The veterinary nursing profession is evolving and, with increasing customer expectations, the role of nurses in practice is more important than ever. Nicola Ackerman discusses how running clinics can make the most of veterinary nurses' talents and skills, while also increasing client compliance and practice profits.
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Nicola Ackerman works as the senior medical nurse at the Veterinary Hospital Group in Plymouth. She is a past-officer of BVNA, past-editor of Veterinary Nursing Journal and currently sits on the Veterinary Products Committee for the VMD.
FOR nurses with a keen interest in consulting, vet nurse clinics offer an ideal opportunity to pursue the specialism that interests them, while still being of use to the veterinary practice. Veterinary practices are businesses and nurses that consult need to perform sufficient work in order to not only cover their costs and overheads but to also make a profit. This isn't necessarily through charging for nurse clinics, but through the products that are sold, through increased footfall in the practice, and by helping with client loyalty and, most importantly, compliance.
Role of veterinary nurses
The role of the veterinary nurse is continuing to evolve. It now stands as a fee-earning regulated profession, and with Kirstie Shield, the outgoing British Veterinary Nursing Association (BVNA) president, stressing the importance of professionalism at the last BVNA Congress and the potential for the new RCVS Charter to significantly strengthen the regulatory framework for veterinary nurses, the profession's role in practice is becoming ever more important (Anon 2014).
Nurses have a vital role to play; their work as consulting nurses is not limited just to offering advice to clients, but includes performing the groundwork of collecting data parameters (eg, blood tests, urine sampling, radiography, complex diet and behavioural histories) in order for the veterinary surgeon to then interpret the collected data and make a diagnosis. Vet nurses also deal with things like the preventative healthcare of animals, postoperative appointments and wound management.
One of the roles of the veterinary nurse is to ensure that the client complies with the recommendations given by the veterinary surgeon. In some cases, this can refer to medications. Nurses are well-placed to discuss with owners how they should administer the medications that their pet has been prescribed. In some cases a different format of medication (eg, liquid instead of tablets) can be of use. In these cases a referral back to the veterinary surgeon is required, as the client will need a new prescription. Many owners do appreciate guidance on the administration of medications, whether this is verbal or via leaflets.
Veterinary nurses that fully utilise the skills learned during their training are more likely to remain with the profession, and they tend to feel more highly valued as team members in their practice (Lantra 2004). Consulting veterinary nurses should not be viewed as ‘mini-vets’; they perform a completely different role from veterinary surgeons (although many veterinary surgeons often undertake a variety of roles that should be completed by nurses). Appointments that deal exclusively with things like blood sampling or postoperative checks need to be scheduled with a veterinary nurse. This will free-up veterinary surgeons' time, and also allow them the freedom to take on tasks that only they can really complete.
From a business perspective, this makes much better use of the entire workforce's time. It is the same argument as for the use of animal nursing assistants and dedicated receptionists/telephonists. Businesses need to utilise staff in the areas where they are most profitable. A simple exercise is to run through the day's consultation list and see how many of those consultations could and should have been performed by a veterinary nurse. The next is to see how many of the consultations seen by the veterinary surgeon could have been referred to the nurse for further guidance on behavioural issues, nutrition, etc.
Veterinary nurse clinics
Regarding veterinary nurse clinics, these are best utilised when the veterinary surgeon offers all newly diagnosed patients an appointment with the nurse in order to discuss all aspects of care for that patient. What this involves will range widely depending on what a specific pet has been diagnosed with. Items that may be discussed in the clinics will usually include:
▪ Diet (weight gain or loss, veterinary diets and life-stage diets, assisted feeding);
▪ Administration of medications;
▪ Exercise regimes;
▪ Palliative care;
▪ Increasing water intake;
▪ Monitoring pets at home (eg,checking capillary refill time, heart rate, urine output, blood glucose);
▪ The importance of compliance.
Discussing all of these factors will mean that owners are more likely to comply with the veterinary surgeon's recommendations and therefore bring in more income to the practice, while also improving the welfare of pets. The CRAFT model (Box 1) shows that, for compliance to occur, the follow through aspect of the equation is required. Use of the nursing clinic to provide the follow through and to ensure acceptance from the client is vital.
CRAFT compliance (AAHA 2009)
C = R + A + FT
Compliance = Recommendation + Acceptance + Follow Through
A good clear recommendation is required, along with the acceptance of the client acknowledging that the recommendation is useful and necessary. The follow through is needed as many clients will accept the recommendation, but compliance can be poor due to a number of factors, including forgetfulness, financial considerations, lack of time or lack of clarity when delivering the recommendation.
As professionals conducting their own nurse consultations, nurses need to be able to portray themselves as professionals in order to be successful. This includes how and where the nursing consults are performed. Conducting a consultation in the waiting room or treatment room doesn't portray professionalism. Figs 1 and 2 depict how clean and tidy examination rooms and personal appearance can portray competence and proficiency. The consultation room, as with a veterinary surgeon's consultation room, needs to be clean, tidy and fit for purpose. When setting up nurse clinics it is important to ensure that all the resources required are in place in order to make the venture a success. This can range from physical items (such as literature and weighing scales) to personnel training.
The literature that you decide to use during consultations with clients needs to be of a high quality. The majority of clients will find it difficult to remember everything that is said within a consultation, so it is helpful to provide hand-outs on what has been discussed, and in some cases in can prove useful to provide specific written instructions.
When clients walk out of the consultation room with information in hand, there is usually the perception that they have received better value for money, compared with just walking out empty-handed. Clients that have received written instructions, whether this is a hand-out or specific written instructions, are more likely to comply with the instructions given to them. If your handwriting is poor it can be useful to type instructions or bullet points for the client. These can be then printed out or even e-mailed to the client. It can also prove useful to direct clients to further information and resources. Having such information available on your practice website can be helpful, rather than having clients seek out other websites on their own – websites that you cannot even guarantee will provide good guidance. All of this needs to be in place before starting to run nurse clinics.
Good and effective communication is one of the most important to tools for running a successful veterinary practice smoothly (Box 2). However, different forms of communication will be needed for different pet owners, and, during a veterinary nurse clinic, the nurse needs to know how to tailor their communication style to make the most of their interaction with the client. For instance, social media is the communication method of choice for one generation, but wouldn't be for another. So adapting how you convey your message during and after a clinic session is important.
Good listening skills are an essential part of communication. The following are some steps that can be taken during a clinic session to help with effective speaking and listening:
▪ Seek clarification;
▪ Take notes;
▪ Avoid distractions;
▪ Use pauses and silences;
▪ Restate and summarise.
Several frameworks for consulting have been developed for medical education and, although none have been developed specifically for veterinary nursing, medical models can be adapted for veterinary use. The Cambridge-Calgary consulting model was adapted by the National Unit for the Advancement of Veterinary Communication Skills (NUVACS) and is therefore probably the most relevant to veterinary professionals undertaking consultations (Fig 3).
Learning how to conduct consultations is vital and does lead to more successful outcomes in compliance and towards greater understanding of the pet owner. The proper training of personnel is also an important aspect of the overall success of nurse clinics. There are many sources of training for nurse clinics, which can include webinars, reading, and day lectures. There are specific courses for veterinary nurses wanting to learn consulting skills. Learning practical skills/tasks through such media can be difficult, but the use of practical sessions, workshops and real-life observations can help adapt theoretical concepts into practical skills.
Watching and modelling other people's consultations can be especially beneficial. Everyone conducts their consultations in a different manner and observing other nurses and veterinary surgeons in action can provide inspiration and ideas that can then be incorporated into the learner's consultations. These methods of coaching can be extended with the use of video coaching, as was discussed in a recent article in In Practice by Sheila Grosdidier (2014).
The Code of Professional Conduct for Veterinary Nurses (RCVS 2014) states that veterinary nurses must seek to ensure the health and welfare of animals committed to their care and to fulfil their professional responsibilities by maintaining five principles of practice:
▪ Professional competence;
▪ Honesty and integrity;
▪ Independence and impartiality;
▪ Client confidentiality and trust;
▪ Professional accountability.
These principles need to be adhered to and held in awareness during nursing clinics. The veterinary nurse is still working under the direction of the veterinary surgeon and the use of written protocols can help staff to keep these principles in mind. As stated in the previous section, good quality training is required in order to ensure that team members are competent and feel confident during consultations; however, there are always situations in which the veterinary nurse will need guidance from the veterinary surgeon and protocols can be particularly useful in these situations (Box 3). For example, options can include the nurse going to find a colleague who is available to examine or discuss the situation with the owner or offering the client an appointment with the veterinary surgeon at a later time that is convenient to them.
Key points when further guidance from a colleague may be required
▪ Show courtesy and respect to both the client and their pet, particularly in situations when it is necessary to convey uncertainty.
▪ Provide solutions, even if this means having to refer the problem on to someone else as part of the pathway to providing a solution. Don't say ‘I don't know’ regarding a specific problem, but turn the statement around to ‘Let me find out for you’ or ‘Let's see what we can do’.
▪ Keep your word. If you say you will contact the owner in a couple of days, ensure that this occurs.
▪ Ask if there is anything else that you can do for the client (other than the situation that you need clarification/guidance on). If the information gathering stage of the consultation has been completed correctly then the client will usually answer no. Asking this question helps to reassure clients and makes them feel that all their objectives for the consultation have been met.
Working as a team
The success of nurse clinics in a practice is directly related to the support offered by other colleagues. For instance, recommendations from team members are invaluable. Having one of the veterinary surgeons referring clients is the best way to increase the number of clients attending nurse clinics. The marketing of veterinary nurse clinics is also key. It needs to be incorporated in to the practice's overall marketing strategy and it needs to be performed in such a way that all practice members are on board for the initiative.
Setting up vet nurse clinics can foster client loyalty. They are a good welfare choice and can also have a significant impact on a practice's finances. It is important to keep in mind that the expectations of pet owners are changing, and many will now expect their local veterinary surgery to offer services like nurse clinics and puppy parties. Veterinary nurse clinics are an integral part of client and patient care in veterinary practice. How these clinics are run reflects on the professionalism not just of the nurse running them, but of their profession and their practice. Good training, practice protocols and client resources are essential in making them a success.
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