Vet Times The website for the veterinary profession https://www.vettimes.co.uk Are vets a barrier in preventing VN consults? Author : Helen Tottey Categories : Comment, RVNs Date : March 2, 2017 Maybe it's time to tear down the walls...? IMAGE: Fotolia/magann. For anyone who has read any of my previous articles, you won t be surprised to find this is another one about nurse consulting, as this, I would say, is my specialist topic. Twenty years ago, I started full-time nurse consulting, working out of my own room, with my own diary, 10:30am to 7pm four days a week with a half day on the other day and 9am to 1pm every other Saturday. It did not take long for these appointments to be fully booked, meaning other veterinary nurses would cover the times I was not there. 1 / 8
These appointments were valued by clients, as well as the vets I worked alongside, and they had a positive impact on the business. Many other RVNs are now doing the same thing and are not only enjoying it, but also giving their patients all-round care and adding to their practice s bottom line. So, why is this still not being offered everywhere as the norm? What is stopping our profession embracing and benefiting from nurse consulting being as usual as vet consults? Research finds requirements At last years BVNA Congress, Onswitch presented research from observing 100 veterinary consultations. They found only 4% of these led to a referral to a nurse. In its #VNVoice poll, meanwhile, the BVNA asked: Within your own practice, of the cases in which you feel could potentially have nurse-led input, how often are you asked to get involved or are referred to? The results (Table 1) found statistics similar to those from Onswitch, with just fewer than 4% answering 76-100% of the time. While clients come to see a vet for many reasons that may not, at first, present as requiring nurse input, we are constantly told, in various reports, pets do need more help in being kept healthy and happy. You only have to read the PDSA PAW Report, for example, to see the opportunity we, as a profession, have to help pet owners. Sure, it can be easy to be judgemental of their choice of breed, parasite control, diet, vaccination status the list goes on; but how do they know what the right choice for them is? Therefore, nurses should be the vital link to education, offering the help and advice owners need to properly care for their pets needs, both clinically and emotionally, because, without our input, they find help by turning to the internet or talking to friends. 2 / 8
Table 1. BVNA #VNVoice December 2016 poll. Also, by offering nurse consulting as standard alongside the vet, we give owners the opportunity to talk to us about general pet care, such as any concerns about their pets smelly breath, if their weight is correct or if we can help them as their dog is scared of fireworks or their cat has started to spray in the kitchen any of these issues are unlikely to be the clinical reason an owner came to see his or her vet about. By helping clients, we can begin to develop relationships with them and show what it is we can do for them and their pets. So, why aren t we offering them in all veterinary practices? We can begin to develop relationships with clients and show what it is we can do for them and their pets. So, I ask again, why aren t we offering them in all veterinary practices? I can almost hear the reasons being shouted out as you read this and will, therefore, suggest what some of these could be. Time you don t have any, of course not. With all the clinical jobs and patient care to do (often with reduced staff numbers as there aren t enough of us), where do you fit in the time when you aren t juggling so many other jobs? Space you don t have a room and, when you do, it is at a time clients generally cannot come to see you because they are at work or on the school run. Knowledge a response from the #VNVoice survey sums up what I believe to be a common misconception here: I am not confident I have enough knowledge on all the subjects. But, I say this: knowledge is something everyone reading this has far more of than the client in front of them and knowledge is developed over time. Think of a new graduate vet, for example he or she doesn t have all the answers on day one, yet he or she still finds themselves in a consulting room. 3 / 8
I believe, instead of a lack of knowledge, it is a lack of confidence and training in this area. Considering that new graduate vet again, think about how many consultations he or she would have observed while seeing practice. How many consultations did you observe before you started consulting or how many will you see before you start? The vet s confidence has also been built by training in consulting has yours? To be fair, nurse consulting training courses are available Onswitch, for example, has a specific nurse consulting course developed for 2017 with dates around the country (www.onswitch.co.uk/en/page/rvn) and you can find others, but the point remains nurse consulting is a skill and not something to just get on with doing. In a wider context By offering nurse consulting as standard, nurses can begin to develop relationships with clients and show what they can do. IMAGE: Fotolia/ milanmarkovic78. Many issues stop nurse consults being considered as commonplace as those with the vet, but, in my experience, those aforementioned are the top ones. However, another exists, I believe, and it is one we may not like to talk about openly all that much that of the vet and/or practice s ethos and beliefs. Comments from the BVNA s #VNVoice survey provide us with evidence of these widespread feelings and make for alarming reading: I often feel vets aren t sure what areas we are competent in, and what tasks we can legally undertake. 4 / 8
Most veterinary surgeons feel nurses will not have any added input above what they themselves have already [done]. I have a certificate in diabetes and know other nurses with behaviour qualifications. I also have a certificate in feline nursing, but, yet, if something needs a behaviour consult or is diagnosed as diabetic, it is never referred to the nurse and sees a vet, which is a waste of the extra training we undergo. I think the vets forget nurses could be used to give advice and free them up to be doing other things. Vets often feel if they need to ask the client to return to the practice they will lose their interest, so discuss any nursing care issues during consults. Although the practice I last worked in was very pro-nurse consults, the vet loved consulting, so was also very good at all the advice and information a nurse would give. I think in some cases this also impacts on nurse referrals. Vets don t think to use nurses on many topics. We have the time and knowledge to run clinics with vet support, but the appointments don t get booked in or they get booked in inappropriately. It is such a shame amazing, passionate and knowledgeable nurses are out there (all RVNs), but being stifled by the head vet or practice manager and not allowed to develop their career to include consulting. If we want to be recognised as professionals in our own right, raise our public profile about what we do and not get seen as a failed vet, nurse consulting will go a long way towards addressing this. But first, we need to get our vets on side, as well as the team that books the appointments. Support from within If you are lucky to have supportive vets, but are still not offering full-time consulting, what other barriers can you start to take down to ensure your nurse consulting is as successful as it could be? Granted, you may not be able to build a room so you have the extra space, but other ways exist that you can educate your clients and vets. Social media, emails and the good old telephone can all be starting points to promoting what you can offer, as well as providing evidence to the boss who may not think clients want this service. Some practices have an ambulance could this be used to go into the community to offer more nurse-led services? What about offering nurse appointments after the vet consults have finished, similar to the way many puppy parties are run? How about calling the owners of pets that went home yesterday with a diagnosed condition you can give husbandry advice about, or to check if they have any questions you could answer? Eventually, the client will start to see you as part of his or her pet s care, which can lead to the vet 5 / 8
seeing the same. Removing the barriers preventing you offering regular nurse consulting will only be done by you, however, so you need to take ownership and start somewhere if you want this to be part of your job. Plus, one large barrier has already been removed, and that is our professional status. While our title is not protected, we are a recognised profession. We have our own VN Futures project, too, overseen by the BVNA and the RCVS, and including representatives from the VPMA and SPVS they are all on our side. If you do not know about VN Futures, I strongly recommend you look at the project in more detail, but, for the purposes of this article, the objectives are: creating a sustainable workforce structured and rewarding career paths confident, resilient, healthy and well-supported workforce proactive role in one health maximising nurses potential a clarified and bolstered VN role via a reformed Schedule 3 It is my belief all of these aims have a nurse consulting angle to them. For example, we know a lack of RVNs exists and they often leave due to feeling no career path or development exists for them. This not only impacts on our numbers working in practice, but also time management issues when a nurse goes sick. Earlier, I suggested the lack of knowledge reported by VNs is more likely to be a lack of confidence. 6 / 8
Social media, email and telephone calls can all be starting points when you decide you want to start promoting what you can offer. IMAGE: Fotolia/Maria Sbytova. Training and development, therefore, will build the confidence that not only will keep VNs in the profession (objective one) and help towards growing the VN role (objective two), but also have an effect on feeling resilient and healthy instead of worrying about things you didn t know or should have said/done (objective three). A proactive role in one health (objective four), meanwhile, could lead to nurses getting more involved in the local community, while the reformed Schedule 3 (objective six) will help to clarify any grey areas that particularly relate to consulting that both VNs and vets worry about. Maximising nurses potential (objective five) is something the veterinary profession as a whole has to embrace. It is a shame promoting our worth internally is needed at all, but as both Onswitch and #VNVoice research shows, it is, so we just need to do what we do best and get on with it. Next steps Moving forward, I would love to see one of the veterinary organisations survey vets to find out their thoughts on nurse consulting. 7 / 8
Powered by TCPDF (www.tcpdf.org) Questions could include: If they don t offer them, why not? What are their concerns? If they do offer them, what positives can they share to encourage others? Our profession has grown massively over the past 20 years, but, in my opinion, it is a shame nurse consulting has not progressed as much as other areas. Therefore, I encourage all of you who want to offer consults, but maybe have barriers in place, to look at these in another way and start doing something different that, in a few months or years time, can be looked back on as the how I successfully started nurse consulting chapter of your career. 8 / 8