ABSTRACT: Noel Fitzpatrick founded Fitzpatrick Referrals in 1997 and currently employs more than 65 people at his state-of-the-art imaging, operative and rehabilitation facility for small animal orthopaedics and neurology in Eashing.

Surrey. At least 30 of his staff are qualified veterinary nurses, or are currently in training to become RVNs. This profile concentrates on the work carried out by the nursing team, and explores the roles that each member plays within the team

Noel Fitzpatrick (Figure 1) founded Fitzpatrick Referrals in 1997 and the building of his £10m cutting-edge centre was completed in March 2008, followed by an open day hosted by D| Chris Evans and comedian, Alistair McGowan, in August 2008. The practice was then officially opened by HRH the Duke of Kent KG in November 2009 (Figure 2).

Figure 1: Noel Fitzpatrick

Figure 2: The front of the referral centre Image courtesy of Matt Connor

The centre currently has three senior surgeons, two surgical residents, five international interns, a radiographer, two chartered animal physiotherapists, four hydrotherapists, 30 Veterinary Nurses and eight nursing auxiliaries, all specifically trained for the surgical and medical care of severely ill, traumatised and debilitated patients.

A team of 12 support personnel also ensures an unparalleled level of service. The nursing team is led by head surgical nurse, Emma Johnson DipAVN(Med), RVN, Al, and head nurse of training, Josie Killner DipAVN(Surg), DipAVN(Med), RVN, Al.

Emma and Josie very kindly gave up a ‘free’ Saturday to show me around this exceptional referral centre, and share with me how proud they are to work with such a dedicated team of people. There is a strict hierarchy within the nursing team, and training is taken very seriously – especially when being introduced to anaesthesia. All nurses have a specific role, and students are supervised by qualified veterinary nurses (RVNs) at all times.

Any new members of the team, whether qualified or in training, have an in-depth training/induction programme. And only senior RVNs undertake anaesthetic monitoring for MRI/CT procedures, and work closely with the qualified radiographer and supervising veterinary surgeon. Emma and losie keep a very close eye on everything that is going on, and support their nursing team very well.

The roles of the Fitzpatrick nurses change on a weekly basis and include: ward nurse, surgical nurse (designated to a specific surgeon), cleaning nurse (for the theatre and prep room), MRI/CT nurse and chemotherapy nurse. There is also a team of nursing auxiliaries who support the qualified nursing team; and some of these staff members are currently undertaking either the Veterinary Care Assistant course or the Animal Nursing Assistant course.

The surgical nurse will scrub in for all major surgical procedures, and be responsible for the patients pre-op care (including premedication and monitoring of their status), through to recovery, and will liaise with the ward nurse. Other duties include assistance with anaesthesia induction and maintenance in the prep room, theatre and imaging – perfomed by senior RVNs only (Figure 3). The theatre nurse is supported by a team of theatre nursing auxiliaries.

Figure 3: The prep room. Image courtesy of Matt Connor

Ward nurses are responsible for the care of all in-patients, including intensive care:

   patient medication maintenance of feeding tubes maintenance of intravenous and urinary catheters

  dressing and bandage changes wound management

   pain scoring.

  barrier nursing (when necessary is performed in the dedicated isolation suite)

  physiotherapy (supported by the in¬house physiotherapists and hydrotherapists) supervision of the ward nursing auxiliaries.

Ward rounds are carried out daily with the supervising veterinary surgeon, head VN and intern. The ward nurse is also supported by a team of ward nursing auxiliaries. Preparation of a patient for discharge is performed by the theatre and ward nurses.

The duties of the nursing auxiliaries (under RVN supervision) include: 

  ward nursing auxiliary: cleaning (animals and the environment), exercising of patients, feeding, grooming, environment enrichment and physiotherapy assistance

  theatre nursing auxiliary: cleaning theatres between procedures, sterilising and preparation of all surgical instruments, preparing surgical kits, handling and restraint of theatre patients (following suitable training), and circulating in the theatre and prep room. Ail nursing staff are trained in auxiliary theatre duties, in case a stand-in is required.

Every Friday, the nursing staff (plus the interns, ward and theatre nursing auxiliaries) meet to discuss the week’s activities, and any comments or queries that have been documented in the dedicated message book. Decisions on these are made at the time, or may be forwarded to the clinical management team for a decision.

The practice also maintains a ‘Protocol Book’, which all staff members must read. They are also responsible for keeping themselves up to date with any additions. Good communication is key at Fitzpatrick Referrals.

The rotas for the nursing team are:

   Day staff: 7am – 4pm, 8ani – 5pm, 3pm – midnight, noon – 9pm.

   Night staff: 9pm – 9am. There is a dedicated team of night nurses.

Surgical procedures take place between 8.30am and 11.30pm (or later if necessary).

Reception is another very important area of the practice and a dedicated team of experienced receptionists provide the first point of contact for the many clients who visit the practice, and help put them at ease.

I was left with the overwhelming impression that Noel Fitzpatrick* is extremely proud of his nursing team, and Emma and Josie take great pride in how they have developed and improved the high standards of nursing care provided to all patients. If you would like to learn more about Emma, Josie, the nursing team and Fitzpatrick Referrals, visit their website, www.fitzpatrickreferrals.co.uk 

   Noel Fitzpatrick will also be at this year's BVNA Congress, as the keynote speaker during the Opening Ceremony.


Claire Fraser RVN

Claire qualified in 1990 and spent many years in general small animal practice. Since September 2006. she has worked as a full-time Internal Verifier for MYF Training, but does still spend some time in practice, to keep her nursing skills current. She has also been a member of the BVNA Council since 2003 and was the Association's president in 2007/2008.

She has a particular interest in medical nursing, especially feline medical diseases.

To cite this article use either

DOI 10.1111/j.2045-0648.2011.00083.x or Veterinary Nursing Journal Vol 26 pp 330-331

Veterinary Nursing Journal • VOL 26 • September 2011 •