all patients have already been assessed and are under the practice ' s care, and the primary point of contact for any new patients would still be a VS. It is also the expectation that VNs would be qualified and registered( RVNs), and that VNPs would also fall under RCVS standards and professional accountability.
Supplementary veterinary nurse prescribers
SVNPs would work in a similar capacity to their human counterparts, SPs. They would not be able to diagnose or prescribe medications independently. SVNPs would work collaboratively with the VS and more with chronic conditions than acute conditions. They would work within a VS ' s care plan instead of following an established care framework and prescribing independently.
For example, if a patient diagnosed with Addison ' s disease came into the practice for a monthly injection of corticosteroids( Zycortal, Dechra), with each change in the animal ' s weight, an RVN would have to discuss the change with the VS before administering the correct dose. However, an SVNP could prescribe the adjusted dose, as this would fall under the VS ' s care plan of medications. Furthermore, the SVNP would be able to top up the patient ' s corticosteroid prescription as, again, this would fall within the VS ' s care plan. This autonomy designated to RVNs would help increase practice efficiency, as a VS would not be needed to discuss and prescribe medication.
This would also work for cases such as arthritis requiring adjustments or changes to dosages of medication. As arthritis is an ongoing condition associated with varying pain levels, different analgesia is often needed at various points, and an SVNP would be able to follow a VS ' s care plan. For example, the VS ' s case notes may instruct:“ If improving on meloxicam, they can continue; however, if still sore, they can try Librela( or other forms of analgesia such as paracetamol)”. Again, this would free up the VS ' s time, as the SVNP could prescribe different dosages or medication as long as it had been stated by the VS beforehand. However, if the SVNP felt that the medication listed was not adequate, they would refer the patient back to the VS for a review, as per the care plan.
Independent veterinary nurse prescribers
The role of an IVNP in veterinary medicine would coincide with that of the medical counterpart, the IP. This role would enable skilled and trained RVNs to diagnose minor ailments and follow a structured care framework, ensuring consistency in care across the board. This structure would entail the IVNP completing clinical assessments, which would result in diagnosis and treatment, further work-up, and referral to a VS if or when required. This would allow the IVNP to work autonomously for minor conditions and liaise with the VS if more complex treatment is needed.
As an example, consider the case of a dog presenting to the practice with vomiting and diarrhoea of a few days ' duration. The first point of contact would be the IVNP, who would take the clinical history and physically examine the dog. The IVNP would refer to an established clinical care framework and arrive at a formal diagnosis, for example, gastroenteritis. This could then result in a typical treatment pathway involving antiemetics, probiotics and a short-term gastrointestinal diet, without oversight from a VS, allowing the IVNP to work autonomously.
However, this does not mean the IVNP will not liaise with the VS at all. To emphasise what safeguards would be in place and when the IVNP would refer to the VS in this case, consider the same scenario of a dog presenting to the practice with ongoing vomiting and diarrhoea for a few days. The IVNP would follow a similar approach, taking into account the clinical history and adhering to an evidence-based care framework. However, the difference in this case is that the dog is an entire bitch that has recently come out of season and is polyuric, polydipsic and pyrexic. Based on clinical findings that suggest this may be more significant than the initial gastrointestinal issue, this case would be referred to the VS for further investigation. This is by no means an exhaustive description but is intended to illustrate how this role may work in one specific case.
Another example to highlight the boundaries of this role could be a male cat presenting to the practice with a history of straining to urinate. The IVNP would take and refer to the clinical history and perform a physical examination, which identified that the bladder was small in size and the cat was still able to urinate. Based on the care framework and the absence of other clinical signs, the IVNP could prescribe a non-steroidal antiinflammatory drug and instruct the owner to collect a urine sample for analysis. Based on the urine sample, if intracellular bacteria were present, the IVNP could prescribe a course of antibiotics and re-examine the cat at a future appointment. If there was no improvement or if the cat stopped urinating, the IVNP would refer the patient to the VS.
However, if it were noted on the examination that the cat ' s bladder was distended, suggesting that the cat had a urinary obstruction, the IVNP would then have to liaise with and potentially refer to the VS for further treatment and intervention. This particular case, however, does not necessarily have to be referred entirely to the VS; if the IVNP was competent in the procedure of unblocking a urinary obstruction in a cat, the VS could then delegate the procedure to the IVNP, allowing for a more efficient multi-team approach. Then, the IVNP and VS could liaise on the best treatment plan going forward.
This example demonstrates how the IVNP role could align with the VS role, especially in emergency settings such as out-of-hours provision. It also indicates that,
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