Veterinary nurse skill utilisation in small animal practice

Veterinary nursing is often cited as a misunderstood profession, not only by clients but also by those within the veterinary industry. This can lead to confusion of utilisation of the position and potentially undermining the confidence of those in the role (Davidson, 2017a; Belshaw et al, 2018; Bourne, 2018; Harvey and Cameron, 2019). Incorrect utilisation of an employee, alongside other factors such as salary, employer recognition and work/life balance, can lead to job dissatisfaction — a situation which can be avoided through open and honest discussions about expectations (Dale, 2013; Davidson, 2017b; Belshaw et al, 2018; Oberai and Anand, 2018; Robinson et al, 2019).

Registered veterinary nurses (RVNs) across the globe encounter the same problem of limited recognition and incorrect utilisation, which has been linked to shortened retention rates in the profession (dmv360, 2009; Bourne, 2018; Gyles, 2019; Robinson et al, 2019). Recognition and appropriate utilisation within the role is important to prevent demoralisation of RVNs who may not be carrying out the duties for which they were trained (dmv360, 2009; Harvey and Cameron, 2019; Robinson et al, 2019). RVNs and veterinary surgeons have campaigned for greater utilisation of nurses in practice and current literature suggests that there are still duties they are not involved with (Belshaw et al, 2018; Saunders, 2020; Yagi and Prendergast, 2020). A potential lack of preparation in these areas by educational providers could lead to RVN reticence, while research has established that lack of involvement in practice is caused by misunderstandings of the remit of RVNs (Davidson, 2017a, b; Saunders, 2020; Yagi and Prendergast, 2020; VN Futures, 2022).

It has been noted that delegation of duties within the scope of Schedule 3 amendments enhances job satisfaction for RVNs, which links to motivation and job longevity (Yagi and Prendergast, 2020; Royal College of Veterinary Surgeons (RCVS), 2022a). Allowing engagement with these activities is dependent on the ability of educators to prepare them for entering practice, and of employers to understand the role of the RVN, as well as the RVN's confidence and competence to be delegated to (Fraser, 2018; Yagi and Prendergast, 2020; RCVS, 2022a). The current research aimed to determine how RVNs are being utilised in small animal practice in the UK.

Methodology

A quantitative approach was taken to the research via a cross-sectional questionnaire design to allow responses to be generalised to the wider RVN population.

Methods

Ethical approval was gained from the Hartpury University Ethics Committee prior to commencing any data collection.

Questionnaire design

The questionnaire was designed using Microsoft Forms (Office 365) and consisted of 25 questions which were adapted from a previously validated questionnaire to suit the UK RVN (Gates et al, 2021). A Royal College of Veterinary Surgeons (RCVS) list of duties was adapted to create the over-all list of duties used in the questionnaire, detailing roles in relation to Schedule 3 and a typical day of an RVN (RCVS, 2022b). The questionnaire began by profiling participants with questions such as age and job title, then scored how frequently they conducted a selection of administration, management and patient care duties. Likert scales were used to collect the data to determine whether duties were applicable to their role in practice ‘Never’, ‘Sometimes’, ‘Always’ or whether they were ‘Not Applicable’. Before releasing the questionnaire, a pilot study was conducted to test the relevance and refine any areas necessary.

Sample

Using social media sites such as Vet Nurse Chatter and the British Veterinary Nursing Association, the questionnaire was published for 3 months. Corporate veterinary practices were also approached to disseminate the questionnaire. Inclusion criteria required participants to be over the age of 18 years, an RVN with a small animal speciality and having worked within a veterinary practice in the 12 months prior.

Data analysis

To ensure ease of analysis, job titles of respondents were separated into veterinary nurse (VN) or manager roles, and educational routes were categorised as degree (Foundation degree (FdSc) and Bachelor's degree (BSc)), diploma (further education (FE) and higher education (HE)) and other (national vocational qualifications (NVQ)) and green book). Data were analysed using frequencies, mode and mean where appropriate and demographic data were displayed as a vignette (Table 1).

Results

Responses were collected from 141 participants with 98.5% being female; 66.4% were in veterinary nursing roles while 33.6% were in managerial roles.

Administrative duties

In relation to administrative duties, RVNs in managerial roles always performed more frequently in all categories except reception duties and communication with colleagues (Table 2). Three categories did not register as not applicable to role to either VNs or managers (communication with colleagues, maintenance of equipment and stock ordering), and the only category to score 0% for never performed was communication with colleagues.

Management duties

Managers selected always performed more often than VNs when thinking about management duties (Table 3). Two categories scored 0% for not applicable to role (management of people and organisation of meetings) and two categories scored 0% for never performed (organisation of rotas and liaison between staff members).

Patient care duties

When asked about patient care duties, those in VN roles always performed more frequently than managers for all categories except assisting with surgery (scrubbed nurse), supportive care of owners and applying bandages (Table 4). Never performed was selected by more than 5% of those in VN and manager roles for assisting with surgery (scrubbed nurse), nurse clinics, minor surgery (in line with Schedule 4) and providing out of hours (OOH) support.

Discussion

The demographic data collected regarding gender identity and age correlate with those of the RCVS for RVNs (RCVS, 2018; Robinson et al, 2019) and data indicate that there are many similarities between the VN and manager positions. The average length of time for an RVN in their current position, according to the data, was between 3.3 and 3.8 years; this should be reflected on in relation to the poor retention rates and aligns with the 2019 Survey of the Veterinary Nurse Profession (Robinson et al, 2019).

Teamwork is paramount to success; developing and nurturing individuals that are able to conduct professional communications will be of benefit to both the practice and staff (Beckwith, 2016; Bonnett and Northway, 2020; Kerr et al, 2020). It is worrying therefore that 17.2% of VNs and 4.2% of managers did not participate in full team meetings, while 19.4% of VNs also did not participate in nurse meetings. Meetings are essential for managing expectations. They allow time for in-depth discussion of caseload and provide opportunities to practise communication skills. Integration of meetings into the RVN workload should therefore be recommended (Geimer et al, 2015). An area that should perhaps be focused on is communication with colleagues as not all respondents stated that this was something that they always did. Communication is a large part of the veterinary profession and has previously been high-lighted as lacking within veterinary education (Pun, 2020). There could therefore be a benefit of further specific communication training within curriculums.

VN clinics provide opportunities for RVNs to showcase their knowledge and skills, reduce the workload of veterinary surgeons, contribute to the financial gains of the practice and educate owners (Ackerman, 2015; Davidson, 2017b). Over 15% of VNs, however, stated that they were never involved in nurse clinics and 3.2% said that nurse clinics were not applicable to their role. It must be considered that some RVNs will specialise in areas such as emergency critical care and therefore will not have the same type of variance to their everyday role. For those within general practice who are not being utilised in this way, it is recommended to put a proposal together for management to highlight the benefits of full nurse utilisation in nurse clinics (Ackerman, 2015; Davidson, 2017b; Yagi and Prendergast, 2020).

Clinical audits allow practices to understand whether procedures need to be altered and should have full staff participation, with RVNs being aware that they form part of their expected professional duties (Mosedale, 2019; RCVS, 2022a). It is thus concerning that 48.4% of VNs and 12.5% of managers state that they are never involved with clinical audits. It would be interesting to determine whether RVNs are clear or uncertain of what clinical auditing is and if those who are participating are in fact doing so without their full understanding. As with communication, it may be beneficial to ensure that clinical auditing is embedded within educational curriculums.

The remit of the RVN has changed considerably since the creation of the role and proposals continue to be developed to increase the positive impact of the position in practice (Westgate, 2020). With 69.9% of VNs and 56.3% of managers stating that they never get involved with minor surgery (in line with Schedule 3), advocates should perhaps be cautious of trying to add to the role. Focus should instead be on determining how individuals can be encouraged to undertake these activities, which are already within their skill set, and also what factors are hindering them from doing so. Staffing levels, competency levels and incorrect use of delegation have all been suggested as factors hindering complete utilisation of RVNs and although much work has been completed to combat this, the data suggest that this is still a focus area (Davidson, 2018; RCVS, 2019; 2022a; Westgate, 2020).

With the ability to support the veterinary surgeon with their range of skills, the importance of the role of the RVN is becoming more apparent; training courses are developing; and RVNs are becoming more embedded within the practice (Gates et al, 2021). Within many practices, RVNs often state that they are underutilised, denying them opportunities to put learned theory into practice (MacDonald, 2017; Saunders, 2020; Yagi and Prendergast, 2020). The data indicate that there are many areas in which their utilisation can be increased and RVNs need to lead the way in ensuring that employers understand the duties with which they can become involved. Support from educators and employers, alongside appropriate delegations from veterinary surgeons, helps to provide opportunities for RVNs to be utilised appropriately and hopefully increase job satisfaction (Ackerman, 2015; Wild, 2017; Fraser, 2018). The aim of focusing on the utilisation of the RVN is not about finding further responsibilities, but rather about ensuring that they are nurtured to become proactive and independent individuals with a clear understanding of what they can and should be doing within their current role (Kerrigan, 2018; Mosedale, 2019; Westgate, 2020; RCVS, 2022a).

Future research

Participation in the current research was purposely restricted to practising RVNs to make the data relevant and current. However, further areas of research should be considered after reviewing these results. Responses from RVNs indicate that they are not being utilised as fully as they could be. Determining how RVNs interpret their duties, such as clinical auditing, would indicate whether such activities are being carried out without full knowledge or whether further clarification of terminology is needed. In some respects, RVNs may not be carrying out duties because they are not within the exact remit of their role; however, it should also be considered that RVNs may not want to undertake the activity. Determining the reasons why duties are ‘never performed’ or ‘not applicable to a role’ may provide further understanding of the abilities, confidence and competence of RVNs.

Conclusions

The present research supports claims that even with their wide range of available skills, RVNs may not be being fully utilised within practice. With the wide range of veterinary practices available to work in, it is no surprise that RVNs are being utilised in different ways. On the one hand, this allows them to diversify and specialise; however, it must also be considered that they may not be doing all that they could or should, or even desire within their skill set. RVNs must ensure that they understand their responsibilities, level of accountability and involvement with veterinary surgery under the Schedule 3 exemptions to allow them to be used to their full potential. RVNs need to be the voice that allows them to become more embedded within the practice, becoming more visible and recognised members of the team, and clearing up any confusion surrounding their role.

KEY POINTS

• Confusion continues to exist in the exact utilisation of the registered veterinary nurse (RVN) between all those individuals that deal with them.
• RVNs are utilised differently in different practices, depending on policies and understanding.
• Having full understanding and making full use of a role can aid job satisfaction.