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    Veterinary Nursing Placements

    Guidance for the Nursing Progress Log (NPL)

    An introduction to NPL systems

    As of 2022, two versions of the NPL will be in circulation:

    • Autumn 2022 onwards NPL
    • 2016-2022 NPL

    Students who commenced their course with us in 2021 (or before) remain on the 2016-2022 NPL system. Students on this system are not permitted to transfer to the updated version.

    Students who joined us Autumn 2022 onwards will be on the latest version of the NPL.

    Therefore, our NPL guidance has been split into the following sections:

    • Specific guidance for the 2016-2022 NPL skills
    • Specific guidance for the 2022/23 NPL skills
    • General NPL guidance (applicable to all)

    Documents

    • - A guide to logging in and getting started for Clinical Coaches

    Specific guidance for the 2016-2022 NPL skills

    • - (Word document)

    Specific guidance for the 2022/23 NPL skills

    • - (PDF)

    Guidance for clinical coaches with Year 1 placement students

    To help students prepare for their practical training, we have provided them with an induction form for use with the clinical coach at their first meeting. Students have been asked to complete the first section of this which provides the clinical coach with details about the students learning and any NPL tasks in which they have previous experience. We hope that this assists clinical coaches in the early planning stages and getting started with the NPL.

    Whilst this new version of the NPL contains a reduced number of tasks, the actual requirements for completing some tasks are quite considerable. In our experience students can find this confusing, so guidance from the clinical coach regarding task expectations, (based on the case load in your practice) may need to be clarified.

    Many sections incorporate a mixture of what we would consider to be basic and more advanced skills so, (depending on the level of experience your student has had prior to placement) it may be unlikely for any sections to be completed in this first placement block.

    We have suggested to students that they look at the NPL and identify 10 tasks that they feel they may be able to complete during this placement. This helps to provide focus and familiarity during this initial block. Other tasks can of course be opened, but clinical coaches may need to advise students that due to amount and variety of experiences associated with many tasks, being declared competent during this block placement may not be possible.

    Where this occurs, it would be really useful for the clinical coach to write a comment at the end of placement, noting the student’s progress.

    We do ask that students only attempt those tasks for which they have covered the underpinning knowledge for at university, as this underpinning knowledge will ultimately form part of their overall competency.

    The table below details those tasks which we feel that students should be able to attempt during this first ten week block placement. We are not expecting that all these tasks be attempted; this is simply a guide of what could be done based on what the student has done at university in their first year.

    In their first year, students will cover the underpinning knowledge to enable them to start the following tasks:

    Section Skill(s)

    1.  Legislation affecting practices

    All

    2.  Communication

    1, 2, 3, 4, 7, 8, 12

    3.  Handling and restraint

    All

    4.  Nursing care

    3, 4, 5, 6, 7, 8, 9, 10, 11, 12

    Students will have had practical tutorials in basic experience relating to these tasks. For example, students will have been taught how to set up IV fluids, but will not have covered placing an IV cannula.

    5.  Laboratory techniques

    -

    6.  Diagnostic Imaging

    -

    7.  Dispensing

    -

    8.  Infection control

    2, 3, 4, 5

    9.  Theatre practice

    2, 5, 6

    In relation to task 5, students will have been taught basic surgical preparation of an operation site.

    10.  Anaesthesia

    -

    Upon completion of 10% of the NPL, the student is notified that they need to undertake the first part of their behavioural evaluation. This will include gaining feedback from both the clinical coach and a nominated peer regarding the student’s professional development.

      

    Using witnesses to support student training

    It has long been acknowledged that training student veterinary nurses should be a team effort and not solely on the shoulders of the clinical coach. The clinical coach is responsible for the facilitation of training and ultimately making the decision regarding student competence in a skill, but the journey to achieve this will likely to include lots of the practice team. This section outlines how witnesses can and should be used to support our student veterinary nurses training.

    Who is responsible for determining the suitability of a witness?

    The clinical coach should be making the decision as to who are appropriately qualified witnesses for supporting the student in any given skill. This will likely include utilisation of staff with particular expertise, for example:

    • An experienced receptionist to support the student whilst undertaking reception duties.
    • An experienced consulting RVN supporting the student learning how to support clients in clinics.

    The clinical coach is expected to liaise with staff members to ask them to act as a witness and what this will involve for the relevant skill(s). This may include discussion and/or provision of written information regarding the skill guidance and skill expectations in line with the practice case load.

    How should use of witnesses be logged in the NPL?

    If a witness is used to demonstrate a skill to the student, and/or observe the student demonstrating this back, the clinical coach should log the name of the witness in their comments and the rationale behind use of said witness.

    In logging their experiences, the student should note either in their case description or reflective comments the name of the witness(es) used.

    In making the decision regarding student competence, the clinical coach will then liaise with the relevant witness(es) and reach a decision regarding overall task competence which should then be recorded in their decision of competence.

    Do witnesses need to write up formal witness statements?

    We do not require witnesses to write formal witness statements. However, where witnesses are used to support training, we do expect transparency of the witness process to be visible on the NPL as detailed above.

    Upon internal quality assurance of the NPL, if this is found not to be the case, the internal quality assurance verifier, (IQAV) may request written witness statements.

      

    Helping students achieve competence in tasks where naturally occurring evidence is not being seen

    It is usual that during the course of NPL completion, there are some tasks which students will struggle to gain experience in because cases are few and far between. A typical example would be first aid cases.

    It can be useful to plan for this from the start of training – making a list of tasks which are deemed ‘rare’ so that the team can be made aware that if such a case comes into the practice, the student can be called to get involved. Course providers do usually ask clinical coaches to wait until a student has learnt the necessary underpinning knowledge at college/university before opening a task, but where rare cases are concerned, the more cases a student can get involved in, the better.

    Simulation

    Simulations are also a very good way for the student to gain experience. However, these need to be carefully managed to ensure the simulation is as realistic as possible, and that it does not turn into a question and answer session.

    Table: Ideas for simulations in areas where cases may be rarely seen

    Experience Required Potential Simulation Exercise

    Emergency intubation to maintain an airway and/or triage of an unconscious patient.

    Use of patients that have been induced for general anaesthesia – simulate that the patient has just crashed and requires intubating. The student can then carry this out and also perform triage checks.

    Bandaging

    Use of an amenable staff pet as a first option or a suitable patient model/toy as a second option.

    Physiotherapy

    Use of an amenable staff pet. A model or stuffed toy is not really appropriate for this task.

    Radiography positioning

    Use of a suitable patient model – ideally one that has recognisable anatomical landmarks.

    Professional Discussion

    Where indicated on the NPL, it is possible for some tasks to be evidence by professional discussion. This is usually for tasks that are very rarely seen, but it is still important the student knows how to deal with them, e.g. reporting incidents that come under RIDDOR.

      

    Guidance on reflective comments

    Reflective comments are an essential part of the NPL. As well as allowing students the opportunity to reflect on each experience, good use of the reflective comments box can also prevent students from over-logging unnecessarily.

    Prior to logging an experience, the student should ask themselves:

    • Why am I logging this experience, what does it show?
    • Does this experience show anything different than the experiences already logged for this task?
    • Which task guidance notes / clinical coach requests have I covered?
    • Am I showing progression; have I had previous difficulties with similar experiences?

    Students should reflect on:

    • How well the skill went
    • Was it successful or un-successful (both should be logged to show learning and progression)?
    • Was anything new learnt?
    • In reality has the student carried out this skill before?
    • Are more experiences required?
    • Is the student confident / competent with this aspect of the skill?

    The reflective comments box should NOT be used as an explanation / narrative of how the skill was executed. This detail should be in the patient description box, and the reflective comments should be purely reflective and suggestive of how the student progresses with this skill moving forward, e.g. add further experiences (what might these be) or is the student ready to claim competence.

    Examples of reflective comments (2016-2022 NPL)

    Section Skill Reflective comment Notes

    1.

    1.

    I put the wet floor sign out multiple times a day. I understand H+S regs and have no difficulties with this

    There is no requirement for the student to log any more experiences of using a wet floor sign. The student should focus on other H+S tasks / legislation

    2.

    1.

    I feel very confident dealing with most clients face to face, but I still struggle with clients that are visibly upset or angry. I need more practice with this.

    The student should avoid logging any more face to face contact with straight forward clients and should focus on more challenging clients.

    3.

    6.

    I feel comfortable restraining any dog, of any temperament for any procedure, and my earlier experiences show this. I now need to build my confidence and focus on cats

    Providing the students previous experiences cover a range of dogs (as suggested), the student should avoid logging any more dogs, and focus solely on cats.

    4.

    3.

    I feel confident performing TPR on anaesthetised patients, but I still struggle with conscious patients

    There is no requirement for the student to log any more experiences of performing TPR on anesthetised patients; focus should be on conscious and more challenging patients.

    5.

    2.

    This was my 1st jugular blood sample on a cat. I managed OK, but I need more practice in knowing where to clip, as I initially clipped in the wrong place

    The student should log further experiences of obtaining jugular blood samples

    6.

    3.

    I now feel confident to position cats, and dogs for lateral chest and abdominal x-rays. I now need to focus on limb and spine x-rays as I struggle more with these.

    The student’s subsequent experiences should include limbs / spines and any other gaps in anatomical positioning. The inclusion of different thorax / abdomen positions could also prove valuable. There is no requirement to repeat log lateral chest / abdomen x-rays.

    7.

    2.

    I regularly package and dispense POM-V tablets into childproof containers, placing the label off the printer onto the pot. I find this task straight forward and easy.

    There is no need to repeat log the dispensing of loose tablets into child proof bottles. The student should focus on the other aspects of this task, to include a good variety of experiences.

    8.

    3.

    I dispose of anatomical waste after every operation and feel very confident doing so.

    The student does not need to log anymore experiences for disposing of anatomical waste. Focus should be on disposing of a variety of other different types of waste, not yet covered.

    9..

    2.

    This is the 1st time I have packaged an instrument. I forgot to label the instrument with the date. I will remember to do this next time.

    The student should log further experiences showing progression through to competence with correctly packaging instruments.

    10.

    4.

    I have just started monitoring anaesthetics and was really nervous. There were no problems with the anaesthetic (ASA risk 1) and the vet was really helpful in giving me some hints and tips. I am looking forward to monitoring more anaesthetics over the coming week.

    The student should log further experiences showing progression with anaesthetics.

      

    Successful Completion of the NPL - our summary for students

    A student summary for the successful completion of the NPL:

    1. Keep a notebook

    Once skills have been opened, keep a notebook in your pocket at all times so you can write down the relevant case details which can then be written up onto the NPL after you finish work that day. This should ALWAYS include a method of auditing the experience, e.g. a case reference number and general notes about the case.

    2. Record your case experiences

    Spend 10-15 minutes each day recording your case experiences onto the NPL. Remember that you only have a time window of two weeks to record your experiences and it is very easy to get behind, especially at the start of your training when it is likely that a large number of basic skills may be open at the same time.

    3. Read the guidance notes

    ALWAYS READ THE GUIDANCE NOTES for the skill (if there are any) and periodically check these to ensure you are covering the range of experiences needed.

    4. Ask your Clinical Coach

    If you are unsure what is expected of you to complete a particular skill, ask your clinical coach. Expectations will likely differ between practices because of different equipment and protocols. Don’t set yourself up to fail by guessing what you need to do.

    5. Use appropriate detail

    Record your experiences in appropriate detail in the ‘case description’ box. This enables your clinical coach to see at a glance what you have covered in relation to a specific skill. Think and use your common sense when it comes to this, and again – check the guidance notes for the skill to ensure you include any necessary detail.

    Example: Logging case descriptions for handling and restraint

    Ensure that you document an appropriate range of points so that across all of your experiences you show a good breadth of experience:

    • What the patient was restrained for – for example, a jugular or cephalic blood sample.
    • The patient’s temperament - you’ll need to be able to demonstrate to your clinical coach that over time you are competent at handling a range of temperaments. Also mention if any restraint aids such as towels or muzzles were used.
    • The breed/size of patient
    • Don’t forget a case reference number as there must be a means of auditing your experience to prove it actually happened.

    Examples of case descriptions may look something like this:

    Case ref: 1256/a ‘Barney’ Placcid cat restrained for jugular blood sample

    Case ref: 4567/b ‘Angel’ Large 40kg aggressive cross breed muzzled and head held for vet to examine ears whilst another nurse restrained hind quarters.

    6. Use the reflective account box appropriately

    Reflective comments are optional and are there for you to comment on your own performance (NOT for you to document how you carried out the skill – this level of detail is not necessary).

    This may include how well you felt you carried out the skill? If it did not go well, why not? What do you need to do to improve with future similar cases?

    Example: ‘This is the first time I’d restrained an aggressive cat so found it quite challenging. Whilst I’d got good control of the head and forelimbs, on future occasions, I need to ensure that I’ve got a towel firmly wrapped around the hind limbs to prevent the risk of being scratched.’

    See the next section of this handbook for further guidance.

    7. Before claiming competency

    Before claiming competency, check that:

    • You have covered all the skill guidance within your experiences
    • You feel confident in performing the skill in a range of situations
    • Have completed learning the theory relating to the skill
    8. Claiming compentency

    Upon claiming competency for a skill, you don’t need to log an experience for this. Likewise you don’t need to log any further experiences for this skill.

    It is recommended that you do write a reflective account upon claiming competency to inform your clinical coach as to why you feel competent at this time. For example

    ‘I have restrained a range of different cats with varying temperaments for a wide range of procedures and now feel that I can do this well no matter what the temperament.’

      

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