diabetic boarder?

If the treatment is directed by the VS then I can't see a problem. They can't work autonomously like a VN can.

Re: Practice standards scheme/trainee nurses

An On MRCVS — Fri, 23 May 2014 21:37:05 GMT

By lay staff I refer to animal care assistants, and staff members who may one day enrol on a nursing course but are currently not undergoing any formal training although called trainee nurses. Management have several such staff members looking after in patients, taking bloods/placing I/V catheters, giving injections via any route etc.

Re: Practice standards scheme/trainee nurses

Hannah Wynne Richards — Fri, 23 May 2014 16:08:27 GMT

The question was " Can i/v injections be given by lay staff members, and nurses not enrolled in any form of training?"

These are lay people,not trainee nurses, and Bob's answer was, quite properly "No"

Injections (all injections) are legally defined as "Acts of Veterinary Surgery" - albeit minor surgery.

As such it is a criminal offence for them to be performed other than by;

a) veterinary surgeons

b) veterinary students during their clinical years

c) qualified VNs

d) VN students enrolled with Royal College.

There is also an exemption which allows owners to inject their own animals, but not anybody else's, and in the case of farmanimals, this exemption is extended to bona fide employees of the owner.

In all other cases, it is as much a criminal offence as allowing RANAs to inject was when I first qualified.

The law is clear cut. These are lay staff, not nurses.

Wynne

Re: Practice standards scheme/trainee nurses

Bob Russell — Fri, 23 May 2014 15:31:11 GMT

[quote user="Hannah Wynne Richards"]

Allowing a lay member of staff to give any injections is a criminal offence - end of.

Wynne

[/quote]

These are not lay staff, they are trainee veterinary nurses. They need to learn the skills required to nurse!

Re: Practice standards scheme/trainee nurses

Hannah Wynne Richards — Fri, 23 May 2014 13:14:54 GMT

Allowing a lay member of staff to give any injections is a criminal offence - end of.

Wynne

Re: Practice standards scheme/trainee nurses

bob lehner — Fri, 23 May 2014 09:58:14 GMT

[quote user="Chris Barker"]Skip the bar room barristers Give the RCVS Prof Con dept a phone call tomorrow and ask these questions directly of them [/quote]

Well the answers to An On's questions are freely available on the RCVS website:

1. PSS Manual para 1.7 - VH/SA - 'The hospital must employ at least one RVN/LVN with responsibility for nursing in the hospital.'

VH/Eq - 'The Hospital must employ at least one RVN Eq.'

2. Un-enrolled students would not be allowed to undertake Sch. 3 duties.

3. PSS Manual para 5.3 VH/All '... a veterinary surgeon, veterinary nurse or an adequately trained member of lay staff is present on the premises 24 hours a day, every day of the year'. (An addendum says that it is preferably - but not necessarily - a LVN/RVN or enrolled student who is present on the premises 24/7).

4. No.

Re: Practice standards scheme/trainee nurses

Malcolm Ness — Fri, 23 May 2014 08:43:36 GMT

[quote user="Chris Barker"]

Skip the bar room barristers Give the RCVS Prof Con dept a phone call tomorrow and ask these questions directly of them Explain the situation - you don't have to state your place of employment and thereby risk dumping the bosses in the mire But our Code of Conduct now expects us to make proper enquiries, for even as a lowly employee we are meant to check that our place of work is code compliant

And report back the advice offered for everyone's interest!

[/quote]

There is a significant and ongoing problem that there are simply not enough nurses about to satisfy the (not entirely unreasonable) aspirations of those who would have all veterinary nursing done by Veterinary Nurses. We currently employ 9 qualified nurses and 4 second year students. In addition, we have a raft of "placement students". If it were practical to employ only qualified, RVNs then that is what we would do. Our policy has always been to get the students as fully involved as is practical in order to develop their understanding and ability to take RESPONSIBILITY as professional veterinary nurses. This conflicts with the ethos of the training centres who concentrate on the complex "box ticking" approach exemplified by the NPL and the extreme interpretation of Schedule 3 that has almost any task other than the wielding of a mop or the gentle patting of a puppy dog's head to be the sole preserve of a Registered Veterinary Nurse.

The current training scheme does not really prepare VNs very well for work in a practice like ours (significant and often complex case load with 24-7 care) and neither should it. But equally, the numbers of nurses being trained is not adequate to satisfy the still reasonable aspiration to have all veterinary nursing done by Veterinary Nurses. It can be made to work (we are not alone in making it work) but it is not really fit for purpose. What is needed is a more user-friendly flexible nursing qualification - perhaps a core qualification with add-on modules to reflect the interests and aspirations of each individual allowing those who want to move into OOH, hospital or referral surgical nursing able to access specific modules in that area while those who want to stay in primary care practice will be able to access similar modules that relate to the specific roles and responsibilities there.

One significant danger of setting the bar too high (only RVNs to work in a Hospital) is that it becomes unachievable for too many. Bear in mind that the current Hospital standard requires only that the practice employs ONE qualified Veterinary Nurse - there isn't even a requirement that a single VN should be present for most of the working week.

Re: Practice standards scheme/trainee nurses

Chris Barker — Thu, 22 May 2014 20:43:52 GMT

And report back the advice offered for everyone's interest!