The new disciplinary procedures introduced on 1 April 2011 for registered veterinary nurses are the latest outcome of the discussion and debate over veterinary nurse regulation which has been taking place within the profession for a number of years. In 2004, the veterinary profession, together with Lantra (the Sector Skills Council for veterinary nursing), sponsored a manpower survey relating to veterinary nursing. The survey not only indicated that veterinary nurses believed that there was a need for an enforceable system of regulation for their profession, but it demonstrated that veterinary nurses wished to enhance their professional status (Lantra, 2004). In recent years, veterinary nursing has indeed gained increased status and recognition as a profession.
‘By becoming regulated, the veterinary nursing profession demonstrates to the public that it is willing to set standards and maintain its own professional skills.’
The members of many professions, for example, lawyers, accountants, doctors and nurses, are regulated, and the main purpose of regulation is to protect the public from those who are unfit to practise. The regulation of a profession requires both a means of identifying the profession's members, and a mechanism in place to prevent from practising those whose behaviour falls far below the profession's standards. Members of the public using the services that professionals provide also expect professionals to adhere to set standards.
In September 2007, a significant step was taken towards veterinary nurse regulation with the opening of the non-statutory Register of Veterinary Nurses under powers in the Royal College of Veterinary Surgeons' (RCVS') Royal Charter. The introduction of complaint and disciplinary procedures represents a further milestone. The RCVS hope that once these voluntary arrangements for regulation are well established, and new veterinary legislation is in place, statutory regulation for veterinary nurses will be achieved.
By becoming regulated, the veterinary nursing profession demonstrates to the public that it is willing to set standards and maintain its own professional skills and knowledge. The acceptance of professional responsibility through a code of conduct, continuing professional development (CPD) and a disciplinary system is something in which registered veterinary nurses (RVNs) can take pride.
What does the disciplinary system cover?
As with veterinary surgeons, these disciplinary procedures deal only with serious professional misconduct, which means behaviour that raises a question about that person's fitness to practise. Some things, such as dishonesty, for example, in case discussions with clients, or being convicted of theft, clearly involve issues of serious professional misconduct. Although it is not possible to draw up a list that would fit every single circumstance, the Guide to Professional Conduct for Veterinary Nurses sets out expectations about professional behaviour, and RVNs are expected to know and stick to the Guide.
Although it will not apply to most RVNs, criminal convictions can also affect fitness to practise, so veterinary nurses are asked when they register, and annually thereafter, to declare any convictions for the RCVS to consider. The RCVS will also remove from the Register anyone fraudulently registering as a veterinary nurse.
How does the disciplinary system work?
When the RCVS receives a complaint, there are four consecutive stages it may go through. Each stage acts like a filter, determining whether that complaint will be taken further, or closed:
- Assessment — decides if a complaint against an RVN raises an issue that could constitute serious professional misconduct
- Investigation and case examination — gathers information from the people involved and decides if the allegations have substance
- VN Preliminary Investigation Committee (VN PIC) consideration — decides if there is a case which needs to be referred to a VN Disciplinary Committee hearing. Under the new Health Protocol, some complaints involving health-related fitness to practise may be dealt with by the VN PIC, rather than going to a public hearing
- VN Disciplinary Committee (VN DC) hearing — a tribunal that decides on the facts, whether serious professional misconduct is proved, and says if any action will be taken. VN DC hearings are held in public. If a complaint is closed before it reaches VN DC, the RCVS might advise the RVN, and tell the complainant the nature of the advice given, but can apply no other sanction.
What about genuine mistakes?
Everyone can make mistakes and even if the outcome is serious it is still very unlikely that a straightforward mistake will amount to serious professional misconduct. If a mistake is repeated or reckless, the RCVS may need to investigate, but it is more likely that this will be a matter for the nurse's employer, rather than the RCVS.
How will trivial or unfounded complaints be handled?
If you are an RVN and a complaint is made, do respond constructively. Sometimes your response will show that there has been a misunderstanding, however, not responding to complaints could itself raise questions about professional conduct.
Even though the RCVS must consider all complaints that fall under its jurisdiction, it can — and in the case of vets, already does — close complaints at the first stage of the disciplinary procedure if they clearly do not involve serious professional misconduct.
In complaints which could constitute serious professional misconduct, the alleged facts are investigated thoroughly. This includes listening to the different people involved and obtaining evidence. If the complaint results in a VN DC hearing (a tribunal at which the RVN is entitled to use legal representation), the Committee will consider the evidence put forwards by both the College and the respondent nurse, and judge what the facts are, and whether they amount to serious professional misconduct. No sanctions can be applied unless the charges are proven and serious professional misconduct found.
Is negligence included?
Negligence means that the treatment of an animal by a veterinary nurse was below the standards expected of a reasonably competent member of the profession, and was to the detriment of the animal. However, unless negligence was so serious as to constitute serious professional misconduct, then it would not come under the disciplinary procedures.
It could be pursued in a civil court and, if quantifiable and consequential loss or damage were proved, the court could order payment of civil damages or compensation.
What insurance do RVNs need to cover negligence claims and RCVS complaints?
The Guide requirement is that RVNs must have professional indemnity insurance, either through their practice or as an individual. The Veterinary Defence Society (VDS) insures the majority of veterinary surgeons practising in the UK, and its policies have always covered the negligent actions of practices' non-veterinary employees, including RVNs.
The VDS now offers a policy to RVNs that provides support should a complaint be made to the RCVS on professional conduct grounds. RVNs whose practices are covered by another professional indemnity insurer are advised to check with the provider whether it can offer appropriate cover for individuals.
How are complaints handled when vets and RVNs are involved?
If there is both a vet and an RVN involved in a case, then the preliminary investigation of both will be taken in tandem but the disciplinary hearings will be separate. Veterinary surgeons and RVNs have different responsibilities — as indicated by their respective Guides — and so what constitutes serious professional misconduct may also be different.
What involvement have RVNs within the complaints process?
Several RVNs will manage and oversee the complaints process, along with RCVS staff. At the first stage of the process, the RCVS Professional Conduct Department can also close complaints. This department has legally qualified staff, and will seek the advice of an RVN when there are clinical aspects to complaints.
The VN PIC will include three RVNs, as well as a lay observer and a veterinary surgeon. Two other RVNs will also join existing members of the RCVS Disciplinary Committee to form the VN DC.
Are RVNs or vets to be held responsible for complaints involving other practice employees or students?
As an RVN, if you line manage, or supervise, or are otherwise responsible for someone's work, you must make sure that person is legally entitled and competent to do what you ask. This is similar to the situation that has always existed for veterinary surgeons; now, in some circumstances, responsibility may be shared between an RVN and their supervising veterinary surgeon.
It is also possible that your line manager may ask you to do something you know you should not. If this happens, try to talk to them and resolve the problem; if this does not work, then let your practice principal know. You can also ask for advice from RCVS Professional Conduct Department staff.
Will records of complaints against an RVN be kept by the RCVS?
Yes; although the RCVS does not generally give information to the media about complaints unless and until they result in a Disciplinary Committee hearing, complaint files will be kept by the RCVS and the VN PIC will be told of previous complaints against an RVN.
Are CPD requirements included?
Compliance with CPD obligations is more likely to be taken into account in a complaint about something else, than to be the focus of a complaint. RVNs need to complete and record on their CPD Record Card 45 hours of CPD averaged over any 3-year period (i.e. an average of 15 hours per year) and the RCVS's current approach is to offer support and guidance to help RVNs complete suitable CPD.
What is the difference between being struck off and being suspended?
An RVN who is struck off and wants to be restored to the Register must apply and the VN DC will consider whether they can be restored. Applications for restoration can only be made 10 months after the strike-off date.
An RVN who is suspended will be automatically restored to the Register once the period of suspension finishes.
How will RVNs' roles change if they are struck off or suspended?
The Veterinary Nurses Council is keen that veterinary surgeons be advised not to delegate Schedule 3 tasks to nurses who have been struck off or suspended, and this advice has been included in the new draft Code of Professional Conduct for Veterinary Surgeons, currently open for consultation. VNs can take part in this consultation and comment on the draft Code online at http://www.rcvs.org.uk/about-us/consultations — so please make your views known.
Struck off or suspended RVNs may not use the post-nominals ‘RVN’. How else their role is affected will mainly depend on their employers.
How can struck-off RVNs be differentiated from other VNs on the List?
For all VNs who qualified after 1 January 2003, joining the non-statutory VN Register is a condition of joining the VN List. Others can opt to join, and there are now only 1540 VNs remaining on the List: around 85% of those eligible to register have done so. A separate section of the List/Register will differentiate listed VNs who have not yet registered from those removed from the Register.
VNs can be removed from the List/Register for not paying their retention fees. This is not part of any disciplinary procedure and, once restoration fees are paid, their names will reappear as before.
Why are struck-off RVNs going to stay on the List?
The position is not ideal, but legal advice counsels against removing a veterinary nurse from the List as well as the Register. The RCVS is seeking a change to the law.
Can RVNs appeal if they consider they have been treated unfairly?
The VN DC will operate to standards of proof similar to those found in the criminal courts and will be assisted by a legal assessor. An RVN who is unhappy with a decision to remove or suspend his or her name can appeal and this will be heard by an independent, senior barrister or solicitor.
If a complaint is closed before reaching the Disciplinary Committee, complainants may also ask for a review of the RCVS's decision.