Veterinary nursing is a relatively new profession in Norway, as in many other European countries. Veterinary clinics have had people filling the role of veterinary ‘nurses’ for many years, but an organized, educated and properly trained group of professionals working as veterinary nurses/technicians has only existed in Norway since 1991.
Much has happened in the last 15 years, both in the education of veterinary nurses and in the legislation governing professionals working with animals.
This article aims to give an account of the developments that have occurred in Norway regarding the veterinary nursing profession, the legislation for authorization of the profession, the education and the future challenges being met for the continuing education of veterinary nurses in Norway.
Union work
The state educational department decided in 1995 that the Norwegian Veterinary Nurse and Assistants Association had to change its name as the title of veterinary/veterinarian was now protected and only to be used for veterinary surgeons (S-115/96, Lovdata 2001).
The association, therefore, changed its name to The Association for Animal Nurses and Technical Staff.
The increasing number of members encouraged the association in 1996 to contact the country's leading labour union organization in the hopes of joining. The members were very interested in getting a collective pay agreement in order, as employment conditions were highly varied and not optimal. Unfortunately, the animal nurses' association was rated as having too few members for the union to want to spend time and resources in attempting to get a collective pay agreement in place for them.
So, in 1999 the association decided to refrain from union work and only act as an interest-organization.
How it beganIn 1991 a small group of dedicated people working at small animal veterinary clinics, saw a need among their colleagues for a common meeting ground to discuss work-related issues, problems and challenges in the work place, the desire and need for organized training and possibilities for education. They were a small group, but they were ambitious for their ‘profession’ and had a deep-rooted desire to learn more and achieve more for their professional group.As a result the association for veterinary assistants, as they were referred to at the time, was established in 1991 (Norwegian Veterinary Nurse and Assistants Association, 1991). Three of the association's board members worked at the Norwegian School of Veterinary Science (NVH), in the small animal department. They worked determinedly and gained support in the institute's administration to put pressure on the government, in the hopes of gaining funding for starting a veterinary nurses course/programme at the veterinary school.Nationally at this time, there were unemployment issues, which the government were under pressure to find solutions for. As a step towards meeting these demands the government allocated funds for projects aimed at increasing job possibilities and other measures for decreasing unemployment.With the pressure from the veterinary assistants' association and the head administration of the vet school the government allocated enough funds to the school to start a 1-year course in veterinary nursing. The first students were admitted the autumn of 1994 and upon graduation in 1995 received a diploma for completing the 1-year course of veterinary nursing.
The fight for legislation and authorization
Attaining adequate legislation and authorization for the professional group has been an important part of the Norwegian School of Veterinary Science and the Association for Animal Nurses' work.
Gaining authorization would mean the profession would become legally recognized and thereby incorporated in the law governing veterinarians and other animal health personnel (Lovdata 2001). The profession's legal rights and responsibilities would become more regulated as a result.
The first application for authorization was submitted in 1995 but it was denied as a 1-year course was not deemed a sufficient qualification, albeit at university level. Hindsight, and comparison to other authorized professions in Norway, such as medical nurses with their 3-year course, tells us that this application was premature.
In the year 2000 the existing legislation concerning veterinarians and other health personnel was revised, leaving an opening for a renewed application for the authorization of veterinary nurses. Along with this new application, an application for a protected professional title was also submitted.
During the winter of 2001/2002 the new legislation was out for review and in 2002 veterinary nurses were granted authorization under the new legislation for veterinarians and other health personel (Lovdata, 2001).
The new protected title for the profession was ‘Dyrepleier’ (veterinary nurse/technician). Around the same time the Association for Animal Nurses changed its name again to the present day's name of Norwegian Veterinary Nurse and Assistant Association (Norwegian Veterinary Nurse and Assistants Association, 1991).
The authorizing governmental body became Mattilsynet (Department of Food Safety) in September 2003 (Lovdata, 2003; Norges Veterinærhøgskole, 2010).
Present day challenges
Many challenges remain before we can consider ourselves adequately satisfied with the legislation such as it is today. We need to continue to work for an improved legislation, a fairer legislation and also a much more specific legislation.
The problems we are facing at present are a result of a legislation that is much too general in its wording. It is too vague to be of any real practical help for acting as a legal guidance for the profession and its employers. The profession is referred to in such a manner that professionals become, in many instances, no more than an extension of the veterinary surgeon's arm. For example, there are no specified areas of responsibility, and no listed competences specified for veterinary nurses. The only reference to specified competences in the legislation concerns veterinary surgeons, including areas of responsibility viewed as exclusive to the veterinary profession (Lovdata, 2001).
As an example, most veterinary nurses/technicians administer treatments to hospitalized animals, however, according to the legislation the actual competence of penetrating skin is not a competence specified in the authorization. This means that in strict accordance to the law, the veterinary nurse is not authorized to inject an animal without doing so under veterinarian supervision, even if this supervision is indirect.
This is obviously not the situation in most clinics and hospitals. The veterinarians prescribe treatment and nurses administer it. However, with the authorization worded as it is, this results in the veterinarian being legally responsible and the veterinary nurse being no more than any other uneducated, unauthorized person aiding the veterinarian (Regelhjelp, 2010).
‘We need to supply the nurses/technicians that the market needs almost before the market is aware of the need’
Therefore, both the Norwegian School of Veterinary Science (NVH) and the Norwegian Veterinary Nurse and Assistant Association (NVNAA) are working to improve the wording in the legislation. In order to achieve this NVH and NVNAA need to formulate the desired changes to the bye-laws that apply to veterinary nurses. This is then sent to the Department for Food Safety and the State Agricultural Department with an application for a bye-law alteration.
Applying for bye-law alterations is easier than applying for an alteration to the entire law as these are revised every 10–20 years and the threshold for initiating extensive changes before the revision time is very high.
The text needs to be much more specific and needs to list specific competences expected to be executed professionally and independantly by veterinary nurses.
In lieu of this one may ask oneself what is the point is in the present day authorization? There is a point and a very important one — namely a legal recognition of a profession. This brings with it legal rights, legal responsibilities and ethical responsibilities for the professionals exercising their profession as stated in paragraph 23 of the law (Lovdata, 2001).
However, there is an additional challenge and that is that there are many non-professionals working in veterinary practices and according to the present legislation and wording in the authorization law, the distinction between the two are indistinct at best.
Paragraph 15 of law 2001-06-15-75 (Lovdata, 2001), governing veterinarians and other animal health personnel, covers the use of a ‘helper’. It states that the use of such a helper is acceptable as long as he/she has been given adequate training by the vet in order to safely perform any desired task. This is vague and can be misused in practice. Situations that can result in conflict include where a veterinary nurse has to refuse to perform certain duties due to lack of qualifications (e.g castrating a male cat) but where a ‘helper’ having been given training, is permitted to perform this task; even with indirect supervision.
Due to the fact that the nurse is authorized, performing such a task makes the nurse legally responsible for the act. An unauthorized helper is not bound by these legal restrictions, here the legal responsibility falls on the veterinarian.
Having a more specific and exact wording in the legislation and authorization bye-laws will help make the distinction between authorized nurses and unauthorized helpers more clear in practical terms, not just relating to legal ramifications, should complications occur, for example, following a possible cat castration.
Norway has an economical agreement with the European Union, even though we are not full members of the EU. This means that according to national law, even with regards to authorization legislation, any person coming from a country within the EU, and having a qualification with a title comparable to veterinary nurse, automatically gains authorization to work in Norway as a veterinary nurse/technician.
There is no quality control of the qualifications of these nurses and we have experienced that certain countries have very little focus on small animal nursing in their programmes. This leads to a challenge for these nurses in Norway, as most of the jobs presently available are in small animal clinics and hospitals. There are also wide differences in theoretical knowledge between vocational schools and universities and the authorization does not illustrate any differences in the criterion for competences and knowledge. Hence, it is an additional difficulty for prospective employers to adequately judge the level of knowledge and competence of foreign educated nurses (Lovdata, 2009).
Educational aspect
This leads us to the educational aspect of the profession and the challenges we, as educators, meet every day. Norway has one educational programme for veterinary nurses/technicians and it is at university level at the NVH.
The programme started as a 1-year course in 1994. In 2003, the programme was extended to become a 2-year course. The students were given 22 weeks additional theoretical teaching and 12 weeks additional practical training at the school. In addition, the students were also placed at seeing-practice clinics to gain 27 weeks of practical training (Box 1).
Box 1.Veterinary nursing programme at the Norwegian School of Veterinary Science (NVH):
- Started as a 1-year course in 1994.
- In 2003, the programme was extended to become a 2-year course.
- The students were given 22 weeks additional theoretical teaching and 12 weeks' additional practical training at the school.
- In addition, the students were also placed at seeing-practice clinics to gain 27 weeks of practical training.
The demands from the job market influence the development of the programme as do European demands such as the Bologna process and directives from the EU (Ministry of Education and Research, 2010a and 2010b).
The programme director and coordinator need to develop the programme and keep it dynamically evolving at a pace ensuring we are ‘ahead’ of the market. We need to supply the nurses/technicians that the market needs almost before the market is aware of the need. The changes that have occurred in the past 10 years within the work market for veterinary nurses/technicians in Norway are stupendous. The large majority of clinics did not previously employ veterinary nurses/technicians. The typical clinic assistant was female, uneducated, with a deep-rooted love for animals, underpaid, working primarily with reception duties, cleaning and other basic and menial tasks (Johannesen, 2007).
The clinics were not initially very interested in receiving students and it was, at times, a difficult task to get all the students placed in seeing-practice clinics. NVH was not in a position to pay the clinics for accepting and training students, so at this time clinics did not see the benefits of taking in students.
The situation today is completely different. There are still many clinic assistants as described above, but now clinics are contacting the school requesting students. One of the biggest clinics in Norway employs nurses almost exclusively from NVH, as they are interested in nurses with the ability to specialize within certain fields, e, g. diagnostic imagery, anaesthesia and rehabilitation. It is very rewarding as educators to see that the nurses/technicians that we educate are in demand. It is certainly an indicator that we are doing something right.
However, we are acutely aware that it is very important for the profession that we have a collaboration with other educators/schools within Europe. Internationalization is becoming an everyday term, people travel more and more, European borders are becoming more ‘invisible’ and work-emigration within the EU more and more common. Not to mention the fact that an increasing number of students are choosing to get their education abroad.
This takes us back to the challenge of nurses/technicians educated abroad and a comprehension of their level of ability and skill.
Realizing the limitations of the Norwegian authorization legislation the veterinary nurse/technician programme at the NVH looks to Europe. The programme joined the Veterinary European Transnational Network for Nursing Education and Training (VETNNET) in 1997. Many European schools are members of VETNNET, and a collaboration and exchange of ideas, questions, solutions, challenges is now underway, as well as emerging projects (VETNNET, 1997).
NVH joined one such collaborative project called Dasvent. This was a project that aimed to create an inter-European standard for competences/skills for veterinary nurses in Europe. After 2 years of intense work the project had generated a Dossier of Competences and a document called Accreditation Policies and Procedures (APP).
The Dossier is a document of competences that acts as a minimum level of competence for a veterinary nurse/technician (ACOVENE, 2009). The APP is a guideline for evaluating educational programmes for veterinary nurses/technicians (ACOVENE, 2009).
To continue this work another foundation was created: Accreditation Committee for Veterinary Nurse Education (ACOVENE).
ACOVENE is an organization that accredits veterinary nurse education programmes in the EU. ACOVENE was established as a foundation in 2007 to address the need for a European accreditation system. Each country has its own way of educating veterinary nurses, but the competences of veterinary nurses throughout Europe are broadly comparable (ACOVENE, 2009).
The work is still not finished as a new project is being finalized at the start of September 2010. This project, pan-European practical assessment system (PEPAS) has developed a pan-European exam based on an objective structured clinical exam format (OSCE).
The objective of PEPAS is to complement the European standard for competences by establishing a common European evaluation method ensuring a comparable level of graduating nurses within Europe (PEPAS, 2008). If the project is successful and European veterinary nursing schools make use of the Pepas exam system, this may go a long way to standardizing the competency level of veterinary nurses in Europe.
Summary and discussion
This article has looked at the development of educating veterinary nurses/technicians in Norway over the past 16 years. The work done in order to achieve a formal recognition of the profession by establishing legislation governing the authorization of veterinary nurses and the ensuing challenges.
The importance of international collaboration in increasing an awareness round the profession, creating a job market for educated veterinary nurses and the continuing education of these professionals was also mentioned.
The veterinary nurses/technician's programme at NVH is very clear in its ambitions and goals for the future. It is important to keep collaborating with other schools across Europe, every day striving to improve the programme and thereby improving the nurses graduating. This again creates a need in the job market, which the programme can then fill. We are seeing the need for specialization and we need to work further on filling this demand within such areas as rehabilition, nutrition, ethology, hygiene, diagnostic imagery and anaesthesia.
The limitations of the Norwegian legislation is also of the utmost importance for NVH to work towards improving. We need more specific authorization where competences are listed as requirements in order to acquire authorization.
Education is not a static affair, it is dynamic and we want a dynamic legislation that reflects an evolving profession comparable to the legislation governing authorizing medical nurses.
The medical nurse legislation stipulates that a nurse is authorized to perform all skills/competences that the nurses are trained for during their education. The educational programmes are accredited by the Norwegian Agency for Quality Assurance in Education (NOKUT) and the state health department, thereby ensuring a quality assurance of the skills and competences taught (NOKUT, 2010).
This will then help with the quality control issues we experience when nurses educated abroad gain the same authorization, even if their education has a limited focus on small animals. With an authorization legislation that stipulates that one is authorized to perform the skills one has been educated in, and not in skills one has had no training, it will aid employers in knowing who to employ for different jobs. NVH is therefore continuing to work for an authorization comparable to medical nurses.
We need foundations like ACOVENE, projects like PEPAS and a continuing European collaboration through VETNNET. The continuing education of veterinary nurses, and increasing the need for such professionals within an expanding work market, is important and an important goal for us as educators.