18. Delegation to veterinary nurses

Introduction

18.1  Registered veterinary nurses are those whose names are recorded in the Register of Veterinary Nurses maintained by the RCVS. Student veterinary nurses are those enrolled with the RCVS for the purpose of training at an approved centre or practice.

18.2  Registered veterinary nurses are subject to the RCVS Code of Professional Conduct for Veterinary Nurses and a similar regulatory jurisdiction as veterinary surgeons.

(Code of Professional Conduct for Veterinary Nurses) (Veterinary Nurse Conduct and Discipline Rules 2014)

Schedule 3 exemption

18.3  The Veterinary Surgeons Act 1966 (Schedule 3 Amendment) Order 2002 provides that veterinary surgeons may direct registered or student veterinary nurses who they employ, to carry out limited veterinary surgery.

18.4  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:

1. Registered veterinary nurses under the direction of their veterinary surgeon employer to animals under their employer's care. The directing veterinary surgeon must be satisfied that the veterinary nurse is qualified to carry out the medical treatment or minor surgery (see paragraph 18.5).
2. Student veterinary nurses under the direction of their veterinary surgeon employer to animals under their employer's care. In addition, medical treatment or minor surgery must be supervised by a veterinary surgeon or registered veterinary nurse 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 student veterinary nurse's training (see paragraph 18.5).

18.5  The RCVS has interpreted these as follows:

1. 'direction' means that the veterinary surgeon instructs the veterinary nurse or student veterinary nurse as to the tasks to be performed, but is not necessarily present.
2. 'supervision' means that the veterinary surgeon or registered veterinary nurse is present on the premises and able to respond to a request for assistance if needed.
3. 'direct, continuous and personal supervision' means that the veterinary surgeon or veterinary nurse is present and giving the student veterinary nurse their undivided personal attention.

18.6  A veterinary nurse or student veterinary nurse is not entitled independently to undertake either medical treatment or minor surgery.

18.7  In considering whether to direct a veterinary nurse or student veterinary nurse to carry out 'Schedule 3 procedures’, a veterinary surgeon must consider how difficult the procedure is in the light of any associated risks, whether the nurse is qualified to treat the species concerned, understands the associated risks and has the necessary experience and good sense to react appropriately if any problem should arise. The veterinary surgeon must also be sure that they will be available to answer any call for assistance, and finally, should be satisfied that the nurse feels capable of carrying out the procedure competently and successfully.

18.8  Veterinary surgeons and veterinary nurses when supervising veterinary nurses undertaking Schedule 3 procedures, should confirm that their names are currently on the Register of Veterinary Nurses maintained by the RCVS and have not been removed from the Register by direction of the VN Disciplinary Committee.

Maintenance and monitoring of anaesthesia

18.9  Veterinary nurses and student veterinary nurses may be directed to assist veterinary surgeons with the maintenance of anaesthesia and the monitoring of patients under anaesthesia. The following advice applies to these tasks:

1. Inducing anaesthesia by administration of a specific quantity of medicine directed by a veterinary surgeon may be carried out by a veterinary nurse or, with supervision, a student veterinary nurse, but not any other person.
2. Administering medicine incrementally or to effect, to induce and maintain anaesthesia may be carried out only by a veterinary surgeon.
3. Maintaining anaesthesia is the responsibility of a veterinary surgeon, but a suitably trained person* may assist by acting as the veterinary surgeon’s hands (to provide assistance which does not involve practising veterinary surgery), for example, by moving dials.
4. Monitoring a patient during anaesthesia and the recovery period is the responsibility of the veterinary surgeon, but may be carried out on their behalf by a suitably trained person*.
5. The most suitable person to assist a veterinary surgeon to monitor and maintain anaesthesia is a veterinary nurse or, under supervision, a student veterinary nurse.

*Evidence of suitable training must be provided if the team member is not a registered veterinary nurse. In-house training is acceptable.

Vaccination of companion animals

18.10  To give a first vaccination with a POM-V medicine or a veterinary medicinal product under the cascade, the animal must be under care of the prescribing veterinary surgeon (see Chapter 4 of the supporting guidance for the meaning of ‘under care’) and the veterinary surgeon must carry out a clinical assessment (see  also Chapter 4 for the meaning of ‘clinical assessment’).

18.11  Whether a physical examination is necessary is a matter for the prescribing veterinary surgeon’s judgement depending on the circumstances of each individual case. When deciding whether a physical examination is required, the prescribing veterinary surgeon should consider the non-exhaustive factors at paragraph 4.17 of Chapter 4.  The veterinary surgeon may then administer, or under their direction, a veterinary nurse or student veterinary nurse may administer (see paragraph 18.5 above). If the veterinary surgeon is to certify the vaccination, the certification rules apply (see Chapter 21 of the supporting guidance on certification) – generally they must do it themselves or witness it being done.

18.12  The administration of the subsequent vaccination typically two weeks or so later, if prescribed and recorded in the clinical notes by the veterinary surgeon at the time of the first vaccination, and appropriately delegated, may then be dealt with entirely by  a veterinary nurse or student veterinary nurse at the practice, provided the veterinary surgeon is not intending to certify the vaccination. Nevertheless, it is helpful for a veterinary surgeon to be on the premises at the time the vaccine is administered to the animal, to be able to assist in the event of the animal suffering an adverse reaction.

Veterinary nurses and dentistry

18.13  Veterinary nurses and student veterinary nurses working under the direction of a veterinary surgeon may carry out routine dental hygiene work.

18.14  The extraction of teeth using instruments may readily become complicated and should only be carried out by veterinary surgeons. The RCVS considers that the extraction of teeth using instruments is not within the meaning of “minor surgery” in Schedule 3.