It is internationally accepted that the veterinary medical profession requires individual registration, a standard level of qualification and a commitment to continuing professional development (CPD) to maintain professional competency and good standing. This premise is reflected in various national veterinary council guidelines around the world including the Australasian Veterinary Boards Council Inc (2014) and the Royal College of Veterinary Surgeons (2014a). In this regard veterinary medicine is similar to other health professions, including human medicine and nursing. Generally there is a legal requirement for all human health professionals that use a widely recognised title to be qualified. For example, in New Zealand, professionals working in an industry using titles such as doctor, nurse, dental technician and physiotherapist need to be qualified, adhere to guidelines set out by their governing organisation and follow agreed terms of membership (Health Practitioners Competency Assurance Act 2003 (NZ)). Human health professionals administer medications and perform various procedures on individuals that if done incorrectly could negatively impact that individual's wellbeing. While veterinary nurses do not directly impact on human health, their actions can still have serious consequences for both animals and humans in the workplace, especially when considering they are regularly dealing with controlled and cytotoxic drugs, radiography equipment and hazardous chemicals. For example, the Code of Professional Conduct for Veterinary Nurses published by the Royal College of Veterinary Surgeons (RCVS) clearly states in section 6.1: ‘Veterinary nurses must seek to ensure the protection of public health and animal health and welfare, and must consider the impact of their actions on the environment’ (Royal College of Veterinary Surgeons, 2014b).
Despite these responsibilities, there are no standardised international requirements that allow formal recognition of veterinary nurses. This is despite an increasing likelihood, at least from a New Zealand perspective, that people will travel and work overseas on an annual basis (MacPherson, 2013). Like wise, there is no consistent terminology used internationally to describe someone working as a veterinary nurse. The USA uses the term ‘veterinary technician’, whereas New Zealand, Australia, the Republic of Ireland and the UK use the term ‘veterinary nurse’. Furthermore, these closely related terms are often referred to as ‘veterinary paraprofessionals’, meaning those that work alongside a veterinarian to deliver veterinary care to animals. This term however is misleading as it has been argued that veterinary nurses are professionals in their own right, and need to be recognised as such (Hamlin, 2013). For ease of understanding, this article will use the term veterinary nurse unless specific exceptions need to be made.
Current practice requirements for veterinary nursing
To understand the currently legal status of veterinary nurses internationally and the progress made, or being made toward registration, it is necessary to understand the status of veterinary nurses in a range of countries.
New Zealand
The New Zealand Veterinary Nursing Association (NZVNA) acts as the representative body for veterinary nurses in New Zealand. Each of the countries discussed has its own representative body (Table 1). It provides CPD guidelines and an ‘Accredited Veterinary Nurse Programme’ as a means of formally identifying veterinary nurses who undertake a minimum amount of CPD (New Zealand Veterinary Nursing Association, 2012). It also supplies a ‘Code of Professional Conduct for Veterinary Nurses’. However, membership and adherence to their terms is entirely voluntary. Also, there is no current legislation restricting the use of the title ‘veterinary nurse’ to qualified staff, and as such, any lay person working in a veterinary clinic can call themselves a veterinary nurse.
Table 1. Summary of regulatory bodies and associations for veterinary nurses
| Veterinary Nursing Association | Regulatory board for veterinary nurses | |
|---|---|---|
| New Zealand | New Zealand Veterinary Nursing Association | No statutory regulatory board |
| United States of America | National Association of Veterinary Technicians in America | Varies state by state |
| United Kingdom | British Veterinary Nursing Association | Royal College of Veterinary Surgeons |
| Australia | Veterinary Nurses Council of Australia | Veterinary Surgeons Board. Government of Western Australia (WA) (registration only available in WA) |
| Republic of Ireland | Irish Veterinary Nursing Association | Veterinary Council of Ireland |
United States of America (USA)
Veterinary nurses in the USA are referred to as veterinary technicians. To work as a (and use the title) veterinary technician a formal education or qualification (it varies state by state) it is not necessarily needed. However; a veterinary technician qualification, bearing in mind qualifications vary between different institutions and states from certificate to degree level (American Veterinary Medical Association, 2014), enables the technician to sit the Veterinary Technician National Exams (VTNE). Passing this examination will then enable the technician to register with that state's governing board, and use the credentials ‘Certified Veterinary Technician’ (CVT), ‘Registered Veterinary Technician’ (RVT) or ‘Licensed Veterinary Technician’ (LVT), depending on the state. These titles are protected by state legislation and their specific credentialing requirements vary from state to state. It is worth noting that there are a few exceptions where states do not offer veterinary technician training. In these states it is possible to apply to sit the VTNE via on the job training (The National Association of Veterinary Technicians in America (NAVTA), 2011a). The tasks and procedures a credentialed veterinary technician can legally perform also vary slightly from state to state, and registration in one state does not necessarily infer registration in another state. In summary, the use of the title veterinary technician is not regulated, but the use of RVT, CVT or LVT is (The National Association of Veterinary Technicians in America (NAVTA), 2011a).
UK
The Royal College of Veterinary Surgeons (RCVS) has in place a non-statutory register for qualified veterinary nurses (Royal College of Veterinary Surgeons, 2013a). This means that while the RCVS governs the status of veterinary nurses in the UK and can remove the title of Registered Veterinary Nurse (RVN) from an individual, they have no ability to remove them from the industry.
To become a Registered Veterinary Nurse (RVN) in the UK, you need to have a recognised veterinary nursing qualification at diploma or degree level (Royal College of Veterinary Surgeons, 2014c), pay the annual registration fees, complete regular CPD and adhere to the RCVS Veterinary Nurse Code of Professional Conduct. Those veterinary nurses qualified but not registered can apply to have their name held on a list and are referred to as ‘listed’ veterinary nurses. These listed veterinary nurses do not have the CPD and Code of Conduct requirements that come with registration. To perform Schedules 3 tasks, as detailed in the Veterinary Surgeons Act 1966, veterinary nurses must be either listed or registered.
The RCVS's 3 year strategic plan for 2014-16 includes revising the RCVS Royal Charter in order to bring veterinary nurse regulation more in line with that of veterinary surgeons, including the requirement for all veterinary nurses (not just those currently registered) to undertake professional development and be accountable for their professional conduct (Royal College of Veterinary Surgeons, 2014d).
As mentioned previously, RVNs who breach the code of conduct can, via process of a disciplinary committee, have their name removed from the register by the RCVS (Royal College of Veterinary Surgeons, 2013b). They can still work as a veterinary nurse and call themselves a veterinary nurse as the title of ‘veterinary nurse’ is not protected by legislation; however, they can no longer use the title of RVN.
Australia
The Veterinary Nursing Council of Australia (VNCA) oversees their optional membership of veterinary nurses (similar to the optional membership offered by the NZVNA). The exception being the state of Western Australia, which has introduced compulsory registration (Veterinary Surgeons Act 1960 (WA) s 26E). Veterinary nurses in the other Australian states can take part in an ‘Accredited Veterinary Nurse’ scheme run by the VNCA that resembles the New Zealand Accredited Veterinary Nurse Programme. Qualified veterinary nurses (Certificate IV) who are current members of the VNCA and complete a minimum requirement of CPD can choose to apply for Accredited Veterinary Nurse status. As mentioned, Western Australia (WA) has compulsory registration for anyone wanting to work as a veterinary nurse (Veterinary Surgeons Act 1960(WA) s 26E). It requires minimum qualification standards and restricts certain tasks to qualified veterinary nurses only, for example monitoring anaesthetics, simple dental extractions and suturing (Veterinary Surgeons Regulations, 1979).
Republic of Ireland
Of the five countries discussed, the Republic of Ireland is the only country to have compulsory statutory registration of veterinary nurses. The use of the title ‘veterinary nurse’ is also protected by law. To register as a veterinary nurse in this country, it is necessary to obtain a recognised veterinary nursing qualification from the training providers recognised by the Veterinary Council of Ireland, or have it assessed as being equivalent. Registration brings with it a requirement to complete a minimum level of CPD each year (Irish Veterinary Nursing Association, 2010). Legislation for veterinary nurses in the Republic of Ireland also includes details of tasks that are able to be carried out by a registered veterinary nurse (Veterinary Practice Act, 2005).
Is there a need to change and how could this be achieved?
Comparing these five countries (see Tables 2 and 3), there are clear differences in the way they recognise veterinary nurses (although direct comparisons between qualifications is difficult, as different countries use different qualification frameworks). Having consistent requirements for veterinary nursing registration worldwide would make the profession more cohesive and allow an individual's qualification to be more internationally transferable. Any qualification and registration would still however need to be governed by a registration authority within each country, defining what veterinary nurses can or cannot do according to that country's legislation. Furthermore, minimum standards of the qualifications, recognised at an international level, would also allow for easier registration of veterinary nurses and facilitate the transfer of registration overseas (Table 3). These are two major areas of the profession which require more in-depth investigation for the future of the veterinary nursing profession.
Table 2. Comparison of qualifications and registration of veterinary nurses
| Country | Lowest level of qualification to work as a veterinary nurse | Lowest level of recognised veterinary nursing qualification | Is there compulsory registration to work in the industry | Is there optional registration to work in the industry | Are certain titles restricted to use by registered veterinary nurses only? |
|---|---|---|---|---|---|
| New Zealand | None | Certificate | No | No | N/A |
| Australia | None | Certificate | No* | No | N/A* |
| United States of America | None | Associate Degree | No | Yes | Yes |
| United Kingdom | None | Diploma | No | Yes | Yes |
| Republic of Ireland | Advanced Certificate | Advanced Certificate | Yes | No | Yes |
Registration is compulsory in Western Australia
Table 3. Requirements to work/register overseas
| To work in New Zealand (no registration) | An individual can work as a veterinary nurse in New Zealand without registration or qualification |
| To work/register in Australia (registration only in Western Australia (WA)) | To work: an individual can work as a veterinary nurse in Australia (with the exception of WA) without registration or qualification.To register in WA: an individual must hold a recognised veterinary nursing qualification from their home country, and have it assessed as equivalent to the Cert IV available in Australia |
| To work/register in the USA | To work: fulfil the requirements of individual state registration. This usually means holding a recognised veterinary nursing qualification from their home country, and completing the NVTE assessment |
| To work/register in the UK | To work: an individual can work as a veterinary nurse in the UK without registration/listing or qualification. To register: an individual must hold a veterinary nursing qualification from their home country that is recognised in the UK and in some circumstances, complete a practical examination |
| To work/register in the Republic of Ireland | To work: an individual must be registered as a veterinary nurse with the Veterinary Council of Ireland. To register: an individual must hold a recognised veterinary nursing qualification from the Republic of Ireland, or have their home qualification assessed for equivalency |
Registration is preferable to non-registration as it allows the profession to be recognised and regulated; it facilitates the enforcement and maintenance of minimum standards and ensures registered veterinary nurses keep up to date with the on-going changes in an ever evolving industry. It also ensures that veterinary nurses qualified in a different country are required to prove competency according to the regulations and practices of the country they are entering and intend on working in.
For consistency within the profession(s) there is a need to give value to qualified veterinary nurses. This is possible through compulsory registration and protecting the use of the term ‘Veterinary Nurse’ (or suitable alternative title), which would also help to clarify the actions and tasks able to be suitably undertaken by a veterinary nurse. This is currently the practice in the state of Western Australia, the Republic of Ireland and some states of the USA, which may provide a reasonable option to the rest of Australia and New Zealand, which do not currently have any mechanism by which the profession can be recognised. For example New Zealand could initially adopt a system similar to that in the UK whereby voluntary registration protects the use of the term Registered Veterinary Nurse. The NZVNA is already looking into this option and is working towards implementing compulsory registration, but so far has found this difficult due to government opposition (New Zealand Veterinary Nursing Association, 2012). The process of formal registration is a long and complex one that would require statute changes to the Veterinarians Act 2005. The NZVNA is a representative body; however the Veterinary Council of New Zealand could act as the governing body for veterinary nurses as well as veterinary surgeons in a similar way that the RCVS act as the governing body for both veterinary surgeons and veterinary nurses in the UK. This is a process that is seen by the NZVNA, the New Zealand Veterinary Association (NZVA) and the Veterinary Council of New Zealand as one that is worth undertaking (Gibson, 2009). The NZVNA applied to the New Zealand government for formal registration in 2010, and this was denied (New Zealand Veterinary Nursing Association, 2012). They are continuing to investigate the options for formal registration and in the meantime are in the process of investigating the viability of optional registration, as is the current system in the UK. Adoption of optional registration would contribute to an increase in professionalism within the industry, making veterinary nurses united in their goals and conduct, and increase the public safety standard, and could pave the way to compulsory registration. Hopefully, the industry in New Zealand will get to the point where compulsory registration (and statutory regulation), like that implemented in the Republic of Ireland, becomes a reality.
Veterinary nurses who are engaged in practice and willingly involve themselves in CPD will help to maintain the profession to a high standard. However, if a country has no compulsory requirement for veterinary nursing CPD there is little incentive beyond the personal satisfaction of the individual veterinary nurse to complete any formal CPD training. As a result, there will always be a subset of the profession that do not attend CPD events. These individuals could potentially be utilising practices taught to them that are no longer current, or may have entered into the profession prior to formal qualifications becoming as widespread and accepted as they are now. The role of veterinary nurses has evolved over time from a cleaning and reception role, to that of a fully involved member of the veterinary healthcare team, valued for the clinical skills they can undertake (for example dental prophylaxis, radiology, nursing consultations, anaesthesia maintenance and pain management) and the knowledge they can contribute to clinical debates and discussions. Veterinary nurses generally monitor, maintain and recover animals from anaesthesia (a high risk procedure with potential for serious negative consequences if not performed properly). Veterinary nurses are also often the member of staff within a veterinary clinic responsible for communicating vital information regarding the use of veterinary medications, animal nutrition and basic behaviour to clients.
‘Veterinary nurses who are engaged in practice and willingly involve themselves in CPD will help to maintain the profession to a high standard’
Currently, there is no clear way for the general public to differentiate between qualified and unqualified veterinary clinic staff in New Zealand, and it is also reasonable to assume confusion among veterinarians as to what certificate vs. diploma qualified veterinary nurses are trained and competent to do. While there is no legal differentiation in the tasks a certificate vs a diploma nurse can undertake within a veterinary clinic in New Zealand, there are differences in the level of training they have received. In New Zealand, the certificate course is a 1-year course, generally focusing on basic animal health and husbandry, with a small amount of practical and theoretical nursing study. The diploma is a 2-year course, with the second year of study involving much more clinical experience and learning. There is also no formal requirement for veterinarians to ensure that veterinary nurses in their employment are undertaking regular up skilling and CPD. Registration (particularly statutory registration or regulation) would bring with it a heightened understanding within the veterinary industry about the differing levels of veterinary nursing qualifications, and the importance of veterinary nursing CPD.
When considering veterinary nursing registration, there is not just the veterinary nursing profession to consider, but also what impacts registration may have on veterinarians, and veterinary practices. Will veterinary nursing registration affect the way veterinarians delegate work, and will this potentially influence stress levels experienced by clinic staff? Will veterinary nursing registration have any financial impact on veterinary clinics? Will registration lead to greater job satisfaction for veterinary nurses?
One major step to formally registering the veterinary nursing profession in New Zealand is the streamlining of the various qualifications available. Fortunately this process has already begun, with the New Zealand Qualifications Authority and the Animal Nursing and Technology Board working with the NZVNA, the NZVA and educational institutes to standardise the veterinary nursing qualifications across the different providers. This will allow students to transfer more readily between courses should their areas of interest/circumstances change and it will allow veterinarians to know what a student has been taught regardless of where the study was undertaken. It will also make it easier for New Zealand graduates to be able to register with the relevant governing bodies in other countries as there will be a standard nationwide curriculum which is more readily assessable for overseas equivalency. For example, at present not all the veterinary nursing qualifications available through New Zealand educational providers are automatically recognised in the UK (Royal College of Veterinary Surgeons, 2014e). This process to standardise the qualifications is likely to be completed in 2015, ready for a roll-out of the new education framework in 2016. Perhaps a similar idea of streamlining veterinary nursing qualifications could be undertaken at an international level, allowing nurses trained in one country to work and register in another. However, this would not be an easy process.
‘Registration allows for the governance of individuals within the profession and increases the responsibility of veterinary nurses to maintain a high standard of practice and professional care.’
What does this information mean for veterinary nurses and the veterinary industry in New Zealand?
Veterinary nursing qualifications are not widely recognised outside the industry. The public, in particular, as users of veterinary services do not have a clear way of knowing if the staff entrusted with the care of their animals are qualified and keeping their practical skills and theoretical knowledge up to date. Do the public assume veterinary nurses are registered, as are their human counterparts?
As with any industry, the potential pros and cons of registration for veterinary nurses need to be looked at, particularly whether any potential disadvantages outweigh the advantages. This is a topic for a much broader discussion, but a few of the key areas relate to the possible increased costs due to liability of veterinary nurses, the impact of compulsory CPD, and whether veterinary nurse registration increases or decreases veterinarian stress due to the ability to delegate more responsibility to veterinary nurses who are accountable for their actions in a clinic.
Further things to explore
- What percentage of veterinary nurses worldwide are qualified is unknown as there is no specific recording for qualified vs. non-qualified veterinary nurses.
- What systems need to be put in place to up skill veterinary nurses who are not qualified to a diploma or degree level, for countries like New Zealand if they are considering transitioning to a registered working population.
Conclusion
In conclusion there is a need to explore the viability of both an internationally standardised qualification (or set of qualifications) and registration of the veterinary nursing profession both in New Zealand and overseas. This is vital for ensuring the professionalism of the veterinary nursing industry as well as providing confidence in the profession to maintain minimum qualification and professional development standards. Registration allows for the governance of individuals within the profession and increases the responsibility of veterinary nurses to maintain a high standard of practice and professional care. However, regardless of how much the industry would like, and feel the necessity of registration in New Zealand, it is not going to happen easily or quickly.