Introduction

Sue Badger and Andrea Jeffery

This book has been nearly two decades in development, in part because veterinary nursing in the UK has developed exponentially in the last decade and until now it has never been the right time to take a snapshot of the profession with a view to putting its development into context with the objective of looking to the future using the lessons learned from the past. From the 'little green book' that marked the early student days, to the formalised assessment and documentation of veterinary nursing skills within the framework of a professional stance in practice, has been a long journey. In producing this book we have attempted to shine a spotlight on veterinary nursing in the UK in the setting of the last 60?years and to explore aspects of this development that are critical to its future as a profession in its own right. In doing so we have focused on the role of the RVN at this point in time in order to explore the journey from humble beginnings to future possibilities. It is important that we try to identify and embrace what makes veterinary nursing unique and build upon this to develop a clear identity that is accessible to all, and fully understood by the members of our own profession, veterinary colleagues and the general public. It has proven difficult to decide which aspects to concentrate upon, but we have had the support of a number of very knowledgeable and experienced veterinary nurses to whom we owe a significant debt of gratitude. In particular, we are indebted to the contributors who have taken immense care to produce each chapter. In addition, there are others who have played their part in bringing the project to fruition and to whom we also extend our grateful thanks.

It is useful to take a moment to reflect on why, and indeed whether, there is a need for a qualified veterinary nurse in modern-day practice. It can be argued that modern veterinary practice bears very little resemblance to that of half a century ago in that it is far more sophisticated, due to the development of advanced medical and surgical procedures and practices, as well as increased understanding of the psychological needs of veterinary patients as a result of behavioural and physiological research. This has led to increased client expectations as well as the requirement for greater understanding of patient needs, both physical and psychological. A prime example of this would be the major change in thinking, from that of 'a little pain is good in the post-operative orthopaedic patient as it prevents them from putting weight on the affected limb too soon', to 'there is no requirement for a patient to experience excessive pain as a result of surgical intervention'. Indeed the aim should be to prevent this in order to promote healing and maintain high standards of animal welfare. In addition, there is a moral imperative for all veterinary professionals to adhere to this maxim. In this context it can be argued that the role of the veterinary nurse is essential as part of the modern veterinary health care team, not least because of the focus that forms the foundation of veterinary nursing - that of delivering exemplary patient care and welfare by means of informed and compassionate nursing in a professional manner. In other words, today's RVN is expected to adhere to a framework exemplified by the tenet:

Figure 1 provides a more detailed overview of the traits that may be espoused by an RVN in the environment of today's clinical practice as well as the other career pathways that are increasingly being pursued, which include education and training, research and referral nursing.

The training of today's RVN bears little resemblance to the process that a trainee veterinary nursing auxiliary engaged with 50?years ago. At the beginning, training was undertaken by veterinary surgeons as they were deemed to be the best people to train young women (and they were generally 16- or 17-year-old girls at that time) to undertake tasks under their direction. 60?years later, with a few specific exceptions, it would be incomprehensible for anyone other than qualified veterinary nurses to train student veterinary nurses, as the skill set and knowledge-base has broadened and diversified, and this combined with the element of accountability means that that RVNs are no longer considered to be 'handmaidens' or 'a second pair of hands' for veterinary surgeons to instruct in how they would like things to be done as was the case then. Rather, today's RVNs are trained to be semi-autonomous professionals who are expected to uphold high standards and to also hold themselves and others accountable, including their colleagues where necessary. This semi-autonomous status requires a degree of innate flexibility from the individuals that make up the profession, which necessitates a robust training and a requirement to maintain currency combined with a high moral outlook. RCVS registration requires registrants to act in a professional manner at all times and to uphold the highest levels of welfare.

The chapters of this book encompass different aspects of professional veterinary nursing, beginning with an historical perspective to set the scene in terms of where the profession has come from and where it is now in the second decade of the twenty-first century. We have concentrated on what can be described as the professional aspects and aspirations of today's Registered Veterinary Nurse and endeavoured to provide discrete chapters, which cover each of the chosen areas. As such, the objective has been to produce a book that can either be read from cover to cover by a newcomer to the profession as part of their training, or can be dipped into by more experienced practitioners who have a special interest in one specific area.

Figure 1 The 'ideal' qualities of a Registered Veterinary Nurse.

One of the most pertinent chapters, 'The Professional Veterinary Nurse', focuses on what it means to be a professional by exploring the development of an explicit identity along with a set of recognised and established behaviours associated with being a veterinary nurse. Within this chapter, the authors have mapped the dates of key events that have been crucial in the shaping of the profession in the UK since 1961. This continues the theme set by the section on historical perspectives, which has been written by an individual who started training in 1970, and so has first-hand experience of the early days. The first veterinary nursing textbook was published in 1966 as Jones's Animal Nursing, and was edited by R. S. Pinniger. The second edition, published six years later, contained just two pages on ethical aspects for veterinary nurses, then titled Registered Animal Nursing Auxiliaries (RANAs). The following entry gives a flavour of the tone set at that time; 'The legal liability of the RANA is that of a servant or employee'. A lot has changed in the intervening 50?years! It would be fair to say that this longevity is a clear indication that veterinary nursing need no longer label itself as an aspiring profession, as it is now a profession with a clearly defined and documented level of accountability and autonomy.

Another aspect of professional identity is engagement with explicit aspects of veterinary nursing jurisdiction as alluded to in another section of the book. The important role that the RVN now plays in the area of clinical accountability and governance is a clear indication of progress on the journey towards a true professional identity. Clinical decision-making is discussed, along with a framework to ensure that, as accountable practitioners, decision-making by RVNs in all areas of professional practice is ethically sound. The process of accountability is also discussed from the perspective of the governing body's response to issues brought to its attention. This is described in detail, along with the potential outcomes that may be implemented in each case as well as a broader discussion of the need to maintain professional oversight in order to uphold standards.

The need for clear and focused leadership within the profession is also discussed in the light of the increase in the representation of veterinary nursing in the wider political context. Leadership is often assumed to be the province of the more senior members of a profession, and whilst this may a reasonable assumption, given the need to bring a degree of experience to the equation, it is also important to ensure that the enthusiasm of youth is not overlooked. Included in the chapter is a discussion of the qualities of leadership that are helpful for those who wish to pursue this as part of their career pathway.

Also included in the book is a chapter that covers another area of professional practice, that of clinical advocacy, an area that is perhaps not given the importance that it deserves, in part because it can necessitate very difficult decisions on the part of the professional dealing with the issues that may arise when engaging with the advocate role. Advocacy is directly linked to autonomy, and veterinary patients cannot be part of any decision-making in terms of their care so the RVN can, and should, play a critical role on their and their owners' behalf. Advocacy also encompasses the role played in both the wider professional and global context and this chapter provides plenty of opportunities for the reader to consider how they engage...