At AMVS we have one of the largest veterinary nursing team in the south. The team consists of Registered Veterinary Nurses (RVNs), Student Veterinary Nurses (SVNs), Patient Care Assistants (PCAs) and Technicians, each working together across all of our disciplines and supporting the veterinary surgeons to provide the best care for the pets that are referred to us.
As a referral veterinary nurse you get to develop your skills in each of the disciplines that we offer from Neurology and Orthopaedics to Emergency Critical Care and Anaesthesia. The role is extremely varied you could be working on wards, in theatre or helping with imaging.
Here is a day in the life of one of our team leaders: Abi Holder, Wards Team Leader. DipAVN(Surg) CertVNECC RVN
With a nursing team of around 100 individuals including Patient Care Assistants, Technicians and the night team, the Nursing Team Leaders have a busy role in a specific area in the hospital with a number of key responsibilities.
Abi describes her day “I am Wards Team Leader and start the day with a brief huddle with the Senior Wards Nurse. This RVN (Registered Veterinary Nurse) has taken the handover from the night nurses, and will then attend rounds with the clinicians, starting with Medicine then Surgery working the way through all the patients finishing with Neurology. The Senior Wards Nurse allocates nurses to patients within our five wards, we try to keep the same nurses with the patients for the week as this allows a better patient nurse bonding.
There are four senior wards nurses who run wards on a rotation, I join in to cover holidays, but mostly I am nursing my own patients in the wards. I don’t have a favourite area, but I do find an enormous amount of job satisfaction when I am nursing in the high dependency unit, this is a small ward that allows monitoring of the sickest patients. In the last month I have nursed a patient with tetanus who had a tracheostomy tube and a patient who was being supported on a mechanical ventilator. As well as the high dependency unit we have two main dog wards an isolation ward and a separate cat ward.
While the Senior Wards Nurse is at rounds we can begin our first checks on the patients under our care. During our shift we unwrap the bandages and inspect the intravenous catheters on every patient. We inspect any surgical wounds, checking any indwelling devices inserted into the patient. There are a number of devices this could be, but some examples include a chest drain that allows the removal of accumulated air in a patient with a pneumothorax. Or a urinary catheter that we use to drain the bladder and collect urine to measure in a patient with an acute kidney injury (that could have been caused by Cutaneous and Renal Glomerular Vasculopathy (CRGV or Alabama rot). Or an Oesophagostomy feeding tube that allows us to provide nutrition to a patient who is unable to eat orally, for example a patient with an injured face following a road traffic accident.
In this photo I am receiving a handover from the Surgical Nurse James, on my patient who has returned to the main dog ward following surgery to remove a cancerous lump from her leg and remove the local lymph node.
Our job is always to make sure the pets in our care are as comfortable and happy as they can be given the circumstances, so we perform multiple and frequent checks on them during the day, ensuring they are comfortable and free from pain and stress. The checks vary but can be a basic temperature, pulse and respiration (TPR) check for a patient receiving a packed red blood cell transfusion, or for an oxygen dependent patient, or an assessment for analgesia using a pain score chart, or the modified Glasgow coma scale (MGCS) for a neurologically unstable patient. We also administer medications prescribed by the clinicians, this can be either intravenously, intramuscularly, subcutaneously, orally or topically. We are lucky that our Patient Care Assistants are available to take for a walk and feed all of our patients and are very experienced in providing comfort, grooming and encouraging eating. Our physiotherapy team are also on hand to perform physio on our in-patients either in the comfort of their kennel, or in their dedicated physio room.
Here I am spending a little time with a nervous dog, offering reassurance. We have Patient Experience Team who meet regularly and discuss what added value extras, we can provide to make our patients feel happy and relaxed, in this case a pheromone infused soft toy.
During the day as team leaders, we supervise and train the nurses while they are monitoring their patients until they feel confident to perform tasks and observations on their own. So, for example a new RVN to the team would be buddied up with an experienced nurse to gain confidence, while our student nurses are supervised and supported by the whole team while they undergo their training.
We have many different cases that we provide after care for and the day is always very varied. In the photo I am monitoring a patient undergoing a blood transfusion to treat anaemia. I am taking a respiration rate from outside the kennel before taking a heart rate and temperature. We monitor these patients closely for potential transfusion reactions, including TPR and visual observations of their neurological status. This patient is receiving a unit of packed red blood cells which we have purchased from pet blood bank. Pet blood bank come here to collect blood donations a few times a year from fit and healthy dogs that their dedicated owners have given their kind permission for.
As wards team leader I try and catch up with my team every day here is Jenna looking after a very relaxed cat in our dedicated cat ward. This is a cat friendly environment with pheromone diffusers and calm atmosphere, beds and hidey areas in the kennel and covers for the front of the kennels as some cats do prefer to hide.
When we make observations about how our patients are doing we update their hospital notes as we do the rounds during the day. Here I am recording a respiratory rate on a patient form from outside the kennel, before I open the door to perform the heart rate and temperature on a dog recovering from general anaesthesia.
We have an Emergency and Critical Care Service and are pleased to be one of a few facilities south of London offering intensive care unit ventilation and the first to provide ventilation for pets below 5kg. This specialist equipment includes a climate-controlled oxygen cage, high flow nasal oxygen and a paediatric incubator with oxygen monitoring. Here is a cardiac patient being stabilised before having a general anaesthetic for a pacemaker to be fitted.
We are a truly multi-disciplinary hospital so as a nursing team we can be working in the Neurology service one minute, then Orthopaedics and Oncology the next. Here I am taking a tiny dog to the chemotherapy team for vital treatment.
As well as monitoring our patients we do also undertake a number of clinical procedures, taking blood samples, placing intravenous catheters, blood pressure and ECG monitoring. Here I am assisting Leila to take bloods from this patient using his jugular catheter central line.
At the end of the day, we make sure we go through and complete thorough hand-over notes. We handover verbally to the twilight nurses who are taking over the care of our patients. The twilight team will then in turn handover to the night team nurses. The night team nurses will then complete the written handovers ready to hand verbally to the Senior Wards Nurse in the morning. We can use the written handover notes to clarify any points."