Reviewing the emotional climates of student veterinary nurses completing industry placements

All student veterinary nurses are required to undertake 1800 hours in industry placement (Royal College of Veterinary Surgeons (RCVS), 2020), gaining their practical skills alongside their knowledge and licence to practice. This study examines how student veterinary nurses (SVNs), from two cohorts of a foundation degree (FdSc) course in veterinary nursing from one education provider felt during their industrial placement year and whether the preparatory support was sufficient during their time in veterinary practice. As an industry should we be doing more to support the emotional wellbeing of our students and preparation for practice in their industry placement year, which has a set number of hours and practical skills in competency as a requirement of RCVS registration?

Mental health has been highlighted within the veterinary profession (Mind Matters, 2021; Mind Matters International, 2021; RCVS 2022), especially during the COVID-19 pandemic (Mind Matters International, 2021; World Health Organization, 2021). However, prior to this, there was already a noticeable trend within veterinary nursing programmes, where some students struggled to cope, unable to manage the stress and upset that comes with ‘the job’ and this ultimately taking a toll on their mental wellbeing (Black et al, 2011; Fraser, 2018). Both cohorts' industry placement experience in this study was impacted by the COVID-19 pandemic. This most likely impacted the study findings but made us consider how we can strengthen the preparation for, and support of, our SVNs during their clinical period.

Research suggests that many veterinary nurses would describe their job as stressful (Black et al, 2011; Williams and Robinson, 2014; Fraser, 2018; MMI 2021; RCVS 2022). The role of the registered veterinary nurse (RVN) and SVN is varied and includes practical skills and knowledge in a range of topics, as well as communication skills to understand owner's needs. Subject knowledge is important but so is looking after themselves and recognising how emotions and mental wellbeing may impact them (Fraser, 2018). Veterinary nurses need to have clear, realistic expectations and preparation around the potential experiences they will encounter in the role both prior to their industry placement and post qualification. Research by Fraser (2015; 2016; 2018) highlighted that students felt that they were cushioned from the reality of practice and respondents in these studies felt that they would have had a better experience had this been embedded within the course provision. Furthermore, within the literature, post-qualification RVNs experience disillusionment and attrition within 1 year of entering the profession (Black et al, 2011; Fraser, 2018) from occupational stress and burnout.

The types of problems faced by SVNs and RVNs include balancing work-life, excessive workload, emotional upsetting and stressful situations, including euthanasia and difficult clients (Black et al, 2011; Fraser, 2018; MMI 2021; RCVS, 2022). Veterinary nurses should demonstrate empathy and compassion, but on-going emotional demands and euthanasia can all contribute to compassion fatigue, occupational stress and poor job satisfaction (Black et al, 2011). Preparing student veterinary nurses for industry placement should be multi-faceted and include developing self-awareness, resilience and recognition of needing support. The first year of theory helps teach the authors' students the underpinning knowledge and RCVS Day One Skills and Competences they will need to start their work placement. This means students have achieved a certain level of skills and knowledge where they are able to carry out a range of basic tasks expected of a SVN on day one. They then build on these skills as they progress through their work placement. However, Fraser (2018: 132) suggests we should also consider ‘being personally prepared’. In line with the RCVS Code of Professional Conduct for Veterinary Nurses (RCVS, 2012), being prepared for clinical practice also includes the ability to look after themselves, including recognising the emotional and mental strain that the job may bring (Fraser, 2018) and reaching out for help. Training programmes for SVNs should move towards treating each student individually by identifying their strengths and weaknesses to help them identify how they will deal with a variety of different, and potentially difficult and stressful, situations (Fraser, 2018). This could potentially be completed through a range of scenarios or individual tutorial sessions prior to placement. In addition, Black et al's (2011) study showed that the social support system is integral within the veterinary team: particularly the role of clinical coach in helping to identify and support staff who are feeling upset, tired or fatigued. Lack of perceived social support was instrumental in student and qualified veterinary nurses feeling socially isolated with low job satisfaction (Black et al, 2011). The early identification and implementation of a range of support systems that can help ensure students' feel supported is key. The veterinary environment can be inher-ently stressful and demanding, as veterinary professionals often deal with euthanasia and end-of-life care, economics, staff shortages, and even bullying in the workplace (Silverwood, 2021). While occupational stress is not a unique concept relating to human or animal health care, unique occupational stressors, such as euthanasia, do exist within the UK veterinary profession (Lloyd and Campion, 2017). Debriefing after a stressful situation, such as euthanasia (Shaw, 2020), enables appraisal of the event and will likely promote an adaptive rather than a maladaptive style of coping (Fletcher and Sarkar, 2013).

Resilience is defined as the ability of an individual to adjust to adversity and continue to move on in a positive manner (Jackson et al, 2007; Kerrigan, 2018) or ‘recover quickly’ (Lloyd and Campion, 2017: 5). It can also be considered as ‘adaptability or robustness’ (Oxford English Dictionary, 2021) and is an important skill for everyone to learn (Mills, 2016). Learning and growing from past mistakes and the ability to be flexible and in control of our emotions all contribute to resilience and the ability of students to thrive within veterinary practice. The process of resilience building is learnt (Crowe, 2017) and therefore this can be incorporated into programmes (Kerrigan, 2018) prior to and during industry placement to help prepare SVNs for their future careers. The skills of the clinical coach to identify and promote positive and supportive relationships between them and the student, as well as the students' resilience, are fundamental during this critical time. Finally, organisations can also develop systems at work (Kerrigan, 2018) that encourage resilience: good regular interactions between team members are important as they enable members to know when colleagues are experiencing difficulty within or outside the workplace, thus enabling additional support if required.

Methods

This research was focused on students' industry placement in veterinary practice's located across the UK as part of their FdSc Veterinary Nursing programme at University Centre Askham Bryan (UCAB) in York.

The industry placement is undertaken within the 2nd year of the FdSc academic year, and this research sought to explore the emotional experiences of two cohorts of students completing their degree with UCAB (academic cohorts 2019–20 and 2020–21). The research aimed to identify if any other areas of preparatory support were required, so that this could be addressed in a timely manner to improve student experience.

Two online questionnaires (pre-placement: 22 questions; post-placement: 58 questions) using Google Forms were distributed amongst two cohorts (2019–20 n=41; and 2020–21, n=44) of FdSc SVNs. The opening page explained the context of the research and how the results could impact on the future design and delivery of UCAB FdSc veterinary nursing. The questionnaire was adapted from the Royal College of Nursing (2020) ‘Helping Students get the Best from their Practice Placements' using the Casey-Fink Readiness for Practice Survey.

Closed questions were used to gain absolute clarity in some key areas, but for other questions relating to emotional indicators a ‘tick all that apply’ option was used. The questionnaire was anonymous and was not time bound and allowed participants to return to their responses after an initial period of reflection.

Statistical analysis of the results was not warranted as this was primarily research identifying themes (from patterns of commonly repeated words such as emotions) and areas of additional support that education providers could provide, which the students identified within the two questionnaires in long answer format. Therefore, percentage figures were considered an appropriate measure to help identify areas that could be used to evaluate improvements or areas that needed further support to guide our provision and preparatory support in the future. All participants were asked for consent prior to completing the questionnaire, and the opportunity to withdraw this consent was made available to them at any time. The anonymised responses were securely held, and the research was approved by the research panel and board at UCAB prior to commencing the study.

Results

For this study, the responses generated a sample size of n=54 (pre-placement) (2019–20 n=29, and 2020–21 n=25) and n=41 (post-placement) (2019–20 n=22, and 2020–21 n=19) out of a total possible number of 85 SVNs (2019–20 n=41, and 2020–21 n=44). All responses were anonymised.

Results from the question ‘List three skills from the non-clinical list where you feel you would benefit from more education’ in the pre-questionnaire for both cohorts is shown in Table 1. The top three key themes identified by SVNs were bereavement and emotive situations, dealing with stress and resilience training and looking after their mental health. There was an increase from 24% in 2019–20 to 40% during 2020–21 in SVNs requiring further help with their mental health (at the height of the COVID-19 pandemic). The percentage decrease in areas requiring further support between the 2019–20 and the 2020–21 cohort for bereavement (decrease 16%) and resilience training (decrease 36%) was interesting to note. Between these cohorts, the education provider in this study piloted an adapted tutorial programme that included some revised guidance and training for clinical supervisors, and a specifically designed template to provide a scaffolding towards these discussions as a toolkit to improving resilience. The results suggest that this was a useful tool.

Table 1.

Results from one of 22 questions from the pre-placement questionnaire over two years prior to completing the industry placement year.

Footnote: This helped identify areas where students required further support, with the top three key themes identified as animal euthanasia and emotionally agility around bereavement, building resilience and mental wellbeing. It is interesting to note the jump in mental health concerns during 2020–21 mid-way through the COVID-19 pandemic

Results from a range of questions from the post-placement questionnaire are presented in Table 2 for both cohorts. Scores under 65% are highlighted. These areas were identified for immediate improvement between the two cohorts as a mid-study intervention through support, training or further education and interventions applied (adapted tutorial program and revised guidance and training for clinical coaches). The results indicated that students would benefit from protected time with their mentors and required support around animal euthanasia and building resilience.

Table 2.

Key results from a sample of 58 questions across the industry placement year in veterinary practice.

Footnote: Results have been derived from a combination of closed questions and categorical options where student veterinary nurses (SVNs) were invited to record their emotional responses. The responses to both the closed questions and categorical options, were then triangulated with the literature to form the evidence base which suggested that students would benefit from robust preparatory support for the clinical environment that encompasses the development of resilience, protected time with their clinical coaches and a focus on support and guidance when working with euthanasia cases.

Table 3 identifies positive emotions that the FdSc SVNs experienced during their placement year in veterinary practice. Emotion results are taken from the post-placement questionnaire. Positive emotions over 65% are highlighted and the top three positive emotions were happiness, excitement and confidence.

Table 3.

Positive emotions that the SVNs experienced during their placement year

Footnote: positive emotions over 65% are highlighted in bold and the top three positive emotions were happiness, excitement and confidence.

Table 4 identifies negative emotions that the FdSc SVNs experienced during their placement year in veterinary practice. Emotion results were taken from the post-placement questionnaire. Negative emotions over 65% are highlighted and the top three negative emotions were sadness, anxiety and stress.

Table 4.

Negative emotions that SVNs experienced during their placement year

Footnote: Negative emotions overs 65% have been highlighted in bold. The top three negative emotions are sadness, anxiety and stress.

Discussion and limitations

In response to findings and interpretation of the data collected, and the trends emerging mid-study, the development of self-paced learning materials on topics such as neurodiversity, resilience, bullying and incivility and managing stress were developed and shared with students. In addition, the adaptation of the tutorial framework used for students engaging in the clinical period included the signposting of positive reframing aspects underpinned by mindfulness theory. The interventions were implemented prior to the completion of the data collection. As trends in the data were appearing, refinements to the student preparations and support mechanisms were implemented immediately. This was so the authors could have an immediately positive effect. These refinements included adaptations of the guidance provided to clinical coaches and also adaptations of the tutorial paperwork.

SVNs highlighted that they required further support with euthanasia. This particularly impacted students as it required dealing with their own emotions in addition to those of the owners', whilst maintaining professionalism. Other areas of additional support were identified as resilience building and looking after their mental wellbeing. Additional support measures were implemented including structured focused tutorial sessions using interactive platforms such as ‘near pod’, role play scenarios, euthanasia support by the course manager when they assisted with their first euthanasia, and time set aside for reflection in practice. The effectiveness of these additional support measures is demonstrated in a percentage reduction between the two cohort academic years in Table 1 (16% reduction for bereavement and 36% reduction for resilience training support between the two cohorts after the implementation of the additional support measures). Additional support sessions also cover self-care, mental health awareness, mindfulness and resilience training.

The clinical coaches' ability to spend time with their SVNs requires a top-down approach from the practice management. This can be rectified with the assistance of the practice by ensuring students meet their clinical coach, have regular meetings organised throughout, and are able to work alongside their clinical coach for at least 2 hours per week, although this may be challenging due to work-force shortages (British Veterinary Association, 2021; RCVS, 2021) and increased pet ownership (British Veterinary Association, 2021). As an outcome of this research, a new tutorial programme was piloted with SVNs during the placement as an additional support measure for both the SVN and their clinical coach. The emerging results have been fed back to industry to assist training clinical coaches in supporting SVNs further during their placement year in industry.

Emotions and how SVNs cope on a day-to-day basis were important aspects to explore because the nature of the job requires compassion and a caring disposition. The top three positive emotions had increased for the 2020–21 cohort and at the end of the industry placement year were happiness (100%), excitement (100%) and feeling more confident (84%), possibly leading to a ‘rich and rewarding career’ (Coates, 2015:364). However, the negative emotions also increased between the two cohorts, with the top three negative emotions that a SVN must consider prior to starting this career sadness (89%), stress (89%) and an increased feeling of anxiousness (84%). These are important emotions to highlight, as students need to consider whether this is the right career path for them and be given the tools to help manage negative emotions. The increase in the number of students declaring mental health concerns prior to starting a career which is ‘stressful’ (Black et al, 2011; Williams and Robinson, 2014; Fraser, 2018; MMI, 2021; RCVS, 2022) and deals with complex themes such as bereavement and euthanasia, is a concern. Educational providers have a duty of care to ensure each student is fully aware of the reality of the job and how they might feel, so that they can make informed choices and have the right tools to manage self-care, mindfulness, build resilience and look after their mental wellbeing. COVID-19 may also have contributed to an underlying emotional climate, particularly those that were considered negative emotions. Research (Essadek and Rabeyron, 2020; Meda et al, 2021; Owens et al, 2022) has already highlighted increased mental health issues that were impacted by lockdowns and may be a limitation of this research. Other limitations included that the mid-study interventions could have impacted the results, the small sample size, only including SVNs from two cohorts completing one qualification pathway, responses were from one education provider, and due to anonymity, the authors were unable to compare individual pre- and post-placement response rates. In addition, reflection may also have affected the results. Despite the preparatory support, a collection of emotions associated with positive and negative reactions were reported by participants. These emotional responses should inform the direction of travel of the non-clinical preparatory support provided.

The authors recommend repeating this research with the online questionnaire adapted by UCAB with other educational establishments to help identify themes or areas requiring further support to ensure a standardised and high-quality experience for students studying veterinary nursing. As the questionnaire was anonymous, it is unknown how many students answered one or both questionnaires, but this should be addressed if the research continues. Further ways to delve into detail would be conducting focus groups, as this will enable identification of further preparatory support and whether the implemented additional support measures are useful and should be included as a toolkit across SVN education.

Conclusions

SVNs undertake a considerable period of time completing practical training in clinical practice. During this time, a range of emotive and stressful encounters will be experienced. All education providers should evaluate their own provision and ensure they provide preparatory support to students ahead of the clinical placement period to help prepare students for the practice environment. Preparation should be considered in its widest context and include both clinical and non-clinical support and guidance. Within the non-clinical preparation, education providers should consider developing the resilience of students, in readiness for experiencing a range of emotional reactions. Going forward, the authors will review the success of the research using the revised tutorial system to improve resilience and their ability to manage the stressful scenarios within clinical practice and continue to adapt our preparatory support measures.

KEY POINTS

• Emotions that featured highly in the study included anxiety, stress, and sadness, and may potentially expose student veterinary nurses (SVNs) to increased risk around emotional wellbeing.
• It is worth noting that happiness, excitement, and increased confidence also rated extremely highly, which may lead to the feeling of a rich and rewarding career.
• Students could benefit from protected time with their clinical coach in addition to increased support measures around animal euthanasia and building resilience.
• Educational providers should embed building resilience, raising mental health awareness and self-care measures as part of their preparatory support.
• It is important that veterinary nurse students are fully briefed leading to realistic expectations of life in veterinary practice.