Delegation to nurses - how does Sch 3 work in practice?

RE: Delegation to nurses - how does Sch 3 work in practice?

David Mills — Tue, 12 Feb 2019 00:58:23 GMT

Big push from me for nurses doing s3s, great use of resource in charity hospital.

Nurses do all the scaling here, and present with a lovely examination summary and the vets come in and do the vet bits. In the meantime, vets are getting on with other things. Best use of time when you crunch it down.

They do xrays, suturing, lumps, aural haetomas, and we plan to train them up on ultrasound too.

They can knock things out with quads too, it being a measured amount of drugs, sedate dogs for rads.

Much underused resource. Engage them, they will pay you back in loyalty, interest, questions, and case ownership.

Engage them.

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Mon, 11 Feb 2019 23:24:04 GMT

[quote user="Liz Barton"]to see them make the most of their extensive training...[/quote]

I've never understood why nurses are legally permitted and trained to do surgery, so ......

Best leave it at that.

RE: Delegation to nurses - how does Sch 3 work in practice?

Michael Woodhouse — Mon, 11 Feb 2019 23:19:43 GMT

[quote user="Liz Barton"]I wonder if there are any nurse CPD days focussing on practical surgical skills?[/quote]

There are:

https://www.improveinternational.com/uk/course/schedule-3-surgery/

https://www.centralcpd.co.uk/course/schedule-3-surgical-procedures-for-nurses-2/

(Although I have no experience of them)

[quote user="Evelyn Barbour-Hill"]Why?[/quote]

I think it's important the whole practice team develops professionally. Nurses can legally do minor surgery so why not encourage it?

RE: Delegation to nurses - how does Sch 3 work in practice?

Liz Barton — Mon, 11 Feb 2019 21:56:45 GMT

[quote user="Evelyn Barbour-Hill"]Why?[/quote]

Interest, challenge, because I enjoy teaching and seeing others develop their skill, to see them make the most of their extensive training...

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Mon, 11 Feb 2019 21:43:49 GMT

[quote user="Liz Barton"] I've often asked the nurses if they want to do minor surgeries,[/quote]

Why?

RE: Delegation to nurses - how does Sch 3 work in practice?

Liz Barton — Mon, 11 Feb 2019 21:11:04 GMT

[quote user="Bob Russell"]

I tend not to do the scale and polish bit. I do the anaesthetic!

Once the basic clean has been done I take over and check the teeth. x-rays and plan treatment.

[/quote]

Quite the opposite for me! I start with a gross descale, X-rays, extractions. I then ask the nurse if they have a preference for continuing the GA or taking over for the final, thorough descale and polish. Some of them prefer to monitor, others love to get stuck into the descale/polish. (I'm useless with the stuff - make such a mess!).

[quote user="Michael Woodhouse"]Aural haematoma ops, skin biopsies, stitch ups. I took our nurse to a cow caessarean and she did the skin sutures.[/quote]

Great to hear! I've often asked the nurses if they want to do minor surgeries, but only one has ever opted to. Shame really. They seem to worry about time and not doing a good job. I get them stitching up PMs to build confidence handling the instruments, but haven't worked with nurses with a particularly strong surgical penchant. I wonder if there are any nurse CPD days focussing on practical surgical skills?

RE: Delegation to nurses - how does Sch 3 work in practice?

ell — Mon, 11 Feb 2019 17:54:44 GMT

So good to hear a vet talk g about team work in a dental. Letting the nurse do scaling while vet in charge if anaesthesia let's the whole process become much more interesting for all involved. In my experience the vets who don't let the nurses assist are generally also the ones who hate "dental". If they worked as a team the enjoyment level would i crease

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Mon, 11 Feb 2019 14:50:12 GMT

I wasn't criticising you at all, Mr. Russell. I think your approach is a perfectly good one, although not mine. But I don't think that what you do is what people usually mean by "the nurses scale and polish teeth".

RE: Delegation to nurses - how does Sch 3 work in practice?

Bob Russell — Mon, 11 Feb 2019 14:16:08 GMT

Scaling is definitely not beneath my dignity. My nurses are extremely good at it and I accept on occasions they may scale a tooth that is to be extracted.

In my defence I would prefer to extract a cleaned tooth than a contaminated one.

It goes without saying that my opinion may be requested at any stage of cleaning. It is team work and it keeps staff members involved.

I am always present at all times. This is not a cost cutting exercise.

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Mon, 11 Feb 2019 14:04:37 GMT

[quote user="Bob Russell"]Once the basic clean has been done I take over and check the teeth. [/quote]

But then your nurse may be wasting her/his () time scrupulously cleaning teeth that you are going to extract, for instance. My examination gets done as I go along with the initial cleaning. A matter of style.

[quote user="Bob Russell"] I find the scaling a bit tedious. [/quote]

I'm not getting at you at all, Bob, but that remark does rather symbolise some of the reasons why some veterinary surgeons wish to delegate tasks to nurses: it's too tedious, it's too boring, it's beneath my dignity.... the nurses can do it, they'll be thrilled.

RE: Delegation to nurses - how does Sch 3 work in practice?

Alison Clare Hickman — Mon, 11 Feb 2019 13:33:30 GMT

Heck, I'd work for you Michael Woodhouse! Sounds like your RVN gets up to all sorts! LIKE LIKE LIKE LIKE!!!

RE: Delegation to nurses - how does Sch 3 work in practice?

Bob Russell — Mon, 11 Feb 2019 11:16:12 GMT

I tend not to do the scale and polish bit. I do the anaesthetic!

Once the basic clean has been done I take over and check the teeth. x-rays and plan treatment.

To be quite honest I believe they do a very thorough job and I find the scaling a bit tedious. I attend 100% of the time. This allows staff to be more involved. 90% of the time they will bring problems to my attention before I do a full examination. I am happy with teamwork, there is better engagement and it does me no harm to monitor anaesthesia from time to time.

Annual dental? That's a thought!

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Mon, 11 Feb 2019 00:22:39 GMT

[quote user="Michael Woodhouse"]It's funny when I go to the dentist the dentist doesn't scale and polish my teeth, a hygienist does.[/quote]

Well, er..... so what? What's done in human dentistry doesn't necessarily apply to veterinary dentistry. And, dental hygienists are highly trained. And, the hygienist's attentions are just in preparation for the dentist's examination. And, there's no GA involved.

[quote user="Michael Woodhouse"]I struggle to get people to brush teeth or follow any home dental care routines.[/quote]

Sure, that can be difficult, but there's a lot more to the initial periodontal treatment than that.

[quote user="Michael Woodhouse"] but sadly the limits most people I come across only really want scale/polish and extractions if needed.[/quote]

Most people just want you to yark out the really bad 'uns and do some entirely cosmetic stuff to the rest? Possibly. In my experience, that's simply because their veterinary surgeon has not enlightened them.

Moreover, though I know this doesn't apply to you Michael, I am sure there are practices where thiat approach is taken, not only through ignorance but because it ensures that the animal has to come back every year for another "scale and polish" – the notorious "annual dental". Ker-ching! And the nurses can do it! Ker-ching!!

RE: Delegation to nurses - how does Sch 3 work in practice?

Michael Woodhouse — Sun, 10 Feb 2019 23:55:44 GMT

[quote user="Liz Barton"]Does this happen very commonly in your practice? And which surgeries? I am quite happy for nurses to do minor surgery but haven't yet come across one who wanted to - mainly due to lacking confidence.[/quote]

Maybe not every day, but every week. Aural haematoma ops, skin biopsies, stitch ups. I took our nurse to a cow caessarean and she did the skin sutures.

[quote user="Liz Barton"]How about performing FNA's and cytology?[/quote]

She has done FNAs, but usually done by vets so they can sample the lump of interest. Yes to things like blood smear exam or occasionally fluids with diff quick/Gramm stain.

[quote user="Evelyn Barbour-Hill"]Examination, diagnosis, prescription and surgery, all in one go, none of which is either permitted to a nurse or, more importantly, within the role of a nurse.[/quote]

It's funny when I go to the dentist the dentist doesn't scale and polish my teeth, a hygienist does.

I do understand that there is a lot you can do with veterinary dentistry, but sadly the limits most people I come across only really want scale/polish and extractions if needed. I struggle to get people to brush teeth or follow any home dental care routines.

I see no reason a nurse cannot come along first and do a comprehensive scale and polish for the vet to have a good look and decide what is needed. We'd always have one involved in the procedure somewhere and available. I think dentistry was one area the RCVS consultation on VN upskilling discussed - I wonder if things will change and they will be able to do extractions?

RE: Delegation to nurses - how does Sch 3 work in practice?

Evelyn Barbour-Hill — Sun, 10 Feb 2019 23:39:18 GMT

Well, you all know that I disagree strongly with many items on Michael's list, so i won't bother arguing.

But I will single out "teeth scaling"

1. Dental attention is done under GA – are you sure you have at least a RVN acting as anaesthetist in addition to the RVN doing the "scaling" – or is the temptation too strong to let the one RVN do the whole business singlehanded?

2. A veterinary surgeon has still got to be in attendance somewhere, because of the GA – he or she might just as well be doing the dental procedure, then.

3. How often is a dental procedure nothing more than "teeth scaling"? Pretty rarely, unless it's being done incompetently or in ignorance.

4. And how can the veterinary surgeon (still has to be one in charge of the case) possibly tell in advance of the GA procedure that the only attention required is "scaling"?

5. As far as I am concerned, even the most straightforward of periodontal procedures includes a full oral and peri-oral examination and assessment, radiography as necessary (whether a full survey or tactically of suspect teeth or something in between) and interpretation of the radiographs, considering all findings and the formulation of a treatment plan, and the carrying out of the first stages of that plan, which may include not only extractions but several different types of greater or lesser subgingival treatments. Examination, diagnosis, prescription and surgery, all in one go, none of which is either permitted to a nurse or, more importantly, within the role of a nurse.

RE: Delegation to nurses - how does Sch 3 work in practice?

Francisco Gomez — Sun, 10 Feb 2019 22:31:37 GMT

[quote user="Michael Woodhouse"]

[quote user="Liz Barton"]So, what are you 'happy' delegating to nurses?[/quote]

I think the answer is pretty much everything they are legally allowed to do, or why bother having them.

Yes to:

2nd vaccs

Post op checks (unless something complex and then VS may want to see it back)

Suture removal

Microchipping

Bloods (both small animal and out on farm)

Assisting with anaesthesia

Assisting with surgery

Minor surgery

Teeth scaling

Reporting of negative results

X rays

Lab tasks - bloods/faecal [WEC etc]/parasitology/swabs

Placing IV cannulae/setting up and monitoring drips

Giving meds

Bandaging and rebandaging

Plus the usual cleaning/husbandry tasks the role involves.

[/quote]

The nurses, at least the ones who work with me, do all the above and perhaps a bit more.

They know where the limit is: diagnosis, surgery and pom-v prescription. However they are still allow most of these under the vet authority.

I think they are not being utilised to their full legal potential in some clinics, but in ours the vet is allowed to delegate most tasks.

Are we confusing what they are allowed with what we allow? If we decide to increase their job description, who is going to be doing what they are doing now?

I would not be too comfortable with delegating all these jobs that nurses do very well now to unaccountable and unqualified lay people.

RE: Delegation to nurses - how does Sch 3 work in practice?

Liz Barton — Sun, 10 Feb 2019 22:20:31 GMT

[quote user="Michael Woodhouse"]Minor surgery[/quote] Does this happen very commonly in your practice? And which surgeries? I am quite happy for nurses to do minor surgery but haven't yet come across one who wanted to - mainly due to lacking confidence.

[quote user="Michael Woodhouse"]Lab tasks - bloods/faecal [WEC etc]/parasitology/swabs[/quote] How about performing FNA's and cytology?

RE: Delegation to nurses - how does Sch 3 work in practice?

Michael Woodhouse — Sun, 10 Feb 2019 21:46:24 GMT

[quote user="Liz Barton"]So, what are you 'happy' delegating to nurses?[/quote]

I think the answer is pretty much everything they are legally allowed to do, or why bother having them.

Yes to:

2nd vaccs

Post op checks (unless something complex and then VS may want to see it back)

Suture removal

Microchipping

Bloods (both small animal and out on farm)

Assisting with anaesthesia

Assisting with surgery

Minor surgery

Teeth scaling

Reporting of negative results

X rays

Lab tasks - bloods/faecal [WEC etc]/parasitology/swabs

Placing IV cannulae/setting up and monitoring drips

Giving meds

Bandaging and rebandaging

Plus the usual cleaning/husbandry tasks the role involves.