I was thrilled when we received approval to apply for Zero Pain accreditation. The anticipation of achieving a tangible result from all our hard work over the past 12 months felt crucial. As a small rural clinic with a dedicated team, we strive to provide exceptional care to every patient who enters our doors. Moreover, our team consists of locals who share a passion for learning, growing, and caring for our patients to the best of our abilities.

Before submitting our evidence, I reviewed the application process and was thrilled to learn that a veterinary nurse could be the lead zero pain practitioner. It is mandatory to have a lead responsible for ensuring the clinic maintains its accreditation. Their application form states that applicants must possess advanced pain management or animal welfare qualifications. The following qualifications are accepted: CertVA, CertAVP, MANZCVS, FANZCVS, DipECVAA, DipECAWBM, MSc (Pain), DipAVN,and  NCert(Anaes). I confirmed with Matt Gurney that they would accept my CertEVECC and WSAVA Pain certificate, and he agreed.

This incredible step acknowledges my veterinary nurse role and passion for ensuring excellent pain management. When I first started nursing many years ago, our understanding of pain was certainly nowhere near what it is today, and it's important to remember that we are still learning. Early in my career, I clearly remember feeling concerned about one patient's pain. This patient was recovering from a GDV, and I can still recall his soft cries in the kennel. I remember requesting help for my patient, but I was told he was fine. It was explained to me that he didn’t need pain relief and was just being noisy because animals don’t experience pain the way we do. This memory has undoubtedly shaped who I am today. Several years later, I worked in a charity clinic and cared for another GDV patient post-surgery. At the time, I was studying for my advanced diploma and had begun learning more about pain physiology and the medications available for treatment. This patient was so different from my first case; after receiving opioids before surgery and during recovery, he was undoubtedly a happier patient, sleeping comfortably, eating, and enjoying human interaction.

These experiences certainly shape you as a veterinary professional. For me, they drove me to keep doing better; my passion for analgesia just kept growing. Again, several years later, I scored my dream job in an ICU/ECC department for the prestigious Royal Veterinary College. I was given the most amazing opportunities here to advocate for my patients and to learn about providing the highest standards of care and how analgesics can be life or death for patients.

The incredible opportunity to lead the Clevedon Veterinary Hospital team and other teams in the Veterinary Hospital Group on a pain journey is truly exciting. As the lead practitioner, I will have several responsibilities alongside the team. My role will be to ensure the team upholds their accreditation, which is reviewed every 24 months. To maintain this accreditation, I will support staff in continuing to use their existing skills. I need to ensure the team stays updated with their CPD related to pain management, both internally and externally. As the group’s clinical educator, one way to achieve this is by providing online or in-person training sessions on topics such as using CRIs, performing local blocks, and utilising pain scores for all patients, whether acute or chronic. We are currently performing local blocks in every case. I want to see veterinary nurses trained to carry these out whenever possible and ensure they understand the reasons and drugs used for local anaesthetics and blocks performed by veterinary surgeons. Under the direction of a veterinary surgeon, our nurses perform all neutering, incisional, ring, and sacrococcygeal blocks for blocked bladders, empowering them and creating highly skilled patient advocates. Pain scoring is a mandatory element of accreditation, so as lead, I would ensure and assist the team in understanding how to perform, the limitations, and the audits conducted to ensure scores are completed and recorded.

Clinical audits are mandatory for zero pain accreditation, and I look forward to performing our first audit. I see daily the many questions we can ask about how we manage pain for our patients. Audits are standard in human medicine, and evidence shows how they can enhance patient care. It’s funny; I realised I often do this subconsciously while learning more about audits during my degree. This might involve examining patient records, reviewing the EBVM, producing an answer, and discussing with the team whether we would like to adjust our practice to improve care.

I have had a bumpy journey as a veterinary nurse, but my love and passion for this profession and my colleagues have remained strong. Our journey shapes us into the person we are and will be. Think about the nurse you want to be. You do not need to be an academic to be a fantastic nurse; travel your journey, show up daily, respect those around you, and empower each other.

Remember the saying, “Just a veterinary nurse”? Well, no! You are not just a veterinary nurse; you are an advocate. Your ability to advocate for your patients in many ways- beyond just pain- makes you an essential part of any veterinary clinic. Always keep that in mind.

Written by: Bronwyn Armstrong

Clinic Manager and Clinical Educator, Clevedon Veterinary Hospital (part of Veterinary Hospital Group), Auckland, New Zealand.