BVA, vet-led team and RVNs

RE: BVA, vet-led team and RVNs

Alison Clare Hickman — Thu, 30 May 2019 21:41:42 GMT

[quote user="Michael Woodhouse"]I'm not convinced that there is a big market for such services, but I may be wrong. Perhaps as an add on to a mobile vet? It's a very inefficient way of working if you cost things out.[/quote]

I was thinking of it as being an add on service to a practice. Or practices. And why not be 'Toadster RVN Ltd' if each practice I am contracted to is my vet direction for their off-site client? Like a locum I would be freelance. Like a locum I would be working with a vet direction...

As for need/demand...there are plenty of clients I've met who would pay for the visits in their own home. Not just those with difficulties getting to the practice but those with pets who could avoid the stressful trip to those patients requiring daily meds e.g. insulin... with glucose curve tests as needed...

The role could also work for an existing permanent nurse; though I realise this would remove a body from the practice work due on site...

The economics of it need to be looked at, certainly, but I do see a client/pet need that is currently not adequately met in any practice I've worked at.

Having said this, I do know of one practice that is looking at setting up a Home Visit Nurse programme as I write... So watch this space...

RE: BVA, vet-led team and RVNs

Michael Woodhouse — Thu, 30 May 2019 20:34:16 GMT

[quote user="Evelyn Barbour-Hill"]That's the problem, the big fat mistake. That exemption should never have been allowed.[/quote]

I understand your point, but respectfully disagree. I like the fact that our nurse can do stitch ups, skin biopsies, skin sutures, aural haematomas etc. Makes her job more satisfying and makes her more useful to me. She has more patience and attention to detail that she's the best at scaling teeth too.

The tricky part is where you draw the line - where would you draw it?

[I learnt surgery mainly doing EMS with a little theory at college, nurses can do a really good and neat job of it]

RE: BVA, vet-led team and RVNs

Evelyn Barbour-Hill — Thu, 30 May 2019 20:29:29 GMT

[quote user="Michael Woodhouse"] They can undertake 'minor surgery not involving entry into a body cavity" [/quote]

That's the problem, the big fat mistake. That exemption should never have been allowed.

RE: BVA, vet-led team and RVNs

Michael Woodhouse — Thu, 30 May 2019 20:24:01 GMT

[quote user="Arlo Guthrie"]I don't think the proposals change that. ie what nurses do as part of schedule 3 is still under the direction of the VS. It just clarifies what vets can delegate. [/quote]

I suppose it then comes down to how you word things. They can undertake 'minor surgery not involving entry into a body cavity" - so can they remove a digit? A whole leg? A 5cm lipoma? A 30cm lipoma? Do a mammary strip?

I feel that there are situations where a VN with lots of surgical experience can remove a larger mass, but putting a magical size figure on it isn't helpful. I also feel it would potentially cause discontent from nurses who aren't allowed to do the surgeries on the desired list.

[quote user="Toadster"]As for being able to work legally without supervision - well my comment about becoming a District Nurse is somewhat without 'direct supervision' but would remain 'with vet direction' as a foundation. As a DRVN I envisage I would be rather more independent of function than an on-site nurse would be. Clearly I would need to be a fully trusted member of the team to do such a role. As such, this half-way meets your own vision?[/quote]

My understanding of the legislation is that you can do all the district nursing duties if employed by a practice and working for them? What you cannot do is set up your own business "Toadster RVN LTD" and advertise in the local paper going house to house doing schedule 3 procedures. I can direct a RVN to do a schedule 3 task off site. You can go to someone's house and take bloods, give IV meds etc.

I'm not convinced that there is a big market for such services, but I may be wrong. Perhaps as an add on to a mobile vet? It's a very inefficient way of working if you cost things out.

RE: BVA, vet-led team and RVNs

Mark Hedberg — Thu, 30 May 2019 18:26:10 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Arlo Guthrie"]

[quote user="Evelyn Barbour-Hill"]Yes. They won't accept it. Try to force them (not sure how that could be done) and they will just go on their own sweet way as they are at the moment, but without even talking to the veterinary profession.[/quote]

In answer to your question about 'how it could be done', it's in the BVA Policy statement:

Recommendation 5: RCVS proposals for the regulation of allied professionals should incorporate a requirement for regulators to mandate veterinary diagnosis, oversight and appropriate access to veterinary records as pre-requisites before treatment by an allied professional.

[/quote]

Fine words. And how would that be enforced upon a body of people who for many decades have been almost invariably working entirely independently, engaging with veterinary surgeons only if they feel like it and utterly unconcerned by the illegality of what they do?

[/quote]

Was that breeders or rodentologists? :D

RE: BVA, vet-led team and RVNs

Evelyn Barbour-Hill — Thu, 30 May 2019 15:55:42 GMT

[quote user="Arlo Guthrie"]

In answer to your question about 'how it could be done', it's in the BVA Policy statement:

[/quote]

RE: BVA, vet-led team and RVNs

Alison Clare Hickman — Thu, 30 May 2019 14:02:39 GMT

[quote user="Gillian Mostyn"]I'm struggling to think of any other profession where that is the case[/quote]

Well in my desired utopia it is a twinning of skills-sets and working together towards a common aim - and those aims can differ widely!

If, personally, I found myself in a practice that couldn't recognise my skills (existing, to be honed or to be found) I would move on and find somewhere that would do so.

I agree I would need a frank conversation with the vet who thought I wasn't capable of cleaning; who knows, perhaps I missed something vital that could cause a problem? After discussion, I might find my techniques improved, or I might be able to uphold my methodology and tutor my vet in modern aseptic cleaning protocols. It's all about communication - and you need a team to be able to communicate (unless talking to yourself or people that don't exist - but that's a whole other ball game).

As for being able to work legally without supervision - well my comment about becoming a District Nurse is somewhat without 'direct supervision' but would remain 'with vet direction' as a foundation. As a DRVN I envisage I would be rather more independent of function than an on-site nurse would be. Clearly I would need to be a fully trusted member of the team to do such a role. As such, this half-way meets your own vision?

RE: BVA, vet-led team and RVNs

Bob Russell — Thu, 30 May 2019 13:29:24 GMT

The training and experience of any one RVN is so variable that it is difficult to make direct comparisons in what a nurse should or should not do.

We have had newly qualified nurses that did not know how to clip up a cat spay!

In human medicine nurses have to do further training to be allowed to do many tasks. This is less available for our nurses outside the larger practices and referral world.

RE: BVA, vet-led team and RVNs

Gillian Mostyn — Thu, 30 May 2019 13:23:53 GMT

But do you think it is good for the nursing profession as a whole to be at the mercy of what a vet says they can and cannot do? I'm struggling to think of any other profession where that is the case. Why can't nurses be trusted to know themselves what they are capable of? What if your vet thinks that anything more than cleaning is outwith your capabilities?

I know I'm playing devil's advocate, but wouldn't it be better if RVNs felt they were legally able to work without supervision, and be trusted to know when it is actually needed?

RE: BVA, vet-led team and RVNs

Alison Clare Hickman — Thu, 30 May 2019 12:48:01 GMT

[quote user="Julie Innes"]I don't believe RVNs want to be "minivets" (well, the good ones don't!) Veterinary surgeon and Veterinary Nurse are two very distinct and separate jobs, which complement each other very well[/quote]

Julie Innes

As an RVN I can absolutely agree with this statement. I trained to be a nurse. I love being a nurse. I want to expand my capabilities but wholly within the nursing field and practice with vet direction (e.g. as a District Nurse tending to patients in their own homes - if such a discipline could be approved). I also agree with Michael Woodhouse that my vet should be able to train and trust me to do what he/she thinks is best for his/her practice - it differs ime from vet to vet/practice to practice what is needed (hence the vagueness of S3?).

Just my twopennorth - don't slay me!

RE: BVA, vet-led team and RVNs

Arlo Guthrie — Thu, 30 May 2019 11:46:12 GMT

[quote user="Michael Woodhouse"]

[quote user="Arlo Guthrie"]I still think clarification of Schedule 3 would really help this. [/quote]

I disagree and think it is fine exactly how it is. It allows vets to delegate what they see fit. It does NOT give a RVN and rights to go and do these things on their own without vet supervision and back up. It's actually great that I can decide what I want to let the nurses do.[/quote]

I don't think the proposals change that. ie what nurses do as part of schedule 3 is still under the direction of the VS. It just clarifies what vets can delegate.

RE: BVA, vet-led team and RVNs

Bob Russell — Thu, 30 May 2019 11:40:24 GMT

I am not arguing that an RVN should not get CPD to cover the additional SQP side of things. I am happy for a member of staff (non-RVN) to do SQP training but any RVN should be more than capable (and qualified) to do the job.

It is a very sad joke that the SQP qualification is considered a higher level than the RVN.

RE: BVA, vet-led team and RVNs

Michael Woodhouse — Thu, 30 May 2019 10:05:27 GMT

[quote user="Arlo Guthrie"]I still think clarification of Schedule 3 would really help this. [/quote]

I looked through the list and its all rather ok. It mirrors a lot of what the RCVS came up with in the consultation recently, looking at expanding the role of the VN. Personally I think it's a good thing. We're putting our nurse through SQP training and whilst she knows some of it, she doesn't know it all. I still think it's a useful add on, or more would need to go back into the VN curriculum. The RCVS hinted that there may be scope for VNs to prescribe all POM-V worm and flea Tx and with extra training I'd be fine with that. Personally (and I'm out on a limb here) I have no problem with VN vaccination, but I feel there needs to be an MRCVS physically on site should something bad happen.

RE: BVA, vet-led team and RVNs

Arlo Guthrie — Thu, 30 May 2019 09:36:07 GMT

[quote user="Evelyn Barbour-Hill"]I suspect that at least the first three of those bullet points, maybe the fourth as well, would really be a matter of giving a legal gloss to what already happens in effect, in practice, pretty often.[/quote]

Suspect you may be right, but I think there is some merit in giving legal gloss.

[quote user="Evelyn Barbour-Hill"]I'm more bothered about all this call for clarification blah blah about what can be delegated to RVNs under schedule 3. If it wasn't clear when first introduced, why didn't BVA bang on about it right then until it got clarified? I suspect that much of this is about getting nurses to do surgery and quietly extending the scope of that surgery.[/quote]

But here we diverge. I've been banging on about the need for clarification of Schedule 3 for years. I first raised it with the College probably over 15 years ago. Why? The College position was that they did not want regulation to be too prescriptive. My argument was that vets are (sorry) often and for a number of reasons, bad at delegating. Fear of DC. Protective of territory. Probably an innate character trait too (perfectionists never think anyone else can do the job as well!). This, I think, has led to an over-cautious use of veterinary nurses who could relieve more pressure on vets and be used more productively. I still think clarification of Schedule 3 would really help this.

But I am not in practice myself, so what do I really know?

In answer to your question about 'how it could be done', it's in the BVA Policy statement:

RE: BVA, vet-led team and RVNs

Julie Innes — Thu, 30 May 2019 09:02:50 GMT

It's daft to me that RVNs should need another "qualification" to be able to dispense flea products, but could be allowed to do surgery without one! . Are the BVA asking the nurses what they want? I was amputating a tail last week and mentioned (jokily!) to my nurse that maybe she should be doing it and I could be off having a coffee. She looked at me with horror!

I don't believe RVNs want to be "minivets" (well, the good ones don't!) Veterinary surgeon and Veterinary Nurse are two very distinct and separate jobs, which complement each other very well, IMO. If I have students for work experience who express the idea that they might become a vet nurse if they are unsuccessful in applying for vet medicine, I quickly disabuse them of the idea that the former is somehow a "step down" on the scale! If you want to be a vet, you will not be happy as a vet nurse. If you want to be a vet nurse, you would never be happy being a vet. The attempts to blur the lines are not useful, IMO, and are actually a little insulting to RVNs.

I do however agree that often in practice RVNs don't get the opportunities to utilise their many skills

RE: BVA, vet-led team and RVNs

Evelyn Barbour-Hill — Wed, 29 May 2019 18:24:23 GMT

[quote user="Arlo Guthrie"]Of course I know you are against nurses as minivets. Genuinely curious to know whether you thought these latest recommendations are all of them wrong, or whether any of them have the potential to be 'well, OK then' in your book.[/quote]

I suspect that at least the first three of those bullet points, maybe the fourth as well, would really be a matter of giving a legal gloss to what already happens in effect, in practice, pretty often.

I'm more bothered about all this call for clarification blah blah about what can be delegated to RVNs under schedule 3. If it wasn't clear when first introduced, why didn't BVA bang on about it right then until it got clarified? I suspect that much of this is about getting nurses to do surgery and quietly extending the scope of that surgery.

[quote user="Arlo Guthrie"]

[quote user="Evelyn Barbour-Hill"]The fact is that some – equine dental technicians are the ones I know about, but I've had some experiences with physiotherapists too – can be perfectly nice people, and often keen to "work with" veterinary surgeons, but want to stay freelance and do not want to be ruled by veterinary surgeons.[/quote]

That was precisely what I was thinking / wondering. Do these people want to be ruled by vets? And if they don't, might it be counter productive to try and force them?

[/quote]

Yes. They won't accept it. Try to force them (not sure how that could be done) and they will just go on their own sweet way as they are at the moment, but without even talking to the veterinary profession.

RE: BVA, vet-led team and RVNs

Bob Russell — Wed, 29 May 2019 17:32:31 GMT

There is no way in the world that an RVN is qualified to a lower level than a SQP.

SQP training is a bit of a joke and always has been. Buy a training manual, read and learn it and book your exam. Level 4 my ar+e!

RE: BVA, vet-led team and RVNs

Iain Richards — Wed, 29 May 2019 17:14:24 GMT

[quote user="Bob Russell"]I consider it is an absolute disgrace that a fully qualified RVN should not have SQP status automatically.[/quote]

Indeed. It's to do with the academic level at which the training is aimed. VN is level 3, SQP level 4.

IF RCVS had kept VN training in house, it might have been possible. Equally if the training centres created an exam that was level 4. SQP training is a near monopoly with AMTRA/AHDA and there is a lot of vested interest. VetPOl are a new qulification body and look very interesting

RE: BVA, vet-led team and RVNs

Arlo Guthrie — Wed, 29 May 2019 17:09:00 GMT

[quote user="Evelyn Barbour-Hill"]Are you trying to wind me up? [/quote]

Moi?

Really, I just wanted to draw your attention to the latest announcement. Of course I know you are against nurses as minivets. Genuinely curious to know whether you thought these latest recommendations are all of them wrong, or whether any of them have the potential to be 'well, OK then' in your book.

That was precisely what I was thinking / wondering. Do these people want to be ruled by vets? And if they don't, might it be counter productive to try and force them?

RE: BVA, vet-led team and RVNs

Evelyn Barbour-Hill — Wed, 29 May 2019 16:37:38 GMT

[quote user="Bob Russell"]

I consider it is an absolute disgrace that a fully qualified RVN should not have SQP status automatically.

[/quote]

In my opinion, a person qualified RVN is a SQP.

The legislation which started this silly SQP business referred to " a suitably qualified person". I do not believe that the intention was to create a new profession of "SQP". I believe that it was worded thus so that people who did not have already a suitable qualification (such as MRCVS or RVN, just for instance) could gain this limited right to prescribe through other courses of study and examination.

[quote user="Arlo Guthrie"]As far as the RVN aspects go, the question there is do you think it goes far enough, or too far? Evelyn Barbour-Hill? (:))[/quote]

Are you trying to wind me up? I think the RVN exemption business has already gone too far, as you know. RVN development has gone in the wrong direction. If it retreated from the mini-vet direction and went in a nursing direction, I'd be much in favour.

[quote user="Arlo Guthrie"] achievable with some of the others, like equine dental technicians, foot trimmers, hydrotherapists, animal behaviourists and physiotherapists, where in some cases they may be competing.[/quote]

RCVS and others keep harping on about the concept of "the veterinary team" incorporating all these people, in a pious sort of hope that it may come about. The fact is that some – equine dental technicians are the ones I know about, but I've had some experiences with physiotherapists too – can be perfectly nice people, and often keen to "work with" veterinary surgeons, but want to stay freelance and do not want to be ruled by veterinary surgeons.

(By the way, although I'm not sure about the others, equine dental technicians are all still operating illegally. I've been involved since 1997 in efforts to bring about a recognisable qualification and exam for EDTs – efforts which have had considerable success – and efforts to achieve a proper legal status for the thus qualified EDT, which have been frutless. Meanwhile in the good old British waywe allow them a sort of quasi-legal not-illegal-illegality by means of a don't-pry-too-deeply fudge.)

RE: BVA, vet-led team and RVNs

Bob Russell — Wed, 29 May 2019 14:14:56 GMT

I consider it is an absolute disgrace that a fully qualified RVN should not have SQP status automatically.