Confidential Veterinary Nursing Reference

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We would be grateful if you would complete all sections below. Please select the option of best fit for the student when answering the questions in Section B. Your responses to these areas will be used in conjunction other evidence to determine the suitability of this candidate for a place on a Licence to Practise, Veterinary Nursing degree training course.

* Tasks suitable for work experience candidate, for example, routine cleaning and infection control tasks.

Level 1 Constant Supervision
Level 2 With Assistance
Level 3 Supervision
Level 4 Decreasing Supervision
Level 5 Independent

Section A: Referee details

First name

Last name/Family name

Your Position

Practice Name

Postcode

Work email address

Work telephone

Section B: Reference

This is a reference for (name of student)

Dates student worked with your practice (DD/MM/YY)

Time management and task completion*

Level 1 Always late for shift. Unable to plan or organise tasks.
Level 2 Often late for shift. Able to plan but easily distracted.
Level 3 Usually on time for shift. Able to organise given tasks with assistance.
Level 4 Rarely ever late for shift. Work well organising tasks with minimal supervision.
Level 5 Always prompt or early for shift. Arranges tasks in logical organised manner and completes them efficiently.

Personal appearance/suitability of attire for veterinary practice

Level 1 Pays little attention to personal appearance. Inappropriately dressed for practice environment. Rarely uses personal protective wear.
Level 2 Frequently untidy in appearance. Some elements of attire inappropriate for practice. Abides by PPE protocols when prompted.
Level 3 Occasionally untidy in appearance/Occasionally some elements of attire inappropriate for practice.
Level 4 Mostly abides by PPE protocols. Maintains suitably attired tidy appearance suitable for practice. Follows PPE protocols.
Level 5 Always well-groomed and appropriately dressed for practice environment. Conforms to PPE protocols.

Communication skills

Level 1 Poor communication skills. Tends to antagonise others or rarely speaks to anyone.
Level 2 Often tactless, unaware of others feelings and own behaviour. Helpful but slow to establish relationships.
Level 3 Demonstrates adequate communication skills when working with others.
Level 4 Develops good relationships with all staff. Good communication skills with colleagues.
Level 5 Excellent rapport and communication with all members of staff.

Attitude towards tasks (for example, brushing and mopping floors or cleaning surfaces)*

Level 1 Needs constant prompting and guidance. Lacks confidence in basic tasks. No interest in the routine tasks of veterinary nursing.
Level 2 Hesitant to do things on their own. Rarely anticipates. Often needs encouragement. Limited interest in routine tasks of veterinary nursing.
Level 3 Capable of working with minimal supervision on basic routine, well-practised tasks.
Level 4 Able to plan ahead on most occasions. Interested and confident in most basic routine tasks of veterinary nursing Recognises own limitations.
Level 5 Able to plan ahead improving with experience. Has the confidence and ability to carry out routine tasks and rises to the challenge of a new tasks but aware of limitations.

Reliability and adaptability

Level 1 Unreliable and unable to carry out the simplest tasks thoroughly. Does not adapt well to changes.
Level 2 Inconsistent in performance of tasks. Slow to accept new situations.
Level 3 Average attention to detail, may avoid unfamiliar tasks. Apprehensive of change but aware of this.
Level 4 Is usually dependable in all areas of work. Good attention to detail. Adjusts well to change.
Level 5 Is always dependable with marked efficiency and precision in work. Adapts to all situations.

Interest and knowledge of RVN role

Level 1 Displays little knowledge of veterinary nursing procedures.
Level 2 Interest not generally displayed/only interested in specific areas of work/practice environment. Deficiencies in knowledge of RVN role.
Level 3 Average interest and asks sufficient questions. Reasonable level of knowledge of RVN role.
Level 4 Good knowledge and awareness of RVN role. Good levels of interest in all areas of practice. Asks suitable questions.
Level 5 Excellent knowledge of RVN role. Interested and willing to learn about all areas of practice. Asks intelligent and appropriate questions.

Can you comment on the suitability of candidate for role as a Veterinary Nurse?

Any other comments?

Section C: Declaration

By submitting this form you declare that, to the best of your knowledge, the information given in this questionnaire is accurate and complete.

Section D: Your data

The information supplied on this form will be in strict confidence and will only be discussed with essential staff working for Harper Adams University. Your data will not be shared with any third parties. Your personal details will be retained in accordance with the Records Retention Guidelines. You can withdraw your consent at any time by contacting the Data Protection Officer. You also have the right to correct inaccurate or incomplete information and have access to your information for use in your own purposes.

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