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https://todaysveterinarypractice.com/table-of-contents-may-june-2021/
Featured, Finding Balance, Practice Management

The Most Underutilized Resource in Your Clinic

Veterinary nurses are trained in a multitude of areas. Don't let their skills atrophy!

Kate BoatrightVMD

Dr. Boatright is a 2013 graduate of the University of Pennsylvania. She currently works as a small animal general practitioner and emergency clinician in western Pennsylvania at NVA Butler Veterinary Associates and Emergency Center. Her clinical interests include feline medicine, surgery, internal medicine, and emergency. As a freelance writer and speaker, Dr. Boatright enjoys educating veterinary students and colleagues about communication, team building, and the unique challenges facing recent graduates. Outside of the clinic, she is active in her state and local VMAs and serves on the VBMA Alumni Committee. In her spare time, she enjoys running and spending time with her husband, son, and three cats.

The Most Underutilized Resource in Your Clinic
Bee Johnson
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I would not be the doctor I am today without the influence and assistance of many veterinary nurses. They helped me survive clinical rotations, supported me when I faced upset clients or made a mistake, and taught me many of the skills I needed to survive in practice. I could not do my job or see the number of patients I do without my veterinary nursing team. Unfortunately, in many clinics, veterinary nurses are one of the most underutilized and, often, underappreciated resources.

WHAT IS A VETERINARY NURSE?

Across the country, veterinary support staff are known by many names, with many clinics referring to both on-the-job–trained and credentialed staff as veterinary technicians. According to Nick Rivituso, CVT, VTS(ECC), “There is no denying the level of experience that on-the-job–trained assistants bring to the table. Many assistants, especially those in the field for a long time, have not only learned a lot, but have developed a significant skill set that should not be overlooked.” However, he feels that the training credentialed technicians receive makes them uniquely qualified members of the veterinary team.

The most notable distinction between credentialed technicians and assistants trained on the job is the legal differences in what each staff member is permitted to do and the requirements to sit for a national credentialing examination, uphold a license through continuing education, and adhere to the Veterinary Technician Oath. Credentialed technicians also have the potential for career advancement through specialization.

Title confusion starts with the fact that a credentialed veterinary technician may carry the title of CVT, RVT, or LVT, depending on where their training was completed. Uniting the profession under a nationally recognized title and credentialing requirements is one of the goals of the Veterinary Nurse Initiative (VNI), which was launched in 2016 and is promoted by the National Association of Veterinary Technicians in America. The term “veterinary nurse” has been suggested as a nationally recognized title for these credentialed technicians, though it has met some resistance in the veterinary and human medical fields.

THE POSITIVE RESULTS OF IMPROVING VETERINARY NURSE UTILIZATION

In addition to creating a centralized title, the VNI is working to improve awareness of the role of these highly trained individuals and their utilization in practice. The Veterinary Innovation Council (VIC), a non-profit organization focused on creating forward-thinking solutions for issues in the field, has developed its Building Better Teams Initiative as well.1 Fully utilizing veterinary nurses, standardizing credentials, and even promoting a new master’s degree that would expand a veterinary nurse’s scope of practice are among the focuses for the VIC. These issues are coming into focus as surveys show that veterinary nurses become frustrated when they are not fully utilized. In the 2016 NAVTA Demographics Survey, lack of recognition and underutilization of skills were 2 of the top 6 concerns of credentialed veterinary technicians.2 More recently, in the NAVC’s Amplifying the Voice of the Veterinary Community survey, 58% of veterinary nurses stated that veterinarians not utilizing their skills and lack of respect from the veterinarian caused frequent stress.3

This stress, combined with other common stressors such as low income, student debt, burnout, and compassion fatigue,2,3 contribute to the high turnover rate seen in the profession. In 2018, the turnover rate for veterinary nurses was 23%, which was higher than the mean national rate.4 Nearly one-third of veterinary nurse respondents to the NAVC survey stated that they will likely leave the profession within the next 5 years—and these responses were collected before the COVID-19 pandemic.3 This turnover leads to an additional source of stress for staff who remain and are expected to work more while the clinic is short-staffed.Additionally, effectively utilized veterinary nurses make a significant contribution to practice revenue. In one AVMA report, practice revenue increased by $93311 for each credentialed technician per veterinarian in the practice.5 In other words, a higher ratio of veterinary nurses to veterinarians will improve revenue by improving efficiency and offering additional revenue streams, such as veterinary nurse appointments.

HOW TO REALIZE THE FULL POTENTIAL OF YOUR VETERINARY NURSES

The first step to fully utilizing your veterinary nurses is to understand their skill sets and what your state’s practice act allows them to do. Veterinary nurses are patient care specialists. Their skills should be utilized in every aspect of patient care. “The most efficient hospitals use not only the technical skills of their technicians, but also the knowledge that they have,” says Stacy Bartholomew, VMD, who is both a practicing small animal veterinarian and an instructor for the veterinary technician program at Manor College outside Philadelphia.

Outpatient Cases

For outpatient cases, veterinary nurses can start appointments by efficiently collecting patient history, vitals, and learning of any client concerns. They should be empowered to provide initial client education on recommendations for vaccinations, screening tests, and preventives. For clients who accept these recommendations, they can streamline the appointment by collecting diagnostic samples prior to the examination. In Rivituso’s experience, “having a CVT fully utilized for treatments, patient care, and lab work, doctors are available to see even more cases.”

To further maximize the number of patients that can be seen in a day, consider scheduling veterinary nurse appointments for some booster vaccines, collection of pre-surgical bloodwork or diagnostic samples that require an overnight fast, blood pressure monitoring, nail trims, and anal gland expression.

Technical Skills and Patient Care

The technical skills of veterinary nurses go beyond phlebotomy and placement of catheters. Nurses are trained to place bandages, give enemas, obtain samples for cytology, and more. Rivituso, who has a specialty in emergency and critical care, is trained to run codes, perform emergency procedures such as trocharizing a gastric dilatation-volvulus, and perform an abdominocentesis or thoracocentesis. This frees the veterinarian to communicate with the owners more quickly in these critical situations.

Additionally, nurses should also be the primary caregivers for inpatient cases and the ones who prepare patients for anesthesia and oversee their safety during anesthetic procedures and recovery. While nurses are placing catheters, starting fluid therapy, administering medications, or prepping a surgical patient, the veterinarian can be working on patient records, speaking with clients, or examining another patient.

When we as veterinarians try to do all the technical tasks plus our jobs of performing exams and developing diagnostic and treatment plans, we end up overwhelmed and our veterinary nurses end up frustrated. Better delegation of duties will improve the mental health of every member of the clinic team.

Patient Advocates

Veterinary nurses often spend more time with the clients and the patients than the veterinarian does. They are often the first to notice that a post-operative patient seems especially uncomfortable or an in-patient’s respiratory effort is changing. They can alert the attending veterinarian to these changes and allow earlier intervention for the compromised patient. Veterinary nurses should feel comfortable sharing concerns with the attending veterinarian about patients, and veterinarians must be receptive to hearing these concerns.

Client Education and Communication

In speaking with many veterinary nurses about which skills they feel are most underutilized, one of the most common answers was allowing them to use their knowledge and communication skills. During their training, veterinary nurses are taught the mechanisms of diseases and taught to understand why they are doing various tasks, not just how to do them. When we as veterinarians step back and allow our nurses to provide client education, we improve the client experience. This demonstrates that “the whole staff is knowledgeable, trustworthy, and, most importantly, giving consistent messages,” says Dr. Bartholomew.

Veterinary nurses are also trained to provide education on other important topics, such as nutrition, behavior, medication administration, and disease monitoring. They can answer many basic medical questions and help with phone triage to minimize the amount of time doctors need to spend on the phone.

For instance, when a patient is diagnosed with a chronic disease, such as diabetes, the veterinarian has the initial discussion of diagnosis and treatment with the owner, but we all know that teaching clients how to handle and administer insulin and discuss at-home care can be a very long conversation. Utilizing a veterinary nurse to have these more detailed conversations and answer follow-up questions can allow the veterinarian to keep moving in appointments without rushing the client.

TRUST IS THE KEY TO UTILIZING VETERINARY NURSES

Veterinary nurses are highly trained individuals who have worked hard to earn and maintain their titles and they deserve the respect of their veterinarian colleagues and clients. Utilizing their skills is the first step in showing them the respect that they deserve. Amanda Olszewski, CVT, sums up the desires of veterinary nurses to work alongside veterinarians: “We are proud and excited to use our skills and knowledge. Don’t let us atrophy!”

For veterinarians who are used to doing all the client communication, patient care, and technical work, it may take some time to become comfortable with allowing their veterinary nurses to perform to their full potential. To make this transition, establish a training program and provide clear, consistent communication and feedback in both directions. Dr. Bartholomew has learned that “delegation is the key to success, happiness, and overall financial gain.”

References

1. The North American Veterinary Community. The Veterinary Innovation Council. navc.com/advocacy/veterinary-innovation-council. Accessed November 2020.

2. The National Association of Veterinary Technicians in America. NAVTA 2016 Demographic Survey Results. navta.net/page/Demographic_Survey. Accessed April 12, 2019.

3. The North American Veterinary Community. Amplifying the Voice of the Veterinary Community. navc.com/download/2020_NAVC_Voice_of_the_Vet.pdf. Accessed December 2019.

4. American Animal Hospital Association. Compensation & benefits. 8th ed. Lakewood, Colo: AAHA Press, 2016.

5. Fanning J, Shepherd AJ. Contribution of veterinary technicians to veterinary business revenue, 2007. JAVMA 2010;236(8):846. 

6. Liss DJ, Kerl MR, and Tsai C. Factors associated with job satisfaction and engagement among credentialed small animal veterinary technicians in the United States. JAVMA 2020;257(5):537-545.

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