Working Out of Hours

RE: Working Out of Hours

Hannah Wynne Richards — Mon, 23 Nov 2015 09:51:56 GMT

I'm with Gillian on this. I'm in the building. If an animalneeds intensive care, I'm with it all the time - and it's charged at a level that's fair toboth the owner and myself. If it just needs checking at (say) 2 hourly intervals, that's what it gets, but I'm still in the building. Hope Royal College won't think it TOO unprofessional of me that I'm dressed in PJs, not uniform for these brief checks!

Wynne

RE: Working Out of Hours

Michael Woodhouse — Sun, 22 Nov 2015 22:39:25 GMT

[quote user="Gillian Mostyn"]How often? Are you specific? Clients, if not told, would assume that their pet is checked periodically ALL night. We are very honest - animals will not be checked at all from midnight to 8am. [/quote]

How could I possibly know how many times it would be appropriate to check a dog overnight that we admitted at 10am? We would check them through the night if clinically justified. It would depend how the animal was at the late night check. We have some animals that are in, but mainly boarding who aren't specifically checked between 6pm and 8.30am the next day (will check if back otherwise).

RE: Working Out of Hours

Gillian Mostyn — Sun, 22 Nov 2015 21:34:58 GMT

[quote user="Michael Woodhouse"]Gill - I emphatically disagree.[/quote]

lol - disagree with what? I told you what MY clients are, and are not, prepared to accept. Your experience, and client base, is obviously different. That doesn't mean I'm wrong!

[quote user="Michael Woodhouse"]We make it clear that hospitalised animals do not have continuous supervision and are checked as often as needed by the vet on duty.[/quote]

How often? Are you specific? Clients, if not told, would assume that their pet is checked periodically ALL night. We are very honest - animals will not be checked at all from midnight to 8am.

Our OOH cover works really well for us but we use a local practice, and animals, if transferred, stay there until they are well. I wouldn't be so happy if they needed to be shipped back and forth every day.

RE: Working Out of Hours

grumpyoldman — Sun, 22 Nov 2015 18:10:40 GMT

We have a facility for constant overnight nursing supervision but i explain to the client that its £20 an hour for the nurse who then has to have the next day off ,so the cost is £240 a night , needless to say there are hardly ever any takers . Clients are really good at demanding the best possible care until they have to foot the bill, its important that they learn the value of other peoples time.

RE: Working Out of Hours

Michael Woodhouse — Sun, 22 Nov 2015 16:53:28 GMT

[quote user="Gillian Mostyn"]Whether I agree with the statement, or not, is irrelevant. Most of our clients assume their per will be supervised...and are not prepared to leave them if they aren't.[/quote]

Gill - I emphatically disagree. We make it clear that hospitalised animals do not have continuous supervision and are checked as often as needed by the vet on duty. Never have I had an owner refuse to leave an animal under those circumstances.

RE: Working Out of Hours

Braden Collins — Sun, 22 Nov 2015 12:12:45 GMT

[quote user="Gillian Mostyn"]

[quote user="Michael Woodhouse"]Animals could recover in the same building as they had their op etc. I think 24 hour supervision is 'nice' but I'm not convinced it is particularly needed in the great majority of our patients.[/quote]

Whether I agree with the statement, or not, is irrelevant. Most of our clients assume their per will be supervised...and are not prepared to leave them if they aren't.

[/quote]

We state quite clearly on our consent forms that we don't have staff monitoring animals 24/7, and if they want that then we can organise somewhere for them to take their pets. It is very rare that people want to do this. In the last 4 years, I can think of 3 cases, and they were all cases I very strongly advised needed more intensive cover than we could provide.

RE: Working Out of Hours

Gillian Mostyn — Sun, 22 Nov 2015 10:17:46 GMT

Whether I agree with the statement, or not, is irrelevant. Most of our clients assume their per will be supervised...and are not prepared to leave them if they aren't.

RE: Working Out of Hours

ruths — Sun, 22 Nov 2015 08:05:27 GMT

In answer to the OP

i have worked for one year doing mon-fri nights

I have done a week on- week off nights and weekend cover.

i've also done various 24 ht shifts over sat or Sunday or bank holidahs

Ive not worked for VN, much of this work was in days pre VN.

i absolitely loved emergency work. It is so much more satisfying than the day to day stuff. Everything is bigger and more complex and more immediate. It's really challenging and really rewarding. I wanted to do an emergency residency before they even existed -))

life has moved on for me now and I had kids and a set back that took me out of clinical work for a bit and I've reorganised my career somewhat and emergency work doesn't quite fit into it for now.

the down sides-

Being on my own clinically. I don't mind too much but there is a lot of responsibility on your shoulders and by nature, I like to collaborate and discuss cases. Another thing is the episodic nature if the work and the lack of contact with the case once you Have gone. I know you can get feedback from the day vet, but it's more complex than going back and cheking your own patient and seeing the changes yourself.

i did find the solitary nature of it a challenege, too, though.

i found it thrilling and draining at times.

i gave up because my body didn't always enjoy being kept up all night in the end.

it suited me when I didn't have kids and I had a few pals who did odd shift work- best friend is a firefighter and my theN boyfriend was a taxi driver -))

when I had kids, it worked so that I could do a 24ht shift once a fortnight at a weeks and my other half would be home for the kids. I could be home with them during the week and he would work and vice versa every other weekend. No child care costs and as one of my kids was tricky to manage I didn't have the constant worry that the childminder would leave ( a few did)

I think the worst thing is the moving animals to and fro between day and night clinic. I think that is very poor for welfare and this troubles me greatly.

RE: Working Out of Hours

Silvia Maldonado — Sun, 22 Nov 2015 03:41:44 GMT

[quote user="Cat Barker"]

I work for one of the leading out of hours providers in the Veterinary Industry and thought it would a great idea to get the thoughts from you lovely experts.

I would like to know -

What would attract someone to work in an Out of Hours Emergency Critical Care practice?

What puts you off working OOH?

and finally

What would be the perfect work life balance for you?

hope to hear from some of you soon.

[/quote]

I do OOH, and not considering moving back to day practice. My main reasons are: first, the caseload is not a 10 minutes consult, cases are more challenging, less routine, kind of you never know what's going to cross that door next, or you thought you had seen everything, until you are on OOH. Second, is team working. Judge me as antisocial, or think I'm unable to integrate in a team, if you like. To me, it is much easier working with a couple of people, avoiding the gossips and "rotten apples" that I have found in all the teams I've worked in the UK

The cons are the hours. Not minding Saturdays, Sundays and bank holidays, but as a human being, working against my biological clock affects me.

A last comment, I gave up after working for your OOH provider, and it's just a coincidence, or pure luck, that I was given a second chance in the practice I'm now. It makes a huge difference in terms of stress, support, clinical benchmarking, opportunities and motivation.

Perfect work life balance, in long term, mixing night shifts with weekends and bank holidays OOH.

RE: Working Out of Hours

Evelyn Barbour-Hill — Sat, 21 Nov 2015 20:11:07 GMT

[quote user="Clive Ansell"]£60 (really £50 + VAT) seems remarkably cheap for overnight hospitalisation[/quote]

I would have assumed that £60 meant £60. Of course the client will have to pay £72, but that's not really relevant.

RE: Working Out of Hours

Anthony Todd — Sat, 21 Nov 2015 20:03:31 GMT

[quote user="patrick murphy"] I feel better off at home and after my major surgery[/quote]

I agree.

And so will our patients, won't they?

Most owners can be instructed in simple "dripmanship" in a few minutes.

You could flood the circulation [which seems remarkably tolerant of overload in most cases], bung the line, and send the animal home, or, if you've got an intelligent practical owner, just give them the basics and keep the drip running.

They can always ring if they are worried, or need advice.

Some owners sit up all night with their routine post-op pets!

RE: Working Out of Hours

patrick murphy — Sat, 21 Nov 2015 17:08:40 GMT

yes, and I am sure that we have all experienced hospitalisation with frequent wake up calls for blood pressure so that they can tick the chart. I feel better off at home and after my major surgery the surgeon started to send selected cases home much earlier, for the rest. we tend to bung off catheters and send them home where I think that they are most comfortable and less stressed, and certainly in all but a very few cases watched very carefully by those who are most fond of them, i.e. the owners. they will often sleep on the couch with them, and I sure won't sleep in a cage with them myself. of course for the really, really sickies that do happen there are horses for courses at the out of hours, but the view from my staff who have locummed in the all nighters is that they would prefer plan A.

RE: Working Out of Hours

Hannah Wynne Richards — Sat, 21 Nov 2015 11:35:27 GMT

I think the 1 person practices will remain viable - because there are people like Evelyn and myself.

The ones who have already been almost squeezed out of existence are the mediun 3/4 veterinary surgeon practices. There used to be a lot. There are now very few. They've either grown to challenge the corporates, or shrunk to 1 or 2 veterinary surgeons, who are owners.

Wynne

RE: Working Out of Hours

Michael Woodhouse — Sat, 21 Nov 2015 11:34:54 GMT

[quote user="Clive Ansell"]Maybe the way forward is larger hospital style practices, or groups with a larger hospital main surgery, doing their own OOH with a separate set of staff for days and nights, and where smaller 1 and 2 man practices become non viable and obsolete ? who knows? [/quote]

Things go round in circles. If practices got bigger and more organised they become impersonal. It leaves a niche that will be filled by smaller practices offering a more personalised service. You might find that the solution are smaller practices doing own OOH just like they used to. People didn't get dragged out of bed that often because smaller number of clients serviced. Animals could recover in the same building as they had their op etc. I think 24 hour supervision is 'nice' but I'm not convinced it is particularly needed in the great majority of our patients.

What I don't think is OK is a practice taking in an animal, performing surgery/diagnostics/treatment knowing full well that it will have to be shipped somewhere else over night, and then come back. If the practice is not prepared to see the case through - then they should sent the case to the facility that can manage the complete care. Would you stand for bundling granny in the car twice a day ferrying her between hospitals? Of course not. Don't start something if you cannot follow it through. That makes me mad.

RE: Working Out of Hours

Clive Ansell — Sat, 21 Nov 2015 11:18:48 GMT

[quote user="Neil Wheadon"]

[quote user="Clive Ansell"]You would need 8 -10 hospitalised patients just to cover wages would you not?[/quote]

Don't forget the OOH model of member practices paying a monthly charge to use the service.

Trying to compare hospitalisation costs to daytime is like apples and pears it's impossible really.

[/quote]

Yes, I know, just opening up the discussion really

I wonder how the provision of OOH care will evolve? staffing seems a major issue in many OOH clinics, and I still receive text messages from a well known OOH provider trying to fill gaps at the last minute, sometimes 30 minutes before the start of a shift because the position is unfilled. Added to that there is still the huge question mark over transferring and transporting critically ill and post surgical patients between day practices and OOH centres, and the even larger issue of the ability to carry out OOH home visits. Maybe the way forward is larger hospital style practices, or groups with a larger hospital main surgery, doing their own OOH with a separate set of staff for days and nights, and where smaller 1 and 2 man practices become non viable and obsolete ? who knows?

RE: Working Out of Hours

Dagmar Steele — Sat, 21 Nov 2015 11:09:07 GMT

I'm late to this, but to answer the original question: It would have to fit my lifestyle and generate enough income to make up for the inconveniences of working antisocial hours. When I was younger I did my own OOH. I had no kids, no pets apart from a cat and no other responsibilities, hence I really enjoyed it. I loved true emergencies, especially when I was able to make a difference, I gained a lot more experience (also before when I did OOH as an employee) and I charged well for it so I was rewarded for it. Then things started to change: I had kids who kept me up at nights, took away a lot of my energy, needed my time. More and more surgeries opened in the area, some corporates as well who did OOH very cheap. All of a sudden OOH was a nuisance, it took away precious family time, most true emergencies went to one of the bigger clinics anyway so the normal surgeries were left with the lowlifes and their dog with diarrhea since donkeys ages. Charging appropriately became increasingly difficult as well as the corporates went in really cheap. Bottomline: If I would do OOH it would have to suit my families lifestyle and leave enough time for myself as well and it would have to be rewarding, financially as well as work wise. Satisfaction is the word that comes to mind when you are able to make a difference, but not if you are confronted with an endless row of moaners not willing to pay.

RE: Working Out of Hours

Clive Ansell — Sat, 21 Nov 2015 11:07:12 GMT

[quote user="Hannah Wynne Richards"]

The welfare of our patients demands 24/7cover

They have to come 1st

Wynne

[/quote]

I don't think anyone is suggesting otherwise are they?

The main thing preventing it is owners unwillingness to pay for it or transfer their animals to OOH facilities, as in my case earlier in the thread with the cat.

RE: Working Out of Hours

Hannah Wynne Richards — Sat, 21 Nov 2015 11:00:05 GMT

The welfare of our patients demands 24/7cover

They have to come 1st

Wynne

RE: Working Out of Hours

Neil Wheadon — Sat, 21 Nov 2015 10:41:23 GMT

[quote user="Clive Ansell"]You would need 8 -10 hospitalised patients just to cover wages would you not?[/quote]

Don't forget the OOH model of member practices paying a monthly charge to use the service.

It's an interesting discussion as practices are never going to go backwards on wanting someone else to do their OOH provision (though a few have taken it back) Therefore OOH clinics have to find a way to retain staff (and good staff) which was the point of the original question. Paying very well is the obvious solution and some do this. Others offer good terms and Mariette looks to have found one. Trying to compare hospitalisation costs to daytime is like apples and pears it's impossible really.

Ultimately for the majority of practices now with the RCVS view that we need to provide 24/7 cover means that to practice Veterinary Medicine we are reliant on folks working these antisocial hours and they need our support

Neil

RE: Working Out of Hours

Clive Ansell — Sat, 21 Nov 2015 09:12:18 GMT

[quote user="mariette asselbergs"]

[quote user="Clive Ansell"]

[quote user="mariette asselbergs"]That is what I meant, our night hospitalisation is £60[/quote]

What level of hospitalisation? a staff member on site all night, or a patient alone in cage all night?

[/quote]

No Sorry Clive, we are a dedicated OOH service, we don't do anything else, so from 19.00 to 8.00 next morning experienced vet and qualified experienced nurse there, seeing patients, checking inpatients, doing emergency surgery when required.

[/quote]

Fair enough.

£60 (really £50 + VAT) seems remarkably cheap for overnight hospitalisation in a fully and properly staffed OOH facility. Do you have varying charges for different levels of care, for intensive or 1 to 1 nursing for example? You would need 8 -10 hospitalised patients just to cover wages would you not?

RE: Working Out of Hours

Hannah Wynne Richards — Sat, 21 Nov 2015 08:38:39 GMT

Average of 5 so you'll just about break even - but definitely no profit. But then, you and I have very different ideas on the desirabilty of profit!

Wynne

RE: Working Out of Hours

mariette asselbergs — Sat, 21 Nov 2015 02:49:28 GMT

[quote user="Hannah Wynne Richards"]

Clive If there's only 1 animal hospitalised, and that's the charge, then either the animal is just left in a cage, the employee isn't even on minimum wage, or the practice owner is considerably out of pocket.

Wynne

[/quote]

That might be the case on some nights, on others we have 10 patients in or do 3 emergency surgeries. As sais above, this is what we do and we are there all night.

Mariette

RE: Working Out of Hours

mariette asselbergs — Sat, 21 Nov 2015 02:47:14 GMT

[quote user="Clive Ansell"]

[quote user="mariette asselbergs"]That is what I meant, our night hospitalisation is £60[/quote]

What level of hospitalisation? a staff member on site all night, or a patient alone in cage all night?

[/quote]

Mariette.

RE: Working Out of Hours

mariette asselbergs — Sat, 21 Nov 2015 02:44:05 GMT

[quote user="Francisco Gomez"]

[quote user="mariette asselbergs"]

For the last 3 years doing 1 in 6 next to another 3 days a week job, the last 4 months it is just this 1 in 3.

[/quote]

And I supposed you had some sort of compensation with that? maybe some more time off if not salary increase?

[/quote]

I don't know what you mean by compensation? I am paid for the work I do, just like you I suppose?

Mariette

RE: Working Out of Hours

Martin Atkinson — Fri, 20 Nov 2015 12:40:42 GMT

[quote user="Robin Grimmer"]Wot Clive says. Unless you've worked in an ooh clinic, you've really no idea what it's like. Sometimes people can be very aggressive ooh, due to combination of sick pet (that is often neglected until it becomes an emergency), not bonded client and ooh fees.[/quote]You're right of course, I have a short memory for when I used to do my own OOH even worse when I shared a rota with local practices. My clients were relatively tame due the principles applied as described in my previous post, there's weren't and worse because they weren't my clients I couldn't be rude to them and risk causing another practice losing a valued client.