Can an RVN do this?

Re: Can an RVN do this?

Peter Ding — Tue, 15 Feb 2011 17:40:19 GMT

What was the existing protocol in the practice in which she worked?

Had the head nurse been given permission to do this on prior occasions by the owner of the practice?

If she was used to doing this for her employer and he was happy with it, is she doing any more than an RSPCA inspector?

It may just need clarifying that the vet on duty is in charge when stretching the law like this so a phone call is necessary.

If the animal was in distress and was suffering IMHO she may even have complied with the spirit, if not the letter of the law.

However a phone call wouldn't have delayed matters significantly , so it certainly should have been made.

I would say Thank you for saving me a job, BUT be very careful PLEASE ring me next time in order to cover yourself and me!

Nurses that think they are vets are very dangerous!

Re: Can an RVN do this?

Kate Richardson — Tue, 15 Feb 2011 16:43:25 GMT

[quote user="Michael Woodhouse"]

[quote user="Kate Richardson"] how would it look if something did wrong- is she going to go out and explain it to the owners? I think not. [/quote]

"I'm very sorry Mr Smith, but fluffy isn't dead?"

Not sure I see what all the fuss is about.

[/quote]

Maybe I didn't word it as well as I could have, but you have quoted me out of context. I was talking in more general terms about if she decided to make other clinical decisions and if something went wrong.

As Wynne has said, it is a matter of trust- most, if not all of the general public would believe an act of euthanasia to be carried out or authorised to be carried out by a vet. I don't think it would reflect well on the profession if this it was found out that this was not the case and nurses were taking decisions into their own hands. She simply should have telephoned Wren and asked her if it was okay to euthanase the dog.

Re: Can an RVN do this?

Hannah Wynne Richards — Tue, 15 Feb 2011 09:43:05 GMT

Micheal It's a matter of trust between owner and veterinary practice Why say "It's different if the owner wants to be there " ? Owners should be able totrust us todo things EXACTLY the same,whether or not they happen tobe present

Wynne

Re: Can an RVN do this?

bob lehner — Mon, 14 Feb 2011 18:37:10 GMT

[quote user="Bob Russell"]

I don't see that the process of euthanasia was the issue but the fact that a euthanasia was performed by a nurse without checking with the vet.

I am afraid I do see what the fuss is about!

[/quote] Exactly - a VN has no legal right to use POM-V drugs without the immediate and direct authorisation of the vet. She can't make that decision of her own volition, which is what seems to have happened here.

Re: Can an RVN do this?

Bob Russell — Mon, 14 Feb 2011 18:12:49 GMT

I don't see that the process of euthanasia was the issue but the fact that a euthanasia was performed by a nurse without checking with the vet.

I am afraid I do see what the fuss is about!

Re: Can an RVN do this?

Mark Holmes — Mon, 14 Feb 2011 18:03:08 GMT

[quote user="Michael Woodhouse"]

[quote user="Kate Richardson"] how would it look if something did wrong- is she going to go out and explain it to the owners? I think not. [/quote]

"I'm very sorry Mr Smith, but fluffy isn't dead?"

Not sure I see what all the fuss is about. I've worked in practices where PTS's if the owner didn't want to stay were done by nurses 'through the back'. Plenty of practices uses nurses to euthanase the seagulls with broken wings with no vet input whatsoever. How is this different to the VN calculating a dose of triple combination and giving it to a cat? This happens every day and the vets don't check each ingredient as it goes in the syringe.

A VN can do IV injections. A consent form was signed. The dog was left. The dog died. I can't see why this couldn't be a practice protocol. Different if they want to be there.

[/quote]

I'm glad I'm not the only one who is not sure what the fuss is about. We recently had a discussion about RSPCA officers stopping euthanasia and decided on the whole it was a bad thing. Isn't an RVN better qualified than an RSPCA officer? There is no reason for a competent RVN to have greater problems than a newly qualified vet and any problems could be handled the same way. I would be annoyed if a nurse made the decision as to whether PTS was appropriate for the dog but this had been decided.

Re: Can an RVN do this?

Michael Woodhouse — Mon, 14 Feb 2011 17:34:46 GMT

[quote user="Kate Richardson"] how would it look if something did wrong- is she going to go out and explain it to the owners? I think not. [/quote]

"I'm very sorry Mr Smith, but fluffy isn't dead?"

A VN can do IV injections. A consent form was signed. The dog was left. The dog died. I can't see why this couldn't be a practice protocol. Different if they want to be there.

Re: Can an RVN do this?

Malcolm Ness — Mon, 14 Feb 2011 13:22:47 GMT

The act involved the use of a dose of a POM. Who decided upon which drug was used (?? an act of veterinary surgery) and who decided upon the precise dose to be used (?? an act of veterinary surgery)? In short, with which veterinary surgeon would the buck stop?

There are paralells with the recent discussion about RSPCA inspectors and euthatal.

In your situation, I would want it made clear that nobody could ever claim, suggest or infer that I was the veterinary surgeon giving the direction under which the VN was killing dogs.

Re: Can an RVN do this?

Kate Richardson — Mon, 14 Feb 2011 12:55:15 GMT

[quote user="Evelyn Barbour-Hill"]Eh? You may not be her employer but you are most certainly the boss in this context.[/quote]

Yes yes yes, totally agree. It may be a much a matter of principle as anything else. She needs to understand the boundaries- what if she makes another decision that compromises you? You are the one who responsible at the end of the day, and the one who has to deal with the owners- how would it look if something did wrong- is she going to go out and explain it to the owners? I think not.

Re: Can an RVN do this?

Evelyn Barbour-Hill — Sun, 13 Feb 2011 18:29:35 GMT

[quote user="Wren"]After all I'm not her boss and have no right to tell her off. [/quote]

Eh? You may not be her employer but you are most certainly the boss in this context.

[quote user="Wren"]

[quote user="Mark Holmes"] Secondly to get furious about it is illogical. Situations like this are better handled by saying "I appreciate you were trying to help and thankyou for that BUT I am somewhat uncomfortable about the lack of communication. In future please check with me. " Staff morale is much better preserved and you don't look like an arse!

[/quote]

Don't worry. Personal face and morale were both preserved. I felt furious but managed to say something along the lines of 'I'm not sure you should have done that, I'll check the legal position but please ask in future'. After all I'm not her boss and have no right to tell her off. I'm not the shouting type anyway.

[/quote]

I think you are both wrong. Maybe it's right to suppress your immediate furious reaction, so don't shout "You what? What the hell do you think you're playing at?" but it's not right to be so wet and conciliatory either. Personally I would have taken her out of earshot of everyone else and hissed "Don't ever do anything like that ever again!" Then I would have made a big show of calming down and explaining things, and only finished off with "I know you meant well and you were trying to be helpful, but you really mustn't do things this way, blah, blah.............."

Re: Can an RVN do this?

Wren — Sun, 13 Feb 2011 13:52:14 GMT

[/quote]

Re: Can an RVN do this?

jamie winstone — Sun, 13 Feb 2011 12:12:06 GMT

This kind of unfortunate euthanasia has probably happened to all of us. I had a similar experience where the dog in question was so moribund that it took a full minute to stop "woofing". This I could cope with. Being called a murderer , I felt was just an emotional response. Not being paid until I ransommed the ashes, again seemed par for the course.

However explaining the full detail to the PIC for the benefit of a compainant who wasn`t even present got me mad!!

P.S. In their even-handed way, I was allowed to continue practising.

Re: Can an RVN do this?

Mark Holmes — Sun, 13 Feb 2011 11:49:37 GMT

Personally I wouldn't have been too worried. The decision for euthanasia had been made. Assuming the nurse was perfectly competent the act of euthanasia is quite within their capacity or rather the odds one a difficult Euth are not different for RVN or vet. Would you have been worried if new grad incompetent vet had carried it out? Secondly to get furious about it is illogical. Situations like this are better handled by saying "I appreciate you were trying to help and thankyou for that BUT I am somewhat uncomfortable about the lack of communication. In future please check with me. " Staff morale is much better preserved and you don't look like an arse!

Re: Can an RVN do this?

Mark Holmes — Sun, 13 Feb 2011 11:49:31 GMT

Re: Can an RVN do this?

Rob Davis — Sun, 13 Feb 2011 11:46:35 GMT

[quote user="James Laidlaw"]yelled at me to stop and called me a wicked wicked man.[/quote]

I hope you haven't let this get to you. It happens to all of us on occasion, and however many times it happens it's still shit. I hope you've gone home, poured a large glass of wine and switched off!

Re: Can an RVN do this?

James Laidlaw — Sat, 12 Feb 2011 20:51:51 GMT

Case in point - my euth today that went terribly. Acute renal failure dog where IV pentobarb through a catheter decided to bypass the vein (drip running fine all day) and blew the vein on injection. Dog started whimpering, stood up while upset owners tried to hold it, yelled at me to stop and called me a wicked wicked man. Consequently upset people in the waiting room, and I managed (only just) to keep my composure enough to explain the risks with elderly, compromised patients (Urea 85+, Phos nearly 8) and that I couldn't just stop injecting in such a situation in case of the patient going into excitement phase of anaesthesia. Dog fairly rapidly went unconcious and became anaesthetised enough that I was able to step back, explain the reason I hadn't immediatley stopped while they were yelling at me and calmed the situation enough to then obtain a nurse to hold the back leg for an IV under GA which finished the job.

Some nurses may cope in such a situation, but if a complaint arose, the practice would certainly be in no position to defend itself were such a situation to occur with no vet on the premises.

Was somewhat difficult to then take the final client of the day through for another PTS... Which fortunately was totally uneventful.

Re: Can an RVN do this?

Andrew Kent — Sat, 12 Feb 2011 18:03:58 GMT

I am certain that none of the nurses I work with would have done this unless directed to do so by a vet, even then I think it unlikely we would direct them to do this in our absence.

I am surprised that any nurse would think it appropriate to perform this without seeking advice and I would think it vital that the nurse be spoken to at this stage as I would be worried about this happening again or about her overstepping the mark in other areas if she has no understanding of where the boundaries are!

Andy

Re: Can an RVN do this?

Alan Tevendale — Sat, 12 Feb 2011 17:28:46 GMT

The issue of disciplinary action regarding nurses as I believe it is still a little grey. Maybe someone else could clarify the issue?

Re: Can an RVN do this?

Kate Richardson — Sat, 12 Feb 2011 15:34:04 GMT

Gosh, I would be furious too! Like has been said, what if something had gone wrong? Agree, yes he/she can do it, but absolutely should not have done without speaking to you first. Definitely would be speaking to the boss about this one, head nurse or not.

On an aside, my understainding is that registered nurses are now responsible for their actions now and can face disciplinary action including being struck off now?

Re: Can an RVN do this?

Evelyn Barbour-Hill — Sat, 12 Feb 2011 14:56:54 GMT

As someone has already said, there's something wrong with the practice culture if the nurse should even consider acting like that.

Re: Can an RVN do this?

bob lehner — Sat, 12 Feb 2011 13:41:58 GMT

Barbiturates for euthanasia are all categorised as POM -V (Sch 3 CD) :

POM-V Prescription only medicine – veterinarian. A medicine, to be supplied only on veterinary prescription, which must be prescribed (either orally or in writing) by a veterinarian to animals under his care following a clinical assessment, and which may be supplied by a veterinarian or pharmacist in accordance with the prescription.

Clearly a VN has no authority to use these products off her own bat.

Re: Can an RVN do this?

Alan Tevendale — Sat, 12 Feb 2011 11:53:19 GMT

Agree with Gillian and Bob on this one. If one of my nurses had done this they would be getting a extremely stern warning. IMO if anything had gone wrong then the situation could have become very difficult for the practice.

Re: Can an RVN do this?

Hannah Wynne Richards — Sat, 12 Feb 2011 11:34:15 GMT

My understanding of the law is that a RVN is technically competant to euthanase-but has no legal authority to use pentobarb without a direct order from a veterinary surgeon. I would be furious as well, and as there could be very serious legal issues,then the nurse should be reprimanded

Wynne

Re: Can an RVN do this?

Edward Jones — Sat, 12 Feb 2011 11:22:30 GMT

Legal matters: Who prescribed the injection? How did the nurse have access to the drug? (I was under the impression that only vets should have access to the controlled drugs but I might be wrong - edit: sorry, I forgot that pentobarb is exempted from the requirement of safe custody).

Practical matters: I'm not nearly as confident as many of the previous posters on this thread that an RVN is necessarily experienced enough to carry out euthanasia on their own. Okay, so an RVN who can start an animal on a drip obviously has the technical skill for a lethal injection - if everything goes right. But, if a drip goes wrong then really the worst thing that can happen is a swollen leg (infusion rate errors notwithstanding), but the consequences of failed IV pentobarb can be much more difficult to deal with - or am I the only one who's had a couple of nightmare-inducing euthanasias?

Re: Can an RVN do this?

Richard Stephenson — Sat, 12 Feb 2011 11:18:05 GMT

This raises a number of interesting questions.

Firstly euthanasia is NOT an Act of Veterinary Surgery so I think that this is possibly not contrary to the law. However the use of a veterinary medicine (a barbiturate) to perform euthanasia without veterinary supervision might well be an issue - you are probably aware that the RSPCA has recently withdrawn euthatal from use by its inspectors for this reason.

I think the best approach would be to sit down with all concerned and put in place a practice protocol so that staff know the correct boundaries. Animal welfare has to be the number one consideration but in the circumstances that you describe there was no dire emergency and a Veterinary surgeon should have been in a position to supervise the procedure (I think at the very least on the premises). We all know that euthanasias can sometimes go wrong, catheters can come out or be incorrectly placed, and it is at these times that a Vet needs to be there. There is also the issue of being certain that the client has consented after being properly informed.

I'm sure that both the RCVS and VDS would be delighted to give you advice as to a practice protocol.

Yours,

Richard Stephenson.