Good afternoon and welcome to today's lunch and Learn, kindly brought to you by VM Futures. I'm Rich Daley, head of partnerships for the webinar vet, and I'm delighted to be your chair for today's session. Before I introduce the speaker, I just wanted to go through some housekeeping with you.

I'm sure many of you have joined the webinar with us before, but for those who knew or haven't been for a while, just a little reminder. So we really do encourage you to ask questions to the speaker. The way you can do that is if you work with your mouse, and at the bottom of the screen you'll see it says Q&A.

Pop in the Q&A box, your question, and then at the end of the presentation, I'll then facilitate those questions to our speaker. If you do have any technical issues or queries, then please do pop them in the chat box, which you can also find at the bottom of the screen, and my colleague Dawn will be on hand to answer them. Alternatively, if you lose connection with us and you want to get back on, you can email office at the webinar vet.com, and she will also be able to, Dawn will be able to help you that way as well.

So on to today's speaker, the title of today's webinar is maximising the potential of the registered veterinary nurse in the vetled team. I'm delighted with you joined by Lou Northway. Lou is qualified as a veterinary nurse in 2009 and has worked in various first opinion practises on a referral hospital.

Her main interests are anaesthesia, analgesia, emergency critical care, nursing, and quality improvement. In 2019, she was awarded the RCVS inspiration Award for her ongoing ability to inspire and enthuse others in practise and further afield. In addition, she became an RCVS knowledge champion.

Alongside working in practise, Lou is a British Veterinary nursing Association council member and a part of the VM Futures career progression working group, which she is very proud of. If that wasn't enough, Lou has also found time to develop a social media blog called Lou the vet nurse, which now has over 13,000 followers. Through this platform, she shares CPD hints and tips to fellow nurses and blogs about her life as an RVN in the UK.

So I'm delighted Lou's here to join us and fit us into a busy schedule, so over to you, Lou. Lovely, thank you so much for the kind introduction. So good afternoon everyone, and thank you for joining me on your lunch break.

I know time is precious, so I hope this will, fill your lunchtime with some goodness. So the title, as we've just said of this lecture this afternoon, is maximising the potential of the registered family nurse in the VATE team. This is all about thinking about you, your team, and how you can all work together, to make Make the best of every single situation.

I'd just quickly like to tell you about VN Futures itself. Some of you may have heard of the initiative before, some of you may have not. And VN Futures is a joint initiative between the Royal College of Veterinary Surgeons and the British Veterinary Nursing Association.

And it was first formed in 2015, and it is a really big group of people now, all working together. On different sort of parts of that nursing. We have a few further webinars coming up over the next few months to keep your eyes peeled for those.

And also at BSAVA this year, we are holding a few lectures on Thursday in hall 6. So make sure you come along, and you'll be able to find out more. OK.

So, in practise, do you feel, currently that you are maximise your full potential. Do you feel that your skills, are being used? Do you feel valued?

And all this is the theme running through this lecture this afternoon. So when I think of me and my team in practise, we work together. I view it a bit like a football team, if anything, and we're not gonna get the golden and the ball in the net unless we work together, and it's who can do what role, and in what way.

So. I always like to think about the oath that we gave when we qualified because if you base your decision making on that oath, often you can't go wrong. The oath is about doing the best for your patients, each other, and also the general public.

So when you get to work in the mornings, what do you think about? Do you go in thinking about how you are going to improve patient care and how you're gonna enhanced efficiency of the day? Often we think that's just down to our line managers to organise that, but actually as individuals, we can all take res responsibility, and think about how we can help as well.

Think about what makes you happy as a value nurse. When you get to work, what do you genuinely really enjoy doing? What can you do yourself to improve your sense of self-worth and wider in your team?

So, do you have any areas of interest that you can bring forward to support each other? What makes your team happy? When, when do you see everyone really buzzing and coming together?

What can I be delegated to do? So we are, we all get a bit confused over who can do what, and we're going to go through that quite a lot in the next few slides. And sometimes I have feedback from nurses who say, I know that I can do that, but my vets do it all themselves, and that's absolutely OK, but equally, speak up and just say, oh, actually, would you mind if I did that?

So, in practise when you get to work. If you are delegated tasks and roles and responsibilities, you will feel listened to, you will feel trusted, valued, supported, encouraged, you'll feel useful, fully utilised, and you'll feel motivated. And this is just such a positive emotion overall.

It's going to make you more effective, more efficient, it, the, the culture and the practise will be so much better. So delegation of roles and responsibilities is really, really important. So a few months ago you would have seen that the Royal College of Veterinary Surgeons released a superb poster, and this is all about delegation in practise.

So if you are interested, you can download this poster for free from the Royal College of Veterinary Surgeons website, and I recommend you stick this up next to your operations board and one front of house at your practise. This is going to help guide you as to what tasks can and cannot be delegated to you. As family nurses in practise.

But you really must think to yourself long and hard, if is what I'm going to be delegated to do, a good idea? Do I have support to do it? Have I done it before?

But some of us may have been in practise for a very long time, but even then, occasionally we'll be asked to do a task, which we've never done before. So that doesn't mean we can do it without support. So just think for yourself, is this really a good idea?

The main difference between a registered veterinary nurse and a student veterinary nurse is that registered veterinary nurses can do a lot of things under the direction of a veterinary surgeon, whereas our student veterinary nurses really must be supervised, and that's the most important point, really. So anything at all from giving in the injections to taking bloods, a registered veterinary nurse will be able to do it under direction, whereas a student vet nurse needs to be supervised. So when we're looking at who can do what, when you look at the code of conduct, it's quite long and I know there's not many pictures to make it all jazzy and beautiful, so it can be quite difficult to read and interpret, but very simplified.

Direction means that the veterinary surgeon is going to instruct you to do something, and supervision means what it says on the tin. So they need to be present on the premises, to make sure that if something goes wrong, you have a query or a concern that they're there to help if need if needs be. When it comes to student veterinary nurses, some of the tasks that they may be asked to do, they must do under direct continue and continuous and professional supervision.

And so that really means if they are doing a task like suturing a wound, that the registered veterinary nurse or the veterinary surgeon must be present. So what can we do as RVNs in practise? Now, when we talk in forums, we're always saying, oh, we should be able to do more, but often when you survey nurses and you ask them what they're doing in practise, some nurses are not actually able or asked or delegated to do the basic nursing things that we are already allowed to do under direction.

So simple things like administering medications, placing intravenous catheters. Taking bloods, administering a second vaccination. So for me in my practise, this is something that I do every single day, all day every day, but in other practises, this doesn't always happen.

So if you are working in a practise at the moment whereby you do not feel certain things are delegated, it's worth just having a chat, and saying, actually, please can I do that? I haven't done this before, can you show me? That's what the type of conversation that we need to be having.

We can really help to speed up the efficiency of the day. So for example, how often does a vet bring a patient through from a consult for admission? They need supportive treatment administered medications.

Does the vet really want to wait until the end of consults, which is another hour and a half to give the patient medication? Or can they delegate and instruct you? To do all of those tasks.

I would hope that they would feel comfortable to do so, because that does improve patient care and also efficiency of the day. And as veterinary nurses, we can also speed up the procedures by taking radiographs for our veterinary surgeons for them then to come along and interpret and give the results to the client. And now there are courses for nurses.

Doing TAT scan, ultrasounds, looking for free fluid, whether patients have a bladder, effusions and things like that. So although that is sort of borderline, a diagnosis, which we know we're not allowed to do, we're not necessarily diagnosing, we are detecting an abnormality, just like with a patient under anaesthetic, and then we would detect that abnormality to the veterinary surgeon. So, on this list, I might, you might be looking at it and think, oh well they're all quite basic things.

I do that every day. Great, you should be doing all of that. But if you're working in a practise where you're not doing these tasks on the list, then it's definitely time to have a chat.

So communication really is key, and I always say to my nursing team, speak up if you're not happy. So that's not just doing tasks, but if you're not happy about a patient or you've got that really uncomfortable feeling in your belly, that something just isn't right, always make sure you speak up, because that nurse initiative that you have is very special, and you must make sure you speak up. So we've spoken about some of the things we can do, but what can't we do?

So as veterinary nurses, we are not allowed to perform any medical or surgical treatment without the consent of the veterinary surgeon. So there are times, I know, when you are in a situation and you think, yeah, I definitely know in my head what the vet is going to say next. I know what they want me.

To do, but we still must make sure we communicate, and we are instructed to do X, Y, and Z. The more experienced you become, the more you feel like your mind read, you always see the future, you know what they're going to ask you. But it's professional courtesy and it's a legal requirement, so make sure you are talking to them.

Other scenarios when you may be tempted to sort of use relationship and go for it, when you have that client come in for their repeat prescription and they the animal's been on the medication for ages, but the vet hasn't written on the notes that they're OK for a repeat. In those instances, we should not dispense the medication unless there is a clear record there from the veterinary surgeon that it's OK to do so. And there are many other things on this list, as you can see, that we shouldn't be doing unless the vet instructs us to, and some of them we're not allowed to do at all.

So we're not allowed to perform any surgery which involves entry into a body cavity. And also things like thoracocentesis, abdominocentesis, and cystocentesis. Technically that is into a body cavity, so we should not be doing that.

And as we all know, performing dental extractions is a no no. So Being about any nursing practise, I came up with just a list of things which I felt were really important. This is what I base sort of myself on when I'm at work.

So communicating to my team, I'm a very verbal person, and I'll always speak up, and give my views. But equally, I would always respect my vets if they come back to me and say, actually, Lou, thanks for that, but no thanks, that's absolutely fine. Only trying to help.

Trusting each other is Really, really important as well. So having a trust between each other, you do have to make each other aware of your capabilities. So that's why I think discussing cases really helps to help you gauge each other as to how much everybody does know.

Making sure people are understanding instructions, and as you all know, you will learn differently. So some people need written instructions, others need verbal instructions, and sometimes getting the person to talk back what the task is is helpful. Self-awareness of your strengths and weaknesses.

So for me, I know what tasks I'm I'm really good at. So for me, I'd say taking blood samples from anything, that's like my little, my little skill in life. But one of my weaknesses is radiographic, positioning, especially dental radiographs.

I don't know what it is, but it's not my strength. So having a think in your team, who is really good at what and using each other for support is helpful. The confident, competence and confidence are very two different things.

So that's the one person might say, I can do that, whereas the other person, the other person may say, oh, actually I, I'm not super confident, but I've done that task, you know, 100 times, and I'm really competent at doing it. So it's not being all gung ho. We need to make sure that one, we are able to do it, and two, we have done it many times before we support.

Responsibility. Now that is a very big thing. Veterinary surgeons ultimately have the ultimate responsibility in the majority of things that we do, but we are registered veterinary nurses, and I would like to think if I ever made a mistake or I decided I was going to do something, and something bad happened, that I would be responsible for my own professional conduct.

So when you are decision making, think to yourself, am I able to do this? Is this in the best interest of my patient? Is this in the best interest of my colleagues, and equally the client as well is to be considered.

Now I have put clinical governance on here because as you mentioned, right, as I'm, Richard mentioned right at the beginning, quality improvement is one. Of my interest in practise. And quality improvement is all about clinical standards and being reflective and thinking about how you're doing and how you can do things better.

So reflect on all the things that you can do. Do you need any extra training? And if so, how can we go about that?

So now we're gonna go on to thinking about ways in which we can work on our weak areas and also champion our really strong areas. So I want you to think, what is it that makes you happy? What gives you that buzz?

And what part of the practise do you feel like you may make the most of an impact? In practise, I truly believe if as a veterinary nurse, you are put into a position that you enjoy, you're gonna really excel in it. So, for example, if you're a nurse that enjoys nurse clinics, then yes, you're gonna be really good at it.

But if you're a theatre nurse that is Occasionally having to do front of house appointments, but you, you don't enjoy it as much, then you're not necessarily going to do as good a job. And that's not to say that you're not capable, but your heart's not necessarily in it. So I think it's really important that practises recognise, individual strengths and champion them.

So, what do we all enjoy? We are so lucky as family nurses that we have loads of different disciplines and areas of interest that we can focus on, and the world really is your oyster when it comes to subjects within our profession. I would recommend that you focus your CPD in your areas of interest, because finding your niche will just make your life so much more enjoyable when you're at work.

Having a focus enables you to look at how you're doing in that area, as a team and as an individual. Look at evidence-based papers, is this what we're doing making sense? Is it up to date?

Are we being effective? And then improving things for the better, that's what we want to do. How can we go about doing that?

By doing CPD. Now, CPD, some people think of it as a chore. I don't at all.

I think we are so lucky to be able to do CPD. How many professions, are there that provide you with money to go on a course and learn about something you love doing? You know, that's, that's quite special.

Equally, you might use it to go on a course and Improve a skill, that you're not so good at. But for me, I have really embraced my love for the last few years, and I focused the majority of my CPD in my areas of interest. And really the way to view it is, not when you go to your bosses, not just to say, I want to go on this course because I find it fun.

You need to be saying, I'm going on this course because I think it's gonna benefit me. I think it's gonna benefit your business because I'll be able to improve clinical standards. I'll be able to educate the team, and I'm going to improve things, and also it's going to massively improve patient care for X, Y, and Z.

At my practise here at Wendover Heights Veterinary centre, we, all of the nurses in my team are encouraged to have their niche. We have nurses that are interested in dentistry, so bottom right in the screen is a registered nurse called Lisa, Lisa Graham. So she will be the first one to say in the morning if she is at.

Our main branch. Can I please do the scale and polishes? And the veterinary surgeons were very happily obliged.

So then they just have to come in and, and have the fun task of extracting the teeth. She also is an absolutely amazing at getting dental radiographs, perfect bisecting angle, gets the perfect image every time. So they'll happily delegate those two tasks to her.

And in the process, it makes their day easier. So while she's scaling and polishing the teeth, they can be typing up some notes, phoning a client, nearby, and, and that's really, really good. Top right in the picture is my head nurse, Mike.

He really loves reproduction. So anything to do with breeding, tends to be dog breeding and breeders, the vets will go to him for his input, and he handles a lot of sort of like the progesterone blood testing, and things like that under the direction. Of the vets, and that works really, really well.

We have nurses also that really like infection control. I know, shocking, but no, they do, they really, really enjoy it. They've championed it.

They've been on CPD. They have completely updated and changed our protocols for the better. And it's fantastic.

And that is just, what we want. Enthusiastic people being encouraged to do what they enjoy doing. We also have equine nurses, they're equine specific to our small animals.

So if I was to go down to our equine unit, I would be like a fish out of water. So we do make sure we have nurses specific to the species. I don't have a picture of her on this screen here, but I have a registered veterinary nurse at my practise called Olivia who absolutely loves exotic patients, but she has just finished doing all of her exotic certificates.

And she's done them now for a multitude of species. So the veterinary surgeons, the small animal vets will go to her for advice and help when they have exotic patients in consults, and she will direct them towards sort of good places where they can find out the information they're looking for. And she's been a massively supportive figure, not only to the vet team, but to the nursing team when we get the more weird and wonderful patients in.

S Making your CPD budget stretch stretch that little bit further. Now we all have a budget generally. Most practises offer their nurses, I think, about 500 pounds a year, which is a congress and maybe a day course or a whole congress.

So, it's not a lot, but it's enough. But we can really push our bosses to spend a little bit more money on us if you almost put a business pitch forward as to Why they should send you on the course. Over the past few years, I have undertaken two certificates, and that is how I pitched it to my practise.

I said to them, This is where I want to go on this course. It's gonna benefit you, it's gonna benefit me, it's gonna benefit the patients, and it's gonna benefit the team as well, because I promised you that all the information that I learn, I will bring back and disseminate to the team and make improvements. And that's what we should all be encouraged to do.

When we go on our CPD courses, simply going, learning on the day, feeling really inspired, often you come away from a CPD course feeling all excited, don't you? But you'll find that if you just come home, you close your folder with all those little words of wisdom in, and you don't take it in. To practise and talk about it.

What was the actual point? Because yes, you might have a few extra sort of light bulb moments in your head, but you won't actually make any positive changes in practise. And those are the things that really make all the difference.

So, I encourage you all to always sell yourselves, to your bosses as to why they should be spending the money, sending you on these courses, because at the end of the day, it really will benefit them. OK, so what does delegation and increased responsibility mean to the veterinary, the registered veterinary nurse? So it's going to advance their knowledge in a particular area.

So as we've already said, if it's an area you're already interested in, it's just gonna make you even more enthusiastic. And I often find, once you have like a niche, I'm not allowed to use the word specialism, but once you have a niche area, the more you learn, the more you realise. As you don't know, and then just how much more there is to learn.

So for me, when I started doing my anaesthesia certificate, at this point, I was 8 years, qualified. I thought to myself, blimey, I've been doing my job for 8 years. And if I'd known all of this extra stuff, then I could have done my job so much better.

And I really think that's what veterinary nursing is all about. It's about learning, reflecting and thinking about How you can become a better nurse. We never are going to learn everything.

You're never going to know everything. And that's why, we are so lucky. It's going to keep you up to date with key advances in areas of interest, so you're going to end up finding that you'll be looking out for new papers, evidence that's come out.

You'll then hopefully disseminate that back through your team and change your clinical nursing protocols as a result. As I mentioned in the last slide, I really, really do encourage you to disseminate all of your knowledge with the rest of your team. So you become that go to figure for X, Y, or Z.

If it will just give you such a fulfilling sense of self-worth. So for me, in practise, being sort of the anaesthesia nurse, it is shared now with one other nurse who is also an anaesthesia geek. If our team are having any problems, they'll come and say, Oh, can you come and help us?

Have you got any ideas about this? And that's vets and nurses, we're all working together. That means so much to me because it means that all of that knowledge that I have, I'm using and I'm helping others as a result.

Also in your practise, you'll probably have the nurses, which are like the cat whisperers, and you'll have the other members of the team which don't mind the more difficult dogs. So you know, champion each other, say, right, yeah, this is a tricky cat, go and get a cat nurse, and it's going to benefit the patient. So, I also think it's really good for clients to know that all of your team members have different areas of interest and enhanced levels of knowledge, because equally our clients are knowing more now as well.

So for example, nutrition, nutrition is a massive subject. When you spend any time doing consultations, in front of house, either standing in with your veterinary surgeons or doing them yourself, you'll know that clients know a lot about nutrition. There's, and it's a massive can of worms now.

So staying up to date is really important, because if clients come in, we've got some information, and we're not prepared to be able to talk about it, then yes, trust and doubt may be in their minds. So if you are a front of house nurse that loves clinics, then making sure that you're kept up to date in things you know your clients are going to ask about is a really, really good idea. Many of you may be are CVS accredited, and if you have been through your inspection process, you'll know that you'll be looking very closely at different parts of your practise and your processes.

There are also awards as part of the PSS scheme, if you're interested, and for that it's going above and beyond the standard requirements. So if you have members of your team that are interested in it, for example, An emergency and crystal care, then you can delegate that area, say, are we up to scratch, are we doing everything as well as we should be, what could be improved, and giving them, you know, sharing the workload when it comes to inspection time, you'll find that really, really helpful. I think it's important to have a sense of direction.

What do you, where are you going? What do you see yourself doing in a few years' time? Some people, I think, worry that, you know, they, they don't want to do a big certificate.

That's absolutely fine. You don't have to. But having sort of a plan as to what your focus is going to be and the impact you can have in practise really will help to keep you motivated.

And finally, having a project or focus in practise, I have numerous projects always ongoing at work. So on those days when it's just a little bit quieter, although that's very rare nowadays, I have something that I can go and work on, that I can reflect on, see how far we've come, and I find that really motivates me. So I encourage you all to have little projects going on to.

And overall, when you put this all together, you'll find that you'll just feel so much more fulfilled with your role. When you, it's not an individual game, being in a vet fashion, it's a team game. So collaboration of knowledge, collaboration of skill, that is what we want.

This is how I view us all, we're all part of a puzzle, and you are a piece of that puzzle. That's what we, we don't make a team unless we're all working together. So how do you feel working in practise right now?

I just want you to take a moment to have a think about that. Do you feel utilised? Do you feel like you're doing all the tasks that you are legally allowed to do?

Do you feel you're delegated to? But if you're not, why not? And I do have a few thoughts as to why delegation does not occur.

I often feel it's a result of a lack of understanding or a lack of communication. That is why delegation doesn't take part, doesn't take place. So I think if, if you're already sat there thinking, well, I don't take bloods wres regularly, I don't place catheters, I'm just a glorified cleaner, we need to sort that out.

We need to change that. And how can we do that? Well, we need to get your heads of department to have a meeting and talk about Schedule 3, and all the different nursing tasks that can be undertaken.

Why are they not being delegated? Have a chat as a team as well. Why a nurse is currently not doing any stitch ups, sometimes you might find that will be because it's just quicker and easier for the vets to do it, but equally, if the nurses do it more, they're going to get quicker at doing it too.

So it is give and take. It's about being thoughtful and conscientious, but equally giving each other opportunities. Doing in-house training can also be beneficial.

So grab a bunch of bananas, sit round the table in the kitchen at lunchtime, and do some suturing practise together. You know, there are many options and ways of educating each other in a very informal and often fun way, which will benefit your patients and the efficiency of the day, another day. When you organise your ops list in the morning, do you ever stop and think what tasks on that list can actually be done by nurses under the direction of the veterinary surgeon?

Because it's very easy just to assign operations to vets, but often there are quite a lot of procedures that can be delegated to nurses. So for example, scale and polishes, and if you've got dentals in, the nurse can get the teeth nice and clean, and the mouth clean ahead of any surgical extractions, and that's very, very helpful. In addition, veterinary nurses could Close the body wall, sorry, not the body wall, the skin following a bitch spa or a dog castrate.

At this point, the veterinary surgeon can leave theatre, start pricing them up, doing the discharge sheets, that's going to speed up efficiency of the day. There are so many options. And if your vets don't feel comfortable delegating, it is worth having a chat with them, you know, why can I not?

Do that, please. It may be that it's just habit, and that's the way it's always been, but that's not the way it has to be. So refer back to the superb poster that I mentioned earlier.

I would recommend you do download it and you pop it up at your, put it up by your op board in practise and refer back to that every single day, to see what you can delegate. So collaboration and delegation reduces stress and improves efficiency, and it massive and it absolutely does. There are so many things that we can do and we should be doing, and it takes a massive weight off our shoulders if they know that we We can start the treatment whilst they finish consulting, for example.

A patient doesn't have to wait, it's a better all-round care. And I think we can just be so enormously helpful, and that's what I would always encourage you all to think. So.

I would encourage you to. Speak to your vets about the following. So ask them how to close the skin following the dog or cat neuter.

Ask them if you can suture up that wound. Can you scale and polish the teeth? Can you remove that little lump or remove that little wart?

And if you have any patients that are more unusual, say for example, I don't know, you might have a baby dragon in, or, or maybe a rabbit or a dog and cat clinic, you don't have rabbits very often, but they want you to take a blood sample. Then maybe they can show you, or maybe they can talk you through it, and you can do that for a change. Unless you are sometimes, the the systems that have been in place forever will just continue.

So it is worth just putting a full stop there and asking a question. Please, can I try that? Please, can you show me?

And you will find that it will massively improve efficiency of the day. One massive role in my practise my nurses have is dispensing repeat prescriptions under the direction of the veterinary surgeon. So we must always make sure that any medications prescribed to patients that are under the care of our veterinary surgeons.

So that really means that a patient has been seen by a veterinary surgeon in the last 6 months or so. Our vets will always make sure there's a very clear written instruction as to how long a patient can have repeat prescriptions for until they are seen again. Normally it's every 3 months.

So we know that we are able to process repeat prescriptions until that point. They may also write a note on that, please can you phone the owner for an update. And sometimes we might use.

Clinical guidelines, so the, Cat Care for Life, for example, the questionnaires, mobility, scoring, we might talk about analgesia levels, and then we'll feed back the information from the client to the veterinary surgeon at that point they may then ask us to phone them back again and get them in for an appointment or they're happy with that. That's so cool. But we can be a real good strong bonding mechanism to the client here.

The client will get familiar with the veterinary nurses. We, you know, not one of the people that just stands behind the desk when they come in. We are one of the professionals that will be phoning to make sure the pets are OK.

And we can also ask the owners if they're suffering, their pets are suffering from any side effects, which, for example, the owners, may not even think of side effects. So having a crib sheet created by your veterinary surgeons with prompts and questions to encourage you asking the right things is a really, really good idea, . So as long as the communication is very, very clear, on the, the computer, you as family nurses, registered family nurses are fine to dispense repeat prescriptions under the direction of your vets.

And we process probably about 50 repeat prescriptions a day in my practise, heaps, and therefore a whole range of things. The majority are chronic, arthritis medications and non-steroidals, so we have the usual questions and protocols in place for questioning clients about those. And then there's not to forget, finally, holistic care of patients at home as well.

So a lot of our patients that are on chronic medication, geriatric. So how can they adapt the the environment at home, getting some extra bits of carpet, if they're saying, oh they're not getting out of their bed well, or can they get a higher bed so they don't sort of have to wake themselves up and things like that. So we can be really, really useful here.

OK, and then I've already mentioned this already, but this is an example that I encounter a lot at my practise. I don't know why, but we have loads of springer spaniels and Labradors, that eat carpet and stones. We have some repeat offenders as well, but depending where you are in the country.

The demographic of dog breeds will change, but here it's all about spaniels, mainly, which is good because they're my favourite. But this is a scenario. So vomiting springer spaniel, the vet's admitted the dog, walked them into kennels.

They look really, really poorly. They're very flat, red injected mucous membranes. They're tachycardic, looking really miserable, and you know this dog, when he's well, he's an absolute nut job.

So the vet says to you, well, this patient, he's probably about 10% dehydrated. He's been vomiting frequently for the last 24 to 48 hours. So please could you place an intravenous catheter?

I would like you to give a bolus of fluids. This is what I would like you to give and this much. Please take some bloods, could you also get a lateral radiograph of the abdomen, set up theatre, and they should be able to write you basically a shopping list of tasks for you to do.

And you are going to get things underway. And at any point, if you have any questions or concerns, as a registered veterinary nurse, we should be going and talking to our veterinary surgeons. Meanwhile, the vet will need to go back to consults to finish what they're doing.

At this point, they might even be able to go and have a bit of lunch upstairs as well, which would be very nice and thoughtful, ahead of the exploratory laparotomy that is likely to happen later this afternoon. So communication is key here, but they should be really, really happy to delegate all of these tasks to you today, because we are here to help. So what what delegation means to the veterinary surgeon, the registered veterinary nurse, and the patient.

It improves efficiency. As you see, we're gonna save so much time already. If the vet had to go back to consults a moment ago, that's another hour and a half, and that's another 1 hour and a half, the patient could have sat in a kennel, vomiting, feeling uncomfortable, feeling rubbish, and then if the vet came through after consults, it's probably then.

The 40 minutes' worth of work up before they're on fluids, and they're still very dehydrated. We haven't even started to address the hydration deficit, so they're not going to be as stable and happy for anaesthesia at that point as if they had started supportive treatment two hours previous. .

The vet can have peace of mind. They go back to consults, relax, knowing that the nurses are working like busy bees out the back to get their patients stabilised. And there's a rooster, they might even get lunch, which would be a bonus, a big treat.

And the nurses will utilise their full potential. They're using all of their skills broadly here. I love it when the vet writes a list of tasks and they come back through, and it's like, here are the bloods.

They've had all the meds, heart rates come down, pain scores improved, winning. That's exactly what we want, working together. And if your vets don't feel comfortable writing new tasks, to be delegated again, I'll just talk to them about it, really.

You don't have to be sort of aggressive and pushy and, bold. It's just a case of having an informal conversation, explaining how it would be helpful, that you can do it, and going from there. So how can you create a collaborative working environment to help a delegation in practise?

There are many different ways. So starting off in the morning, clinical rounds. I'm not sure how many people listening today will do clinical rounds every morning, but at my practise we have clinical rounds every morning between 8:30 and 9 o'clock.

That involves the kennel nurses, theatre nurses, and all of the vets. And if we've got these students as well, they will be there. That's EMS students and student nurses.

At this point, we'll discuss inpatients, we will discuss stay patients, and anything else that's going on. And at that point really, we'll talk about who can do what and what we can do. Mentoring each other.

If you have, people in your team who are less experienced, working alongside more experienced people, if it's a quieter day, then this is the perfect time to take them under your wing and show them and explain to them exactly what's happening. So for example, your new grad vet. They could watch an operation or scrub in on a bitch vein and help the more experienced there.

That would be great. Equally, a veterinary surgeon could delegate suturing the skin of that bitch bay at the end. There are so many opportunities.

I do believe that combined vet and VN meetings, are really, really important. At my practise at the moment, this is something we don't do as much as I would like, but I do think it really helps, engagement with each other, talking about what's going well, what's not going so well, what people think could be done better and differently, and how we can all help each other. I think arranging regular in-house CPD is always a good idea too, especially if you have an area where everyone feels a little bit uncomfortable.

So for example, if I was to say to you, rabbit anaesthesia, I know a lot of people feel really under confident dealing with bunnies. Well, this is the perfect opportunity to get a rabbit vet and a rabbit veterinary nurse, or two people with a real strong niche interest in bunnies to come and do some CPD for you, because if they disseminate their knowledge to your whole team, everyone's gonna feel better, . Equally, if you go away on a day course, make sure you come back and you spread all of your knowledge to your team on your return.

When I did my anaesthesia certificate, often I would make short PowerPoints as revision aids for myself, but then I would teach it to my team. And when I wanted to make any sort of clinical changes at the practise, I had reasons and evidence as to why we should be updating what we're doing. Having informal team chats is a really good idea as well.

So it's not always chatting about when things go really great, but when things don't go as well, I think having a chat afterwards is really important and these might also be known as significant event audits, or huddles, and this is just having a Reflection really. Why did this not go well today? Is it because the person wasn't supported?

Is it because the training wasn't in place? Is it because the equipment wasn't available? Is it because something to do with the patient?

Is it something to do with the client? But having informal team chats is really, really good. And as I've just mentioned, debrief and significant event audits.

I put that really with informal. I don't think you need to make significant event audits formal. It makes it scary.

And we don't need to be that way. OK, so when we're thinking of clinical rounds, look at the Ox board, think what procedures are booked in today. It's a perfect opportunity for discussion and suggestions.

So at this point, it's not just saying, right, well, he, he can do that and she can do this. It's saying, thinking about using your knowledge. So actually, perhaps that drug wouldn't be suitable.

Maybe this approach would be better, and that's not just vets talking, that's nurses talking as well. So professional to professional, into professional discussion is absolutely OK. The only times when we shouldn't really discuss drugs and procedures in that sort of way is in front of clients, but together, that's absolutely fine.

During rounds as well, nurses, should be encouraged to calculate, administer and administer prescribed pre pre-medication drugs so the vets can say what they would like their patients to have and the nurses can go away and do that. If we're using controlled drugs, it might be sensible to get a second. Nurse to double check your calculation.

Some practises have that as standard procedure, but it is a good idea. IV catheter placement, always safety first, this is something I think should be compulsory everywhere if it's physically possible in the species of patient. But IV catheter placement.

Can be delegated to veterinary nurses. So as soon as the patients have their pre-med, place an IV if they're a nice animal, and that will save time later. Pre-op blood sampling again, delegate to nurses, the veterinary surgeons do not need to do this.

They can ask us to do that. And also minor procedures, so nurses, should be encouraged. We've already spoken about mentoring, but we need to make sure we're allocating time to teach each other.

Registered veterinary nurses and experienced veterinary nurses still need support and help. There will be new things coming out every year. When you come back from Congress, often everyone's got loads of ideas.

Those should be shared. And even when you've been in practise for 15 years, you're still gonna learn new things. So we're gonna finish up now, I've actually spoken really really fast.

But the take home message really is, we should all make a concerted effort to encourage collaboration and delegation. We need to be talking to each other, we need to be communicating, we all need to be on the same page. We all need to understand that veterinary nurses are not trying to be mini vets.

We are our own professionals and in enabling us to do our jobs to our our best ability, taking into consideration our clinical skills and our knowledge, we're gonna make everything in the practise much smoother. We're gonna support our vets, make it less stressful for them, . Give them a shorter sort of task list on top of the the mountain of things that they have to do in a day, and everyone is going to feel much more valued but we need to be really aware of each other.

So it's taking the time to think about who we are, what we're doing, does this make sense? What, what's gonna happen if something goes wrong, if I do this task? Is it actually a good idea or should I speak up?

And just to finish, it's not what we know as individuals, it's how much we could know and do if we work together. So that's, that's my little mojo in life. Nobody knows everything.

Some people believe they do, but they don't. But we all know a lot, but together we know heaps, and that really is the take home. So if you want to hear more about maximising the role of the RVN in the vet led team at BSA congress, I'm giving a lecture with one of my vets who I work with, Lisa, she's lovely, and she is a vet clinical lead and I'm nurse clinical lead, and we're going to talk through different areas of our practise and who does what, so.

At what point do you vets delegate to us? At what point would we say, actually no, not happy to do that, and things like that. So please come along, there's lots of other streams in the, I'm sorry, themes in the VN Futures stream that day, and it's gonna be really, really positive, so come along.

But anyway, I think that is my little talks done in a nutshell. I've spoken extremely fast, so I'm, I'm finishing quite ahead of time, so we've got loads of time for questions, and I hope we'll have lots. Brilliant, thank you, thanks for that, Lou.

That was superb. As Lou says, yep, she rattled along at a fair pace there, but obviously, yeah, conscious that all of you have taken time out of your day to, it's to attend this webinar, which is absolutely fantastic, and thank you very much for giving up your time to do that, and I'm sure you have found it very beneficial. We do have time for some questions, and I know a few have come in already, so, yeah, no, no, we've got, oh, it looks like at least 8 questions so far for you, so, I'm sorry I say it so fast and I'm excited.

I talk really fast. No problem. Your enthusiasm came through in abundance and no problem about that whatsoever.

And, you know, for those people that, want to go back to any of the, content you covered, this webinar is being recorded and will be available to watch in the next 48 hours on the webinar vet website. So if there are any points that you'd like to go back over, that Luke covered, then, you know, please do log in. We will be sending out an email.

We'll log back into the website in the next 48 hours, and it'll be there ready for you to watch again. Great. So, let's have a look, .

Someone's typed in, which minor surgeries are we unable to do, please, just for clarity? Yeah, so something min a minor surgery that we would not be able to do, well, you could say a cat castrate is a minor surgery really because it takes about 2 seconds and it doesn't look massively invasive, but we are not allowed to do, cat castrates as registered family nurses. In addition, little incisor, teeth removed.

You know, sometimes they're almost wobbling and they just need a little tug, but no, we're not allowed to do that either. So any extraction of teeth that involves an instrument, that is a no no. But you know, pulling nails under sedation, suturing wounds, removing little warts, anything like that is absolutely fine.

Brilliant, thank you very much. And obviously they can always er clarify with the vets as well, can't they? Exactly, yes, well, the vets, the vets should know, but I know everybody gets a bit confused.

I have got some scenarios that I spoke to. Conduct at the Royal College about. So if anybody does have any questions or queries, I'm happy to take emails as well.

But anyway, sorry, continue. No problem, that's great, cheers. So I was about to say is like, can you get that information from the BVNA and but you've covered that, so that's great, thank you.

A good question here, and it comes to, it comes back to attitudes and you know, ways of working and so someone's type er typed in asking, how would you suggest encouraging practises to develop who are very set in their ways. Yes, now this can be a challenge, because it's like changing clinical protocols, isn't it, when it's been set in, it's set in stone for 20 years or sometimes longer than some of us have been alive, coming in and, saying, right, well, we can do this differently. People can sort of dig their heels in, but I really think it's good to have a sit down and have a meeting as a team collectively.

Presenting, you know, facts, what, what we can do, and saying, well, you know, can we do this? And then asking, Well, why can we not? It can be hard to have the conversation, but making it informal, sometimes is the best, is the best way.

But, chat it out, that's the best, the best thing that I can suggest. And in my practise, I'm quite lucky. I have a quite a young team.

And, the senior, the sort of the senior partner, older vets, . Not making to make sure I'm not going to get sacked. They, they have been convinced by the majority, that's what I'm gonna say.

So I would say try and get the majority of your team on board, and often the minority will follow. But ultimately, when it comes to delegation, the vet has the ultimate responsibility, so we do have to respect them. But educating each other, chatting it out, improving relation.

Relationships will really help. Mm. Brilliant.

And it's something you referred back to before when you said that you feel comfortable putting across your point of view. But then at the same time, almost the vet's word is final, so if the vet says thanks, but actually we're gonna go this way, it's about being respectful of that and saying no problem and continuing the way the vet has directed as well. Yeah, I think that's crucial because, as I say, like, I'm very passionate about what I really like now.

So if I have a suggestion, of course I'm gonna bring it forward. And they know that I'm only ever trying to be helpful, but equally, if they'll say, well, actually, Lou, I'm quite happy with what I'm doing, or I think this would be a better idea, then I'm not gonna argue with them. That's absolutely fine.

It's all about, profession professional courtesy. No problem at all. That's great, thank you.

And I suppose, as you say, it's about finding, you're not everyone is going to be as supportive, so it's almost finding those who are happy to champion you those and support you and understanding that if you're on a shift with Individual A, that you probably get more freedom and more opportunities to try things and if you're on with, Individual B. And so it's about almost judging that as it, as it at the right time as well. Yeah, absolutely.

And you will find in your team, some people will be much more open to teaching you than than others. And those people that do want to teach you really stick onto them, because you'll get so much more out of your job and your career if you're learning from each other. Brilliant, thank you very much.

. A really good, and I'm, I'm going to thank this person for typing it. They're anonymous, but, I think a lot of people probably feel the same that there's certain tasks that make this person quite nervous in practise, but there aren't many chances to develop them with support. So how would you suggest they tackle these weaknesses?

Yeah, so this is a really good question, and I know exactly where this person's coming from. So I'll, I'll use an example of how I feel at the moment. And so I really want us to get, using dental nerve blocks, up and off the ground in my practise.

Some of the vets do them, but not everybody. A lot of the vets are not comfortable, or particularly confident, therefore, they're not willing to teach. So therefore, we can't do it unless we're taught how to do it.

So I think the best way The way to target situations like this is to almost go on CPD as a tag team, so you get a nurse together, because then the two of you can come back into practise, and then teach everybody else. Did, did the individuals specify like what situation, like what type of task it was that they were uncomfortable with? No, they haven't said which tasks in particular.

It just said there's certain tasks that make them quite nervous in practise. But if that person would like to comment further. On this, on your question, then, that'd be great and we can come back to that towards the end.

Yeah, but I would say just try and do some learning with someone else, so then you have someone like this in the same situation as you that you can sort of, bounce back, back and forth with. And the same things like skin suturing, if your practise aren't particularly keen to sort of like do an in-house training, then there are, providers now which will do sort of wet lab and suturing practise, and that might be a good idea too. Brilliant.

Also, I've got a couple more questions before I do, I've got a couple of comments, so fantastic webinar, looking forward to taking this back to my team in our next nurse meeting. I think that was your, a relative of yours, Luke? No, I'm only joking.

I wouldn't be surprised. Becky said fabulous talk. Thanks a lot.

Thank you, from Sharon. So a lot of positive feedback coming back as well. Sharon, in response to your question, yeah, you can't copy the slides, but as I say, they are available to watch, at a late.

In the next 48 hours so you can go back to them then, and then you can obviously play it on a computer in the practise, if you want to show the rest of the loud, on loudspeaker, that's preferably maybe put it on in the, in the lunchroom when the people that are resistant to change are having their tea break. Subconsciously brainwash them. Got one here from Lily.

Lily's asked, what is the clear film on the skin on the photo of the IV catheter, please? So then if you want to skip back through and or you know which one. So this is, do you know what, it's gonna literally go out of my head now.

It's a film, so you place your IV catheter and then you put it over the top. So I know here it looks like the catheter's gone through the film, but it hasn't. It's stuck over the top of the.

I know that most veterinary companies sell this, but again, I'm not, even if I knew what it was, I wouldn't be allowed to say it because then I'd be endorsing it, and then that's not allowed, and I'd get my bum smacked. So, yes, but, this is a really good, well, I personally think it's a really good method of being able to actually visualise a castor. So when you take your tape off, you can actually see your insertion sites.

Safe looking for phlebitis because if you, if that's covered with micropore, Gripo, or lapass, you can't actually see whether there's any inflammation at the insertion site. So I quite like using this clear film, but that's all I'm going to say there because I've probably just said too much already. Speak to your to your nearest suppliers and they'll be able to, inform you.

Yeah, exactly. No problem. Fiona has messaged in saying, hi, what course would you recommend to update the Schedule 3 procedures I can carry out in practise, i.e.

Stitching, suturing, etc. There are courses available, but again I think I'm not allowed to recommend anyone specifically. If you, .

If you Google it, to be honest, I think it will come up. There is one big CPD provider which does like a schedule 3 day type thing. OK.

Which you can't mention because this is the webinar vet, so we're not gonna mention any of the CPD. It's a bit of a tricky one because it's all to do with the professional code of conduct, what I'm allowed, what I am and I'm not allowed to say, but what I'll do is I will double check if I'm allowed to share, and then I will do a follow-up post on one of my social media feeds in response to this. Brilliant.

That's OK. Yeah, no, no worries, that'd be great, thank you. I'm not sure this is the, same person who asked about being sane about nerves about certain procedures.

But they've come, someone's come back saying our vets would like us to be able to do more tasks, however, we tend to have a shortage of nurses to monitor an anaesthetic, etc. Any tips on how to get around this? I think it might be a different person.

To be honest, no, not really, because you have to make sure you have enough people to do everything. So when it comes to, you know, suturing a wound, that's one thing, but you do need to make sure your patient is appropriately monitored, and preferably by a registered veterinary nurse or a supervised student nurse. So, when I clarified this with the Royal College, I asked them about a few different scenarios.

They said the monitoring of anaesthesia can be Done by an RVN without out of that in the room. So one RVN suturing, and one doing the anaesthetic. However, theoretically, turning off the vaporizer dial to adjusting anaesthetic depths can only be done by the veterinary surgeon or via us with their, authorization.

So the vet does really need to be present. So you do almost need, well, If the vet does the anaesthetic, you can do the stitch up, that's fine. But I would be very cautious for two nurses to do a procedure together without a vet being fairly free to help.

I think that's when it comes down to thinking, if this goes wrong, are we prepared to deal with it? Because although it is the vet's ultimate responsibility, we're RVNs, so we have to make decisions too as to whether it's appropriate. Brilliant.

No, that's fine, that's great, thank you very much. Hopefully that's answered your question. And I think we've touched on this, this is from Michel, in terms of the can't do list, is it legally, binding, or is it just an ethical recommendation?

A lot of it is legally binding, I presume from what you've been saying throughout the presentation. Yeah, it is. So the, the, our CVS code of Professional conduct, that's relevant to the UK practising veterinary surgeons and nurses, that's what we do need to abide by.

But the communications team there, if you send them a message with any scenarios, they're very good at coming back to you. So, as I said, I, I emailed them yesterday about a few different scenarios. What would be OK and not be OK.

So if you have any queries like that, drop them a message and they will come back to you. Brilliant, thank you very much. Well, I think we have made it through all the questions, and, and it seems that we're just rang on time just before 1:30, which is really good.

So I think, you know, my take home message from this is. Do what you love, you know, pursue it, see how much, how you. Don't see that being, being limited to what you can do.

If there's an avenue you want to pursue, then there's support out there, obviously the VM Futures, you're going to be at BSAVA Congress, so there'll be plenty of people around to come and chat to and see how you can progress and develop in your career. And really exploring the world to your limit, which is that a good summary for for your. I think so, yeah, absolutely.

Nail on the head there, yeah, I just, I want everyone to feel really motivated and empowered if they've got a niche and an interest to learn lots, and then take their skills into practise and use them. Push to be able to use them because you all deserve to. Brilliant.

Well, thank you very much. So, well, first of all, thank you to all of you for attending today and giving up your lunchtime. I hope I'm sure you have found it really useful, so thank you for that.

Thanks. Thank you to VM Futures for sponsoring this webinar, and, I'm sure there'll be other ones in the future. And obviously, thank you to Dawn, who's been in the background, giving people access, making sure everything runs smoothly, and obviously, last but not least, thank you to Lou for delivering such a fantastic, webinar.

And obviously, as I mentioned at the top, Lou does have her own social media blog, which is Lou the vet nurse. So please do check that, and I know Lou was saying when we're setting this up that she does do her own Instagram lives. And all the rest of it, so please do check that out because I know she puts out some fantastic content through that as well, so please do check that out.

So have a great rest of the day and I look forward to hearing about some of your career progressions in the future. So thank you very much and enjoy the rest of your day. Goodbye.

Thanks everyone.