Clinical education and preceptor-led training in practice are integral parts of both human and veterinary nursing courses (Elliott, 2002; McClure and Black, 2013; Holt et al, 2022). A preceptor interacts with and instructs the student in the clinical facility (Smith and Sweet, 2019). In student veterinary nursing education, the preceptor role for the support of pre-registration students is fulfilled by their clinical supervisor (also termed clinical coach, mentor or assessor). In the UK, the Royal College of Veterinary Surgeons (RCVS) Standards Framework for Veterinary Nurse Education and Training specifies that ‘all students are allocated a clinical supervisor responsible for confirming competency of RCVS Day One Skills for Veterinary Nurses’ (RCVS, 2022a:55).
The COVID-19 pandemic has had a significant impact on clinical education. In human healthcare, the challenges of continuing practical training with social distancing, isolation and workforce shortages have been demonstrated (Dewart et al, 2020). Anecdotally, veterinary nursing education is thought to have faced similar challenges, which remain beyond the end of the periods of UK government furlough and domestic legal restrictions, which were in place from March 2020 until February 2022 in England (Brown and Kirk-Wade, 2022), until April 2022 in Scotland (Scottish Government, 2022) and until May 2022 in Wales (Welsh Government, 2022).
The RCVS report on the effect of the COVID-19 pandemic on veterinary nursing (Robinson et al, 2021) states that 40.2% of registered veterinary nurses had to self-iso-late. There was strong agreement that compounding the effect on staff numbers, there has been an increase in caseload as a result of new animal ownership (Robinson et al, 2021), an increase confirmed by recent People's Dispensary for Sick Animals (PSDA) data (YouGov, 2022). When asked what needed to be changed, a common theme was that practices were understaffed and needed more registered veterinary nurses (Robinson et al, 2021). Furthermore, in a 2021 RCVS survey of European veterinary professionals working in the UK (Roberts and Robinson, 2023), there was strong agreement that the UK veterinary profession is experiencing recruitment difficulties due to Brexit. The combination of these circumstances has significant potential to impact the clinical education of student veterinary nurses in practice.
This aim of this research was to explore the current (April 2022) and recent (from the onset of the COVID-19 pandemic in March 2020 and immediately before this) capacity for clinical supervisor-led training of student veterinary nurses in primary care and referral veterinary practice and the factors contributing to this. Specifically, to assess whether training managers have experienced a reduced capacity for student veterinary nurse training defined by: (i) difficulty appointing clinical supervisors; and (ii) clinical supervisors reporting an inability to fulfil the role and explore reasons for the reduced capacity if it exists.
Methods
This was a prospective, cross-sectional survey-based study, approved by the RCVS Ethical Review Panel. The inclusion criteria for participation were being a registered veterinary nurse (UK practicing) and fulfilling the supervisory role of training manager in a UK primary care or referral practice in a major employers group. Veterinary surgeons were not included as it was known that there were no veterinary surgeons that held the position of training managers. This was purposive sampling, as the training manager has oversight and management of the clinical supervisors and student veterinary nurses within their practice.
The study used an online 15-question questionnaire (Table 1), including a question to gain informed consent and to assess eligibility. Two questions collected demographic data on the type of practice (referral or primary care) and number of student veterinary nurses employed or on placement. The subsequent multiple-choice questions explored capacity for clinical supervisor-led student veterinary nurse training before (prior to March 2020), during and after the COVID-19 pandemic period of significant UK government domestic and workplace restrictions and the difficulties encountered. Respondents could select multiple options and enter free text under ‘other’ and in a final open question asking for comments. The questionnaire was piloted by two registered veterinary nurses who were not participants or authors of this study.
Table 1.
Questionnaire used in the cross-sectional survey of capacity for clinical supervisor-led training of student veterinary nurse training in veterinary practices in the UK
| Question | Answer options |
|---|---|
| 1. I understand participation in this study is voluntary and anonymous. By completing this questionnaire I consent to participate in this study | Tick box for consent |
| 2. I confirm that I am a registered veterinary nurse (UK practising) and a trained clinical supervisor/coach | Tick box to confirm eligibility |
| 3. What type of veterinary practice do you work in? |
|
| 4. How many student veterinary nurses do you have at the moment? Include college and university students in this number | Open text field to complete |
| 5. During the COVID-19 pandemic, have you found it difficult to find clinical supervisors for your student veterinary nurses? |
|
| 6. If your answer is ‘yes’ what are the reasons for this? Check all that apply |
|
| 7. During the COVID-19 pandemic, have your clinical supervisors reported that they have difficulties fulfilling their clinical supervisor role? |
|
| 8. If your answer is ‘yes’ what are the reasons for this? Check all that apply |
|
| 9. If you have selected ‘A lack of time’ in question 8 please select the factors that contribute to this. Check all that apply |
|
| 10. Have you had to revise your student numbers due to lack of clinical supervisors during the COVID-19 pandemic? |
|
| 11. If you have had answered ‘yes’ to question 5 or 7 (difficulty finding clinical supervisors, or fulfilling their role), when was this? Tick all that apply |
|
| 12. If you have had answered ‘yes’ to question 5 or 7 (difficulty finding clinical supervisors, or fulfilling their role), did you experience this before the COVID-19 pandemic? |
|
| 13. Do you have to turn down enquiries into student veterinary nurse placements and/or employment? |
|
| 14. If you could have more clinical supervisors, with dedicated time to fulfil the role, would you take on more students? |
|
| 15. Please add any comments that you feel are relevant to this questionnaire or where you have put ‘other’ as your answer | Open text field to complete |
A link to the electronic questionnaire was circulated in April 2022 by email. Before completing the survey, all respondents read a study summary, including confirmation that all responses would be anonymous. Participants had 4 weeks to respond. The email was sent to 105 practices that were training practices with 105 contacts. 105 participants met the inclusion criteria.
Microsoft Excel was used to undertake descriptive data analysis, which was conducted using relative and absolute frequency measures for categorical and median 25th and 75th percentiles for quantitative variables. Free-text responses were recorded and themes were broadly interpreted, however as the purpose of this study was not to perform qualitative exploration, they were not analysed with a systematic qualitative methodology. Selected free-text responses and themes are highlighted in the results.
Results
A total of 58 registered veterinary nurse training managers took part in the survey – practice demographics are presented in Table 2.
Table 2.
Veterinary practice demographic data for the 58 study participants: proportion of respondents working in referral and primary care practice and average number of student veterinary nurses employed or on placement in the practice at time of survey completion
| Type of practice (n=58) | Number of practices (%) | Average number of student veterinary nurses median [25th, 75th percentiles] |
|---|---|---|
| Primary care practice | 48 (83%) | 2 [2.0,5.0] |
| Referral practice | 10 (17%) | 4 [2.25,5.75] |
A small majority (57%; n=33) did not find it hard to find a clinical supervisor during the COVID-19 pandemic. For the 43% (n=25) that did, ‘qualifying staff being reluctant to be a clinical supervisor due to other work commitments’ (n=21) was the most selected reason (Figure 1). Two respondents selected ‘other’, reporting a ‘higher workload associated with increased number of pets…’ and ‘time is the biggest factor…’.
Response of 25 training managers to reasons for difficulty finding clinical supervisors for student veterinary nurses during the COVID-19 pandemic.
A large majority of respondents selected that the clinical supervisor reported difficulty fulfilling their role during the pandemic (86%; n=50). ‘A lack of time’ was the most selected reason (n=46) (Figure 2). Three respondents selected ‘other’, reporting ‘Increasing workload and expectations…’, ‘The system is new to myself and most of the nurses, so things are taking slightly longer’ and ‘Practice split into “teams” and students and clinical coach…didn't see each other’.
Response of 46 training managers to reasons clinical supervisors had difficulty fulfilling their role during the COVID-19 pandemic.
Those who selected ‘a lack of time’ as a cause of difficulty fulfilling the clinical supervisor role, commonly selected ‘time taken up with other nursing responsibilities’ (n=41) as the reason (Figure 3). Two respondents selected ‘other’, reporting ‘low staff ’ and ‘increase in workload’.
Response of 46 training managers to reasons clinical supervisors had a lack of time leading to difficulty fulfilling their clinical supervisor role during the COVID-19 pandemic.
Of the respondents who reported challenges with clinical supervisor-led training of student veterinary nurses during the pandemic, 27 reported that they experienced the same challenges (either difficulty appointing clinical supervisors or with clinical supervisors fulfilling the role) before the pandemic. Of these, 19 reported increased challenges during the pandemic and a minority (n=7) reported that challenges remained at the same level as before the pandemic. Only one respondent reported challenges continued but decreased during the pandemic.
Most respondents stated that they had not had to revise their student numbers because of a lack of clinical supervisors during the pandemic (78%; n=45), a minority selected that they decreased (16%; n=9) or increased student numbers (6%; n=4). A majority (69%; n=40) reported that at the time of completing the questionnaire, they were turning down enquiries into student veterinary nurse placement/employment. In total, 41% (n=24) reported that they would take on more student veterinary nurses if they had more clinical supervisors with dedicated time to fulfil the role, 36% (n=21) were not sure and the remaining 22% (n=13) responded that they would not.
The free text responses to question 12 (‘Please add any comments that you feel are relevant to this questionnaire or where you have put ‘other’ as your answer’), were broadly interpreted to identify seven themes, and selected responses are presented in Table 3.
Table 3.
Broadly interpreted themes and selected responses from free text around reasons for difficulty appointing clinical supervisors or difficulty fulfilling the clinical supervisor role
| Theme | Quote |
|---|---|
| Not enough time | ‘I think we also need to make sure we only take on students when we can honestly give them the time and care they deserve during their course…’ |
| Stress/anxiety associated with clinical supervisor role | ‘We have had a few clinical coaches back out of coaching due to the added stress of work over the last few years who have felt they either did not have the mental capability to carry on or would only carry on for a monetary benefit….’ |
| Lack of reward | |
| Increased challenges due to COVID-19 pandemic | |
| Staff absence | ‘Sickness/absence has been the biggest factor in this. Scheduling time for meetings is easy but fulfilling them when one or more nurses are absent becomes extremely challenging.’ |
| Requirements of training college are difficult to accommodate | ‘One of the things I have found hardest as in question 8, is understanding the college side of things…’ |
| Other priorities for own learning and development | ‘…not all staff want to be clinical coaches as they wish to focus on other qualifications etc.’ |
Discussion
The results of this study demonstrate that during the COVID-19 pandemic, there was reduced capacity for clinical supervisor training of student veterinary nurses in some practices, both referral and primary care, primarily as a result of clinical supervisors finding it hard to fulfil their role and to a lesser extent because of difficulty appointing clinical supervisors. This reduced capacity existed before the pandemic and continued beyond the end of significant COVID-19 domestic and workplace restrictions. Respondents reported that they were continuing to turn down enquires into student veterinary nurse placements in April 2022 and indicated they would take on more student veterinary nurses if they had more clinical supervisors with time to fulfil the role.
Factors affecting the ability of the registered veterinary nurses to fulfil the role of clinical supervisor
The results of this study indicate that, in clinical veterinary nursing education, reduced capacity for clinical supervisor-led student veterinary nurse training primarily arises from clinical supervisors finding it difficult to fulfil their role, mainly attributed to time taken up with other nursing duties. In human clinical nursing education, researchers have highlighted the need for recognition of the time needed to effectively supervise students and the challenging, time-consuming nature of the role (Mekgoe et al, 2019; Barrett, 2020). The American sociologist William Goode's long-standing theory of ‘role strain’ (Goode, 1960) provides a framework for understanding the pressures healthcare preceptors experience. ‘Role strain’ occurs when an individual has difficulty meeting the obligations associated with their different roles (Goode, 1960). In a study of human healthcare preceptors, ‘role strain’ was identified as the primary challenge for preceptors, with work hours, patient numbers and the challenge of balancing conflicting clinician and educator responsibilities cited as causes (Henning et al, 2008; Dodge et al, 2014). Applying this theory, a registered veterinary nurse who occupies the role of clinical nurse and clinical supervisor may experience conflicting priorities, resulting in ‘role strain’. Indeed, for those study participants who selected that they found it difficult to find clinical supervisors during the COVID-19 pandemic, the most popular reason was registered veterinary nurses having a reluctance to take on the role due to other work commitments and ‘stress/anxiety associated with the role’ was a theme identified in the free text responses with the word ‘stress’ being repeated by multiple respondents, suggesting that some registered veterinary nurses may anticipate the potential negative impact of taking on multiple roles.
Interestingly, in human healthcare preceptors, it has been shown that experiencing role strain meant providing feedback to students was challenging (Dodge et al, 2014). In the present study, participants reported difficulty scheduling meetings with the student veterinary nurse, suggesting a similar issue. In fact, some participants indicated putting into practice the university/college requirements was generally a challenge and it can be speculated that working hours, patient numbers and balancing nursing and educator responsibilities could be reasons for this. Interestingly, only a minority of participants in the present study found that the college and university requirements were difficult to understand, which contrasts with a recent survey exploring training and preparedness of UK veterinary nursing clinical supervisors for their role (Holt et al, 2023), which found that the majority (82.5%) of participants felt unprepared after their training to perform the role of clinical supervisor. It may be that this feeling of unpreparedness was not related to a lack of understanding of university/college requirements, or it is also possible that the training managers surveyed in this study did not accurately represent the feeling of the clinical supervisors, possibly because the clinical supervisor would be reluctant to mention a lack of understanding to the training manager.
Factors affecting recruitment to the role of clinical supervisor
For participants who reported difficulty finding a clinical supervisor to fulfil the role, ‘reluctance due to other work commitments’ and ‘no additional benefit (eg moral or other recognition such as bonus/uplift in salary)’ were the most popular reasons. Across healthcare professions, it has been demonstrated that there are many contributing factors to professional fulfilment and job satisfaction (Rosenthal and Frank, 2006; Shanafelt et al, 2014; Shanafelt et al, 2016; Simpkin et al, 2019), including being treated with respect, feeling valued by leadership and a supportive environment (Simpkin et al, 2019). Though monetary reward can demonstrate value, evidence suggests that rewards such as flexibility or protected time to pursue meaningful aspects of work are also important, leading to greater professional fulfilment (Rosenthal et al, 2006; Shanafelt et al, 2016). In this study, the most selected reason for difficulty recruiting clinical supervisors was reluctance because of other work commitments, highlighting the importance that registered veterinary nurses place on having sufficient time to properly fulfil the role and suggesting an association with their job satisfaction. In the free text, one participant indicated further monetary benefit is needed to take on the role, particularly because of the increased stress of the pandemic. Satisfaction with salary was strongly associated with intention to leave the profession in a study of registered veterinary nurse retention in the UK from 2014 to 2019 (Jeffery and Taylor, 2022), indicating that monetary reward will also contribute to job satisfaction in some cases. Participants also reported ‘low numbers of staff who qualify to be a clinical supervisor’. In 2021, 54% of registered veterinary nurses leaving the profession had been registered for 10 years or more (RCVS, 2022b) and it may be that if more experienced registered veterinary nurses are leaving the profession, some practices could be left with predominantly registered veterinary nurses who are fewer years qualified and less able to take on the clinical supervisor role.
The effect of the COVID-19 pandemic
A significant proportion of participants in this study reported that the challenges of appointing clinical supervisors and difficulties faced by clinical supervisors fulfilling their role existed both before the COVID-19 pandemic and beyond the period of significant workplace and domestic government restrictions (Figure 4), with a majority turning down enquiries into student nursing placement/employment at the time of the survey (April 2022). For many, these challenges worsened during the pandemic, with ‘staff isolating due to illness or isolation’ being chosen by 21 participants as a reason for the lack of time to fulfil clinical supervisor responsibilities. This is in accord with the RCVS report on the impact of COVID-19 (Robinson et al, 2021), in which there was moderately strong agreement with the statement ‘it has been hard to supervise student veterinary nurses adequately’ (mean score 3.75/5). Apart from the effect on resources and staff numbers through self-isolation or furlough, several studies have highlighted the impact of the pandemic on staff wellbeing and levels of burnout in the veterinary profession (Beetham et al, 2021; Monticelli et al, 2023). It is apparent that the effect of COVID-19 on the veterinary profession is significant, and the exacerbation of the challenges in clinical supervisor-led student veterinary nurse training reported by the participants in this study, is likely to be multifactorial, associated with both resourcing and staff wellbeing, the influence of which appears to be ongoing in some practices.
Frequency of selection of the years in which challenges were encountered by registered veterinary nurse training managers who reported clinical supervisors had difficulty fulfilling their role or they had difficulty finding clinical supervisors during the COVID-19 pandemic.
Limitations
Having 58 respondents recruited using purposive sampling means that care should be taken in extrapolating these results across the veterinary nursing profession. Nonetheless, the results of this study provide an initial evidence base for future research and innovations to clinical nursing education. Future studies could include a qualitative exploration of this subject, using the themes identified here to inform the study design.
Conclusions
This study indicates that, for some, there was a reduced capacity for clinical supervisor-led training of student veterinary nurses throughout the COVID-19 pandemic, primarily as a result of lack of time to fulfil the role because of other nursing responsibilities. The challenges of preceptor-led clinical veterinary nursing education appear to have existed prior to April 2020 and a reduced capacity still exists beyond the end of the pandemic for some, with problems having simply been exacerbated by the pandemic. There was a suggestion that additional reward for taking on the role has become more important because of the effect of the COVID-19 pandemic on staff wellbeing. Future studies are needed to explore factors associated with job satisfaction in the profession following the pandemic, including the relationship between professional fulfilment and being involved in clinical veterinary nursing education. It could be beneficial to consider innovative models of clinical supervisor-led student veterinary nurse training in practice, that address the time-consuming nature of the role and the strain that may occur through fulfilling both a clinical and educator role.
Key points
- During the COVID-19 pandemic there was reduced capacity for clinical supervisor training of student veterinary nurses in some practices, both referral and primary care. This reduced capacity existed prior to the pandemic and continued beyond the end of significant COVID-19 domestic and workplace restrictions.
- The reduced capacity for clinical supervisor training of student veterinary nurses was primarily due to clinical supervisors finding it hard to fulfil their role and to a lesser extent due to difficulty appointing clinical supervisors.
- Reduced capacity for clinical supervisor-led student veterinary nurse training primarily arises from clinical supervisors finding it difficult to fulfil their role, mainly attributed to time taken up with other nursing duties.
- It could be beneficial to consider innovative models of clinical supervisor-led student veterinary nurse training in practice, that address the time-consuming nature of the role and the strain that may occur through fulfilling both a clinical and educator role.