A Report for the Royal College of Veterinary Surgeons

The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

A report for the Royal College of Veterinary Surgeons

Dilys Robinson, Megan Edwards and Matthew Williams

27 October 2017 Final report Institute for Employment Studies

IES is an independent, apolitical, international centre of research and consultancy in public employment policy and HR management. It works closely with employers in all sectors, government departments, agencies, professional bodies and associations. IES is a focus of knowledge and practical experience in employment and training policy, the operation of labour markets, and HR planning and development. IES is a not-for-profit organisation.

Acknowledgements

The authors are indebted to the veterinary nurses and veterinary surgeons who took part in the survey and follow-up interviews.

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IES project code: 00194-4724 Contents

Executive Summary...... 1 Demographics of respondents...... 1 Work profiles...... 1 Understanding of Schedule 3...... 3 Future role of the VN...... 3 Support from the RCVS...... 4 And finally…...... 4 Post-survey interviews...... 5 1 Introduction...... 6 1.1 Background...... 6 1.2 The survey...... 6 1.2.1 Process...... 6 1.2.2 Response...... 6 1.2.3 Analysis...... 7 1.3 Follow-up qualitative research...... 7 1.4 This report...... 7 2 Demographic Profiles...... 8 2.1 Veterinary nurses...... 8 2.1.1 Gender, age and ethnicity...... 8 2.1.2 Status and year of qualification...... 9 2.2 Veterinary surgeons...... 11 2.2.1 Gender, age and ethnicity...... 11 2.2.2 Year of qualification...... 12 2.3 Differences between VNs and VSs...... 13 3 Work Profiles...... 15 3.1 Overview...... 15 3.1.1 Veterinary nurses...... 15 3.1.2 Veterinary surgeons...... 15 3.2 VNs and VSs working outside clinical practice...... 16 3.3 VNs and VSs working in clinical practice: type of practice, role and location...... 17 3.3.1 Veterinary nurses...... 17 3.3.2 Veterinary surgeons...... 21 3.3.3 Differences between VNs and VSs...... 25 3.4 VNs and VSs working in clinical practice: work activities...... 26 3.4.1 Veterinary nurses...... 26 3.4.2 Veterinary surgeons...... 31 3.4.3 Differences between VNs and VSs...... 35 4 Understanding of Schedule 3...... 37 4.1 Veterinary nurses...... 37 4.1.1 Level of understanding of different groups...... 37 4.1.2 Main things that prevent the full utilisation of the VN role...... 38 4.2 Veterinary surgeons...... 40 4.2.1 Level of understanding of different groups...... 40 4.2.2 Main things that prevent the full utilisation of the VN role...... 41 4.3 Differences between VNs and VSs...... 42 5 The Future VN Role...... 43 5.1 Veterinary nurses...... 43 5.2 Veterinary surgeons...... 45 5.3 Differences between VNs and VSs...... 48 6 Perceptions of Support and Advice given by the RCVS...... 50 6.1 Overall views...... 50 6.2 Further support and advice...... 50 6.2.1 Clarity...... 50 6.2.2 Communication...... 51 6.2.3 Training...... 52 6.2.4 Responsibility...... 52 7 Final Survey Comments...... 54 7.1 Underutilised, undervalued, underappreciated & underpaid...... 54 7.2 Further training and specialisation...... 55 8 Post-survey Interviews...... 57 8.1 Interview themes...... 57 8.2 The VN interviewees...... 57 8.2.1 Profile...... 57 8.2.2 Views...... 58 8.3 The VS interviewees...... 73 8.3.1 Profile...... 73 8.3.2 Views...... 74 8.4 Differences between VNs and VSs...... 88 9 Conclusions...... 90 Institute for Employment Studies 5

Executive Summary

The 2017 RCVS survey on the future role of the veterinary nurse (VN) was launched on 3 May and closed on 12 June. Its aim was to assess the extent of delegation under Schedule 3 of the Veterinary Surgeons Act 1966, the level understanding of Schedule 3 within the profession, whether VNs would like to extend their role, and whether veterinary surgeons (VSs) supported their aspirations.

All student VNs and qualified VNs and VSs registered with the RCVS to practise in the UK were invited to respond, and a total of 11,625 people (6,873 VNs and 4,752 VSs) did so; this represents a response rate of 34.9 per cent for VNs and 21.3 per cent for VSs.

Demographics of respondents

■ Ninety seven per cent of VNs are female, compared to 63 per cent of VSs. The average ages are 24 for student VNs and 35 for qualified VNs. VSs are older, with an average age of 41.

■ VN students represented 29 per cent of VN respondents; this level of involvement is encouraging, given that the survey had a future focus.

■ The veterinary profession is not ethnically mixed, with 98 per cent of VNs and 96 per cent of VSs identifying as white.

■ Seven per cent of qualified VNs hold the Diploma in Advanced Veterinary Nursing (DipAVN).

■ Eighty six per cent of VNs, compared to 62 per cent of VSs, had qualified in the past 20 years.

Work profiles

■ Ninety four per cent of VNs and 89 per cent of VSs who are working within the profession are working in clinical veterinary practice.

■ Of the relatively small numbers working outside clinical practice, just over half of VNs and just over a quarter of VSs work in veterinary schools, VN colleges or universities. Around a quarter of VSs, but only 2 per cent of VNs, work for the Animal and Plant Health Agency (APHA), the Food Standards Agency (FSA), government departments or local government.

■ Of those in clinical veterinary practice, 76 per cent of VNs and 74 per cent of VSs work in first opinion small animal practice. 6 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ■ When asked about the tasks they did, and how often they performed these tasks, three-quarters of VNs identified nine tasks that they did ‘frequently’, that is every day or several times a week (see figure 1).

Figure 1: Most frequently performed tasks, respondent VNs

■ VNs in small animal practices are also very busy with a variety of clinics (see table 1).

Table 1: VN respondents’ involvement in nursing clinics

Clinic No. % None 723 14.0 Puppy/kitten 3,441 66.5 Nutrition 3,348 64.7 General check-ups 3,232 62.5 Dental 2,944 56.9 Vaccination 2,457 47.5 Geriatric/senior wellness 2,283 44.1 Other 1,349 26.5

■ When VSs were asked similar questions about tasks carried out by VNs in their practice, there was a fairly close correspondence with the activities reported by VNs, which suggests that VSs are very aware of what their VN colleagues are doing. Both VNs and VSs, for example, had similar views about the tasks performed ‘frequently’ by VNs, although the ordering of the lists was slightly different. There was also a fairly close correspondence in views about the clinics in which VNs are involved, although again the order differed slightly. Institute for Employment Studies 7 Understanding of Schedule 3

■ Confidence in their understanding of what VNs can do under Schedule 3 is not very high among VNs or VSs. VNs rate their personal understanding at 6.74 out of 10, and that of VNs generally at 6.43 out of 10. VSs are less confident, scoring their personal understanding at 5.57 out of 10, although they rate VNs more highly at 6.57 out of 10.

■ When asked what prevented the full utilisation of VNs, a lack of understanding of Schedule 3 was the clear leader (see figure 2). However, VSs in particular admit that they are not good at delegating, while VNs feel they need more training and lack confidence in themselves.

Figure 2: Things preventing the full utilisation of VNs, comparing VN respondents overall with VS respondents

Future role of the VN

■ A very high 92 per cent of VNs and a clear majority (71 per cent) of VSs agreed that VNs should be able to undertake additional areas of work that are not currently permitted under Schedule 3.

■ There is very clear agreement between VNs and VSs regarding the top three tasks that VNs should be able to carry out (see figure 3); these are already permitted under Schedule 3, so the high level of agreement is encouraging. Other tasks are less clear, although it appears that some activities common in small animal practices but not currently permitted under Schedule 3 (such as cat castrations and dental extractions) are popular candidates for adding to the list of permitted activities for VNs to perform. 8 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Figure 3: Tasks that VNs should be able to carry out, comparing VN respondents overall with VS respondents

Support from the RCVS

■ The majority (61 per cent) of VNs think the RCVS gives sufficient support and advice to VSs and VNs about Schedule 3; however, only 50 per cent of VSs agree.

■ Both VNs and VSs would like more clarity, particularly around ‘grey areas’ such as the meaning of ‘body cavity’ and ‘minor surgery’. They asked for more communication from the RCVS about Schedule 3, and for more training for VNs to ensure they are both competent to, and confident about, carrying out additional procedures should they wish to do so.

And finally…

■ At the end of the survey, respondents were given the opportunity to add anything they wanted to say. Most of the comments related to VNs being under-utilised, underappreciated and under-valued – both by the general public and by VSs. It should be noted that many VS respondents were in agreement with VNs who felt they were not being recognised:

‘I am proud to be a veterinary nurse and just wish the general public would recognise us as nurses not just the underdogs to the vets.’

‘VNs are invaluable - they're essential colleagues in practice! If there are more tasks that they could be safely doing and they want to be doing, then all vets should support and encourage that.’ Institute for Employment Studies 9 ■ Another theme was that that there should be further training and qualification opportunities, allowing for specialisation and more opportunities for career progression. Comparisons were made with the veterinary profession in the USA and with human nursing, both of which have specialist qualifications and a clearer career path.

Post-survey interviews Interviews with ten VNs and ten VSs explored some of the survey themes in more detail. The interviews illustrated that both VNs and VSs believe that:

■ The career path available to VNs is limited, particularly in smaller, first opinion practices; large first opinion practices, referral practices and hospitals offer considerably more by way of career development.

■ VN pay is poor relative to the training undertaken and the work that is done; pay is a big contributing factor to VNs leaving the profession, and appears to be leading to recruitment difficulties and more locum working. Some suggested there should be standardised salary scales within their profession that recognise experience and further qualifications.

■ Some, but by no means all, VNs would like to increase their range of tasks and responsibilities, with suitable training if necessary. There is enthusiasm for advanced practitioner or specialist status, which would recognise those VNs with additional qualifications such as the DipAVN and could be linked to standardised salary scales.

■ Although VNs and VSs both, on the whole, feel that Schedule 3 should be reviewed, there are some anxieties about extending the list of tasks; firstly, it is important that VNs are properly trained to take on new tasks, and secondly, VNs who do not want to extend their role should not be forced to do so. Interviewees also pointed out that VNs in many practices do not take on some of the tasks they are already permitted to do under Schedule 3, either from choice or because VSs prefer to do these tasks themselves or do not have the time to supervise.

■ VNs feel strongly that there is a lack of recognition and appreciation for their role, from VSs and from members of the public.

■ VSs are more cautious about extending the VN role, in part because of accountability if things should go wrong. VNs are also aware of accountability, and feel this issue may lead to firstly a reluctance to take on more, and secondly an unwillingness among VSs to delegate.

■ VSs reported a shortage of experienced VNs, and gave examples of recruitment difficulties. However, they are also aware that they may be contributing to this shortage; firstly, practices are run as businesses and feel unable to offer higher salaries, and secondly, in busy practices it is difficult to find time to train and develop VNs. 10 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

1 Introduction

1.1 Background The Royal College of Veterinary Surgeons (RCVS) asked the Institute for Employment Studies (IES) to manage a survey on its behalf of veterinary nurses (VNs) and veterinary surgeons (VSs) registered to practise in the UK. The aim of the survey was to assess firstly the nature and extent of delegation under Schedule 3 of the Veterinary Surgeons Act 1966; secondly the level of understanding of Schedule 3 within the veterinary profession; and thirdly whether and how VNs would like to extend and develop their role, and the extent to which VSs support them in these aims.

Schedule 3 allows VSs to delegate some medical treatments and minor surgical procedures to VNs, while also listing procedures that are outside the scope of this delegation. The RCVS is conducting a review of Schedule 3 in order to assess whether it would be appropriate to widen the scope of delegation and therefore to enrich the VN role; these survey results provide evidence for this review.

1.2 The survey

1.1 Process The questions for the survey were initially drafted by IES researchers, then discussed and agreed with the RCVS project team. The survey was then set up online using the Snap survey tool, and was tested both by IES researchers and the RCVS team before being launched on 3 May 2017.

Every non-retired VN and VS registered with the RCVS to practise in the UK was sent an email invitation to take part in the survey, which was accessed via a link in the email; in total, 19,671 VNs and 22,263 VSs were invited. Three reminders were sent at intervals to those who had not yet completed and submitted their questionnaires. The survey was closed on 12 June 2017.

2 Response A total of 11,625 people (6,873 VNs and 4,752 VSs) responded, of which 1,968 (1,097 VNs and 871 VSs) were partial responses (i.e. the individuals did not finish the survey by clicking on the ‘submit’ button at the end). The majority of the partial responses contained usable data, however. The overall response rate was therefore 27.7 per cent, reducing to 23 per cent if only the completed and submitted returns are included. The response rate for VNs was 34.9 per cent (29.4 per cent without partial responses), while that for VSs was 21.3 per cent (17.4 per cent without partial responses). Institute for Employment Studies 11 3 Analysis The analysis of the survey data was carried out using the statistical software package SPSS. Initial survey headlines were produced for the RCVS, following which the data were analysed in depth, with a particular focus on any differences in views using a variety of breakdowns (e.g. VN or VS, area of work, home country, and length of time since qualification).

1.3 Follow-up qualitative research In addition to the survey findings, this report contains the results of the analysis of telephone interviews with a sample of ten VNs and ten VSs who volunteered, via a question in the survey, to take part in an interview. A sample of 50 was chosen randomly from the 1,430 VNs and 1,171 VSs respondents who indicated they would be happy to be contacted again, and checked to ensure there was a good geographical spread across the UK. These individuals were approached via email to secure interview dates and times. The telephone interviews were carried out by members of the IES research team during August, September and October 2017.

1.4 This report This report consists of the following chapters:

■ Chapter 1: Introduction

■ Chapter 2: Demographic Profiles

■ Chapter 3: Work Profiles

■ Chapter 4: Understanding of Schedule 3

■ Chapter 5: The Future VN Role

■ Chapter 6: Perceptions of the Support and Advice Given by the RCVS

■ Chapter 7: Final Survey Comments

■ Chapter 8: Post-Survey Interviews

■ Chapter 9: Conclusions 12 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

2 Demographic Profiles

2.1 Veterinary nurses

3.1 Gender, age and ethnicity Almost all (97 per cent) of respondents are female, with only three per cent identifying as male. There is a small difference when student (diploma and university) VN respondents are compared to registered VNs, in that males account for 4.6 per cent of the students, but only 2.8 per cent of those who are qualified; this may suggest that the VN profession is becoming a little more attractive for men, although the numbers are too small for certainty.

The age given by respondents ranged from 16 to 79, although the mean average age of 32 and the modal (most common) age of 23 indicate that the VN population is relatively young overall. Table 2.1 gives a breakdown by age group, and shows that only ten per cent of VN respondents are over 45.

Table 2.1: Age breakdown of VN respondents

Age group No. %

Under 25 1,848 32.0 26 to 35 2,180 37.8 36 to 45 1,154 20.0 46 to 55 466 8.1 56 to 65 112 1.9 Over 65 9 .2 Total 5,769

However, when student VNs are removed, leaving only qualified VNs, the picture is somewhat different (see Table 2.2), with 70 per cent of respondents being between 26 and 45 years of age. The mean and modal ages of qualified VNs are 34.7 and 31 respectively. It is still, however, relatively unusual for a qualified VN to be over 45, in that only 13.7 per cent fall into this age category.

Table 2.2: Age breakdown of qualified VN respondents

Age group No. % Under 25 656 15.9 26 to 35 1,804 43.7 36 to 45 1,100 26.7 46 to 55 448 10.9 Institute for Employment Studies 13 56 to 65 109 2.6 Over 65 9 0.2 Total 4,126

Table 2.3 gives the age breakdown of student (diploma and university) VN respondents. As would be expected, the majority (66 per cent) are under 25, and fewer than 12 per cent are over 30. The mean and modal ages of student VN respondents are 24 and 20 respectively.

Table 2.3: Age breakdown of student VN respondents

Age group No. % 16 to 18 89 5.3 19 to 21 593 35.6 22 to 24 422 25.3 25 to 27 248 14.9 28 to 30 118 7.1 Over 30 195 11.7 Total 1,665

Almost all (98 per cent) of respondents gave their ethnicity as White; two per cent identified as Black and Minority Ethnic (BME). The percentage of White respondents aged under 25 is slightly lower (97 per cent) but this is not enough of a difference to indicate with any certainty that the BME population is increasing overall among VNs.

4 Status and year of qualification The majority (71 per cent) of respondents are qualified VNs; 18 per cent are students (Level 3 Diploma) and ten per cent are students (university degree).

■ Of those who are Diploma students, 37 per cent hope to qualify in 2017, 43 per cent in 2018, 19 per cent in 2019 and the remaining one per cent in 2020 or 2021.

■ Of those who are studying for a degree, 27.5 per cent hope to qualify in 2017, 26.5 per cent in 2018, 33 per cent in 2019 and the remaining 13 per cent in 2020 or 2021.

● The majority (83 per cent) of degree students had completed, or were undertaking, their work placements; the 17 per cent who had not yet completed/started their placements were not asked any further questions about area of work or experiences at work.

The year of qualification for qualified VNs ranged from 1968 to 2017, with a mode of 2016. The breakdown of qualification years (see Table 2.4) shows clearly that the majority of qualified VN respondents have qualified relatively recently. 14 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Table 2.4: Qualified VN respondents: year of qualification

Year of qualification No. % 1968 - 1977 26 0.6 1978 - 1987 134 3.3 1988 - 1997 436 10.6 1998 - 2007 1,193 29.0 2008 - 2017 2,320 56.5 Total 4,109

Seven per cent of qualified VNs hold the Diploma in Advanced Veterinary Nursing (DipAVN). Further analysis shows that the majority of those holding the DipAVN qualified either between 1998 and 2007 (40 per cent) or from 2008 onwards (38 per cent). Table 2.5 gives the age breakdown of VNs holding the DipAVN, and shows that over three- quarters (77 per cent) of those with the DipAVN are between 26 and 45.

Table 2.5: VN respondents holding the DipAVN: age breakdown

Age group No. % Under 25 22 7.9 26 to 35 117 42.1 36 to 45 96 34.5 46 to 55 35 12.6 56 to 65 7 2.5 Over 65 1 0.4 Total 278

Further analysis showed that VNs working outside clinical practice were more likely to hold the DipAVN: 13.1 per cent, compared to 6.2 per cent of those working within clinical practice. This proved to be due mainly to the relatively high percentage (17 per cent) of VNs working in veterinary colleges/universities who hold the DipAVN. Within clinical practice, there is a big difference between VNs working in first opinion practices (where 5 per cent hold the DipAVN) and those working in referrals practices (where the percentage is a much higher 19.6 per cent).

2.2 Veterinary surgeons

4.1 Gender, age and ethnicity The majority (63 per cent) of VS respondents are female. The age given by VS respondents ranged from 21 to 86, with mean average age of 41 but a considerably younger modal age of 28. Table 2.6 gives an overall age breakdown of VS respondents, and Table 2.7 gives a gender breakdown by age. This latter table shows very clearly that Institute for Employment Studies 15 the ratio of females to males increases as age decreases. Figure 2.1 gives a different presentation of the information in Table 2.7.

Table 2.6: Age breakdown of VS respondents

Age group No. % Under 25 177 4.6 26 to 35 1,296 33.7 36 to 45 1,029 26.8 46 to 55 776 20.2 56 to 65 453 11.8 Over 65 110 2.9 Total 3,841

Table 2.7: Gender and age breakdown of VS respondents

Age group Female Female Male Male no. % no. % Under 25 142 80.7 34 19.3 26 - 35 951 73.4 344 26.6 36 - 45 683 66.6 343 33.4 46 - 55 435 56.2 339 43.8 56 - 65 175 38.8 276 61.2 Over 65 14 13.0 94 87.0 Total 2,400 62.7 1,430 37.3

Figure 2.1: Percentages of VS respondents by gender and age group 16 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Almost all (96 per cent) of respondents gave their ethnicity as White; two per cent identified as BME, with a further two per cent preferring not to say. An analysis of ethnicity by age shows little variation in the percentage of VSs who classify themselves as White.

5 Year of qualification The year of qualification ranged from 1956 to 2017, with a mode of 2015. The breakdown of qualification years (see Table 2.8) shows that the majority of VS respondents have qualified in the past 20 years.

Table 2.8: Year of qualification of VS respondents

Year of qualification No. % Before 1968 24 0.6 1968 - 1977 141 3.7 1978 - 1987 576 14.9 1988 - 1997 732 19.0 1998 - 2007 1,077 27.9 2008 - 2017 1,306 33.9 Total 3,856

2.3 Differences between VNs and VSs

■ The most obvious difference between VN and VS respondents can be seen in the gender breakdown; while almost all VNs (97 per cent) are female, over one-third of VSs overall (37 per cent) are male.

■ It is also very clear that VN respondents are notably younger, on average, than VSs, due in part to the longer training period for VSs and the earlier age at which VNs can start training. When VN students are removed from the analysis, the difference in the age breakdowns is less stark (see Figure 2.2). Institute for Employment Studies 17 Figure 2.2: Age comparison of qualified VN and VS respondents

■ The ethnicity of the two groups of respondents is very similar, with no clear signs to indicate this is changing over time.

■ The relative newness of the VN profession in comparison with VSs is indicated by the qualification years of the two groups of respondents (see Figure 2.3): only 3.9 per cent of VN respondents qualified before 1988, compared to 19.2 per cent of VS respondents.

Figure 2.3: Qualification year of VN respondents compared with VS respondents 18 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

3 Work Profiles

3.1 Overview

■ Almost all VN respondents are working, either full-time (75.4 per cent), part-time (20.8 per cent) or in voluntary work (0.3 per cent).

● Of the 1.9 per cent (N = 99) who are not working, 22 per cent are on a career break, 20 per cent are studying, eight per cent are unemployed, four per cent are retired and 45 per cent gave ‘other’ reasons. These ‘other’ reasons mainly related to maternity/childcare (51 per cent of those who selected ‘other’), medical/illness (self or others) (11 per cent), or travelling (11 per cent).

● Of those who are working (N = 5,088), almost all (97.5 per cent) are working within the veterinary profession, that is in a role that requires them to use their VN qualification.

■ Of the 228 respondents who are either not working, or are working outside the profession, 61 per cent plan to return to the profession within the next five years. These individuals were asked further questions about the future role of the VN, while those who said ‘no’ were asked no further questions.

■ Almost all (94 per cent) of the respondents who are currently working within the profession are working within clinical veterinary practice. The work of these respondents is described in more detail in section 3.3 below, while the area of work of the 275 respondents who are working outside clinical practice is summarised in section 3.2 below.

6 Veterinary surgeons

■ Almost all VS respondents are working, either full-time (73 per cent), part-time (23 per cent) or in voluntary work/unpaid clinical work experience (1 per cent).

● Of the three per cent (N = 107) who are not working, 31 per cent are on a career break, nine per cent are studying, nine per cent are unemployed, 25 per cent are retired and 25 per cent gave ‘other’ reasons. These ‘other’ reasons mainly related to maternity (30 per cent of those who selected ‘other’), being between jobs (26 per cent), or medical/illness (self or others) (19 per cent).

● Of those who are working (N = 3,775), almost all (99 per cent) are working within the veterinary profession, that is in a role that requires them to use their VS qualification. Institute for Employment Studies 19 ■ Of the 152 respondents who are either not working, or are working outside the profession, 64 per cent plan to return to the profession within the next five years. These individuals were asked further questions about the future role of the VN, while those who said ‘no’ were asked no further questions.

■ Most (89 per cent) of the respondents who are currently working within the profession are working within clinical veterinary practice. The work of these respondents is described in more detail in section 3.3 below, while the area of work of the 422 respondents who are working outside clinical practice is summarised in section 3.2 below.

3.2 VNs and VSs working outside clinical practice The place of work of the 275 VN respondents who work within the profession, but outside clinical veterinary practice, is given in Table 3.1 below.

Table 3.9: Area of work of VN respondents who are working outside clinical veterinary practice

Area of work No. % Veterinary school/VN college or university 142 51.6 Commerce/industry (private sector) 30 10.9 Charity/trust 26 9.5 Other university/educational establishment 24 8.7 Home Office 4 1.5 Other UK government department/agency, including Defra 1 0.4 Portal (contracted or employed) 1 0.4 Other 47 17.1 Total 275 100

The area of work of the 422 VS respondents who work within the profession, but outside clinical veterinary practice, is given in Table 3.2 below.

Table 3.10: Area of work of VS respondents who are working outside clinical veterinary practice

Area of work No. % Veterinary school/VN college or university 112 26.5 Commerce/industry (private sector) 88 20.9 Animal and Plant Health Agency (APHA) (contracted or employed) 41 9.7 Food Standards Agency (FSA) (contracted or employed) 40 9.5 Charity/trust 29 6.9 Other university/educational establishment 21 5.0 Other UK government department/agency, including Defra 15 3.6 Local government 5 1.2 Home Office 3 0.7 Research Council 3 0.7 20 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Portal (contracted or employed) 1 0.2 Other 64 15.2 Total 422 100

The data indicate that, while working outside clinical practice is not the norm for either VN or VS respondents, it is relatively more common for VSs. In particular, higher percentages of VSs work for commerce and industry, the APHA, the FSA and other government departments, whereas the majority of VNs working outside clinical practice are in education. In total, 104 respondents (99 VSs and five VNs) work for central government departments and agencies.

3.3 VNs and VSs working in clinical practice: type of practice, role and location

6.1 Veterinary nurses Table 3.3 indicates that most VN respondents work in a small animal practice; it is likely that the next two most common practice areas, mixed and referral/consultancy, also treat considerable numbers of small animals.

Of the 2.5 per cent who specified what they meant by ‘other’ the most frequent response, accounting for one-quarter of the ‘others’, was ‘emergency/out-of-hours’. Other responses included ‘charity’ (20 per cent), ‘both first opinion and referral’ (13 per cent) and ‘hospital’ (7 per cent); in addition, 20 per cent described their ‘other’ type of practice as ‘small animal only’, which might indicate a degree of respondent confusion.

Table 3.11: Type of clinical practice: VN respondents

Type of clinical practice No. % Small animal/exotic 3,935 76.1 Mixed 543 10.5 Referral/consultancy 405 7.8 Equine practice 84 1.6 Other first opinion practice 69 1.3 Farm/production animal 3 0.1 Other 130 2.5

The majority of VN respondents (85 per cent) say they work in a [veterinary nurse] Training Practice (TP), with 13 per cent answering negatively and one per cent being unsure. Further analysis indicates that there was considerable variation in response, depending on the position the respondents held within the practice: almost all students (99 per cent) and assessors/training managers (97 per cent) answered ‘yes’, compared to 84 per cent of senior/head VNs and 81.5 per cent of VNs. Institute for Employment Studies 21 When asked if their practice was in the RCVS Practice Standards Scheme (PSS), a relatively high 22 per cent overall said they were unsure; however, 64 per cent said ‘yes’ and 14 per cent ‘no’. The VN roles displaying the most uncertainty were students (34 per cent unsure), locums (33 per cent unsure), and VNs (23 per cent unsure). By contrast, only ten per cent of assessors/training managers, nine per cent of senior/head nurses, and well under five per cent of those in business management, practice management/ownership/ directorship/partnership roles, were unsure.

Respondents were asked to identify their position in the practice, and could select more than one position if applicable. Table 3.4 shows that over one quarter of VN respondents have a senior/head role, while over one fifth are students.

Table 3.12: Position within practice of VN respondents

Position No. % VN 2,344 50.1 Senior/Head VN 1,264 27.0 Student VN 1,021 21.8 Assessor/training manager 444 9.5 Locum 176 3.8 Practice manager/administrator 161 3.4 Practice owner or partner/director 36 0.8 Joint venture partner 25 0.5 Business manager 16 0.3 Other 113 2.4 Of VN respondents who selected more than one role, 84 per cent selected two roles, 13 per cent three roles, and the remaining three per cent between four and six roles.

Ten per cent of VN respondents (N = 460) typically work for more than one practice. Of these, most (63 per cent) worked for two practices, although 19 per cent worked for three practices, four per cent for four practices, and 14 per cent for five or more practices. The roles of VN respondents working for more than one practice are shown in Table 3.5. Unsurprisingly, those in a locum role are most likely to currently or typically work for more than one practice, although almost one in ten students, VNs and senior/head VNs also work for more than one practice.

Table 3.13: Roles of VN respondents working for more than one practice

Role Currently/typically work for more than one practice? Yes No Total Locum No. 123 53 176 % 69.9 30.1 Practice manager/administrator No. 23 138 161 % 14.3 85.7 Joint venture partner No. 3 22 25 % 12.0 88.0 Other No. 13 100 113 % 11.5 88.5 VN No. 220 2,124 2,344 22 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

% 9.4 90.6 Student VN No. 88 933 1,021 % 8.6 91.4 Senior/Head VN No. 98 1,166 1,264 % 7.8 92.2 Assessor/training manager No. 33 411 444 % 7.4 92.6 Business manager No. 1 15 16 % 6.3 93.8 Practice owner or partner/director No. 1 35 36 % 2.8 97.2 Total No. 468 4,213 4,681

Respondents were asked about the full-time equivalents in different roles in their place of work. The results showed considerable variation:

■ VSs: between zero and 300, with a mean of eight and a mode of two

■ VNs: between zero and 200, with a mean of seven and a mode of two

■ Student VNs: between zero and 250, with a mean of three and a mode of two

■ Animal care assistants/auxiliaries: between zero and 70, with a mean of three and a mode of zero

■ Other roles: between zero and 300, with a mean of six and a mode of two. The workplaces with very high numbers of staff proved, on analysis, to be veterinary hospitals; the average (mean and modal) figures are a more reliable indicator of the size of veterinary practices.

Figure 3.1 shows the work location of qualified VNs who are working within clinical veterinary practice, using the first two letters/digits of workplace postcodes provided by respondents. Institute for Employment Studies 23 Figure 3.1: Postcode map showing location of qualified VN respondents working within clinical veterinary practice

7 Veterinary surgeons Table 3.6 indicates that most VS respondents work in a small animal practice, although mixed and referral/consultancy practices account for almost one-fifth of respondents.

Table 3.14: Type of clinical practice of the respondent VS

No. % Mixed practice 323 9.8 Small animal/exotic practice 2,436 73.8 Equine practice 147 4.5 Farm/production animal practice 63 1.9 Other first opinion practice 8 0.2 Referral/consultancy practice 283 8.6 24 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Other 42 1.3 Total 3,302

When asked to specify which ‘other’ practice, the most frequent answers were ‘charity’ (24 per cent of those selecting ‘other’), ‘zoo/wildlife’ (21 per cent), ‘emergency/out-of- hours’ (17 per cent), ‘equine and large animal’ (12 per cent) and ‘small/avian’ (10 per cent).

Three-quarters of VS respondents (74 per cent) say they work in a TP, with 21 per cent answering negatively and five per cent being unsure. When asked if their practice was in the PSS, 14 per cent said they were unsure; however, 62 per cent said ‘yes’ and 23 per cent ‘no’. Uncertainty was very low (well under 3 per cent) among sole principals, directors, and equity or joint venture partners, and much higher among salaried partners (16 per cent), assistants/employees (18 per cent), consultants (22 per cent) and locums (29 per cent).

Respondents were asked to identify their position in the practice. Table 3.7 shows that slightly over one half (52 per cent) of VSs identify themselves as ‘assistant/employee’. A variety of answers were given by those who identified their position as ‘other’, the most common being ‘clinical director’ (28 per cent of those selecting ‘other’), ‘senior/head vet’ (14 per cent), ‘academic/professor/teacher/lecturer’ (8 per cent) and ‘intern’ (8 per cent).

Sixteen per cent of VS respondents (N = 520) typically work for more than one practice. Of these, most either worked for two practices (43 per cent) or three practices (23 per cent), although eight per cent worked for four practices and 26 per cent for five or more practices. Table 3.8 shows the roles of those working for more than one practice. Unsurprisingly, locums and consultants are by far the most likely to work for more than one practice, although this type of working is found in reasonable numbers in every role.

Table 3.15: Position within practice of VS respondents

No. % of Position respondents Assistant/employee 1,753 53 Director of limited company 449 14 Locum 309 9 Consultant 158 5 Sole principal 153 5 Joint venture partner 135 4 Equity partner 117 4 Salaried partner 61 2 Other 168 5 Institute for Employment Studies 25 Table 3.16: Roles of VS respondents who are working for more than one practice

Currently/typically work for

more than one practice? Yes No Total Locum No. 221 88 309 % 71.5 28.5 Consultant No. 51 107 158 % 32.3 67.7 Sole principal No. 25 128 153 % 16.3 83.7 Other No. 23 145 168 % 13.7 86.3 Joint venture partner No. 18 117 135 % 13.3 86.7 Director (of limited company) No. 42 407 449 % 9.4 90.6 Assistant/employee No. 132 1,621 1,753 % 7.5 92.5 Equity partner No. 7 110 117 % 6.0 94.0 Salaried partner No. 3 58 61 % 4.9 95.1 Total 522 2,781 3,303 Respondents were asked about the full-time equivalents in different roles in their place of work. The results showed considerable variation:

■ VSs: between zero and 300, with a mean of eight and a mode of three

■ VNs: between zero and 311, with a mean of seven and a mode of two

■ Student VNs: between zero and 600, with a mean of three and a mode of one

■ Animal care assistants/auxiliaries: between zero and 400, with a mean of three and a mode of one

■ Other roles: between zero and 300, with a mean of five and a mode of two. The workplaces with very high numbers of staff proved, on analysis, to be veterinary hospitals; the average (mean and modal) figures are a more reliable indicator of the size of veterinary practices.

When asked if their practice employed VNs, 94 per cent of VS respondents said ‘yes’. The six per cent who did not work with VNs were not asked any questions relating to the work carried out by VNs, but were asked their opinions about the future of the VN role.

Figure 3.2 shows the work location of VSs who are working within clinical practice, using the first two letters/digits of workplace postcodes provided by respondents. 26 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Figure 3.2: Postcode map showing location of VS respondents working within clinical veterinary practice

8 Differences between VNs and VSs

■ Small animal practices are by far the most likely place of work for both VN and VS respondents, and similar percentages of VSs and VNs are also found in mixed and referral practices. In two practice areas i.e. equine and farm animal/production, there are notably higher percentages of VSs compared to VNs, although the numbers are still small.

■ Knowledge about whether their practice is a TP or a PSS is somewhat shaky among both VN and VS respondents, especially for the PSS.

■ VN respondents are much less likely to occupy director or partner roles than their VS counterparts; the locum role also appears to be far more common among VSs. Institute for Employment Studies 27 ■ When asked about the number (full-time equivalents) of people in different roles in the practice, VN and VS respondents gave similar responses when mean and modal values are compared.

3.4 VNs and VSs working in clinical practice: work activities

Tasks undertaken Respondents were presented with a list of clinical and non-clinical tasks, and were asked how often (if ever) they undertook these tasks: the options were ‘frequently (every day or several times a week)’, ‘sometimes (once or twice a week)’, ‘occasionally (less than once a week)’,’ rarely (less than once a month)’, and ‘never’. The results are presented in Table 3.9, while Figure 3.2 shows the most frequently-performed tasks (classified as ‘frequently’ by 75 per cent or more respondents). It should be noted that for two of these tasks, less than 75 per cent of VS respondents said that their VN colleagues did these ‘frequently’: administration of medicines by intramuscular injection (VSs said 73.4 per cent); and administration of anaesthetic pre-medication (VSs said 73.4 per cent).

Figure 3.2: Most frequently performed tasks, respondent VNs 28 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Table 3.17: Frequency of VN respondents undertaking clinical and non-clinical tasks (%)

Task Frequently Sometimes Occasionally Rarely Never Caring for hospitalised animals 84.2 9.6 4.0 1.8 0.4 Nursing clinic/counselling 49.9 19.9 10.6 9.7 9.9 Nutritional advice/counselling 32.6 25.6 17.9 13.7 10.2 Behaviour consultations 6.4 16.1 19.4 27.4 30.8 Placement of catheters, intravenous 71.4 14.1 6.2 3.4 4.9 Placement of catheters, urinary 9.9 17.0 18.5 29.5 25.0 Planning nursing care 51.2 22.9 13.1 8.5 4.2 Administration of medication 90.1 6.5 2.0 1.0 0.5 Placement of feeding tubes 3.7 7.9 13.1 29.6 45.8 Setting up & administration of intravenous fluids 85.4 8.8 3.4 1.6 0.9 Administration of vaccinations 27.0 15.8 11.0 14.5 31.7 Administration of medicines by subcutaneous injection 91.4 4.9 2.0 1.2 0.5 Administration of medicines by intravenous injection 71.3 13.3 7.5 4.4 3.5 Administration of medicines by intramuscular injection 85.6 9.1 2.9 1.5 1.0 Dispensing of medications to clients 72.2 13.6 6.5 3.5 4.2 Administration of other preventative POM-Vs such as endo- and ecto-parasiticides 62.0 16.8 9.8 6.4 5.0 Administration of anaesthetic pre-medication 75.1 11.8 4.6 4.0 4.4 Giving local anaesthesia 8.9 13.7 14.6 23.7 39.1 Induction of anaesthesia by increment 10.3 8.7 7.4 14.6 59.0 Induction of anaesthesia by set dose 17.3 14.0 10.3 15.1 43.4 Monitoring of anaesthesia 86.5 6.0 2.6 2.3 2.6 Laboratory test interpreting e.g. in house cytology and blood smears 39.9 18.0 14.6 14.4 13.1 Dental hygiene work 23.4 21.5 16.6 15.7 22.9 Institute for Employment Studies 29

Task Frequently Sometimes Occasionally Rarely Never Suturing and wound management 5.4 12.6 16.5 26.6 38.9 Performing dental extractions 1.2 1.6 1.8 5.2 90.2 Performing cat castrations 1.1 0.7 0.8 2.8 94.6 Performing calf castrations 0.1 0.0 0.2 1.1 98.6 Performing disbudding (i.e. removing the horn buds from young calves) 0.1 0.1 0.2 1.4 98.3 Performing supernumerary teat removal 0.0 0.0 0.1 1.1 98.7 Carrying out TB testing 0.1 0.2 0.3 1.6 97.9 Clinical cleaning (e.g. consulting rooms, theatre, instruments) 91.8 4.6 1.8 0.9 0.9 Taking radiographs 57.0 23.2 9.7 4.8 5.2 Processing radiographs 66.3 18.5 5.8 3.2 6.2 Assisting with ultrasound 61.3 22.5 9.3 4.1 2.8 Performing in-house laboratory tests 82.7 10.7 3.5 1.6 1.6 Taking blood samples 73.1 14.4 5.3 3.0 4.3 Teaching/supervising student VNs 43.8 13.2 8.6 8.1 26.3 Visiting clients 12.8 19.5 23.2 21.2 23.3 Reception work 47.8 23.1 13.9 9.2 6.0 Practice administration 34.1 18.5 14.8 14.0 18.6 General domestic cleaning 66.4 15.0 8.0 6.5 4.2 30 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

Additional surgical procedures? VN respondents were asked to identify any further surgical procedures that they carry out themselves (rather than ‘assist in’). Only seven per cent of respondents (N = 372) said they carried out additional surgical procedures; the analysis of the free text responses given by these respondents can be found in Table 3.10.

Table 3.18: Additional surgical procedures reported by VN respondents

Procedure No. % Lump removal 101 24.8 Aural haematoma 74 18.1 Wound suturing & management 57 14.0 Tail amputation 51 12.5 Lance/flush/drain abscesses 15 3.7 Biopsy 13 3.2 Castration (cat) 15 3.7 Amputation (toe) 7 1.7 Placing central lines 6 1.5 Dew claw removal 5 1.2 Ear flush 4 1.0 Other (3 or fewer responses per procedure) 60 14.7

Nursing clinics The majority of VN respondents are involved in at least one type of clinic offered by their practice (see Table 3.11).

Table 3.19: VN respondents’ involvement in nursing clinics

Clinic No. % None 723 14.0 Puppy/kitten 3,441 66.5 Nutrition 3,348 64.7 General check-ups 3,232 62.5 Dental 2,944 56.9 Vaccination 2,457 47.5 Geriatric/senior wellness 2,283 44.1 Other 1,349 26.5

The 26.5 per cent who said they were involved in ‘other’ clinics were asked to specify which clinics; the results are in Table 3.12. Institute for Employment Studies 31 Table 3.20: VN respondents’ involvement in ‘other’ clinics

% of those ‘Other’ clinic description saying ‘other’ Post-op 17.4 Weight 11.2 Nails 10.4 Anal glands 6.0 Flea & worm 5.7 Diabetic 5.1 Suture & wound management 3.3 Behaviour 3.3 Bandages 3.1 Blood 2.7 Parasites 2.6 Admit & discharge 2.2 Rabbit 2.2 Microchip 1.8 Other (mentioned by less than 1%) 23.0

A separate analysis was carried out to identify the involvement of qualified VNs only in nursing clinics (i.e. removing student VNs); the results are in Table 3.13.

Table 3.21: Qualified VN respondents’ involvement in nursing clinics

Clinic No. % None 406 11.1 Nutrition 2,676 73.2 Puppy/kitten 2,633 72.0 Dental 2,445 66.9 General check-ups 2,421 66.2 Vaccination 2,002 54.8 Geriatric/senior wellness 1,894 51.8 Other 1,004 27.5

9 Veterinary surgeons

Clinical and non-clinical work tasks undertaken by VNs When asked about the tasks performed by VNs at their place of work, VS respondents were given the same list of tasks as VNs and the same options regarding frequency, although ‘unsure’ was added as an option on the basis that VSs might not always know how frequently their VN colleague carried out these tasks. The results are presented in Table 3.14. 32 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Table 3.14 shows that the most frequently-performed tasks by VNs (classified as ‘frequently’ by 75 per cent or more respondents) are, according to VSs:

■ Caring for hospitalised animals 95.5 per cent

■ Monitoring of anaesthesia 94.1 per cent

■ Clinical cleaning 91.7 per cent

■ Performing in-house laboratory tests 84.2 per cent

■ Administration of medication 88.9 per cent

■ Administration of medicines by subcutaneous injections 85.9 per cent

■ Setting up & administration of intravenous fluids 80.4 per cent Institute for Employment Studies 33

Table 3.22: Frequency of VNs undertaking clinical and non-clinical tasks in VS respondents’ practices

Clinical Task Frequently Sometimes Occasionally Rarely Never Unsure Caring for hospitalised animals 95.5 2.9 1.0 0.5 0.2 0.0 Nursing clinic/counselling 62.5 19.2 8.0 5.1 4.6 0.6 Nutritional advice/counselling 52.3 24.8 10.9 6.6 4.5 0.8 Behaviour consultations 13.6 20.5 23.2 20.4 19.9 2.5 Placement of catheters, intravenous 73.4 15.7 6.3 2.8 1.5 0.3 Placement of catheters, urinary 12.6 17.8 17.3 23.8 26.4 2.1 Planning nursing care 58.8 22.0 9.8 5.3 2.5 1.6 Administration of medication 88.9 7.4 2.3 0.9 0.4 0.2 Placement of feeding tubes 3.5 6.1 9.7 21.6 55.0 4.0 Setting up & administration of intravenous fluids 80.4 12.3 3.9 2.0 1.0 0.5 Administration of vaccinations 24.8 16.7 12.3 14.4 29.6 2.2 Administration of medicines by subcutaneous injection 85.9 8.1 2.7 1.8 1.2 0.4 Administration of medicines by intravenous injection 54.2 19.4 10.9 7.8 7.0 0.8 Administration of medicines by intramuscular injection 73.4 16.0 5.7 3.1 1.5 0.4 Dispensing of medications to clients 59.1 14.4 8.8 5.9 9.9 1.9 Administration of other preventative POM-Vs such as endo- and ecto-parasiticides 62.4 19.8 7.8 3.7 4.3 2.0 Administration of anaesthetic pre-medication 73.4 11.9 5.6 4.3 4.2 0.5 Giving local anaesthesia 5.3 9.6 12.9 26.2 43.4 2.5 Induction of anaesthesia by increment 7.7 7.1 7.7 14.5 60.5 2.5 Induction of anaesthesia by set dose 12.0 10.9 11.1 16.1 47.8 2.1 Monitoring of anaesthesia 94.1 1.7 0.9 0.8 2.3 0.2 Laboratory test interpreting e.g. in house cytology and blood smears 23.0 16.2 16.5 18.5 24.2 1.5 Dental hygiene work 24.1 26.2 17.0 14.1 16.8 1.9 Suturing and wound management 3.3 10.6 18.4 28.9 36.5 2.3 Performing dental extractions 1.2 1.9 2.9 6.3 85.5 2.2 Performing cat castrations 1.2 0.9 1.1 3.1 91.7 2.0 Performing calf castrations 0.2 0.1 0.0 0.5 93.1 6.0 34 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Clinical Task Frequently Sometimes Occasionally Rarely Never Unsure Performing disbudding (i.e. removing the horn buds from young calves) 0.3 0.1 0.1 0.4 92.3 6.7 Performing supernumerary teat removal 0.2 0.1 0.0 0.4 93.0 6.3 Carrying out TB testing 0.3 0.2 0.1 0.4 92.3 6.8 Clinical cleaning (e.g. consulting rooms, theatre, instruments) 91.7 4.6 1.1 0.8 1.5 0.4 Taking radiographs 50.9 30.3 9.2 4.1 4.8 0.7 Processing radiographs 72.1 15.8 4.2 1.7 5.2 0.9 Assisting with ultrasound 64.3 21.7 7.0 2.4 4.1 0.5 Performing in-house laboratory tests 84.2 10.0 2.1 1.3 2.1 0.3 Taking blood samples 71.3 19.8 4.7 2.5 1.4 0.3 Teaching/supervising student VNs 72.8 11.0 3.6 2.1 9.0 1.6 Visiting clients 12.6 22.1 22.5 18.7 21.0 3.1 Reception work 42.7 24.3 16.9 9.2 6.3 0.7 Practice administration 29.9 27.4 19.7 11.4 9.3 2.4 General domestic cleaning 51.7 17.3 11.4 11.3 7.5 0.8 Institute for Employment Studies 35

Additional surgical procedures undertaken by VNs? When asked if VNs at their workplace carried out any further surgical procedures, only five per cent of VS respondents (N = 140) said VNs carried out such procedures; the analysis of the free text responses given by these respondents can be found in Table 3.15.

Table 3.23: Additional surgical procedures carried out by VNs, reported by VSs

Procedure No. % Lump removal 60 19.5 Tail amputation 44 14.3 Wounds suturing and management 35 11.4 Aural haematoma/Otohematoma 28 9.1 Digit amputation 12 3.9 Lancing/flushing abscesses 12 3.9 Scrub into surgeries 12 3.9 Pinna amputation 6 1.9 Ear flush 5 1.6 Nail - clipping/removal 5 1.6 Orthopaedic 5 1.6 Cat castration 4 1.3 Ex lap 4 1.3 Minor sutures 4 1.3 Toe amputations 4 1.3 Skin biopsies 3 1.0 Other (3 or fewer responses per procedure) 64 20.9

Nursing clinics According to VS respondents, the majority of VN respondents are involved in at least one type of clinic offered by their practice (see Table 3.16).

The 19.6 per cent who said their VN colleagues were involved in ‘other’ clinics were asked to specify which clinics; the results are in Table 3.17.

Table 3.24: VNs’ involvement in nursing clinics in VS respondents’ practices

Clinical No. % None 400 12.9 Nutrition 2,371 76.8 Dental 1,625 52.6 Puppy/kitten 2,046 66.2 Vaccination 1,169 37.8 Geriatric/senior wellness 1,371 44.4 General check-ups 1,299 42.1 Other 605 19.6 36 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

Table 3.25: VNs’ involvement in ‘other’ clinics, according to VS respondents

% of those ‘Other’ clinic descriptions saying ‘other’ Post-op 17.3 Weight 8.8 Nail 8.2 Diabetes 5.7 Laser 4.7 Anal glands 4.6 Flea & worm 4.2 Behaviour 4.0 Bandages 2.8 Sutures & wound management 4.3 Physio 1.8 Second vaccination 1.6 Arthritis 1.5 Obesity 1.5 Parasite 1.5 Administer meds 1.3 Adolescent checks 1.3 Other (mentioned by less than 1%) 24.8

10 Differences between VNs and VSs On the whole, there is a fairly close correspondence between the activities reported by VNs, and the views of VSs about what VNs in their practices do. Both VNs and VSs, for example, had similar views about the tasks performed ‘frequently’ by VNs, although the ordering of the lists was different. In addition, 75 per cent of VSs identified only seven tasks performed ‘frequently’, compared to nine tasks by 75 per cent of VNs. For ‘administration of medicines by intramuscular injection’, only 73.4 per cent of VSs said this was performed ‘frequently’, compared to 85.6 per cent of VNs. For ‘administration of anaesthetic pre-medication', 73.4 per cent of VSs said this was performed ‘frequently’ compared to 75.1 per cent of VNs.

There was also a fairly close correspondence in views about the clinics in which VNs are involved, although again the order differed slightly. Finally, when asked about additional surgical procedures carried out by VNs, both VNs and VSs identified the same four most common procedures: lump removal, tail amputation, suturing wounds, and aural haematoma. Institute for Employment Studies 37

4 Understanding of Schedule 3

10.1 Level of understanding of different groups Respondents were asked about the understanding of what could be done by VNs under Schedule 3 on a scale of 1 to 10, where 1 represents ‘poor’ and 10 ‘excellent’. There were four aspects to rate: their personal understanding, the understanding of VNs generally, the understanding of VSs at their workplace, and the understanding of VSs generally. Table 4.1 shows the percentage of responses for each of the ratings from 1 to 10, for these aspects. The final column gives the mean score out of 10.

Table 4.26: VNs’ rating of the level of understanding of what can be done by VNs under Schedule 3

Personal understanding

Poor Excellent 1 2 3 4 5 6 7 8 9 10 Mean % of respondents 1.6 2.1 5.7 5.5 12.1 10.5 20.3 23.3 11.4 7.5 6.74

Understanding of VNs generally

Understanding of VSs at your workplace

Understanding of VSs generally

It is apparent, from the spread of ratings and the mean scores, that VN respondents consider their own personal understanding, and that of VNs generally, to be greater than that of VSs; however, there are relatively few respondents who are confident enough to rate even their own personal understanding at 9 or 10 out of 10. Further analysis indicates that student VNs are more optimistic about the levels of understanding of Schedule 3 than their qualified colleagues (see Figure 4.1). 38 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Figure 4.1: Views about the understanding of Schedule 3, comparing qualified VN respondents with student VN respondents – mean scores

VNs working in veterinary schools, VN colleges or universities are more confident in their personal understanding of Schedule 3, scoring this as 8.61 out of 10 – much higher than the overall VN respondent average of 6.74. They also rate the understanding of VNs generally somewhat higher than average (6.94 compared to 6.43) but are less confident about the knowledge of VSs generally (5.22 compared to 5.56).

11 Main things that prevent the full utilisation of the VN role When asked to identify the main things that prevented the full utilisation of VNs, respondents rated ‘lack of understanding generally of what tasks can be delegated under Schedule 3’ as the main reason (see Table 4.2). However, over half of the VNs who responded to the survey selected three further reasons: ‘VSs are not good at delegating’, ‘VNs are not trained to take on further tasks’ and ‘VNs lack confidence in themselves’. Only seven per cent selected ‘VNs are not interested in enhancing their role’.

The top three ‘other’ reasons given by VN respondents are: ‘understaffed’, ‘lack of time – to teach/do the procedures/learn’ and ‘vets do the task themselves’.

When the views of qualified VNs and student VNs are compared, it is apparent that students feel less strongly than their qualified colleagues about barriers in the way of the full utilisation of VNs (see Figure 4.2).

Table 4.27: Main things preventing the full utilisation of VNs: VN respondents overall

% of VN respondents Lack of understanding generally of what tasks can be delegated under Schedule 3 72.9 Veterinary surgeons are not good at delegating 54.3 RVNs are not trained to take on further tasks 52.2 RVNs lack confidence in themselves 50.3 Institute for Employment Studies 39 Veterinary surgeons do not have confidence in the ability of RVNs 43.6 The lack of career progression makes RVNs unwilling to take on further tasks 38.2 Veterinary surgeons are averse to taking risks 33.5 RVNs are not interested in enhancing their role 7.2 Other 12.8

Figure 4.2: Things preventing the full utilisation of VNs, comparing qualified VN respondents with student VN respondents

VN respondents working in veterinary schools, VN colleges and universities feel more strongly than average that ‘lack of understanding generally of what tasks can be delegated under Schedule 3’ prevents the full utilisation of VNs (80.3 per cent selected this option, compared to an average of 72.9 per cent). They also feel more strongly that ‘veterinary surgeons are not good at delegating’ is an issue (62.7 per cent compared to an average of 54.3 per cent).

4.2 Veterinary surgeons

11.1 Level of understanding of different groups Respondents were asked about the understanding of what could be done by VNs under Schedule 3 on a scale of 1 to 10, where 1 represents ‘poor’ and 10 ‘excellent’. There were four aspects to rate: their personal understanding, the understanding of VNs generally, the understanding of VSs at their workplace, and the understanding of VSs generally. Table 4.3 shows the percentage of responses for each of the ratings from 1 to 10, for these aspects. The final column gives the mean score out of 10. 40 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Table 4.28: VSs’ rating of the level of understanding of what can be done by VNs under Schedule 3

Personal understanding of what VNs can do under Schedule 3

1 10 Poor 2 3 4 5 6 7 8 9 Excellent Mean % of respondents 6.5 4.5 10.4 9.0 16.6 12.0 18.9 14.0 5.1 2.9 5.57

Understanding of VNs generally of what VNs can do under Schedule 3

Understanding of other VSs at your workplace of what VNs can do under Schedule 3

Understanding of VSs generally of what VNs can do under Schedule 3

It is apparent, from the spread of ratings and the mean scores, that respondent VSs are not particularly confident about their own personal understanding, or the understanding of their colleagues or VSs generally, and feel that VNs have a notably better understanding.

In general, VSs working outside clinical veterinary practice are only slightly less confident about their personal understanding of Schedule 3, rating this as 5.54 compared an average overall of 5.57. However, VSs working in farm/production animal practices, where very few VNs work, are less confident about their personal understanding, rating this as 5.11 out of 10. VSs working for APHA, the FSA, government departments or local government are even less confident about their personal understanding, rating this at 4.99.

VSs in clinical practice who do not work with VNs are less confident about their personal understanding of Schedule 3 (5.20 out of 10, compared to 5.56 for those who do work with VNs).

12 Main things that prevent the full utilisation of the VN role When asked to identify the main things that prevented the full utilisation of VNs, VS respondents rated ‘lack of understanding generally of what tasks can be delegated under Institute for Employment Studies 41 Schedule 3’ as the top reason (see Table 4.4), followed by ‘VSs are not good at delegating’. Only ten per cent selected ‘VNs are not interested in enhancing their role’. VSs working outside clinical practice were much less likely to select ‘VNs lack confidence in themselves’ (29 per cent, compared to 41 per cent of those working within clinical practice). VSs in clinical practice who do not work with VNs are much less likely to agree with two reasons than those who have VNs in their practice: ‘VNs are not trained to take on further tasks (23.9 per cent compared to 37.3 per cent) and ‘VNs lack confidence in themselves’ (24.4 per cent compared to 42.3 per cent).

The top four ‘other’ reasons given by VS respondents are: ‘understaffed’, ‘not enough time’, ‘quicker/better for VSs to do it if they have to supervise anyway’ and ‘overstaffed with VSs/ratio of VNs to VSs is poor’.

Table 4.29: Main things that prevent the full utilisation of VNs: VS respondents

No. % Lack of understanding generally of what tasks can be delegated under Schedule 3 2,445 64.9 Veterinary surgeons are not good at delegating 2,274 60.3 Veterinary surgeons are averse to taking risks 1,698 45.0 VNs lack confidence in themselves 1,494 39.6 VNs are not trained to take on further tasks 1,347 35.7

Veterinary surgeons do not have confidence in the ability of VNs 909 24.1 The lack of career progression makes VNs unwilling to take on further tasks 806 21.4 VNs are not interested in enhancing their role 367 9.7 Other 621 16.5

4.3 Differences between VNs and VSs It is clear that both VNs and VSs do not feel entirely confident about what VNs can, and cannot, do under the provisions of Schedule 3. However, VNs rate their personal understanding more highly than VSs do, and both VNs and VSs think that VNs have a better understanding than VSs. VSs are somewhat harder on themselves than VNs are, in the sense that they rate the understanding of VSs generally at a fairly low 5.2 out of 10, compared to a slightly more generous 5.56 given by VNs.

VNs and VSs give similar reasons for the things preventing the full utilisation of VNs, with both identifying a general lack of understanding of Schedule 3 as the top reason and citing VSs being not good at delegating as also being important. However, VNs are notably more concerned about their own lack of confidence and training to take on further tasks, and also believe much more strongly than VSs that ‘veterinary surgeons do not have confidence in the ability of VNs’. Figure 4.3 compares the responses of VNs overall with those of VSs. 42 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Figure 4.3: Things preventing the full utilisation of VNs, comparing VN respondents overall with VS respondents Institute for Employment Studies 43

5 The Future VN Role

5.1 Veterinary nurses A very high 92 per cent of VN respondents agreed that VNs should be able to undertake additional areas of work that are not currently permitted under Schedule 3. These respondents were presented with a list of tasks (some of which are already permitted under Schedule 3) and asked to give their opinions about whether, with appropriate training, VNs should be able to undertake each task. The results (see Table 5.1) indicate that there is a very high level of agreement that three tasks in particular should be permitted: administration of medicines by intramuscular injection, administration of medicines by intravenous injection, and administration of preventative POM-Vs. These tasks are already allowed under Schedule 3, so the high level of agreement is encouraging. Over three-quarters also believed that performing cat castrations should be permitted, and over two-thirds that dental extractions should be allowed; these tasks are not permitted under the current interpretation of Schedule 3.

The views of VNs working in veterinary schools, VN colleges or universities are very similar to those of respondents overall, except in one category: 70.5 per cent think that VNs should be able to carry out TB testing, compared to only 47.3 per cent of respondents overall.

Table 5.30: VNs views on whether VNs should be able to undertake particular tasks

Yes No No. of Task % % Unsure respondents Administration of medicines by intramuscular injection 99.7 0.1 0.2 5,232 Administration of preventative POM-Vs such as endo- 99.1 0.5 0.4 5,230 and ecto-parasiticides Administration of medicines by intravenous injection 99.0 0.4 0.6 5,229 Performing cat castrations 78.5 14.9 6.6 5,218 Performing dental extractions 68.3 21.9 9.7 5,205 Other minor surgical procedures, 55.9 18.3 25.8 5,176 e.g. supernumerary teat removal Carrying out TB testing 47.3 17.4 35.3 5,142 Performing disbudding 29.9 28.7 41.4 5,136 Performing calf castrations 27.9 30.8 41.4 5,144 Other tasks 44.7 15.9 39.4 2,127

When asked to specify the ‘other’ tasks that VNs should be able to do, VN respondents produced a long list, although only five tasks were cited by more than 50 respondents. Table 5.2 shows that by far the most-frequently mentioned task was ‘anaesthesia’. For some tasks, such as ‘amputation’, ‘diagnostics’ and ‘emergency work’, it is not always 44 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey clear what is meant by respondents or how far they would like their responsibilities to extend in these areas. Within the large category of ‘anaesthesia’, over half of those who cited the task clarified this by saying that VNs should be able to administer the ‘induction of anaesthesia’, and in turn half of those who thought VNs should be responsible for induction of anaesthesia said that induction should be ‘by increment’. A small number of the total responses related to anaesthesia, around ten per cent, thought that VNs should be able to administer anaesthesia ‘to effect’ and further ten per cent thought they should be able to ‘monitor and maintain’ anaesthesia1.

Table 5.31: ‘Other’ tasks that VN respondents think they should be able to carry out

% of those specifying Procedure an ‘other’ task No. Anaesthesia 35.6 344 Lump removal 11.4 110 Wound suturing & management 11.2 108 Tube placement 7.6

73 Prescribe & dispense medication

6.7 65 Vaccination 4.6 44 Amputation 2.9 28 Castration 2.7 26 Cystocentesis 2.6 25 Dental work 1.7 16 Scans 1.4 14 Epidurals 1.4 14 Anal gland expression 1.0 10 Diagnostics 0.9 9 Acupuncture 0.9 9 Emergency work 0.8 8 Blood work 0.6 6 Abscess management 0.6 6 Equine specific procedures 0.5 5 Thoracocentesis 0.5 5 Lab work 0.5 5 Clinics & consults 0.4 4 Microchipping 0.4 4 Euthanasia 0.4 4 Ear flush 0.3 3 Other (3 or fewer responses per procedure) 2.2 21 Some VNs added some comments in relation to the procedures they outlined above. The majority of comments related to the prerequisites they felt should be in place before they

1 Guidance about the role of the VN regarding the maintenance and monitoring of anaesthesia can be found in section 18.9 of the Code of Professional Conduct for Veterinary Surgeons. Institute for Employment Studies 45 took on the procedure. Many VNs felt that in order to take on additional work, especially anaesthesia, there should be further training and qualifications to become specially trained in certain areas. Additionally, a minority of VNs felt that there should be a VS supervising, or at least in the building, in order for them to carry out the tasks. An illustrative selection of comments by VN respondents is given below.

‘Induction and maintenance of anaesthesia for nurses with certificates.’

‘Induction of incremental anaesthesia provided a vet is on the premises and can be called upon if needed.’

‘“Nurse practitioner” or specialist technician roles where high level qualifications have been obtained e.g. in anaesthesia or in the pharmacy (beyond SQP).’

‘With a greater core anaesthesia training nurses should be able to make more decisions as in my experience many VNs know a lot more about anaesthesia than veterinary surgeons.’

5.2 Veterinary surgeons A majority (71 per cent) of VS respondents agree that VNs should be able to undertake additional areas of work that are not currently permitted under Schedule 3. However, among VSs working for APHA, the FSA, government departments or local government, a lower 58 per cent agree. Within clinical practice, VSs who work with VNs in referral practices are particularly likely to agree (76.2 per cent) likely to agree; however, among VSs in clinical practice who do not work with VNs, the percentage is much lower (58 per cent). Further investigation into age, year of qualification and role within practice showed no significant findings related to whether VNs should or should not be permitted to do more.

As for VNs, the respondents who agreed were presented with a list of tasks and asked to give their opinions about whether, with appropriate training, VNs should be able to undertake each task. The results (see Table 5.3) indicate that a very high level of agreement about three tasks that are already permitted under Schedule 3: administration of preventative POM-Vs, administration of medicines by intramuscular injection, and administration of medicines by intravenous injection. Around two-thirds also agree that some procedures not currently permitted under Schedule 3 – performing cat castrations, carrying out TB testing, and performing further minor surgical procedures, in addition to those allowed – should be permitted.

Table 5.32: VS’ views on whether VNs should be able to undertake particular tasks

% % No. of Task Yes No VS Administration of medicines by intravenous injection 96.0 4.0 2,692 Administration of medicines by intramuscular injection 99.4 0.6 2,707 Administration of preventative POM-Vs such as endo- and ecto-parasiticides 99.5 0.5 2,704 Performing dental extractions 51.2 48.8 2,592 Performing cat castrations 69.8 30.2 2,632 Performing calf castrations 46.8 53.2 2,462 Performing disbudding 60.5 39.5 2,477 46 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey % % No. of Task Yes No VS Other minor surgical procedures, e.g. supernumerary teat removal 64.9 35.1 2,520 Carrying out TB testing 65.0 35.0 2,494 Other tasks 55.2 44.8 882 VSs working in farm/animal production practices were more likely to agree that VNs should be able to carry out calf castrations (57.1 per cent compared to 46.8 per cent overall) and disbudding (86.4 per cent compared to 60.5 per cent overall), but not TB testing (58.1 per cent compared to 65.0 per cent overall).

VSs in clinical practice who do not work with VNs are less likely to agree VNs should be able to carry out administration of medicines by intravenous injection (80.8 per cent compared to 97.4 per cent of those working with VNs), dental extractions (35.9 per cent compared to 52.7 per cent) and cat castrations (60.6 per cent compared to 71.6 per cent). However, they are more likely to agree that VNs should be able to perform disbudding (69.0 per cent compared to 59.2 per cent) and TB testing (69.9 per cent compared to 62.7 per cent).

When asked to specify ‘other’ tasks that VNs should be able to undertake, ‘anaesthesia’ was the most commonly reported task, followed by ‘wound suturing/management and ‘tube placement’ (Table 5.4).

Within the ‘anaesthesia’ category, when VSs provided more detail in their comment, over half the respondents specified ‘induction’ of anaesthesia as a suitable task. Of those who specified induction, half thought it should be ‘induction by increment’. Around a third of the comments related to anaesthesia mentioned ‘monitoring and maintaining’, while a small number suggested ‘local anaesthesia’.

Some VSs raised a number of concerns and queries when responding to this question. Mostly, this related to the need for further qualification and training if VNs take on additional tasks in general, especially anaesthesia. An illustrative selection of comments by VS respondents is given below.

‘I would favour a further formal anaesthesia qualification for nurses.’

‘We need to raise nurse training/qualifications to give them an anaesthesia role that they are trained to perform.’

‘Additional training/official certification should be available to those nurses with specific interests.’

‘I would support creation of an advanced tier of veterinary nurses who are allowed to be more responsible.’

Table 5.33: ‘Other’ tasks that VS respondents think VNs should be able to carry out

Procedure % No. Anaesthesia 23.9 173 Wound suturing and management 12.0 87 Vaccines 7.2 52 Tube Placements 6.5 47 Prescribe & dispense 4.6 33 Institute for Employment Studies 47 Procedure % No. Dental work 4.4 32 Clinics & consults 4.1 30 Lump removal 3.5 25 Castration 3.3 24 Blood sampling 3.2 23 Anal gland expression 2.5 18 Ultrasound 2.3 17 Cystocentesis 1.7 12 Diagnosis & assessment 1.7 12 Emergency 1.2 9 Thoracocentesis 1.1 8 Biopsy 1.0 7 Pre/Post-op examinations 0.8 6 Client 0.7 5 Minor surgery 0.7 5 Amputation 0.7 5 Lab 0.7 5 Equine 0.7 5 Flea 0.6 4 Physiotherapy 0.6 4 TB 0.6 4 Ear 0.6 4 Ultrasound 0.6 4 Aural haematoma 0.6 4 Other (3 or fewer responses per procedure) 8.3 60

Within the ‘anaesthesia’ category, when VSs provided more detail in their comment, over half the respondents specified ‘induction’ of anaesthesia as a suitable task. Of those who specified induction, half thought it should be ‘induction by increment’. Around a third of the comments related to anaesthesia mentioned ‘monitoring and maintaining’, while a small number suggested ‘local anaesthesia’.

Some VSs raised a number of concerns and queries when responding to this question, a selection of which are given below. Mostly, this related to the need for further qualification and training if VNs take on additional tasks in general, especially anaesthesia.

‘I would favour a further formal anaesthesia qualification for nurses.’

‘We need to raise nurse training/qualifications to give them an anaesthesia role that they are trained to perform.’

‘Additional training/official certification should be available to those nurses with specific interests.’

‘I would support creation of an advanced tier of veterinary nurses who are allowed to be more responsible.’ 48 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey 5.3 Differences between VNs and VSs There is very clear agreement between VNs and VSs regarding the top three tasks that VNs should be able to carry out. Other tasks are less clear, although it appears that some activities common in small animal practices (cat castrations, dental extractions and further minor surgical procedures) are popular candidates for adding to the list of permitted activities for VNs to perform. VNs are unsure about some tasks that most of them – being small animal practitioners – do not encounter, such as TB testing, although VSs believe this would be a suitable task for VNs.

Figure 5.1 compares the responses of VNs overall with those of VSs.

Figure 5.4: Tasks that VNs should be able to carry out, comparing VN respondents overall with VS respondents Institute for Employment Studies 49

6 Perceptions of Support and Advice given by the RCVS

6.1 Overall views The majority (60.5 per cent) of VN respondents think the RCVS gives sufficient support and advice to VSs and VNs about Schedule 3.

By contrast, opinions of VS respondents are exactly divided, with 50 per cent saying yes, the RCVS gives sufficient support and advice to VSs and VNs about Schedule 3, and the other 50 per cent saying no.

6.2 Further support and advice Respondents who said ‘no’ were asked to provide free text information about the further support and advice that should be provided. The responses of VNs and VSs were very consistent.

13 Clarity Overwhelmingly, both VNs and VSs desire more clarity around Schedule 3. There appear to be many grey areas that are left open for interpretation; this ‘grey area’ impacts the effective delegation of some procedures:

‘Black and white yes/no for certain procedures. Grey areas are where veterinary surgeons are least willing to delegate to VNs.’

‘Clarity - there are many 'grey' areas which few vets are prepared to take a risk on.’

Veterinary Nurses ‘Clear direction. Less fuzzy grey interpretation.’

‘Clear advice, the vet surgeons Act is confusing and wordy.’

Veterinary Surgeons Respondents highlighted that there is ambiguity around some wording within Schedule 3, notably around ‘minor surgery’ and ‘body cavities’:

‘Clarification of grey areas such as ‘minor surgery’ for example.’

Veterinary Nurse ‘It is impossible to decide what a body cavity is: epidural is not allowed as it is a ‘body cavity’ but IV or arterial lines can be placed by VNs as can urinary catheters... are these not body cavities? Consistency is important and it is lacking and I also feel the RCVS does not support our VNs as much as they should.’ 50 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Veterinary Surgeon It was suggested that clarity could be gained by a clear list of what is and what is not included in Schedule 3:

‘I think the RCVS should provide a list of procedures, especially surgical procedures, a VN can do under Schedule 3; to make it clear to VNs and Vets. As the current information is slightly unclear, and open to interpretation.’

Veterinary Nurse ‘Comprehensive list of duties and required evidence to enable due diligence of competencies.’

Veterinary Surgeon

14 Communication Respondents suggested that the way that the RCVS communicates about Schedule 3 could be improved. This could be in the form of leaflets, posters, checklists, emails and an online space where those in the profession can access information simply and quickly:

‘Literature and maybe a short video on their website explaining schedule 3, the older vets in my practice struggle to not see lay people as VNs even though they have no formal qualifications and have been in the job for years.’

Veterinary Nurse ‘Schedule 3 info sheets which clearly lists what nurse can and can’t do that could be put up in practice.’

Veterinary Nurse ‘Posters for the practice on what can / can't be done so everyone is on the same page and nurses don't get offended if vets say no.’

Veterinary Surgeon Effective communication, so that both VNs and VSs are equally informed, was considered important. VSs in particular would like to see an increase in the communication from the RCVS, to ensure any changes are communicated and the procedures authorised under Schedule 3 remain in the forefront of their minds:

‘Email practices with examples of what VNs can do, with examples. Perhaps a monthly email for a year to all practices, followed by a six monthly one, to keep it in people’s minds. Or a mail going out with the annual retention fee notice.’

Veterinary Surgeon

15 Training VNs and VSs think that there should be further and ongoing education/training regarding Schedule 3, both during qualification and on the job. Refreshers, such as training days, to keep knowledge up to date following qualification would be welcomed. Additionally, VNs Institute for Employment Studies 51 and VSs would like there to be more training and more continuing professional development (CPD) about which specific tasks they can carry out under Schedule 3:

‘At uni there should be more info given over the legislation. Simple access to the rules should be publicised more.’

Veterinary Surgeon ‘Regular training day/webinars to highlight what can be done, and how to make the most of it.’

Veterinary Surgeon ‘I don't know if it already exists but a CPD-like course, to refresh every few years or when there is a change.’

Veterinary Nurse ‘The training for nurses should be a lot harder and more detailed. At the moment we get away with minimal knowledge and some practical skills. The practices should be monitored more closely for what they allow nurses, student nurses and assistant to do. The nurses should have opportunity to specialise, like they do in America. There should be additional things allowed to do for nurses with further qualifications, like Advanced Diploma. More further qualifications should exist. Otherwise nurses hit the wall.’

Veterinary Nurse ‘Schedule 3 CPD sessions designed to help nurses train specifically for the tasks they are allowed to do and become confident in these roles.’

Veterinary Nurse ‘I would like better support in training for schedule 3 tasks. I have had no formal training in suturing or other minor surgery, and I find vets are reluctant, or often too rushed, to teach.’

Veterinary Surgeon

16 Responsibility A less commonly-occurring theme, but mentioned by both VN and VSs, relates to what happens when something goes wrong. Some VSs are apprehensive to delegate, and some VNs are reluctant to take on more responsibilities, when neither is clear about who is accountable. Clarity regarding legal accountability would be welcomed:

‘Just make it clear what the rules are and who is accountable if it goes wrong! Vets don't like to be accountable for someone else's actions!’

Veterinary Nurse ‘It should be clearer on whose responsibility it is if things go wrong and also down to the discretion of the vet and nurse. There is a massive variation in ability in vet nurses. Most vets are too scared to allow nurses to do much for fear of being hauled before the RCVS if anything goes wrong.’

Veterinary Surgeon 52 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Institute for Employment Studies 53

7 Final Survey Comments

Respondents were given the opportunity, at the end of the questionnaire, to provide free text comments about the future role of the VN. These have been grouped into themes, with illustrative examples of the comments that were made.

7.1 Underutilised, undervalued, underappreciated & underpaid Overwhelmingly, the comments from VNs related to their view that their role and their skills are significantly underappreciated by the public and by VSs, not helped by the lack of a protected title. The type of work that they are asked to do does not, in some respondents’ view, match the training that they have received, and some feel like ‘glorified cleaners’. Many VNs feel underutilised and underpaid, a view shared by some VSs. Protection of the VN title would be welcomed; this would acknowledge the training and experience of a qualified VN, especially with the rise of the ‘nursing veterinary assistant’ in the profession (a role not requiring formal training and examination).

I am proud to be a veterinary nurse and just wish the general public would recognise us as nurses not just the underdogs to the vets.

Until our title is protected, the public is always going to have a misrepresentation for what we do, and how qualified we are

We are worth more as advocates than the industry gives us credit for, help improve public perception and opinion by bolstering our role and highlighting our importance!!!

I think the future of the VN is in jeopardy as there is no career progression and we all feel like qualified cleaners.

VNs are expected to have the underpinning knowledge in order to enhance their care of patients. However, they are not allowed the opportunity to utilise the breadth and depth of their knowledge.

PAY US BETTER The lack of monitoring the out of hours that we do means our employees can get away with making us work ridiculous hours without any check up from the RCVS The pay is poor compared to nurses in the NHS and there is little progression.

Veterinary nurses

Comments from VSs support those from VNs. VSs commented that VNs were underappreciated and underutilised, despite being essential for their practice:

VNs are still grossly under-utilised. They have a wide skillset yet most are still used as kennel assistants/cleaners.

My nurses are wonderful and in many cases they will prompt me with a line of investigation I had not thought of. My experience generally is that they are highly motivated and take pride and care in what they do. They are less likely to omit any information when discharging patients. When I 54 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey started work we actually didn't have any nurses, now I cannot imagine running my practice without them.

Nurses are an invaluable help and can make a vet’s life much easier. They are ridiculously underpaid, underused and underappreciated.

VNs are invaluable - they're essential colleagues in practice! If there are more tasks that they could be safely doing and they want to be doing, then all vets should support and encourage that.

Veterinary surgeons

7.2 Further training and specialisation A frequently-occurring comment from VNs was that there should be further training and qualification opportunities, with some citing the American system. They felt this would allow for specialisation and more opportunities for career progression. They also think that the profession would be aided by the mirroring the human approach to medicine:

With training, I think VNs could mirror what is happening in the human medicine world i.e. Nurse/Paramedic practitioners in support of GPs.

I think we should look at the human nurse model of training and look to progress the Veterinary nursing training and career path/opportunities in a similar direction.

VNs should be acknowledged in the same way human nurses are, still too many animal nursing assistants and lay people claiming to be ‘veterinary nurses’ when they are not, this is however much improved, but I think the public should be made aware. Also that there are different levels of veterinary nurses, would be great if the RCVS introduced specialism, similar to the American vet tech specialist courses, as it would be more convenient and relevant to UK-based VNs.

Veterinary nurses

Drawing comparisons with the American system and human approach was something supported in some comments from VSs. They felt that this approach would be more rigorous and therefore give VSs more confidence that VNs were appropriately trained to undertake more complex tasks, and that VNs would also be given the opportunity for career progression:

RCVS needs to recognise higher qualifications such as advance nursing qualifications awarded by yourselves, the American Veterinary Technician Specialist roles (or create a UK equivalent) and the difference between an VN trained by bachelor’s degree versus NVQ level. Only by sorting out career progression can we hope to keep the best VNs in practice. They leave because they are under-used and under-challenged.

Further training in certain areas would allow VNs to take on additional tasks/responsibilities - rather than additional tasks that all VNs can do, this should be broken down into tasks or procedures that can be done with x further qualification.

I think there is huge potential for the veterinary nursing profession to be 'allowed' to contribute more; these are highly trained and capable individuals. We need to be more progressive with regard to the nursing role and draw comparisons with the human field!

Veterinary surgeons Institute for Employment Studies 55 56 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

8 Post-survey Interviews

8.1 Interview themes Following the survey, 20 telephone interviews (10 with VNs and 10 with VSs) took place during August, September and October 2017. The participants had all volunteered for follow-up interviews via a question in the survey, and had provided their contact details to enable the IES research team to approach them directly.

Participants were asked for their views on the following themes:

■ The career paths and development available to VNs.

■ The pay and benefits offered to VNs.

■ Reasons for some VNs leaving the profession.

■ Their understanding of Schedule 3.

■ Whether it is time for a review of Schedule 3.

■ Their opinions about the benefits of creating advanced or specialist roles for VNs.

■ Whether VNs should be able to take on more tasks and more responsibility, and if so, which tasks.

■ What might make VNs unwilling to take on more.

■ Their views on the guidance currently provided by the RCVS about Schedule 3, and any additional guidance that might be useful.

In addition, VSs were asked:

■ Whether the current number of VNs within the veterinary profession was sufficient.

■ The potential benefits, to VSs and to the veterinary profession generally, of an enhanced role for VNs.

Finally, all interviewees were given the opportunity to make additional comments. Institute for Employment Studies 57 8.2 The VN interviewees

16.1 Profile

■ There are eight female and two male interviewees, ranging in age from 25 to 41.

■ All ten are qualified, with the year of qualification ranging from 1997 to 2015. Two qualified in the late 1990s, four between 2000 and 2009, and four between 2010 and 2015.

■ Six work in first opinion practices, of which four are small animal only, one mixed, and one charity (small animals including wildlife); three work in small animal referral practices or referral hospitals; and one works in education.

■ Six are VNs, two senior VNs, one a head VN and practice co-ordinator, and one a tutor. Two of the VNs are locums, while the tutor also carries out some locum work in either small animal or mixed practices.

■ Nine are currently working as a VN (eight full-time, one part-time), while one is just embarking on maternity leave. However, of the nine currently working, one is leaving the profession at the end of the year to train to become a human radiographer, while another is studying for a degree in psychology with a view to becoming a clinical psychologist, and is doing locum work only at weekends for additional income.

■ Six work days only, three nights only, and one shifts including nights.

■ Eight are based in England, mainly in the south or south-west; one works in Northern Ireland, and one in Wales.

■ Background: most have worked in several different practices, some in different parts of the country. Several had worked in both first opinion and referral. Only one has always worked in the same practice (for 16 years), rising to be head nurse; another has been in the same practice for 12 years (and is now a senior nurse) but has worked in other practices before the current one.

■ When asked why they had decided to become a VN, the overwhelming answer, given by all ten interviewees, was an interest in animals and/or a love of animals, and a desire to work hands-on with animals. Five had wanted to be a VS but did not get the ‘A’ level grades or thought they would not get the grades, while four had considered becoming a VS but preferred the caring, hands-on role, especially after doing some work experience and finding out about the VN role. One interviewee, in addition, specifically mentioned wanting to work with and educate clients about their animals, while another wanted a worthwhile job, and thought the VN role fulfilled this. 58 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey 17 Views

Interviewees’ own career and development When asked if they were pleased with their career and development so far as a VN, views varied considerably. The majority expressed positive views, with those in senior or teaching positions and those working in referral being particularly positive:

‘I love being a veterinary nurse… I’m happy to be in referral because there are more opportunities.’

VN (referral) ‘I’m pleased with my career progression – I’ve been able to do a teaching degree, advanced post grad diploma and may do a masters. I’m still studying now, a course for teaching dyslexic students. I paid for my own qualifications.’

VN (education) ‘Yes, very much so. I’ve advanced to become a head nurse and do some management; I’ve enjoyed it, and kept it varied.’

Head VN ‘I feel that the profession has good career prospects and development opportunities – you never will be out of job and there are lots of jobs available.’

VN (mixed) ‘Yes, I still enjoy it. The role has evolved, so I can do more of the things I enjoy.’

Senior VN ‘I’m pleased with my career to date… In my job I’m always learning, every day is different – I’ll want to do further learning in the future and my employer would support me... However, if I’d stayed in primary care, I wouldn’t be so happy – the practice didn’t have any scope for me to do anything further, every day was the same.’

VN (referral) ‘Yes, I feel I’ve come a long way since I started. At that point, I was told that being a VN wasn’t a job for a man – it was more for a wife who wanted a part-time job! Now, it’s recognised much more as a profession.’

Senior VN (nights) However, some interviewees were clearly unhappy, particularly those who were leaving:

‘I’m now leaving. I can’t stay in the profession because there’s no opportunity for progression and the salary is poor... My twin went to medical school and is now a surgeon; I feel left behind.’

VN (hospital - leaving) ‘I’m disillusioned… I feel like I’m just a glorified cleaner and vets are so scared to allow nurses to do anything due to the suing culture. I’m just bored, really bored.’

VN (locum - leaving) Institute for Employment Studies 59 Career paths and development opportunities available to VNs generally Views were mixed, with some believing that the situation had improved while others thought that opportunities were limited. Some pointed out that opportunities varied depending on the area of the country and type of practice; another view was that progression depended to some extent on personality and drive. Several said that gaining experience and advanced qualifications should be linked to a more structured salary scale.

‘It’s very, very dependent on the practice; some practices give very little push. Even when nurses gain extra qualifications, they’re not properly rewarded or recognised for these… Some just lose interest in development. Human nursing has several levels of experience linked to pay bands; we don’t have this in the vet nursing profession.’

VN (hospital - leaving) ‘In standard general practice you haven’t got a lot going but if you are at the PDSA or RSPCA they use their nurses to the max… so do the referral centres. General practice is detrimental to a nurse’s career progression – it depends on you as a person and what you are interested in but good progression is not widespread.’

VN (locum – leaving) ‘Career development is very dependent on where you are - which area of the country.’

VN (referral) ‘Vet nurses have more available to them than they ever did have before– there are so many qualifications they can do. However, the profession desperately needs a structured career path featuring advanced practitioner roles, specialist status and nurse assistants.’

VN (education) ‘It’s opening up and getting better, but we’re way behind where we should be. We learn a lot of things which we don’t get to use. You can be a nurse or a head nurse, but that’s it. It’s better in referral practices, because you can specialise in a particular area.’

VN (charity) ‘They’re limited, very limited. It’s getting better but in comparison with human nursing there are very few options; in human nursing there are all sorts of doors open to you. In veterinary practices, nurses tend to have to do everything rather than specialising.’

Head VN ‘Opportunities are out there if you know what you want and where you want to go, people just need to know where they want to go.’

VN (mixed) ‘Things are progressing, and at a faster rate now. However, it depends a lot on where you live. I’m lucky, because the out-of-hours practice where I work has 60 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey hospital status. Whether nurses progress is down partly to the type of practice, partly to personality... You can make your job more interesting, or just sit back. Having said that, you can’t really progress in equine or large animal practices, there just aren’t enough nurses in those areas.’

Senior VN (nights)

Pay and benefits There was a general view that pay was poor and benefits were few, even for those in more senior roles. However, working nights or as a locum attracted better pay, while larger practices and corporate chains sometimes offered better benefits. Although several interviewees said that they loved animals and had good job satisfaction, they also pointed out that the role could be stressful and involve anti-social hours, and felt that their pay did not compensate them for these aspects.

‘They’re very poor... I’d have stayed in the profession if nurses had been paid £10k more, because it’s interesting; vet nurses have a varied set of things to do, more so than human nurses. ‘

VN (leaving) ‘I was working in a permanent position but the money was rubbish so I decided to locum... because there is such a shortage of nurses, being a locum I can name my price and timeframe.’

VN (locum - leaving) ‘It needs a lot of improvement! Where I work, pay increases in line with experience, and we get decent holidays, but in previous jobs it’s been quite poor.’

VN (referral) ‘Surviving on vet nursing pay is so hard… nurses do a robust training course, work long hours, have high stress levels, they do so much – but they could work less hours and get more pay in a supermarket.’

VN (education) ‘It’s known to be an industry that people don’t go into for the money. People love the work, but some go into repping etc. just to get more money.’

Head VN ‘You get huge satisfaction from your job; however [you] don’t get paid as much as you could do in another profession for fewer hours.’

VN (mixed) ‘This has always been an issue. If you compare with other jobs, the pay’s not good and is below what it should be... I’m paid the least of all my friends [working outside the profession]… It’s kept artificially low; if one practice went out on a limb, maybe others would follow, but wages tend to be kept low. There’s currently a shortage of VNs, though, so wages do seem to be going up because people are bargaining.’

Senior VN Institute for Employment Studies 61 ‘I get paid better because I work nights and at an out-of-hours establishment, but I’m not sure I can keep it up longer term. I’d probably have to take a big pay cut if I went over to daytime work.’

Senior VN (nights) ‘It’s a very low wage for a very stressful job! It’s not all about the money, but many VNs have to have second jobs to make ends meet, and some are still living with their parents well into their 30s.’

VN (charity)

Reasons for VNs leaving the profession There was general agreement that low pay, followed by the lack of a career path, were the main reasons for VNs leaving the profession. Other reasons were the lack of respect and recognition given to VNs by some VSs and members of the public; boredom and having to do unsuitable tasks; unrealistic expectations; long/antisocial hours (especially as VNs get older) and stress; and a poor culture, even bullying, in some workplaces.

‘It’s mainly the poor pay and lack of progression, but there’s also a lack of respect… It’s better in referral practices, but in first opinion practices nurses have to do a lot of admin – reception, insurance forms etc. The public give very little recognition to VNs; vets get all the thanks.’

VN (leaving) ‘People may have had a ‘rose-tinted’ idea of what being a vet nurse might be like... You’re not playing with kittens all day.’

VN locum (leaving) ‘Work-life balance is a big issue; VNs are expected to stay if things run over, and this isn’t just for emergencies. People are over-used and under-paid. We’re also sometimes treated as if we’re unimportant, e.g. for cleaning kennels and doing reception duties. These things are all part of the job, but it seems that we’re expected to do everything.’

VN (referral) ‘Nurses leave the profession due to poor pay, low job satisfaction, lack of progression and being bored. However, this is variable depending on your employer and what type of practice you are in.’

VN (education) ‘The lack of career progression and poor pay are the main reasons. This practice is very supportive of CPD, but nurses are essentially assistants to vets and tend not to feel valued – and they also don’t value their own skills. Some leave because there’s nowhere to go, unlike human nursing.’

Head VN ‘Stress, salary and hours. Some of my friends have gone into teaching and their salary is better. The hours are bad, and being a mostly female profession, having a child makes it hard to come back. Part-time hours are not favoured by employers.’ 62 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey VN (mixed) ‘The unsocial hours and the stress.’

Senior VN ‘It’s mainly the lack of progression and especially the pay – but also, the job gets harder as you get older. Also some nurses cut down their hours when they have children, and drift into other jobs that aren’t necessarily better paid, just more convenient.’

Senior VN (nights) ‘It’s a lot to do with the low pay and lack of a career path, but bullying is definitely an issue – I almost left because of this. I’m able to move around but some nurses aren’t, and they get broken by the bullying on top of low pay and no progression. Some go into marketing, e.g. become sales reps. There’s a shortage of VNs but no- one seems to be making the connection!’

VN (charity)

Understanding of Schedule 3 Interviewees mostly expressed themselves as reasonably confident about what they could and could not do under Schedule 3, although some were less sure and several pointed out that there were ‘grey areas’. There was also a view that the interpretation of Schedule 3 had changed over the years, which added to the ambiguity. Some interviewees felt that VNs tended to have a better understanding than VSs.

‘I think only a vet can go into a ‘body cavity’, but there’s confusion about what this means. In some clinics, nurses can do cat castration, but in others, they can’t. It’s a grey area, which isn’t clear even when you look it up. It’s never really talked about unless you’re mentoring a student.’

VN (leaving) ‘I’m 95 per cent sure... The area I’m least confident in is what can be done alone or what needs to be supervised.’

VN (locum – leaving) ‘No, I really don’t! Things I thought we could do, now I find out we can’t... I go with what my manager and the anaesthetist says we can do.’

VN (referral) ‘I understand what can and cannot be done under Schedule 3, I think because I’m really interested by law and ethics and accountability.’

VN (education) ‘Yes, I think I have a handle on this. However, Schedule 3 is a short piece of text and it’s not completely clear, e.g. the interpretation of ‘under direction’; this doesn’t have to mean that a vet has to stand over the nurse, or even have to be in the same building. I’ve had to email the RCVS for advice though.’

Head VN Institute for Employment Studies 63 ‘Yes, I think so. It seems to have evolved over the years, e.g. nurses used to do cat castrations and dental extractions – I even went on a weekend course to learn how to do extractions! – but now it’s been re-evaluated. There’s a debate around ‘body cavity’. It’s a grey area and there’s the issue of risk too.’

Senior VN ‘Regarding Schedule 3, I’m not 100 per cent on anything but I know most things in it. I know there are certain things I’m legally able to do under Schedule 3 that I currently don’t do.’

VN (referrals) ‘Yes… Although I’m not as clear as I should be. There are grey areas, and the RCVS leaves these too grey when it should be clearer. Employers and vets aren’t clear either. Clarity would give vets more confidence to delegate.’

Senior VN (nights) ‘I believe so! It’s not been long since I had to learn all this. Schedule 3 can be ambiguous though, and in many practices nurses don’t get to do many of the things that are permitted anyway.’

VN (charity)

Views about a review of Schedule 3 When asked if it was time for a review of Schedule 3, the majority of interviewees said yes, although some added caveats. Interviewees thought that a review might lead to an extension to the list of things that VNs could do (with training if necessary), or at least clarification of the current situation. Those who expressed a view said that the RCVS should lead such a review, and should involve both VSs and VNs, perhaps with others, such as practice managers; some also suggested that education providers and representative bodies such as the British Veterinary Nursing Association (BVNA) should take part.

‘Yes. It needs simplifying so everyone can understand it. We need to talk about it more. The RCVS should lead it, but should involve a panel of VSs, VNs and practice managers so everyone has a voice.’

VN (leaving) ‘Definitely yes, because some practices get nurses to do things they probably shouldn’t be doing, while in others, vets are so worried that nurses are hardly allowed to do anything. It would also encourage nurses to do more if we had more clarity. The RCVS should lead this review but with nurses and vets involved.’

VN (referral) ‘It should be led by an independent body, with a panel of contributors, including education providers, practising vets and nurses, the BVNA and the BVA. The RCVS should oversee.’

VN (education) 64 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘Yes. Vets are eternally cautious; nurses are too, but those at the top of their game are keen to advance. The review needs to involve proactive nurses and vets, those who are keen for VNs to do more.’

Head VN ‘Yes… Although, it’s all very well to do a review, but it needs to filter down to the people who matter, ie the vets who are responsible for delegating. Vets not being clear, or not being communicated to, is the big issue. Also, if a vet doesn’t want to delegate, they won’t. There would be an issue if nurses were pushed into things they don’t want to do, or if vets were pushed into allowing nurses to do things they weren’t happy with.’

Senior VN ‘Yes definitely. It would need to involve people on the front line, in practice – vets and vet nurses.’

Senior VN (nights) ‘Yes, even if just to clarify things, e.g. which surgical procedures are allowed. When nurses aren’t sure about something, and vets aren’t sure either, vets just think it’s quicker to do it themselves. You’d need vets and vet nurses to be involved in the review.’

VN (charity)

Views about ‘advanced practitioner’ or ‘specialist’ roles for VNs Interviewees were asked if the VN profession would benefit from the creation of roles (and accompanying titles) that would recognise, in a formal way, the experience and further qualifications of VNs; they were also asked whether this might prevent some VNs from leaving the profession. In general, there was agreement that this was a good idea. However, some interviewees pointed out that many VNs already had additional qualifications, such as the DipAVN, but this had not necessarily brought them increased recognition, status or pay. There was also a strong view that there should be standard recommended salary bands for VNs, although the issue of small practices – where there might not be scope for a senior or advanced role – was also raised. It was considered important, by some, not to push VNs into more advanced roles if they were happy with their current position. It was also considered important for the title of ‘VN’ to be protected.

‘The very first thing that should be done is the creation of standard salary bands that are more consistent around the country – like human nursing. CPD should be pushed from the top, with salary linked to further qualifications. The RCVS needs to do this pressurising.’

VN (leaving) ‘Yes. A lot of people don’t understand what a VN does, so it’s important to have qualified VNs with a protected role, and to be recognised as a professional.’

VN (referral) ‘Yes definitely. We need further qualifications to be available, and we need practices to be willing to give VNs more responsibility. There are diplomas available Institute for Employment Studies 65 to VNs, e.g. the surgical diploma, but we’re still bound by restrictions so having a diploma doesn’t necessarily mean that VNs get more pay.’

Head VN ‘An advanced role could be good depending on what the practice is looking for. If you have further qualifications it would give you the edge in [an] interview and demonstrate your ability. A lot of VNs would like these additional roles and it would encourage people to stay in the profession – it would give them an extra skill base.’

VN (mixed) ‘I don’t know if we need this. We have the DipAVN – do we need anything else? University degrees haven’t led to more pay or a higher status, nor has the DipAVN. We should be looking at rewarding the DipAVN; as it is, people who have the DipAVN don’t necessarily benefit, unless they work in a referral practice.’

Senior VN ‘A lot of nurses want to be the best they can and if they are willing to have more responsibility, advanced status would make them more than just a vet nurse. There are nurses that are happy plodding along, and there has to be that type of nurses, but there are nurses who want to do more.’

VN (referrals) ‘Yes definitely. The profession is ready for this now – but the RCVS needs to ensure that the training is in place first. The advanced/specialist title would need to be linked to a qualification.’

‘Hopefully yes, it would encourage more vet nurses to stay in the profession. However… in South Wales, there are lots of small practices, with maybe one or one and a half nurses, and these wouldn’t have the scope for a more senior role. There are corporates taking over practices now, which might give more scope for development, progression, further qualifications etc.’

Senior VN (nights) ‘Yes, although I’m very disappointed that VNs weren’t granted protected status – it was a bit of a kick in the teeth. It means anyone could call themselves a VN. Vets and human nurses have protected status. It would boost morale; the recognition and pride might encourage people to stay in the profession.’

VN (charity)

Views about VNs taking on more tasks/responsibilities When asked if VNs should be able to take on additional tasks beyond those currently permitted by Schedule 3, there was general agreement. Some, however, pointed out that veterinary practices did not necessarily allow VNs to do the full range of tasks that they were able to do.

‘Vet nurses learn a lot that isn’t put into practice, which causes them to lose confidence. It depends a lot on the practice, e.g. some encourage nurses to do things like catheterisation whereas others don’t. Nurses can lose their skills.’ 66 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey VN (leaving) ‘Vet nurses should be able to take on more; however, firstly they should do what they are legally able to do under Schedule 3... Nurses used to be able to neuter cats and they aren’t allowed to anymore – it’s a simple procedure - but they can amputate a tail or a toe which is more complicated. They seem to take more away every review. In practice, it’s up to the vets to delegate and they just aren’t.’

VN (locum – leaving) ‘Yes, if they’re comfortable with this, and depending on confidence and experience.’

VN (referral) ‘Yes, although I’ve never come across a vet who has been keen to encourage VNs to do much more.’

Senior VN ‘Yes, we should be delegated more tasks, but this needs to be linked to training and experience, and there should be a banding system, a bit like human nursing.’

Senior VN (nights) ‘Personally yes, but we’re a long way off that happening. We learn so much already that we’re not getting to do. It would be great to be able to do more; I think we’d be more willing to take on accountability.’

VN (charity) When asked about the tasks that VNs should be allowed to take on, with additional training if necessary, interviewees listed procedures that mirrored those identified via the survey:

‘Stitch-ups in theatre, X rays, and in anaesthetics, intubation – ie things that happen already in referral practices.’

VN (leaving) ‘Cat castrations and dentals, including extraction (although it is tricky and not an easy thing to do).’

VN (locum – leaving) ‘Local blocks, under the direction of the anaesthetist. Dental extractions, no; this should be a further qualification. Cat castrations – I did these as a student but now I don’t do them, because there’s uncertainty about whether they’re allowed. It’s quite a minor procedure.’

VN (referrals) ‘The additional tasks advanced vet nurses should be able to take on must include prescribing (what they can currently do is only the same as a pet shop owner). They should be able to prescribe POM-V and wormers, flea products - preventative health care on prescription. Nurses could TB test – I don’t see why a nurse can’t be trained. Nurses would take a great deal of pride in cat castrations, but it is going into the body cavity.’

VN (education) Institute for Employment Studies 67 ‘Vet nurses already do some things that technically they aren’t supposed to do, such as prescribing flea treatments and the administration of certain medications (e.g. induction for anaesthesia). Some of these are fuzzy areas. Dental extractions, cat castrations, minor surgical procedures? Nurses don’t do these here – vets do them – but there’s no reason why nurses shouldn’t be able to do them, with training, as they aren’t hugely technical.’

Head VN ‘I’d like to see dentals back on the agenda. Vet nurses sometimes understand more about dental care than vets, and dental work is often seen as a bit of a nuisance by vets. Maybe suturing wounds, wart removal, and stitching up.’

Senior VN ‘Vet nurses are capable of controlling anaesthesia by themselves rather than the vets overseeing everything. There are lots of certificates they can do and nurses who have the certificate should have more responsibility.’

VN (referrals) ‘Minor surgeries – there’s a grey area around ‘body cavity’, and some scope for extending this. Formal training might be necessary, to give vets the confidence that nurses can do this. Examples are cat castrations, and dental extractions – nurses who are familiar with dental work could probably do these now.’

Senior VN (nights) ‘Stitch-ups, definitely – nurses are perfectly competent to do suturing. Anaesthesia needs to be reviewed, too; in practice, nurses know when to increase or lower anaesthesia and prompt the vet, but in theory they’re supposed to wait until the vet tells them to.’

VN (charity)

What might make VNs unwilling to take on more? When asked why VNs might not want to take on more tasks/responsibilities, the most frequent response was a lack of confidence; anxiety about accountability was also perceived to be an issue. Several interviewees also said that the attitude of VSs might be a barrier. Other issues were that VNs would expect more pay for more responsibility, lack of ambition, and a culture in some practice environments that did not encourage people to volunteer for additional tasks.

‘A lack of confidence; a lack of clarity about Schedule 3; a lack of confidence of vets in the ability of their nurses; skills fade because learning isn’t put into practice; and peer environment in the practice that doesn’t encourage people to volunteer for additional tasks/responsibilities.’

VN (leaving) ‘It’s the fear of things going wrong - also, if you are given more responsibility you should be compensated for it.’

VN (locum – leaving) 68 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘Lack of confidence; if you’re not used to doing something, and don’t have support. More training is needed in things like chest drains and arterial lines, which I’ve learnt on the job rather than via training.’

VN (referrals) ‘In terms of what would make vet nurses unwilling to take on more, it would be due to a lack of confidence, the type of person who is a nurse (followers not leaders), practice support from employers, engagement from employers – empowerment, where they do their training.’

VN (education) ‘Nurses are so cautious; they have a self-limiting attitude and assume they can’t do things that in fact they can do under Schedule 3. Their psychology seems to stop them from wanting to do more.’

Head VN ‘In terms of what would make vet nurses unwilling – extra time added to what they are already working, and they’d expect a salary increase.’

VN (mixed) ‘Fear about accountability and being ‘struck off’ (now that we’re ‘registered’ rather than ‘qualified’).’

Senior VN ‘Maybe it is to do with the fact they don’t want the responsibility if something goes wrong – don’t want the accountability. There is also a personality factor – some people just don’t want to progress – they are happy doing the lower level stuff.’

VN (referrals) ‘They would need to be confident about doing the procedure, either via formal training or training within the practice.’

Senior VN (nights) ‘It depends entirely on the VN. Some want to do more, others don’t want any more responsibility or accountability. Some have more confidence. Even if we are allowed to do more, not all VNs will want to, and there shouldn’t be pressure on them. Everyone has their own strengths, and we need an element of choice. Some people even like cleaning!’

VN (charity)

Advice and guidance about Schedule 3 from the RCVS Opinions of interviewees varied a lot, from those who were unaware of guidance, to those who were aware of it but thought it could be improved, to those who were completely satisfied with it.

‘The guidance and advice is fine – there isn’t a problem with the guidance, you can always find out – you can just phone them if you can’t find it online.’

VN (locum – leaving) Institute for Employment Studies 69 ‘It’s ok but I’d like more.’

VN (referrals) ‘I’m quite happy with the RCVS guidance… but a lot of people want a definitive list.’

VN (education) ‘I’m not aware of any guidance. You can email, but have to wait for a week at least. The answers are concise and slightly non-committal.’

Head VN ‘I think the guidance is good if you are looking for… there is plenty of stuff if you want to have a look – it’s just that people don’t go looking for it.’

VN (mixed) ‘It’s not made very clear. It’s on the RCVS website but isn’t widely understood by vet nurses or vets.’

Senior VN ‘It’s ok but could be more clearly laid out.’

Senior VN (nights) ‘Actually, when I got the email about doing an interview, I went onto the RCVS website, but couldn’t find any additional notes to help with the ambiguities in Schedule 3. In other areas there are masses of guidance notes!’

VN (charity) When asked to describe the additional advice and guidance that the RCVS could provide, interviewees mostly said either that the existing advice needed to be publicised more, or that it needed to be more practical and accessible. It was also pointed out that it was very important for VSs to understand Schedule 3, as they were the people responsible for delegating tasks.

‘It needs more prominence and clarity. Standards need to be set by the RCVS and publicised.’

VN (leaving) ‘Something you could have in practices, like a handbook to refer to. There’s too much uncertainty now; you have to go and ask the head nurse, or look it up, or call the RCVS.’

VN (referral) ‘I don’t think there is much more the RCVS could do – they have tried really hard... It’s the lack of engagement from employers, and practices, and nurses that is the problem.’

VN (education) ‘I’d like more people available at the RCVS to email or speak to. It would also help to have a leaflet, or a website, with clear examples of everyday practice, especially with regard to anaesthesia. Or a pack for practices to have.’

Head VN 70 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘It depends why we’re doing this. Do vets want it, or do nurses want it? If the former, more advice is needed to vets, because they’re the ones who delegate.’

Senior VN ‘Maybe they could send out updates/refreshers/reminders – it would be good to message us along the lines of ‘Don’t forget you could be doing XX’ or ‘Don’t forget nurses can do XX under Schedule 3’. There could be more CPD opportunities for tasks under Schedule 3 so people will see it as a development opportunity.’

VN (referrals) ‘It’s such a long time since Schedule 3 was written, it needs a formal review. Some VNs have progressed so much, and are so knowledgeable, that we need a review of Schedule 3. The guidance could then be revised.’

Senior VN (nights) ‘It’s quite difficult, because I can see the arguments for and against being more specific. In the past, nurses could do cat castrations and dental extractions, but now the advice is that these aren’t allowed. I can’t really see why, as long as there’s a vet around in case of an emergency. In the past, nurses used to do loads of cat castrations – they had real expertise and even used to advise vets!’

VN (charity)

Any regrets? When asked if they had any regrets about becoming a VN, and whether they would still chose to become a VN if they could go back and start their career again, responses varied; however, most felt they had made the right choice, and would do so again.

‘This is difficult. Probably 50:50. I enjoy it but feel maybe I should have done clinical psychology from the start. I love animals but wish the pay was better… Having said that, I have skills which I’ll retain, and I’m doing locum work; there’s lots of locum work available now.’

VN (leaving) ‘I have no regrets about becoming a vet nurse, but I’m not sure I would do it again as I didn’t foresee I’d be in my current position – bored and a glorified cleaner.’

VN (locum – leaving) ‘No, I’ve always wanted to work with animals, so yes, I’d still do this.’

VN (referrals) ‘Yes and no… I’ve been pigeon-holed and bored and considered leaving, but I’m really proud of my profession. It wasn’t the wrong decision. Financially, I couldn’t have a house if I’d stayed in general practice – I needed to go freelance.’

VN (education) ‘No, not at all. I thought I might only do it until I was 30, but I’m still doing it! There have been a couple of times recently when I’ve wondered about doing something different, but not that strongly.’ Institute for Employment Studies 71 Head VN ‘No regrets, I enjoy my job.’

VN (mixed) ‘No regrets, I love my job.’

VN (referrals) ‘If I had my time again, I wouldn’t become a vet nurse because of the night duties and long hours – it gets harder. But I have high job satisfaction.’

Senior VN ‘Not really, because I love the job, and I’m loving the fact that vet nurses are progressing; I want to push the profession forward as much as possible. But if I had my time over again, I might consider going into human healthcare, because there are more opportunities.’

Senior VN (nights) ‘Looking back, I should have left the bad practice – where I was bullied – sooner. If you’d asked me then, I’d have had regrets. But no, not now. Maybe I might have done the diploma instead, because degree nurses aren’t popular with many vet nurses. This is only among nurses; if anything, vets seem to prefer degree nurses.’

VN (charity)

Final comments A small number of interviewees added some final thoughts at the end of the interview:

‘It’s great that the RCVS is doing these surveys and listening to people.’

Head VN ‘I have a concern that we’ll suddenly be ‘made’ to do certain things, because they’re considered to be ok under Schedule 3; this would be for the wrong reasons.’

Senior VN ‘I made the move into referrals sooner than I thought … I love it – it’s a continuous leaving curve and there are lot of opportunities for nurses. Primary care wasn’t very forward striving, I have more responsibility in referral work – I’m trusted more on the anaesthesia side of things. Vets are overseeing everything but they rely on the nurse’s knowledge and expertise – nurses have free will to question things, they suggest things and the vets take their opinions into account. I get so much support at my current practice in terms of development.’

VN (referrals) 72 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey 8.3 The VS interviewees

17.1 Profile

■ Six are female, four male. Their ages range from 32 to ‘well past retirement’; three are in their 30s, three in their 40s, three in their 50s, and one is over 60.

■ They qualified between 1972 and 2011. One qualified in the 1970s, two in the 1980s, three in the 1990s, three between 2000 and 2009, and one after 2010.

■ Seven currently work in a first opinion practice, one in a referral practice, and two in a veterinary hospital. All work exclusively with small animals, although one is in a mixed practice.

■ Five are VSs (e.g. assistants), one is a senior VS, two are specialists/advanced practitioners, one is a clinical lead and one is a clinical director. One of the specialists is a locum.

■ Nine are currently working (seven full-time, two part-time), while one has just started maternity leave.

■ Background: most have worked in several different practices, some in different parts of the country, although some had been in the same workplace for a considerable time. Several have worked in both first opinion and referral. Several had worked in other types of practice than small animal, e.g. equine, farm, mixed and charity. One had owned a practice for many years then sold it to a corporate, but still works there. One had owned a practice and been a management consultant, and now works part-time.

■ When asked why they has chosen to become a VS, six said they had ‘always’ or ‘from a child’ wanted to be a vet; two had been good at/interested in science and wanted to apply this interest in a practical way; one had a father who was a VS; and one had become a VN after leaving school, then retrained as a VS due to a desire to make diagnoses and carry out surgery. Two had done other academic qualifications before attending veterinary school, due to not gaining the necessary A level grades initially.

■ Two are based in Wales, three in Scotland, and five in England (Manchester, Sussex, South Yorkshire, the North West, and Devon).

■ All currently work with VNs, and some also work with student VNs.

18 Views

Career paths and development opportunities available to VNs In general, interviewees thought that, although things had improved, VNs had limited career opportunities; this was particularly so in first opinion practices. A minority view was that it was possible for VNs to progress fairly quickly to senior or head positions, but only if they were prepared to move practices frequently. Institute for Employment Studies 73 ‘I think they’re excessively limited. The glass ceiling is ridiculously low and there are very limited opportunities to progress; only a few practices have policies and practices in place to facilitate progression. Vet nurses do it for love.’

Specialist ‘The lack of career path is a big issue in the profession. There are not enough pathways for vet nurses and there is a severe lack of career progression.’

First opinion ‘Unless they work in a supportive and/or specialised practice, their opportunities for career progression are very limited... Once nurses are qualified… they get into a rut.’

First opinion ‘They actually have a large opportunity to ‘better themselves’ by going into management, the pet food industry, pharmaceutical companies, pet insurance etc… For those wanting to stay in practice, it depends on the size of the practice. In small practices, they have to do a bit of everything.’

First opinion ‘Unless you regularly move jobs it is harder because you are dependent on the head/senior nurses leaving, dying or getting pregnant... [To get on] nurses have to be willing to do additional things, such as locum, behaviour, physio, nightshifts, teaching.’

‘In terms of nurse training, you need to find people who are willing to do the training. It’s difficult to find time in a busy practice.’

Hospital ‘It’s better than it was but is still very limited – although it’s limited for vets, too. To get on, VNs have to work in a veterinary hospital or go into education, or go into practice administration or management. However, there are limited opportunities and nurses would have to up sticks and move – not everyone can do this.’

Clinical lead ‘There’s still a celling – they can only go so far.’

Director ‘The career opportunities for VNs have improved hugely from being a second rate job to being a good profession – I’m very happy with that. The profession is finally attracting better brains and better people.’

Advanced practitioner ‘There are quite a lot of post-qualification routes and specialisms, such a behaviour, dermatology, surgery etc, but in most practices nurses are generalists. A lot are happy with this.’

First opinion 74 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey Pay and benefits Again, the majority of interviewees thought pay and benefits were poor for the nature of the job and the training required; however, some thought the situation was improving. Another issue raised was that pay could vary a lot depending on the practice and the area of the country.

‘The pay for vet nurses is low for what they do; and there’s a marked discrepancy in benefits compared to vets.’

Specialist ‘The pay is far too low and vet nurses could work at Tesco for the same money. The low salary means that nurses are unable to live independently and still have to live with parents, which is appalling.’

First opinion ‘The pay for VNs is poor relative to their level of responsibility and especially if compared to human nurses. There aren’t lots of benefits, typically it’s just care for their own animals at cost. Bigger practices are a bit better at offering CPD and providing benefits, but there’s not a lot in small practices.’

First opinion ‘I don’t feel there’s a huge problem with pay and progression once qualified, although it does depend on the practice. If nurses are ambitious and flexible it can be a fantastic job, there are also opportunities outside of practice such as within pharmacy.’

‘In regards to pay … it’s still too low based on what they do and their skills.’

Clinical director ‘The pay for vet nurses is a lot better than it was, but probably still not good enough, especially the pay given to younger nurses. They love animals so sell themselves for low pay – then they realise they want to get on, but can’t.’

First opinion ‘As least we can live on our pay; the pay for vet nurses is too poor to allow them to live independently without another person contributing. This isn’t good.’

Clinical lead ‘In my practice I think we pay a competitive rate – they all get a pension, travel costs, they are in the process of offering new benefits across the board, memberships to gyms etc. As a profession as a whole, pay and benefits are pretty poor... Salaries depend on the practice you work in.’

Director ‘The pay and benefits are getting better, however it is still variable between practices… The role is so variable it’s difficult to compare. For example, there is a difference between hospitals and practices. There is such a wide range of what nurses want to do, there needs to be a difference in pay.’

Advanced practitioner Institute for Employment Studies 75 ‘It’s not great! Here [a corporate chain] we’re above the curve but it’s not much compared to what they do and their skills. I’ve seen jobs advertised in [supermarkets] that pay more – but specialist nurses earn more.’

First opinion

Reasons for VNs leaving the profession Poor pay and the lack of career advancement were considered the main reasons why VNs leave the profession, but a variety of other things were also mentioned: poor workplace culture, anti-social hours (especially for those with children), stressful work that is emotionally draining, under-use of skills, and lack of management competence among VSs.

‘Some vet nurses get disillusioned because they work hard but the pay isn’t commensurate, and there’s a lack of progression. Also, some don’t like some of the practices they see; the quality of practice is variable, and there aren’t consistent standards, so they sometimes witness poor behaviours to both animals and other members of staff.’

Specialist ‘The unsociable shift patterns and weekend working add to the problem. I’ve spoken to nurses that have left the profession to become human nurses, when they didn’t want to at all, because of the better pay and career progression. The benefits nurses get include subsidised treatment for pets, but that isn’t enough to keep them in the profession.’

First opinion ‘As well as the pay issue, the hours can be anti-social, and particularly difficult for those who have children; it’s very unusual to get jobs with school hours or term-time working. There are plenty of other, quite menial, jobs available that pay at least as much. You have to love the job to do it. It’s also draining mentally; VNs get emotionally invested in the animals they care for.’

First opinion ‘Practices don’t use the skills of vet nurses to full effect and they use them for low skill tasks, such as cleaning. This underutilisation impacts on nurses leaving the profession.’

Clinical director ‘It’s pay mainly. But also a lot of bullying goes on; the culture in some practices is poor. Also some vets insist on doing everything themselves.’

First opinion ‘Vets aren’t good at looking after staff, it’s not part of our training. We’re not good at caring for staff, providing a good and safe environment… In addition, the job can be unpredictable and can involve long hours – a lot of people just want a straightforward job with fixed hours.’

Clinical lead 76 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘Another reason for people leaving is that the majority are female so there will be a natural wastage – children and working mums. Accommodating part-time work is very challenging.’

Director ‘Some nurses realise that for the hours they do they could get a lot better paid elsewhere, some have families – some practices are poor at understanding that mums make excellent nurses – practices don’t want to employ part-time mums.’

Advanced practitioner ‘Children have a big bearing, because nurses with children don’t want to do nights and weekends.’

First opinion

Are there currently enough VNs? Very strong views were expressed that there were not enough VNs, with several interviewees pointing to difficulties in filling jobs and poor responses to advertisements. It was particularly difficult to appoint experienced VNs.

‘No, not in the referral sector. Most referral practices are advertising for nurses.’

Specialist, referral ‘There are nowhere near enough vet nurses in the profession; the last job my practice advertised for got no applications... The practice relies very heavily on trainees.’

First opinion ‘When practices in this local area recruit, they really struggle to find suitable – or even any – applicants. The area is fairly rural, which might not help, but it’s hard in Cardiff and Swansea too. There are often no applicants.’

First opinion ‘I’d be anxious if one of my nurses left as it would be difficult to replace with an experienced nurse... There is a shortage of quality VNs.’

Clinical director ‘We’re finding it difficult to recruit, primarily due to location as we are a rural practice... Some nurses are deciding to locum, and earn more money for more convenient work. So there may not actually be a deficit, it’s just that people are choosing to locum.’

Hospital ‘We find there are plenty of trainees and newly-qualified nurses, but there aren’t enough with experience – these are the people we find hard to recruit and retain. It’s got worse in the last two years.’

Clinical lead ‘There is a shortage of good quality nurses round here. A lot of practices are reluctant to have trainees – they didn’t want to employee them because they claim it Institute for Employment Studies 77 cost them a lot of money and time. A lot of people want to train to be vet nurses but a there’s a lack of practices wanting to take them on.’

Advanced practitioner ‘There seem to be a lot going through college but they don’t stay long. From my vet nursing class in college, only two of us are still in the profession, and I’m now a vet rather than a nurse. We’ve been advertising for two nurses for months here, and have only recently filled the positions. There are lots of brand new graduates but we need more experienced, confident nurses.’

First opinion

Understanding of Schedule 3 Most interviewees were reasonably confident about Schedule 3, although there were areas where they were less sure. VSs in TPs and the PSS tended to be clearer. There was a view that the RCVS needed to emphasise the importance of VSs understanding the provisions of Schedule 3.

‘With regard to our practice, yes, but I’m hazier about things that the practice doesn’t do, such as dental work.’

Specialist, referral ‘I have a fairly adequate understanding [of] what qualified vet nurses can and cannot do under Schedule 3. Partly this is due to the structured nature of PDSA (where I used to work) who had ‘Schedule 3 days’… Anything I’m not sure about, I’d just go the RCVS website and look it up.’

First opinion ‘Moderately… Yes and no. I’m aware of the basics but am also aware that there might be things that nurses can do which I think they can’t do, and vice versa. I think superficial lump removal and ear stitching is ok.’

First opinion ‘As a PSS, we’re very keen to be up-to-date with rules and regulation and this impacts the familiarity with Schedule 3.’

Clinical director ‘An honest answer? I used to. Some restrictions have now been placed unnecessarily, like dental work and cat castrations. Vet nurses can do these, they know when to ask a vet for help. Schedule 3 isn’t as clear as it used to be.’

First opinion ‘Vets don’t get any training and guidance… so it is up to you to learn it.’

Hospital ‘I think I have a reasonable understanding generally, for day-to-day things, but I need to check sometimes, for more unusual things. Some of my colleagues and vets I’ve worked with in the past have quite poor understanding.’

Clinical lead 78 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘We’re a TP so are au fait with what nurses can and can’t do.’

Director ‘The RCVS… should be more forceful rather than letting vets live in blissful ignorance.’

Advanced practitioner ‘I’m ok but I don’t know the legislation inside out. Regardless of Schedule 3, as vets, we only give nurses things they’re comfortable with, because the buck stops with us … There are fuzzy areas like IV catheters.’

First opinion

Views about a review of Schedule 3 Views varied about the need for a review of Schedule 3. Some thought that a review was definitely needed, while others either did not see the need for a review or considered that Schedule 3 was not the most important issue. When asked who should be involved in a review, the most frequent response was that the RCVS should lead it and should definitely involve both VNs and VSs; others were also mentioned, such as members of the public, training providers, representative bodies and insurance companies.

‘It should be conducted in conjunction with the RCVS, but it’s important that it isn’t dictated by vets. Schedule 3 is limiting and was more appropriate to a time when there weren’t many qualified VNs; it’s more appropriate to lay people. It panders to an old system and is no longer fit for purpose.’

Specialist, referral ‘I don’t think that Schedule 3 is the biggest issue the profession faces. The largest problem is the salaries and how are they going to fix that? A review of S3 isn’t necessary.’

First opinion ‘It should be the usual people involved: vets, VNs, training providers, practices that host student VNs, lay people (to provide a public perception viewpoint).’

First opinion ‘I’m apprehensive about a review of Schedule 3… I’d be more inclined for vet nurses to take on a fuller role within their current legal remits. If there was to be a review it should be led by people working in the profession every day in consultation with the professional associations, e.g. BVA, BVNA.’

Clinical director ‘Without question. It’s time that the work of a VN is examined and that vets are challenged to use them properly... The RCVS should oversee the review, obviously... We’d need ordinary nurses and vets involved, that’s essential. And members of the public.’

First opinion ‘Schedule 3 doesn’t need reviewing, because it’s changed in the past and I’m not completely happy with those changes.’ Institute for Employment Studies 79 Hospital ‘I don’t know… It’s a tricky one. Vet nurses have a better understanding in some areas but it’s not wise to increase things on the Schedule 3 permitted list too much, because nurses just don’t have the training to do many things. A few things could be added, provided nurses have the proper training. If there’s a review, both vets and nurses should be involved, plus all the other veterinary and veterinary nursing organisations like the BVNA. Also, the companies that provide insurance for veterinary practices.’

Clinical lead ‘They reviewed it recently… What vet nurses can do is pretty appropriate. There shouldn’t be a review, just more meat put on the bones.’

Director ‘With regard to who should be involved a review, you have to have senior nurses with lots of experience in different types of practice, colleges, a wide range of vets. It should be led by experienced nurses as it’s their profession.’

Advanced practitioner

Views about ‘advanced practitioner’ or ‘specialist’ roles for VNs On the whole, interviewees thought it would be beneficial to have advanced practitioner and specialist roles for VNs, although there were some caveats about pay, the ability of practices to offer a career ladder, and accountability.

‘Yes, and this already exists in the USA. In the USA, lots of vet nurses have the vet technician qualification, but it’s not recognised in the UK. It would encourage more academic nurses to remain in the profession; we need a formal framework.’

Specialist, referral ‘The profession would benefit from further qualification if it actually led to better practice/roles for vet nurses, but I feel that it probably wouldn’t happen as it is dependent on the practices. Further qualifications would have to be reflected in terms of salary increases.’

First opinion ‘Yes, definitely, and it could be in different areas: physiotherapy, dentistry, skin, surgery. There could be modular courses, which could be added together to give a qualification. Vet nurses with experience in the area could have an assessment instead. It could help nurses to stay in the profession, although not all want an advanced status; some are happy as they are. It could help nurses who feel they’re stuck and in a rut.’

First opinion ‘The profession also needs more advanced nurses, for example, referral centres need highly technical nurses.’

Clinical director 80 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘Yes, they ought to have that option of a career ladder if they want it and choose to do so. It would be hard for an ordinary small practice to provide a career ladder, though; it’s ok for a referral practice.’

First opinion ‘I don’t know if it will help nurses to stay in the profession – if they work to achieve more, but don’t see the benefits, then they may become more disillusioned. It depends on how the industry uses them.’

Hospital ‘We need to consider that vets currently have the accountability when things go wrong; if the vet nurse role is extended, e.g. if a nurse did surgery that went wrong, they’d be accountable and would have to face the owner and explain. This is a big thing.’

Clinical lead ‘More qualifications are good – but there are limited opportunities the profession can provide. There is no question that it would motivate vet nurses, but it still needs to have a financial output. Further money would be expected – but as a business owner that’s not how it works.’

Director ‘It would give nurses something to work for... Nurses could take on more responsibility, but it must be regulated and quality assured.’

Advanced practitioner ‘Yes, and it would benefit vets too, for knowing who has competencies to do x, y and z – currently, we err on the side of caution. Having more structured training would enable high fliers to do more.’

First opinion

Views about VNs taking on more tasks/responsibilities Most interviewees felt that VNs could take on more, although some interviewees added ‘cautiously’, ‘with training’, ‘within limits’ or ‘to some extent’.

The procedures named by interviewees were, on the whole, those identified via the survey: cat castrations, dental extractions, stitch-ups and vaccinations. Additional procedures were mentioned by some. However, opinions were not consistent, for example about dental extractions.

‘From the perspective of anaesthesia, epidurals, acupuncture and chest drains.’

Specialist, referral ‘Dental extractions, cat castrations (this is a very minor procedure), second vaccinations. They could do dog and rabbit castrations too, and other minor surgical procedures, with a vet on site to help out in an emergency. When I became a vet, in the early days, it was the nurses who talked me through how to do a cat castration – not the vets!’

First opinion Institute for Employment Studies 81 ‘Really, the only potential expansion to the role I would consider would be around vaccinations and vet nurses being able to take a leading role as per human nurses. I find it strange there are more stringent regulations around what vet nurses can do in comparison to human nurses.’

Clinical director ‘There are lots of things that vet nurses can do already that some practices won’t let them do: cat castrations, stitch-ups, blood blisters in the ear, dental work, and some types of client-facing consultations.’

First opinion ‘I’d rather vet nurses did cat castrations than lump removals - less problems, complications and risk… Once you go out of the remit it’s a problem, for example whilst TB testing is relatively simple, it’s everything else that goes alongside it – general observations and other things to discuss with farmers… Vet nurses in my practice do second vacs, once the animals have already been checked and the vet has done the first vacs. Nurses should not be doing things that haven’t been looked at by vets as it’s never as straightforward as just giving a vaccination.’

Hospital ‘Perhaps more complex wound-management, debriding, and more extensive dental work – maybe extractions, with training. Vet nurses are better at some of these things, e.g. dental work, because they’re more patient. Vets end up doing them at the end of the day, when they’re tired and just want to get things done quickly.’

Clinical lead ‘Cat castration is fairly easy depending on the technique – nurses could do that with appropriate training – it’s one of those body cavity anomalies though. With appropriate training, they could do TB testing - TB testing doesn’t have to be done by a vet.’

Director ‘I wouldn’t be happy for nurses to administer an induction agent for general anaesthesia. There needs to be a stricter standard for procedures nurses can undertake if they have the qualifications, there should be set courses that are very regulated so it can be standardised across the profession. The discussion about ‘minor surgery’, surgical/stitch ups/cat castrations, is a whole other discussion - what is minor surgery and when does it cross into entering the body cavity? Nurses could be used more for nutrition, skin problems, ear hygiene – not surgery.’

Advanced practitioner ‘I wanted to do more when I was a nurse, but you need some sort of a boundary. It’s easy to castrate a cat – and vets don’t particularly enjoy dental work, but some nurses do.’

First opinion 82 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey What might make VNs unwilling to take on more? A variety of opinions were offered, notably VNs not being supported, a lack of confidence, anxiety about accountability, inadequate training, being unwilling to take on more due to poor pay, and a workplace culture that discourages volunteering to take on more.

‘Not feeling supported, recognised or properly paid. Some are happy where they are, but others want to push more. It’s a balance between job satisfaction and reward.’

Specialist, referral ‘It‘s mainly about the anxiety about error and penalties for getting things wrong. More senior VNs are confident enough to take on more. However, pay would need to increase.’

First opinion ‘Lack of confidence, lack of support, lack of recognition. Also, some VNs just don’t want the added responsibility; some like routine work, like X-rays, lab work etc.’

First opinion ‘Inadequate training impacts their confidence, and vets often don’t train nurses as it’s quicker to do it themselves – although this is counterproductive long term.’

Clinical director ‘They wouldn’t get paid for it. They may not be allowed to do it, in some practices. Some nurses may feel they’re separating themselves from the rest of their profession; they might get criticised or even bullied for being too ambitious.’

First opinion ‘It’s time – if you work in a busy practice you have to do study in your free time and nurses aren’t always up for studying in their free time.’

Hospital ‘Lack of support and training mainly – especially a lack of support in their work area. Vets are always busy, and never have the time to train and develop nurses. It’s a vicious circle! Also, some nurses don’t want more responsibility and are happy with what they’re doing. It’s a minority, but they shouldn’t be forced to do more.’

Clinical lead ‘I think it’s the nature of people who go into the vet nurse role, they just want to be basic nurses – they aren’t ambitious and don’t want to give the time and finance.’

Advanced practitioner ‘Some vet nurses hate studying and college work – some are happy where they are. The more ambitious ones could get on if grades and pay were linked to experience and qualifications.’

First opinion Institute for Employment Studies 83 Benefits to VSs of an enhanced role for VNs Interviewees mostly believed that an enhanced role for VNs would benefit the profession, as it would enable practices and hospitals to be more efficient by allowing VSs to focus on more complicated procedures.

‘It would take a great deal of the pressure off vets, although there’s maybe a bit of an ego thing here, in that some vets think that the ‘fun’ stuff belongs to them. For example, the vet could do the initial consultation, then leave it to nurses to do a lot of the work – like human nurses, who are allowed to carry out certain procedures.’

Specialist, referral ‘The benefits for an enhanced vet nursing role would be retention of experienced, able nurses. We’re losing them in droves.’

First opinion ‘We’d be able to concentrate on the more difficult cases, and drop the more routine work. We could get through more work, so practices would be more efficient. Things would be less stressful, because there would be less time pressure and nurses would have more autonomy – they wouldn’t have to keep coming to ask if it’s ok for them to do something. We could get through a far higher caseload in the practice.’

First opinion ‘Vets wouldn’t have to do the mundane, repetitive work... This would allow for better development of vet skills.’

Clinical director ‘It would help to streamline practices, and reduce the stress on vets.’

First opinion ‘We would only benefit if the enhancement can be done well and there is structure... It may make things worse if the nurse tells the client incorrect information or does something wrong and the vet has to sort it out. Maybe it’s fine if you’re at the PDSA but in my practice people are paying top dollar for an animal to be operated on by a vet, not a nurse.’

Hospital ‘It would definitely free up time for vets for the things they need to deal with – and would enable things to be delegated to nurses that they have more patience for. Generally, it would improve veterinary practice.’

Clinical lead ‘It could impact the frustration of not being able to find or keep nurses.’

Director ‘The profession does not champion the value of teamwork, it should be a group of people who want to learn and create a learning environment and we should be encouraging that environment. We don’t want the nurses feeling they are second rate.’

Advanced practitioner 84 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘It would share the burden. It’s a team so it would be brilliant if we were confident that a nurse could do more, linked to a more formal grading and qualification structure. It would keep nurses because they’d have more job satisfaction.’

First opinion

Advice and guidance about Schedule 3 from the RCVS Views about the available advice and guidance about Schedule 3 varied considerably, with some interviewees thinking it was adequate and others saying it was confusing and not very accessible.

‘It’s legalistic in terms of how it’s written; it’s not very accessible. There’s a tendency for the RCVS to be overly conservative if they don’t know the answer. The guidance is difficult to unpack.’

Specialist, referral ‘The current advice and guidance are adequate, I’d just go look anything up I was unsure of.’

First opinion ‘It’s a lot of reading and it’s very wordy! It’s hard to look for.’

First opinion ‘The RCVS could be doing more in terms of guidance… One big thing is who takes the blame when things go wrong?’

Hospital ‘It’s ok but it definitely could be clearer. It’s not vague, but there are grey areas. Also, it needs to be hammered home to vets; it needs better governance.’

Clinical lead ‘Vets need to be encouraged to read about what nurses can and can’t do.’

Advanced practitioner In terms of additional guidance that the RCVS should provide about Schedule 3, several interviewees suggested simplifying the guidance, being clearer, and communicating more often; however, some did not think that any further guidance was needed.

‘Just the act of performing a review will help. The profession has developed a lot, and the process of a review will make it much easier to update the guidance. It needs to be formal but accessible.’

Specialist, referral ‘An annual update/summary of Schedule 3 may be beneficial.’

First opinion ‘I’d prefer a simpler, bullet-point approach. This is what a vet nurse could do, with bullet points of the procedures. With the current guidance, it takes too long to find what you want.’

First opinion Institute for Employment Studies 85 ‘I don’t think the RCVS could provide additional guidance.’

Clinical director ‘Whatever they do, they need to be supportive to nurses and informative to vets.’

First opinion ‘The RCVS could give more communication – more specifically pointing to the procedures that vet nurses can do.’

Hospital ‘Just more clarity, and more monitoring of what goes on.’

Clinical lead ‘They need to make everyone aware… they should have a more interactive role with TPs, to check they are doing it ok and if they could do more. As a TP we’re inspected, and Schedule 3 could be added into the inspection… with PSS, there could be more emphasis that hospitals engage with Schedule 3 more.’

Director ‘With a grading structure, the RCVS guidance could be clearer because it could be linked to a level: at the basic level, nurses could do this, at the next level, these procedures are added etc.’

First opinion

Final comments Several interviewees provided additional comments about a range of issues at the end of the interview.

‘Our nurses are professionals; exceptionally trained, undervalued, and underpaid. Anything that improves their opportunities is a good thing. VNs need champions!’

Specialist, referral ‘Vet nurses in practices are quite under-appreciated. Vets take them for granted, and the public doesn’t recognise them as professionals. People feel they’re getting fobbed off by a second-class person.’

‘I’m pleased that the RCVS is making the effort to do this, as it could benefit vets, nurses and pets.’

First opinion ‘With different levels of nurses, the CPD that they’d need to maintain their advanced status would need to be defined and closely checked and monitored.’

‘A country-by-country comparison of vet nurse qualifications could be interesting. The American vet technician training seems longer and in more depth than the UK vet nursing qualification – but we’ve had locums from some countries who call themselves vet nurses but haven’t done any training.’

First opinion 86 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey ‘Vets are coming out of colleges not understanding what VNs should or could be doing… The RCVS needs to be supportive and clear, and we need to enable vet nurses to have job and career satisfaction. This will ultimately lead to less stress for vets too.’

First opinion ‘My main concern is that, if there is a shift of vet nurses doing more things, it leads to junior vets doing less. Especially those in their final year of vet training. If the things we give to junior vets may go into the nursing role, we are taking their training away from vets.’

Hospital

8.4 Differences between VNs and VSs There is clear agreement among the VN and VS interviewees in most areas explored during the interviews:

■ The career path available to VNs is limited, particularly in smaller, first opinion practices; large first opinion practices, referral practices and hospitals offer considerably more by way of career development and specialisation. VNs who are able to move around can gain senior positions relatively quickly, but those who are limited to one geographical area may find advancement difficult or impossible.

■ VN pay is poor relative to the training undertaken and the work that is done. Again, VNs who are geographically mobile are more likely to be able to gain salary uplifts; it appears that locum working among VNs is also becoming more common and is a way to increase earnings. Some corporate chains seem to offer more to VNs by way of benefits, and often have more standardised salary scales; they can also offer more opportunities to move around within the company.

■ Some VNs would like to increase their range of tasks and responsibilities, with suitable training if necessary, and some VSs appear to be supportive. There is enthusiasm for advanced practitioner or specialist status, which would recognise those VNs with additional qualifications such as the DipAVN and could be linked to salary. However, interviewees also point out that some VNs are content in their current role, and do not necessarily want to advance further.

■ Although VNs and VSs both, on the whole, feel that Schedule 3 should be reviewed, there are some anxieties about extending the list of tasks. Firstly, it is important that VNs are properly trained to take on new tasks, and secondly, VNs who do not want to extend their role should not be forced to do so. Interviewees also pointed out that VNs in many practices do not take on some of the tasks they are already permitted to do under Schedule 3, either from choice or because VSs prefer to do these tasks themselves. Some VS interviewees admitted that VSs, on the whole, are not good at delegating or indeed at people management generally – partly because these aspects are not covered in their training.

Some differences are also apparent from the interview analysis: Institute for Employment Studies 87 ■ VNs feel much more strongly that there is a lack of recognition and appreciation for their role, from VSs and from members of the public.

■ VNs are also more likely to cite lack of confidence as a reason for not wanting to take on more.

■ VSs are more cautious about extending the VN role, in part because of accountability if things should go wrong. VNs are also aware of accountability, and feel this issue may lead to firstly a reluctance to take on more, and secondly an unwillingness among VSs to delegate.

■ VSs believe there is a shortage of VNs, especially experienced VNs, and give examples of recruitment difficulties. However, they are also aware that they may be contributing to this shortage; firstly, practices are run as a business and feel unable to offer higher salaries, and secondly, in busy practices it is difficult to find time to train and develop VNs.

■ VNs believe there should be salary scales within their profession that are more consistent around the country, and that recognise experience and further qualifications; support for such standardisation is mixed among VSs. 88 The Future Role of the Veterinary Nurse: 2017 Schedule 3 Survey

9 Conclusions

It is clear that there is considerable support among VNs and VSs for a review of Schedule 3 and an enhancement of the VN role for those who wish to progress and take on additional tasks. VSs, at least those in small animal practices (by far the most likely type of VS to have responded to this survey), have a good understanding of the activities undertaken by VNs in their practices and many value the contribution of their VNs highly.

There is a high level of agreement among VNs and VSs working with small animals about the additional tasks that VNs could take on, although there is also a shared view that further training might be necessary for some of these tasks. However, VSs working outside clinical practice have slightly different ideas about what might be appropriate for VNs. It will be necessary to provide clear guidance about the activities that VNs are authorised to do (with further training if necessary), as many VSs concede that they are risk-averse, and both VSs and VNs have concerns about accountability. It also appears that some VNs are happy in their existing role, and do not want to be asked to take on more.

One caveat, however, is that VNs feel underappreciated and underpaid, which might make many unwilling to take on additional tasks without being recognised by a higher status and higher pay; there may not be opportunities for such advancement within small practices.

The follow-up interviews explored these themes, and provide additional illustrative detail to enhance the survey findings. It is particularly clear, from the interviews, that opportunities for VNs to advance their careers and their pay, and possibly specialise, are much greater in some areas of work: referral practices, hospitals and larger first opinion practices. Smaller practices are very limited in what they can offer. VNs who are able to move geographically can advance more quickly, while those who become locums report greater financial rewards.