vet:nurse ratios

RE: vet:nurse ratios

J G Wray — Thu, 16 Jul 2015 07:37:05 GMT

The last time we went through a bout of recruitment, the process was not driven by the vets, but by the nurses. The Head Nurse was asked to make the case. All staff have access to practice costs and profit figures, published quarterly. The Head Nurse knew how much the new member of staff would cost to recruit factoring in recruitment and training costs it came to ~£30k in that year.

The problem of congestion had been identified by the vets, who are never shy in pointing this out and only ever have one solution - more resources. The nurses had a different point of view on demands at certain times and the result was a change in a number of areas. For instance, reception staff were asked to change the questions they asked of the client. They we able to stagger the work better, reorganise the work most likely to have a high demand on nurse/vet, just by asking some questions, because they had understood the impact of certain types of work. Nurses read the appoitnments lists and agreed to be more flexible in scheduling their tasks e.g. managing repeat orders and stock control/orders.

For a vet it is the most important and urgent thing in their world is the work they are doing in a moment and they are capable of finding all sorts of justifications for this view. They were asked to consider educating reception, not demanding behaviours of reception, accepting staggering of their work, learning to explain the congestion to clients and negotiating a change of plan, re consideriug the impact of their work on others and offering to assist their colleagues themselves.

The vets were also asked to measure their problem, by recording when the problems arose.

They were then asked to divide the extra cost of the nurse between them and add a multiple of 4 times this to their turnover to cover the extra resource.

This last part stripped away naivety.

HAving resources for your work is great. I prefer having the 2:1 nurse to vet ratio for all the reasons cited by others, but it is not the only answer to congestion and there is always a cost which comes back to the fee earners.

RE: vet:nurse ratios

Neil Wheadon — Wed, 15 Jul 2015 22:25:55 GMT

[quote user="Mark Hedberg"]1:1 is very helpful, but in fact having more than 1 nurse per vet (oh, happy day!) would be even better, because you can then delegate work they're perfectly capable of sorting on their own.[/quote]

See Clive's answer as well

I simply can't remember the last time I worked in a practice with a ratio less than or equal to 1:1.

1:2 is almost the minimum and it's fantastic, nurses are great at placing catheters, taking bloods, bandaging etc etc, taking a lot of pressure off at busy times

Neil

RE: vet:nurse ratios

grumpyoldman — Wed, 15 Jul 2015 22:16:32 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="grumpyoldman"]and dentals[/quote]

[/quote]

Sorry , the scaling and polishing bits of course ,although one had got a post grad certificate , and is I have to say a lot more informed and handier than any new graduate

RE: vet:nurse ratios

Evelyn Barbour-Hill — Wed, 15 Jul 2015 21:23:18 GMT

[quote user="grumpyoldman"]and dentals[/quote]

RE: vet:nurse ratios

grumpyoldman — Wed, 15 Jul 2015 19:17:54 GMT

[quote user="Marie Kubiak"] optimal levels?[/quote]

4 vets 12 nurses +/- 2 part -time, no receptionists , the 3.25:1 is about right , ,staggered lunches , lots of inpatients , bloods dressings and dentals ,anaesthesia as well as reception and insurance, , a late /night nurse 1in 8 . Depends on your business model really .

RE: vet:nurse ratios

Gillian Mostyn — Wed, 15 Jul 2015 18:53:50 GMT

Clive Ansell - actually, I was working on the number of RVN/SVNs in the building at the same time as the vet! You're right...the complicated nurses rota makes it hard to compare... but when the practice is open, there are usually at least twice as many nurses working as vets! Sickness and holidays can reduce it to a lower ratio....but you can really feel the difference!

RE: vet:nurse ratios

Virginia Campbell — Wed, 15 Jul 2015 18:11:51 GMT

6.5 full time equivalent vets and 9 nurses of which 5 qualified VNs, 4 trainees ( the more experienced trainees very good though and the younger two keen though needing more guidance). We've usually got quite a few inpatients to deal with and the bosses do a fair bit of ortho/MRI referrals which takes quite a lot of theatre nurse time sorting gear etc.

A few months ago we were down to 6.5 nurses and life was pretty stressful....such a waste of time waiting for a nurse to be available to monitor GA so you could get something knocked and keep the ops list moving, and a lot more vet time spent doing jobs that could have been done by a nurse.

[quote user="J G Wray"] if there are longer periods when there is little for the nurses to do [/quote] oh pray tell when is this magical witching hour? I think that might have happened once, briefly, one day last year....

RE: vet:nurse ratios

Martin Atkinson — Wed, 15 Jul 2015 17:54:27 GMT

For what it is worth I am sole charge and presently have 2 unqualified 'nurses' with no additional staff. They also do reception and cleaning duties. I used to have 3 for easing the rota when one was off sick or on holiday. However for reasons of difficulty finding the right staff and cost restraints in the light of reduced business due to local competition and the recession when we lost one I didn't replace her. Rota allocation meant that the two that remained don't do longer hours, they just double up less but are paid more with the bonus of more overtime as well when covering for each other. They are more than happy with this.

RE: vet:nurse ratios

Clive Ansell — Wed, 15 Jul 2015 17:37:23 GMT

Of the 5 regular practices, and some I have worked this year:

3 vets over 2 branches, 5 nurses of which 3 are RVN/VN's. 1 receptionist, 1 manager.

2 vets, 4 nurses, no VN's. 1 cleaner

2 vets over 2 branches, 7 nurses, 1 VN

1 vet, 4 nurses, 2 are VN's other 2 are trainees

1 vet, 4 nurses, 1 is a VN

1 vet, 2 nurses, no VN's

1 vet, 3 nurses, 2 are VN's, 1 receptionist

1 vet, 3 nurses, 1 is a VN

RE: vet:nurse ratios

Clive Ansell — Wed, 15 Jul 2015 17:24:13 GMT

[quote user="Gillian Mostyn"]We usually work on a 2:1 ratio of nurses to vets.[/quote]

Is that the number of nurses to vets, or the number of nurse hours worked to vets hours, given that nurses usually work shorter days and fewer hours than the vets do?

[quote user="Gillian Mostyn"]I don't see how practices keep up with the inpatient care, cleaning, stocking and training with a 1:1 ratio?[/quote]

They frequently don't.

RE: vet:nurse ratios

Gillian Mostyn — Wed, 15 Jul 2015 15:39:36 GMT

We usually work on a 2:1 ratio of nurses to vets. Apart from directly helping the vets, I don't see how practices keep up with the inpatient care, cleaning, stocking and training with a 1:1 ratio?

RE: vet:nurse ratios

Marie Kubiak — Wed, 15 Jul 2015 14:47:00 GMT

Thanks all, this is the worry for me that we are perhaps overburdening the nurses we have but trying to work out if the vet numbers are an issue too. Currently working at 3 fully booked vets to 2 nurses which is a recipe for stressed vets and stressed nurses and have to put forward a case for another nurse to counter the cost implications. The article Mark has linked to will be very useful :)

RE: vet:nurse ratios

Braden Collins — Wed, 15 Jul 2015 13:50:11 GMT

We have around 2 nurses to each vet, but as said above just employing more nurses is going to cost a lot of money. as we have grown, we have created two lists of jobs. One list is things vets must do, the other list is things nurses can do. Obviously it's cheaper to have nurses perform tasks they are capable of doing (nail trims, bandaging, suture removals, etc) so we use our nurses to the limits of their abilities.

Rather than just looking at it from a "do we have enough nurses" point of view, also consider "do we have too many vets" as a posibility. It may not be a case of sacking a vet, but when a vet leaves look hard to see if they could be replaced with a nurse.

If waiting for nurses is limiting your vets work rate, that's when it may actually cost you money not having another nurse.

RE: vet:nurse ratios

Mark Hedberg — Wed, 15 Jul 2015 13:25:32 GMT

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1624915/ Interesting article on the economics of non-DVM staff in Canada; the more you have, the more money your practice may make.

RE: vet:nurse ratios

J G Wray — Wed, 15 Jul 2015 11:35:15 GMT

[quote user="Marie Kubiak"]Really, why is it a strange question? With regards inefficiency I find that when there is a blood sample/wound clean/FNA etc as a consult then vets are fighting over nurses to assist so things take longer as a queue builds up.[/quote]

Ah OK, you're talking about this from the clinical perspective. There are other views, notably associated with cost. In its simplest form having additional nurses creates additional costs. Are these costs truly offset by working more efficiently at those times when there is congestion? If so then fine, but if there are longer periods when there is little for the nurses to do then the efficiencies become diluted.

Are there any other ways of improving efficiency, like changing the vets routines to reduce call on the nurse resource? There might even be a case for removing a vet and replacing them with an additional nurse or two, increasing the amount of clinical work the remaining vet does, but getting it done more efficiently. It would also change the vet:nurse ratio of course, which was in the title of the thread.

RE: vet:nurse ratios

Mark Hedberg — Wed, 15 Jul 2015 08:56:10 GMT

1:1 is very helpful, but in fact having more than 1 nurse per vet (oh, happy day!) would be even better, because you can then delegate work they're perfectly capable of sorting on their own.

RE: vet:nurse ratios

Marie Kubiak — Wed, 15 Jul 2015 08:46:03 GMT

[quote user="J G Wray"]This is a v strange question. What do you mean by "inefficient"?[/quote]

Really, why is it a strange question? With regards inefficiency I find that when there is a blood sample/wound clean/FNA etc as a consult then vets are fighting over nurses to assist so things take longer as a queue builds up.

Marie

RE: vet:nurse ratios

J G Wray — Wed, 15 Jul 2015 08:42:15 GMT

[quote user="Marie Kubiak"]We currently have more vets than nurses and I am worried this is making life inefficient.[/quote]

This is a v strange question. What do you mean by "inefficient"?