Which Statutes are Most Relevant to Me as a Veterinary Nurse?

Veterinary Surgeons Act 1966

Animal Welfare Act 2006

Data Protection Act 2018

Public Interest Disclosure Act 1998

Veterinary Medicines Regulations 2013

Ionising Radiation Regulations 2017

What Does This All Really Mean?

When looking at owners and animal caregivers, it allows them to administer medications and treatments in order to improve welfare. For example, it enables owners to give prescribed medications to their horses without the need for the vet to be present on site. Owners can perform first aid procedures whilst waiting for veterinary assistance if required.

The Schedule 3 amendment also allows for other equine professionals, such as farriers and physiotherapists, to perform certain procedures on horses in their care. However, if the patient is receiving non‐routine care from these professionals, it is likely that a vet will need to delegate the task.

For RVNs and SVNs, Schedule 3 states that vets may direct RVNs or SVNs who they employ, to carry out limited veterinary surgery. Under this Schedule 3 exemption, the privilege of giving any medical treatment or carrying out minor surgery, not involving entry into a body cavity, is given to [2]:

• RVNs under the direction of their employer to animals under their employer’s care. The directing vet must be satisfied that the veterinary nurse is qualified to carry out the medical treatment or minor surgery.
  
• SVNs under the direction of their employer to animals under their employer’s care. In addition, medical treatment or minor surgery must be supervised by a vet or RVN and, in the case of minor surgery, the supervision must be direct, continuous and personal. The medical treatment or minor surgery must be carried out in the course of the SVN’s training.

The RCVS has interpreted these terms as follows [2]:

• ‘Direction’ means that the vet instructs the RVN or SVN as to the tasks to be performed, but is not necessarily present.
  
• ‘Supervision’ means that the vet or RVN is present on the premises and able to respond to a request for assistance if needed.
  
• ‘Direct, continuous and personal supervision’ means that the vet or RVN is present and giving the SVN their undivided personal attention.

What RVNs and SVNs Cannot Do

• Perform medical treatment or minor surgery independently, without direction from a vet.
  
• Make a medical diagnosis.
  
• Administer medication to horses that are not under the care of their employing veterinary practice.
  
• Administer anaesthesia or sedation to effect.
  
• Perform surgical procedures that enter into a body cavity.
  
• Perform any procedure that is outside their competence regardless of whether it enters a body cavity or not [2].

Should RVNs and SVNs Perform Procedures that Fall Under the Remit of Schedule 3?

There is a general consensus that RVNs would like to improve recognition of their role and performing Schedule 3 procedures, which can help clarify the status and role of RVNs to the wider veterinary profession and the public. There is, however, no definitive list to describe what minor surgical and medical treatment is, and it is therefore vital that RVNs must always be aware of their level of competence in a task.

The pressures of veterinary practice do mean that when RVNs are allowed to perform Schedule 3 procedures, they can improve the smooth running of the practice. They often have the time to give their patients a more personal approach and perform tasks at a pace that maximises animal welfare. This can improve job satisfaction as RVNs feel more fulfilled within their role. Performing these tasks does not, however, come without potential negative outcomes. RVNs are accountable and liable for their actions both within criminal and civil law. RVNs may not feel comfortable with the weight of responsibility associated with performing some of these tasks. This should be respected by the veterinary team. The safest RVN is one who is fully aware of their limitations, as well as their competencies, and is able to put patient welfare at the fore of their decision‐making. The RCVS has produced a ‘SUPERB’ poster as guidance for vets on delegating Schedule 3 tasks to RVNs (Figure 3.1).

Lack of clarity surrounding Schedule 3 can often lead to vets being reluctant to delegate Schedule 3 procedures to RVNs. The British Equine Veterinary Association (BEVA) has produced a set of guidelines to help with the interpretation of Schedule 3, with a view to instilling confidence in vets to delegate more Schedule 3 procedures to RVNs in practice.

The BEVA Schedule 3 guidelines can be found here:

https://www.beva.org.uk/Career‐Support/Nurses/Schedule‐Three

What Makes a Professional RVN?

As far back as 1947, the role of the veterinary nurse was becoming more recognised and Phyllis Peake (vet and veterinary nurse) wrote that a good animal nurse needed ‘a strong vocational call … for self‐sacrifice, tenderness and the ability to consider the patient as an individual’ [4]. These sentiments still resonate with RVNs today. The recognition of veterinary nursing as a profession started with the first Animal Nursing Auxiliary training scheme being approved by the RCVS in 1961. The term ‘veterinary nurse’ was not used until 1984 as the title ‘nurse’ was protected within human medicine until then. Within 30 years of the first training scheme, the VSA was amended to recognise the role of the veterinary nurse in law. From this point, the profession has evolved very quickly with the introduction of further qualifications, such as the Diploma in Advanced Veterinary Nursing. In the year 2000, the very first equine veterinary nurses qualified, and this became a turning point for all veterinary nurses wanting to specialise in treating equine patients.

In 2002, the Veterinary Nurses Council was established, and in 2007, the non‐statutory register was introduced. This was a voluntary register where qualified veterinary nurses could choose to sign up. Once on the register, veterinary nurses were able to perform procedures that fell under the remit of Schedule 3 and were accountable for their actions. Now, all newly qualified nurses apply to the RCVS Register to be able to practice as a veterinary nurse in the United Kingdom and make the following declaration:

I PROMISE AND SOLEMNLY DECLARE that I will pursue the work of my profession with integrity and accept my responsibilities to the public, my clients, the profession and the Royal College of Veterinary Surgeons, and that, ABOVE ALL, my constant endeavour will be to ensure the health and welfare of animals committed to my care [5].

The RCVS continues to strive for more recognition of the role of the veterinary nurse and alongside the British Veterinary Nursing Association (BVNA), the Veterinary Nursing (VN) Futures project was launched in 2015. This project aimed to provide a view of the future of veterinary nursing and the progress of the profession.

What Does Statutory Regulation Mean?

• All veterinary nurses must now be on the RCVS Register for Veterinary Nurses.
  
• All nurses on the register can use the post‐nominal RVN.
  
• RVNs are accountable for their conduct and are subject to the standards set by the RCVS Veterinary Nurses Council (VN Council).
  
• All RVNs will have to undertake compulsory continued professional development (CPD), which is now 15 hours every year.
  
• All RVNs will have to abide by the RCVS Professional Code of Conduct for Veterinary Nurses.
  
• All RVNs will be subject to the RCVS disciplinary procedures in cases of misconduct.

Because statutory regulation is required by law, the regulator has the force of the law to ensure its requirements are upheld. Non‐statutory regulation does not require any Acts of Parliament/laws to ensure requirements are upheld. The RCVS VN Council replaced the Veterinary Nurses Committee in 2002.

It is responsible for:

• Setting education and training standards to enable nurses to enter the register.
  
• Reviewing post‐qualification training to ensure professional development for veterinary nurses can be maintained.
  
• Setting the standards for behaviour, conduct and discipline for RVNs.

Whilst performing the above, the RCVS VN Council must keep animal welfare and good veterinary practice at the forefront of its values.

RCVS VN Council consists of:

• Six UK‐based practising RVNs who are voted for by RVNs.
  
• Two UK‐based practising vets who are appointed by the VN Council.
  
• Four lay members who are also appointed by the VN Council.

The RCVS VN Council is classed as self‐regulating as it is run mostly by members of the profession but does endeavour to provide some balance with the appointment of lay members. It has been suggested that ideally, there should be a 50 : 50 split between members of the veterinary profession and lay people. An independently run regulatory body would comprise of members outside of the veterinary profession. This could be a government‐run regulatory body. The structure of VN Council is currently under review. Readers are encouraged to check up to date sources for the most accurate information.

The General Dental Council and Nursing and Midwifery Council are independent regulatory bodies which comprise of multiple committees. These committees consist of members from both inside and outside of the profession. They have the same aims as the RCVS and core standards: they maintain the register of practitioners, set the standards for practitioners and education providers and investigate complaints. The advantage of self‐regulation is that the regulators have a full understanding of the profession. Therefore, it is anticipated that decisions made would be in the best interests of the profession and its members. However, it could be said that independent regulation would lead to greater transparency and ensure that members are held fully accountable.

RCVS council is responsible for the governance of the RCVS college and its members as defined in Schedules 1 and 2 of the VSA 1966. It comprises of vets from veterinary universities, RVNs, lay members and the chief veterinary officer (CVO). The structure of RCVS Council is currently under review. Readers are encouraged to check up to date sources for the most accurate information.

In summary, the RCVS and VN Council are there to maintain the registers of vets and RVNs who are qualified to practice, and to guide and monitor the quality of education within the sector. They aim to ensure good ethical practice is adhered to, ensure continuous improvement in welfare of patients and protection for people who use veterinary services. The introduction of the RCVS practice standards scheme (PSS) aims to raise standards across the profession.

The RCVS has produced a Code of Professional Conduct for Veterinary Nurses. Within this code, there are five main principles of practice:

1. Professional Competence
   
2. Honesty and Integrity
   
3. Independence and Impartiality
   
4. Client Confidentiality and Trust
   
5. Professional Accountability [5]

These five principles are set to help RVNs protect and promote the health and welfare of patients within their care.

This code provides essential professional guidance for practising RVNs over six main themes:

1. Veterinary nurses and animals
   
2. Veterinary nurses and clients
   
3. Veterinary nurses and the profession
   
4. Veterinary nurses and the veterinary team
   
5. Veterinary nurses and the RCVS
   
6. Veterinary nurses and the public

There are also many additional supporting documents covering commonly encountered scenarios an RVN may experience and to provide a framework of best practices for an RVN to follow. Areas of practice covered include client confidentiality, referrals and second opinions and clinical governance.

The RCVS also has a veterinary nurse disciplinary procedures policy should any concerns be raised about an RVN. This involves a three‐stage process which is comparable to the disciplinary process in place for vets:

1. Stage one is an assessment and investigation process. This is a fact‐finding exercise to gain all of the facts relating to any concern that is raised. The decision from this process may be that there is no case to answer to, it may be that the RVN is given advice and the case is closed, or if there is a sufficient concern, then the case will progress to stage two.
   
2. In stage two, the case is reviewed by the Preliminary Investigation Committee (PIC). The facts are reviewed, and further investigations are carried out. A decision will be made as to whether the case should be referred to stage three and if the RVN’s conduct may affect their fitness to practice.
   
3. Stage three involves an RVN disciplinary committee hearing. This is similar to a hearing in court, and a decision is made as to whether the RVN is guilty of serious misconduct and what formal action should be taken.

Potential courses of action:

• Not guilty – no action taken, or advice or guidance given
  
• Guilty of serious professional misconduct. This involves three possible sanctions:
  
  
  
  • – Reprimand or warning
    
  • – Suspension for up to two years
    
  • – Removal from the register (may reapply after ten months to the committee to be reinstated).

Both stages one and two are confidential; however, stage three is usually public and may be listed on the RCVS website. The RCVS will only deal with serious concerns that affect a person’s ability to practice as an RVN. For example, a serious breach of the code of professional conduct or serious criminal convictions [6].

RCVS VN Registration Rules 2017

The RCVS has a set of rules that have been approved by the VN Council and provide guidance for anyone wishing to register. These rules include:

• Completing and achieving a recognised educational programme and practical period of training.
  
• Make a disclosure that they are of ‘good character’ where they have declared any criminal convictions and if they have been removed from or refused to be registered by a professional organisation in the past.
  
• Pay a registration fee.