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Optimising the value of VNs
  1. Adele Waters

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IN the mid-1950s, qualified veterinary nurses were more of a novel idea than a reality and their potential introduction caused rather a stir. Vets debated their potential value in the pages of this journal, even though it wasn't exactly clear at the time what nurses would actually do.

‘Well, well, what marvellous people they are going to be,’ wrote one vet. ‘They will know so much about so many things, they will probably be of little use at any one thing.’

More than 60 years on, while practice life today looks and feels very different, the question about what nurses can and should do persists.

Of course many vets have come to regard qualified veterinary nurses as essential to the safe and efficient delivery of patient services. Nurses can run their own clinics, supervise unregistered support staff and provide treatments, vaccinations and dietary and lifestyle advice, for example. Some carry out dental examinations or perform cat castrations.

For others, their role is ill defined and poorly understood. Nurses may be supervising staff one minute and, the next, cleaning out pet cages. They may be regarded as interchangeable with unregistered support staff.

Next month the RCVS will begin an important piece of work to understand this variability. It will survey all practices to find out what nurses actually do. The College is keen for as many vets and nurses to complete the survey as possible – the more data it gets back, the more it will understand the scope and shape of current nursing practice, ie, the number and type of tasks nurses undertake or delegate.

The survey is being conducted as part of VNFutures – an initiative that last year identified the key challenges for the profession and an action plan to tackle them. This, in turn, grew out of VetFutures – a joint initiative by the BVA and RCVS, aiming to future-proof the veterinary profession for 2030.

Certainly, there are a number of serious problems that need fixing. Take recruitment difficulties, for example. Nurse shortages are apparent across the UK. Talk to anyone involved in recruitment for the sector and they will report serious struggles – employers have been known to wait a year to recruit a qualified nurse.

To plug the gaps, some practices are employing support staff instead so that a number of tasks that used to be the preserve of qualified nurses are increasingly being carried out by unregistered support staff; for example, flushing drips, giving medication, even assisting with anaesthesia. That may sound OK until something goes wrong and, because these staff are unregulated, the vet is accountable.

There is a retention problem too – many nurses leave and they don't come back; for example, only 5 per cent return after maternity leave. And there is also a reward problem – salaries are not standardised and transparent, as they are in the NHS. As a result, salaries are variable, even erratic. Some qualified nurses attract salaries around the £30,000 per year mark, while others earn half that, perhaps £18,000 in London.

Nurses want a more structured and rewarding career path. That was the strong message they gave the VNFutures team at a series of regional events last year. Nurses told them they want to be able to develop along a career path and get recognition for their skills.

However, the current plethora of job titles used for nurses and support staff does not make it easy to recognise seniority. One corporate chain recently undertook an audit of job titles and found as many as 50 different job titles in use across its practices. This is confusing enough for nurses and vets, let alone clients. Importantly, it does nothing to incentivise those ambitious nurses who are hungry to progress.

Failing to tackle these problems is not only a missed opportunity for nurses, but for vets too. Investing in a nursing workforce can save vets time, create efficiencies and improve team functioning/morale.

One practice that needs no persuading about the value of qualified nurses is the 387 Vets in Walsall, West Midlands. Established 10 years ago, it has the highest nurse:vet ratio in its area (2:1) and is proud to have never lost a single veterinary nurse from its staff.

Vet and business owner Hamish Duncan says investing in nursing staff has paid dividends. The nursing team delivers all the added-value services for clients and clinics such as post-op checks, weight management and pain management. This frees up vet consultations that generate more money for the practice.

‘The practice just works better with more nurses,’ he says. ‘You get more ideas with a broader dynamic in the team. It also raises standards – I think it makes the difference between doing an OK job and a good job.’ Testament to that is head nurse Nicky Smith, who has just become Petplan's Vet Nurse of the Year.

Currently an RCVS working party is examining how to reform Schedule 3 – the supplement to the Veterinary Surgeons Act 1966 – in order to widen nurses' scope of practice. Of course, that would legitimise new ways of working but it could take years before that work leads to tangible change.

For vets, recruiters or service directors looking to fill vacancies now, they need to find solutions and that pressure is already driving role innovation. At a time when it can take months to recruit vets, for example, it is no longer unthinkable to replace a vet who leaves a five-vet practice with an advanced-level nurse.

Similarly, many practices have established three or even four tier nursing and support teams made up of auxiliaries or assistants, students, qualified nurses and, at the apex, advanced level nurses. This sort of skill mixing can enhance efficiency.

The RCVS survey will show the extent of these types of working arrangements and, as such, will be an important milestone for the veterinary nursing profession. Results will provide a barometer for how far the nursing role has changed since 1984, when the job title ‘veterinary nurse’ was first used. It will enable us to judge the extent to which vets are optimising value from their nursing teams.

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