Thoughts?

RE: Thoughts?

Hannah Wynne Richards — Sat, 09 Jul 2016 11:07:12 GMT

I was at an RCVS regional meeting in 2003, when the then President introduced this subject. All the large animal veterinary surgeons gave it a thumbs down - even those who 20 or 30 years earlier had been employing lay blood testers at the time brucellosis eradication was at its height.

Their ratioale was that with the depressed state of agriculture, and farmers doing more and more for themselves, then giving extra tasks to nurses would make it impossible to employ sufficient veterinary surgeons to keep the out of hours rota low enough for agricultural practice to remain attractive to new grads.

Difficult one.

Wynne

RE: Thoughts?

svn — Fri, 08 Jul 2016 22:40:19 GMT

[quote user="Michael Woodhouse"]

We already intend to use them in some less traditional roles [farm work - blood sampling and dripping calves, lameness scoring, vaccinating, dehorning calves, assisting the vets with surgeries etc].

[/quote]

That's really interesting, I think there is definitely a place for a LA VN, heard rumours of it being offered as a pathway a few years ago when I was in mixed practice, but as far as I know it never really got off the ground

RE: Thoughts?

Michael Woodhouse — Fri, 08 Jul 2016 21:37:15 GMT

JGW - I don't red star you, but I suspect you are as bothered by them as I am.

[quote user="J G Wray"]Our practice is 4 FTE 5 VN 1 SVN 1 ACA, but then we are a more typical practice because we are a SA practice. We value nurses. We place a value on nurses. We charge clients for their time. Getting to this point required a change in attitude and then a plan.[/quote]

Quite. We are 3.5 FTE vets but (depending on the season) probably only ~1 FTE with small animal work (although does vary from day to day and time of year).

We fully intend to value the nurses to the best of our ability. We intend (once qualified) to do what they are allowed to do under the VSA. Some of that will be chargeable work, but some of it will be FOC work that the vets are currently doing (post op checks, suture removal, phone advice, parasite checks).

[quote user="J G Wray"]

Then whilst you may work and take further qualifications and do veterinary stuff, your practice will not progress. That would take a change in attitude and a visit from your accountant, or worse, your bank manager.

Holding on to the old model of a veterinary nurse is a sign of holding on to the past in running practice. Developing practice needs resources beyond money. However, first it needs attitude.

[/quote]

As is often the case with your posts - I really have no idea what you mean! Having qualified nurses is a positive move forwards for the practice [I believe]. We already intend to use them in some less traditional roles [farm work - blood sampling and dripping calves, lameness scoring, vaccinating, dehorning calves, assisting the vets with surgeries etc]. One of the girls is already a qualified dog groomer (new things to the practice), we've already spoken about training them us as a SQP so can give decent advice on sheep and cattle parasites.

This doesn't detract from the fact the floor needs to be cleaned and kits sterilised. Who does that in your practice? There would simply not be enough work to have additional staff doing these roles (in our practice). The staff recruited for the roles are local and fully aware of what we expect of them.

Personally I thought we were looking ahead and going to maximise the use of these nurses.

RE: Thoughts?

Martin Atkinson — Fri, 08 Jul 2016 09:01:17 GMT

[quote user="J G Wray"]I'll begin with an apology to all vet nurses. We, in our practice, do not look at veterinary nurses as the ones who have the "crappy jobs" and "clean up shit". So, please do not lump us in with those articulating such an archaic, patronising attitude.....we place a value on nurse time which the public are aware of through the care they provide in clinics they run, with the charges for those clinics. The practice is aware of the value of nurses because they have a management group status, separate budgets and above all an agreed set of behaviours including the respect of vets.[/quote]OMG I've just given you 5 stars Jon although I'm not sure Michael is the most obvious target in this thread.

RE: Thoughts?

J G Wray — Fri, 08 Jul 2016 07:23:59 GMT

[quote user="Michael Woodhouse"]

3.7 vets and 2.1 nurses.

The bigger practices (especially referral centres and universities) will skew this to the right.

[/quote]

Our practice is 4 FTE 5 VN 1 SVN 1 ACA, but then we are a more typical practice because we are a SA practice. We value nurses. We place a value on nurses. We charge clients for their time. Getting to this point required a change in attitude and then a plan.

[quote user="Michael Woodhouse"]Before I get lambasted (love that word) I also have to clean up shit and sometimes clean and sterilise my own kits. I was unblocking a sink earlier this week.[/quote]

I don't subscribe to the hair shirt view of practice any more. That required a change in attitude and a plan.

[quote user="Michael Woodhouse"]I can't also have a kennel maid, dog walker, cleaner, handyman etc also on staff and still make any money.[/quote]

Holding on to the old model of a veterinary nurse is a sign of holding on to the past in running practice. Developing practice needs resources beyond money. However, first it needs attitude.

RE: Thoughts?

Michael Woodhouse — Thu, 07 Jul 2016 23:28:31 GMT

[quote user="Nicola M"]I know Michael can stand up for himself but I read the above to mean the majority of vets AND nurses have to do the crappy jobs that come with general practice, as opposed to everyone becoming super-specialised, NOT that nurses do the crappy jobs.[/quote]

Thank you for the support.

I kind of meant it in two ways. Let me try and explain better.

RCVS Facts 2014 (most recent I can find) has 5321 registered premises, 19,682 uk practising vets and 11,661 uk practising nurses. You can pick holes, say they are not evenly distributed etc, but on average a UK registered premises (ie practice or branch practice) has:

3.7 vets and 2.1 nurses.

The bigger practices (especially referral centres and universities) will skew this to the right.

We've never had anyone in a formal nurse role and instead trained lay staff to do things we need them to under our direction. For various reasons we have just offered jobs to two girls we will train (one has a place at college). We do more small animal work than we ever have, but the nurses will be employed to do the traditional nursing roles, but they will also be walking dogs, cleaning kits, mopping floors, folding bills etc. I appreciate in a bigger practice there may well be a role for dedicated cleaners, dedicated auxiliary staff (not sure what you'd call them) leaving the nurses just to 'nurse'.

I'd rather have 2 'nurses' (inverted commas as neither trained at this point) that also do some cleaning, reception duties etc than 1 nurse who is put on a pedestal and one auxiliary - so we are without a nurse when other lass at college, on holiday, ill etc. When I saw practice this was generally the case - 4/5/6 vet practices had a core of nurses who also did the cleaning, some reception etc.

Before I get lambasted (love that word) I also have to clean up shit and sometimes clean and sterilise my own kits. I was unblocking a sink earlier this week. Saying that - if we have an in patient with explosive diarrhoea I do expect it will be the nurse doing the majority of the cleaning up. That's the role I want them to do.

I can't also have a kennel maid, dog walker, cleaner, handyman etc also on staff and still make any money.

RE: Thoughts?

svn — Thu, 07 Jul 2016 23:12:55 GMT

[quote user="minnie"]

I wish they would pack it in spending money producing these God awful videos and spend it instead on producing stable, accessible and affordable training.

[/quote]

TBH, much as I love the video, I don't think they really spent much on it....

RE: Thoughts?

svn — Thu, 07 Jul 2016 23:06:37 GMT

Everyone who chooses to work with animals, especially in the Veterinary world, is going to have to be OK with being splattered in bodily excretions on a semi regular basis - it's an occupational hazard no? :p

RE: Thoughts?

Minnie — Thu, 07 Jul 2016 21:42:52 GMT

I wish they would pack it in spending money producing these God awful videos and spend it instead on producing stable, accessible and affordable training.

RE: Thoughts?

Nicola Cole — Thu, 07 Jul 2016 20:37:29 GMT

[quote user="Michael Woodhouse"]

I think you are in an impossible position and that's a shared position with a lot of vets. Most of us are in general practice, whatever your special interests or extra training the basic work needs to be done. Nurses have to deal with the inpatient with diarrhoea and the vet needs to squeeze anal glands. In small (and even medium sized practices) there is not the scope for people to follow their special interests with the exclusion of everything else. Yes some vets and some nurses will end up in very specialist roles in universities or large referral centres - but the very great majority of us will not.

.......

Someone has to do the crappy jobs. Someone has to squeeze the anal glands and clean up the shit.

[/quote]

I know Michael can stand up for himself but I read the above to mean the majority of vets AND nurses have to do the crappy jobs that come with general practice, as opposed to everyone becoming super-specialised, NOT that nurses do the crappy jobs.

RE: Thoughts?

Anthony Todd — Wed, 06 Jul 2016 13:09:53 GMT

[quote user="grumpyoldman"]Just remove them or send them to someone who can. [/quote]

Or you could just empty them and pack with your favourite AB/steroid prep yourself and fix most of them.

RE: Thoughts?

Anthony Todd — Wed, 06 Jul 2016 11:20:53 GMT

[quote user="Michael Woodhouse"]Someone has to do the crappy jobs. Someone has to squeeze the anal glands and clean up the shit.[/quote]

And it's usually those lowly "kennel maids" that point out the bitch spay is looking pale and turn the last op onto it's other side or sit it on its sternum.

It's called "nursing" and you need the ability to cope with s*it, have good observational and common sense, none of which is part of any examination syllabus I know.

After all, the educated, qualified VNs are totally occupied with checking and correcting the vets.

"squeezing anal glands"? why?

If they need it they need a vet, surely?

RE: Thoughts?

grumpyoldman — Wed, 06 Jul 2016 11:04:32 GMT

[quote user="svn"] expressed 5 maybe 6 lots of anal glands during my nurse consults today - Anal gland juice and aroma is not only the province of MRCVS[/quote]

That is a problem with the practice , who wants a waiting room full of people wanting foetid pussy anal sacs emptied every day? Just remove them or send them to someone who can.

RE: Thoughts?

J G Wray — Wed, 06 Jul 2016 10:29:27 GMT

[quote user="Arlo Guthrie"]But it doesn't change the commercial reality that profession or no profession, nurses do still need to do some shitty jobs. At least until the day that all practices can afford to hire a dedicated Faecal Discharge Disposal Executive.[/quote]

Well, old fruit, since you are keen to make a point about a small part of a vet nurse time, why not post this on a vet nurse site and invite comments? I wonder if your spade fella dwells on this aspect of a nurse or animal care assistant's job when recruiting as in

"Are ye prepared to shovel shit lass/lad? We've gut just tha job fo' thee"

RE: Thoughts?

Arlo Guthrie — Wed, 06 Jul 2016 09:57:41 GMT

[quote user="J G Wray"]Veterinary Nursing is defined as a profession and that's how we look at Nurses.[/quote]

As you should, of course But it doesn't change the commercial reality that profession or no profession, nurses do still need to do some shitty jobs. At least until the day that all practices can afford to hire a dedicated Faecal Discharge Disposal Executive.

RE: Thoughts?

J G Wray — Wed, 06 Jul 2016 09:22:17 GMT

[quote user="Arlo Guthrie"]I don't think that's fair. MW is the last person in the world who needs me to defend his point. But we all know that he calls a spade a spade, and he is merely reflecting the reality of the economics of general practice in many parts of the country where there just isn't the money to employ someone else to do the 'shitty' jobs. I certainly didn't read his post as patronising. In fact, surely his point is absolutely central to this discussion, which is how you balance the aspirations of nurses with the economic realities. Is that easier in relatively affluent Basingstoke?[/quote]

Veterinary Nursing is defined as a profession and that's how we look at Nurses. That is attitude and not geography.

[Anecdote time. When seeing practice in Gawber Road Barnsley, the less bucolic part of Yawksheuh, I remember the first time I saw a vet squeeze anal sacs. I was about 13 or so. The look on my face was, apparently, a picture and prompted my uncle, the vet, a Scot, to give me a sound piece of advice:

"If ye cannae tek a joke dinnae join the job.."]

RE: Thoughts?

Arlo Guthrie — Wed, 06 Jul 2016 08:15:43 GMT

[quote user="svn"]

[quote user="Evelyn Barbour-Hill"]

Well, I have no intention of engaging in "Facebook" to get the details, but the splash page looks rather depressing.

[/quote]

This is the blurb above the video, I personally find it inspiring, and am excited to see my profession progress... If you find that thought depressing then I am very sorry for you and your nursing staff - Apologies in advance if I have read you wrong though[/quote]

Read the second sentence of your reply and thought "uh oh, svn's about to go off on one again!"

But saved by the apologies! svn, please be careful not to jump to conclusions. Remember, Evelyn has been in these forums since the pleistocene era (or whenever I set them up, anyway), and most of us 'know' him well enough that I think we'd read his post differently to the way you first did. When you've read more of people's posts, you'll get to understand that!

Interesting discussion though. Here's the video for those of you not on Facebook:

www.youtube.com/watch

[quote user="J G Wray"][quote user="Michael Woodhouse"]My fear (when you bring up the Vet Futures) is if we create these aspirations that we can be a specialist in our little area and love every minute of our job - are we creating more resentment and dissatisfaction to the great majority 'stuck' in practice. That applies just as equally to vets and nurses.

Someone has to do the crappy jobs. Someone has to squeeze the anal glands and clean up the shit.[/quote]

I'll begin with an apology to all vet nurses. We, in our practice, do not look at veterinary nurses as the ones who have the "crappy jobs" and "clean up shit". So, please do not lump us in with those articulating such an archaic, patronising attitude.[/quote]

I don't think that's fair. MW is the last person in the world who needs me to defend his point. But we all know that he calls a spade a spade, and he is merely reflecting the reality of the economics of general practice in many parts of the country where there just isn't the money to employ someone else to do the 'shitty' jobs. I certainly didn't read his post as patronising. In fact, surely his point is absolutely central to this discussion, which is how you balance the aspirations of nurses with the economic realities. Is that easier in relatively affluent Basingstoke?

RE: Thoughts?

Hannah Wynne Richards — Wed, 06 Jul 2016 08:09:58 GMT

And I thought FB meant foreign body!

Wynne

RE: Thoughts?

Stephen Courtney — Wed, 06 Jul 2016 07:53:12 GMT

A rectal temp of 39.4 in a dog that was otherwise well, especially on a warm day would not bother me - but i would look carefully in case I was missing something.

i consider a temp of 39.5 definitely up, and 39.1-39.4 as maybe up. i'm aware some colleagues are less tolerant, but i am happy with my cut off points.

RE: Thoughts?

J G Wray — Wed, 06 Jul 2016 07:27:22 GMT

[quote user="Michael Woodhouse"]

My fear (when you bring up the Vet Futures) is if we create these aspirations that we can be a specialist in our little area and love every minute of our job - are we creating more resentment and dissatisfaction to the great majority 'stuck' in practice. That applies just as equally to vets and nurses.

Someone has to do the crappy jobs. Someone has to squeeze the anal glands and clean up the shit.

[/quote]

We have taken a different route to Vet Futures in developing our nurses, one that comes from being a general practice, something Vet Futures is not strong on.

The manifestation of this is quite clear at its most basic level in our practice, in that we place a value on nurse time which the public are aware of through the care they provide in clinics they run, with the charges for those clinics. The practice is aware of the value of nurses because they have a management group status, separate budgets and above all an agreed set of behaviours including the respect of vets.

GenX - not very progressive.

RE: Thoughts?

Michael Woodhouse — Wed, 06 Jul 2016 00:49:23 GMT

I think the other thing you need to face as a profession is your base qualifications. Human nurses have been degree only for a number of years. Paramedics are moving that way. The vast majority of nurses (as far as I understand it, please correct me) come in with a level 3 diploma - on an academic level to A-levels.

Does that not mean that your first step in career progression should be a degree (or even a foundation degree)? Only allowing the higher qualifications (if they brought in nursing certificate, advanced practitioners) to university graduates?

Fundamentally IF you decide to create an 'advanced nurse practitioner' it needs to be at the same academic level as a the vets - so level 7/masters.

I'm not convinced that to be a great nurse you need a degree, but I think you probably do if you you want to progress academically. It's sad to see how little more the graduate nurses earn compared to the level 3 diploma holders.

RE: Thoughts?

svn — Wed, 06 Jul 2016 00:38:36 GMT

[quote user="Michael Woodhouse"]

[quote user="svn"]It's a discussion the RCVS have opened, obviously as a RVN I'm all for career progression, I understand your concerns though. I would like to see a structured RCVS qualification if VN practitioners ever came to be[/quote]

And what difference would that make to what you do?

I did a cert, I can't do anything I couldn't before, but I do it a bit better.

Is that enough for you, or do you want to do a qualification that means you can do more (that was the reading in part of the report you linked)?

[/quote]

Good question, and tbh I'm not really sure... I have pondered recently that maybe we should be able to do annual vaccs, but then I had to call a VS in to check a 2nd vacc I did today with a temp of 39.4 (VS checked and told me to go ahead and give 2nd vacc no worries) Not entirely sure I agreed with him, but agree I don't have the knowledge to disagree... Food for thought actually..

RE: Thoughts?

Michael Woodhouse — Wed, 06 Jul 2016 00:24:29 GMT

And what difference would that make to what you do?

I did a cert, I can't do anything I couldn't before, but I do it a bit better.

Is that enough for you, or do you want to do a qualification that means you can do more (that was the reading in part of the report you linked)?

RE: Thoughts?

svn — Wed, 06 Jul 2016 00:21:03 GMT

It's a discussion the RCVS have opened, obviously as a RVN I'm all for career progression, I understand your concerns though. I would like to see a structured RCVS qualification if VN practitioners ever came to be

RE: Thoughts?

svn — Wed, 06 Jul 2016 00:17:38 GMT

[quote user="Michael Woodhouse"]

Someone has to do the crappy jobs. Someone has to squeeze the anal glands and clean up the shit.

[/quote]

I expressed 5 maybe 6 lots of anal glands during my nurse consults today - Anal gland juice and aroma is not only the province of MRCVS :p