Mock Paper 5 (mostly) Benner's Stages of Clinical Competence

You, a Registered Veterinary Nurse (RVN), oversee delegation of tasks for the day. There are high-risk surgical and medical patients requiring attention. You have another RVN, Ilaria, and first year degree student, Ali (new to veterinary practice and awaiting RCVS enrolment) as part of the veterinary team. The Veterinary Surgeon (VS) has asked for the patient to have an Intravenous cannula placed. 

 

  

  

Question 1. 

(a) Using the above scenario, identify one of your professional responsibilities: 

You, a Registered Veterinary Nurse (RVN), oversee delegation of tasks for the day. There are high-risk surgical and medical patients requiring attention. You have another RVN, Ilaria, and first year degree student, Ali (new to veterinary practice and awaiting RCVS enrolment) as part of the veterinary team. The Veterinary Surgeon (VS) has asked for the patient to have an Intravenous cannula placed. 

(b) Which legislation prevents you from assigning Ali to place the Intravenous catheter:

You, a Registered Veterinary Nurse (RVN), oversee delegation of tasks for the day. There are high-risk surgical and medical patients requiring attention. You have another RVN, Ilaria, and first year degree student, Ali (new to veterinary practice and awaiting RCVS enrolment) as part of the veterinary team. The Veterinary Surgeon (VS) has asked for the patient to have an Intravenous cannula placed. 

(c) Which part of this legislation would allow Ilaria or yourself to place the intravenous catheter if directed to do so by a veterinary surgeon:

Question 2. 
At least one member of the veterinary team should be delegated to monitor anaesthesia. Identify who is ultimately responsible for overseeing the maintenance of anaesthesia:

 

Ali understands why they are unable to place the intravenous catheter; however, they feel that they should monitor the anaesthetic for the surgery as it is an essential part of their training. It is decided it is not appropriate to delegate this task to Ali. 

 

 

Question 3. 
(a) Using RCVS guidelines, suggest three reasons why this decision was made:

Answer explanation

1.2  Veterinary nurses must keep within their own area of competence and refer cases responsibly. 

Emily as a SVN should remain working within her own competence and as she has little or no experience with monitoring anaesthetics, she should refer this case to a suitable member of the team.  Shadowing the monitoring of the anaesthetic would be more suitable.  

2.3  A second suitably trained person other than the surgeon must be in attendance for the specific purpose of monitoring the patient and maintaining general anaesthesia (except in emergency or very short procedures e.g. cat castrate). 

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

Although Emily may be deemed as a second suitably trained person, if she has not received any in-house training then this particular case should still be referred to a qualified team member due to the complex nature   

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4.2  Veterinary nurses must ensure that tasks are delegated only to those who have the appropriate competence and registration. 

As the RVN you must ensure tasks are delegated to only those who have appropriate competence and registration, as Emily is a SVN she may or may not yet be on the RCVS register, however, her competence would be minimal in this case.  Therefore abiding by point 1.2, Emily should refer the case. 

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. 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). 

As Emily is an RVN, the administration of medical treatment (in this case the administration of  anaesthetic gaseous agent) must be supervised.  The VS operating will not be able to give the required attention, therefore an RVN should oversee the anaesthetic. 

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 his/her undivided personal attention. 

Definition that could be provided to Emily as per point B above 

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

Emily as a SVN is not entitled to undertake independently medical treatment, therefore she must be supervised whilst doing so 

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 he/she 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. 

 

18.9  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 his or her 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. 

As a registered veterinary nurse, you understand that in the acquisition and development of a skill, a nurse passes through five levels of proficiency.  Identify the levels associated with Benner’s Stages of Clinical Competence and describe the changes in the stages as a nurse advances through each stage. [10 Marks]

Answer explanation

(1 mark for identifying each stage, 1 mark for description of each stage) 

Novice 

• No previous experience 

• Lacks confidence to demonstrate safe practice 

• Requires continual verbal cues 

• Unable to use discretionary judgement 

 

Advanced beginner 

• Minimal prior experience 

• Demonstrates partial efficiency 

• Requires occasional supportive cues  

• Reliant on protocols 

Competent 

• Has prior experience for 2 years 

• Demonstrates efficienct, confident and coordinated actions 

• Capable of conscious and deliberate planning 

• Able to complete skill independently within a suitable time frame with no supportive cues (Provides independent care) 

• Assumes greater independent responsibility 

Proficient 

• Understands the situation as a whole in relation to long-term goals 

• Learns from experience to understand what to expect in given situations and how to adapt plans in response to changes 

• Able to recognise when normal response does not materialise 

• Able to respond to rapidly changing clinical situations e.g. unstable patients 

Expert 

• Able to operate a deep understanding of the whole situation 

• Performance is fluid, flexible and highly proficient  

• Patient advocate 

• Intuitive management of complex cases 

Question 5) You want support and advice to help your decision, list three ways you could obtain this: 
[3 marks] 

Answer explanation

Webinars

Veterinary related congress

Seminars

Article reading

Lunch and Learn

Lectures

Online training

etc.