Nursing support

Re: Nursing support

Malcolm Ness — Tue, 02 Mar 2010 13:20:41 GMT

.....or alternatively, the VNs in practice can see that the whole thing is stitched up tight and that being the token practising VN would be a waste of their time and their employer's moey.

Re: Nursing support

Hannah Wynne Richards — Tue, 02 Mar 2010 12:25:00 GMT

Since they were returned unopposed, then I think the problem is that ordinary RVNs in practice are either intimidated by RCVS , or their employers won't give them time off with pay

Wynne

Re: Nursing support

Malcolm Ness — Mon, 01 Mar 2010 22:31:31 GMT

Read today that another 2 members of VN council were "elected"/returned unoppopsed. Both are employed in the VN trainig industry, as are, I believe, most of their colleagues on council.

Representative/democratic body or lobby group???

Re: Nursing support

Adi Nell — Sun, 28 Feb 2010 19:59:01 GMT

[quote user="Hanna Bennett"] I like an injection to slide in smoothly and quietly and I love to hear the owner say "has he had it already?" (or even "aren't you going to give him the injection?" five minutes later).[/quote]

I sometimes wonder what's better: the client not noticing (and not appreciating the work has been done - to the point, sometimes, of thinking you might be charging for something you haven't done!), or the puppy flinching and my apologising and cuddling it and rewarding it with a biscuit.

If the client's perception is that it's that easy or not noticing your expertise, have you met his or her expectations?

Re: Nursing support

Hanna Bennett — Sun, 28 Feb 2010 15:11:19 GMT

[quote user="Evelyn Barbour-Hill"]

An unfair comment, I know, but while I am in Grumpy Old Man mode: I would hope I never "jab" a puppy or anything else. I like an injection to slide in smoothly and quietly and I love to hear the owner say "has he had it already?" (or even "aren't you going to give him the injection?" five minutes later).

[/quote]

i could have phrased it differently, but have no fear, i agree the puppy should not be traumatised by it's first visit to the vets, and am a big fan of bribery (read biscuits) in order to acheive such. Made easier by the fact that it has had cuddles and time to settle in the room before i come anywhere near it with a needle.

Re: Nursing support

Hanna Bennett — Sun, 28 Feb 2010 15:06:19 GMT

[quote user="Evelyn Barbour-Hill"]

Well, with respect Hanna, the comment was made in relation to nurses doing veterinary surgeons' jobs, of which the suturing of wounds is just the most obvious.

[/quote]

fair enough, but my point is that by using them as nurses they save me time and money. I don't have the time to spend that half an hour with every new puppy, but my nurses do a good job of bonding the client to the practice on my behalf. We have a rule that any vet consult is charged as vet time, so if the clients wants a vet to clip their dogs claws they can do, but will pay a premium for it as the vet consult includes a full clinical exam whatever the presenting problem, whereas a nurse can do so for much less as she is only clipping claws. Although s/he may well discuss and advise on any number of things the client often feels more comfortable asking the nurse than the vet.

Re: Nursing support

Evelyn Barbour-Hill — Sat, 27 Feb 2010 22:24:14 GMT

[quote user="Hanna Bennett"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Arlo Guthrie"]

Evelyn, I don't understand how you can say that it is a waste of a nurse to use her as a cheap substitute for a vet.

What is a veterinary nurse's time charged out at? Is it half that of a vet? A quarter?

I'm no Richard Branson, but surely it makes sense to delegate AS MUCH as possible to a nurse who is able to do certain tasks for, what?, a quarter of the cost of you doing it?

[/quote]

Well, at least you agree that VNs are used as cheap substitutes for vets.

[/quote]

So if an owner phones up asking about how to wean her puppies, or discuss the fact that her Labrador is getting progressively fatter do you deal with these queries?

[/quote]

Well, with respect Hanna, the comment was made in relation to nurses doing veterinary surgeons' jobs, of which the suturing of wounds is just the most obvious.

However, since you ask. In the situation you describe, Mrs Owner would first be made aware that they were speaking to a nurse not a vet; in fact they would probably already be well aware of that and might well know the nurse by name. Every enquiry is slightly different, but generally speaking they would have some general comments and "practice protocol advice" offered, and be asked if they would like to speak to Mr Barbour-Hill. If that is what they would like, that is what they will get. Also, if the nurse is the slightest bit uneasy about the query, she will recommend Mrs Owner to speak to me.

[quote user="Hanna Bennett"]We also have all our first vaccs see a nurse first, who discusses toilet and general training, worming, neutering, microchipping, the ins and outs of insurance and feeding (hot potato there i know....). The client gets 20-30 mins with the nurse, then a vet comes in, checks the pup over and hopefully jabs the pup after a quick chat with the owner. This gives us well informed happy clients. Yes, some of what the nurses say is practice protocol, but they are also qualified to answer so many of the clients questions that it saves alot of my time.[/quote]

Well, that seems a good plan and not so different from what I do. The only difference is that they get a higher proprtion from me and a lesser proportion from a nurse. As I say, the way I set out my stall is that if the client has come for veterinary advice then they see the veterinary surgeon. I think clients appreciate my taking time to get properly acquainted with the puppy.

Re: Nursing support

Hanna Bennett — Fri, 26 Feb 2010 16:10:17 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Arlo Guthrie"]

Evelyn, I don't understand how you can say that it is a waste of a nurse to use her as a cheap substitute for a vet.

What is a veterinary nurse's time charged out at? Is it half that of a vet? A quarter?

I'm no Richard Branson, but surely it makes sense to delegate AS MUCH as possible to a nurse who is able to do certain tasks for, what?, a quarter of the cost of you doing it?

[/quote]

Well, at least you agree that VNs are used as cheap substitutes for vets.

[/quote]

So if an owner phones up asking about how to wean her puppies, or discuss the fact that her Labrador is getting progressively fatter do you deal with these queries?

We book them in to see a nurse and the owner gets as much time as they need to make them happy and confident to do what is needed. I don't have time for these consults, and love being able to hand them over to someone qualified to deal with this.

We also have all our first vaccs see a nurse first, who discusses toilet and general training, worming, neutering, microchipping, the ins and outs of insurance and feeding (hot potato there i know....). The client gets 20-30 mins with the nurse, then a vet comes in, checks the pup over and hopefully jabs the pup after a quick chat with the owner. This gives us well informed happy clients. Yes, some of what the nurses say is practice protocol, but they are also qualified to answer so many of the clients questions that it saves alot of my time.

Re: Nursing support

Evelyn Barbour-Hill — Fri, 26 Feb 2010 00:59:52 GMT

[quote user="Adi Nell"]Nurses, like any team member, need to feel that they are continuing to develop their skills and experience with time. [/quote]

[quote user="Adi Nell"]Same goes for nurses: to keep them as cleaners and receptionists is utterly demotivating.[/quote]

Which comments apply to all nurses, not only VNs. And I agree completely.

[quote user="Adi Nell"]some very happy, enthusiastic ones who have taken all the changes and developments over the years in their stride, and sought out ever-improving ways to do things.[/quote]

Some of whom have obediently followed every latest dogma, and some of whom have preferred to follow their own instincts and do things their way.

Re: Nursing support

Evelyn Barbour-Hill — Fri, 26 Feb 2010 00:52:04 GMT

[quote user="Arlo Guthrie"]

Evelyn, I don't understand how you can say that it is a waste of a nurse to use her as a cheap substitute for a vet.

What is a veterinary nurse's time charged out at? Is it half that of a vet? A quarter?

I'm no Richard Branson, but surely it makes sense to delegate AS MUCH as possible to a nurse who is able to do certain tasks for, what?, a quarter of the cost of you doing it?

[/quote]

Well, at least you agree that VNs are used as cheap substitutes for vets.

So, in a very narrow sense, it's good financial practice to use VNs to do veterinary surgeons' tasks, yes.

And while they are acting as cheap substitutes for vets, they are not doing nursing.

I'd say it was kind of demoralising when you realise - if you realise - you have been hired not to do nursing but so that the partners can get more chargeable work put through without having to hire the vet they should be hiring.

[quote user="Arlo Guthrie"]Aside from the cost savings, there is the motivating (or should I say demotivating) aspect of all of this. How utterly demoralising to work hard for your qualifications, and wind up in a practice that doesn't allow you to use and develop the skills you've learned.[/quote]

P'raps so, if you've been looking forward to being a mini-vet. But the training and qualifications should never have been designed to give this expectation.

[quote user="Arlo Guthrie"]It is completely beyond me why any practice would hire a qualified nurse, and then NOT get him or her using ALL the skills they have learned, for example Schedule 3,[/quote]

Seems a good reason to not hire a VN then.

Re: Nursing support

Adi Nell — Thu, 25 Feb 2010 14:45:42 GMT

[quote user="Arlo Guthrie"]How utterly demoralising to work hard for your qualifications, and wind up in a practice that doesn't allow you to use and develop the skills you've learned[/quote]

I couldn't agree more.

Nurses, like any team member, need to feel that they are continuing to develop their skills and experience with time. We all know some really miserable vets out there who have chosen not to engage and develop as time has gone by, and some very happy, enthusiastic ones who have taken all the changes and developments over the years in their stride, and sought out ever-improving ways to do things. Same goes for nurses: to keep them as cleaners and receptionists is utterly demotivating.

Sometimes you need to push them a little as they can undervalue their skills (as can vets!), but they almost always blossom with the right guidance and motivation.

Re: Nursing support

Arlo Guthrie — Tue, 23 Feb 2010 17:57:47 GMT

[quote user="Evelyn Barbour-Hill"]If the nursing isn't getting done, the VNs are being wasted. It's wasting a VN to dedicate her to floor mopping, but it's also wasting her to use her as cheap substitute for a vet.[/quote]

Evelyn, I don't understand how you can say that it is a waste of a nurse to use her as a cheap substitute for a vet.

What is a veterinary nurse's time charged out at? Is it half that of a vet? A quarter?

I'm no Richard Branson, but surely it makes sense to delegate AS MUCH as possible to a nurse who is able to do certain tasks for, what?, a quarter of the cost of you doing it?

It is completely beyond me why any practice would hire a qualified nurse, and then NOT get him or her using ALL the skills they have learned, for example Schedule 3, as much as possible (provided, as you say, that what you call 'true' nursing isn't compromised).

Aside from the cost savings, there is the motivating (or should I say demotivating) aspect of all of this. How utterly demoralising to work hard for your qualifications, and wind up in a practice that doesn't allow you to use and develop the skills you've learned.

Re: Nursing support

Hanna Bennett — Tue, 23 Feb 2010 12:49:32 GMT

[quote user="Evelyn Barbour-Hill"]Hanna, you have staffing levels to envy[/quote]

We don't think so! Definitely need another trainee and one more qualified would not go amiss.... We have six full time vets, one occasional locum. This is balanced by five experienced qualified VNs, one qualified in the last couple of months and three trainees. Could not cope with any less, and we pay them what i consider a good wage for a VN, and manage to have some pennies left over at the end of the month. We are a busy practice but no more so than usual I would say.

Re: Nursing support

Evelyn Barbour-Hill — Tue, 23 Feb 2010 10:50:35 GMT

[quote user="Arlo Guthrie"]o I'm curious - although your bill was itemised, was the client really aware of the lengths you had gone to? Or do you think they might have been short of money, and that was just, well, an expression of their frustration? (if that makes sense).[/quote]

Nah. They're just horrible people.

Re: Nursing support

Rob Reid — Tue, 23 Feb 2010 10:05:07 GMT

[quote user="Evelyn Barbour-Hill"]"we are amazed that you feel you can charge £117.50 for one night's 'intensive care' ". [/quote]

That really makes my blood boil. Your fee of £117.50 is incredibly reasonable in the grand scheme of things. I would like to know how many hospitals in the UK could honestly say that they could have a doctor sitting with a patient all night.

I had a similar fee related whinge from a breeder last week that has made me very angry. He moaned about the £500 I charged to C-section and spey his Bulldog (Matthew Watkinson grinds his teeth at this point ) It's not like it needed an hour and a half of my time to knockout, prep, op and recover this pateint and 4 nurses to bring the 10 pups round. And it's not like he stands to make the best part of 10 grand selling his pups. People really are quite unreasonable at times!

Re: Nursing support

Arlo Guthrie — Tue, 23 Feb 2010 09:10:28 GMT

[quote user="Evelyn Barbour-Hill"]After a couple of reminders I eventually got a cheque with an affronted letter saying "we are amazed that you feel you can charge £117.50 for one night's 'intensive care' ". I think it was the inverted commas that really upset me.[/quote]

I'm not surprised you were upset by those inverted commas. I mean, they're making me quite angry for you.

Ten years ago or so, my time as a marketing consultant used to be charged out at £150+ per hour. Although I used to think I was pretty good at it, the qualifications needed for me to 'practice' were precisely ... zilch. Given a veterinary surgeon's level of qualification, I would have thought £100 for a night's intensive care was an absolute steal. So much so, I would probably have demanded to pay more. At least double that.

So I'm curious - although your bill was itemised, was the client really aware of the lengths you had gone to? Or do you think they might have been short of money, and that was just, well, an expression of their frustration? (if that makes sense).

Re: Nursing support

Clive Ansell — Tue, 23 Feb 2010 08:09:43 GMT

Highlights a problem we all face at times; people want and expect a gold standard service, intensive care, undivided attention over night, then don't expect to pay for it, particularly if the animal dies. I think you're charge of £100 is cheap, particularly if it was presented OOH

In the two OOH clinics where I work, intensive care with the undivided attention of a vet and a nurse assigned solely to the case is priced at around £50 per hour plus all consumables; drugs, oxygen, IVFT etc. Standard overnight hospitalisation s about £50, and to be seen OOH is about £120.

Re: Nursing support

Evelyn Barbour-Hill — Mon, 22 Feb 2010 22:34:15 GMT

Hanna, you have staffing levels to envy.

Almost completely irrelevant anecdote:

a local rescue shelter brought me at night a dog they had just picked up. It was at death's door. I explained this and how if I were to do anything at all other than euthanasia, it had to be some pretty expensive fluid therapy and care, so I suggested euthanasia. No, that wouldn't do, we had to give it that chance and they would pay. So, OK. I absolutely gave it the works and sat up all night with it myself (it was my turn). It died about 6 a.m.. I sent them an itemised bill for something like £100 plus VAT. After a couple of reminders I eventually got a cheque with an affronted letter saying "we are amazed that you feel you can charge £117.50 for one night's 'intensive care' ". I think it was the inverted commas that really upset me.

Re: Nursing support

Hanna Bennett — Mon, 22 Feb 2010 20:37:04 GMT

[quote user="Evelyn Barbour-Hill"] Did every surgical operation have an anaesthetist nurse, a scrubbed nurse and an unscrubbed nurse?[/quote]

if required, yes. Most routine ops don't require a scrubbed nurse (how do you fit two pairs of hands in a cat spay?) but we have an anaesthetist nurse and an unscrubbed nurse, and can usually supply a scrubbed nurse if needed.

[quote user="Evelyn Barbour-Hill"]Was there constant supervision of the recovery ward by a nurse appointed to that task? [/quote]

our theatre nurses monitor recovering patients, mainly the unscrubbed nurses responsibility - this is not ideal but given recovery is next to theatre it works.

[quote user="Evelyn Barbour-Hill"]Could true intensive care with a dedicated nurse attending to no more than four patients be guaranteed?[/quote]

Thankfully we rarely have more than one true 'intensive care' patient in at a time so we have two nurses responsible for running ward, one qualified and one trainee. Inpatient numbers vary widely from none (not often) to probably a (rare) maximum of ten, most of them simple ie. gastroenteritis patients on fluids in which case two nurses is sufficient.

[quote user="Evelyn Barbour-Hill"]Was it possible when the necessity arose to have true one-to-one nursing , one nurse with one patient non-stop?[/quote]

Most definitely yes, this situation arises with RTAs, dyspnoeic animals etc, and we will have a nurse, either qualified or a trainee with a qualified within shouting range monitoring the animal until stable be that mintues or hours.

[quote user="Evelyn Barbour-Hill"]Were nurses on these tasks actually dedicated, or might they be called on to answer the phone, answer the door, clean up blood splashes in the waiting room, as well? [/quote]

Our nurses do not answer phones to clients, or doors for that matter. We also have a dispensary nurse who is responsible for the waiting room, so she would clean up the blood. I suppose she might be busy but emergencies are respected and so nurses will not be taken away from the critical patients for 'routine' tasks'. Our nurses are rotaed to a specific job and emergencies notwithstanding they are responsible for that particular area of the building/group of patients and this means that there is at least one vet and one nurse responsible for each patient. Helps to ensure nothing is forgotten.

Re: Nursing support

Gillian Mostyn — Mon, 22 Feb 2010 19:51:04 GMT

My nurses do like to provide individual care to the patients, and they do so if required (we have 4 nurses, 2 receptionists and 1.5 vets so staff levels always allow this). However, rather than just watching and recording, they are free to draw blood - eg glucose curves, ACTH stims, dynamic bile acids, place/replace iv catheters, administer meds etc etc... I see all these tasks as part of nursing - not only vet ones. And these tasks therefore occur on time and as needed, rather than when I can get away from consults!

I think we'll have to agree to disagree on this one Evelyn!

Re: Nursing support

Evelyn Barbour-Hill — Mon, 22 Feb 2010 19:29:17 GMT

[quote user="Adi Nell"]Do the readers feel that an experienced lay nurse, who has worked at a practice for many years and been trained by the veterinary surgeon to fulfill all the duties that would routinely be required of her (such as clipping nails, monitoring anaesthesia, giving tablets or injections,[/quote]

Yes

[quote user="Adi Nell"]potentially taking bloods and running blood tests, setting up i/v lines)[/quote]

No.

[quote user="Adi Nell"]A big part of motivating and encouraging my nurses is giving them responsibilities that reflect their training and experience. In my view, holding a nurse back from doing things that she's capable of and has been trained to do is very bad for morale, while giving them more responsibility - including nurse clinics where appropriate - is appreciated and makes them feel much more positive about their role.[/quote]

I entirely agree. But: " reflect their training"............. what if they are being trained inappropriately?

By all means run nurse clinics if you want to: assuming you have so many nurses that you have some spare even after all the nursing is done.

I once quizzed a senior member of the small-animal branch of this profession, a hospital owner. He had been extolling nurse clinics and all the stuff his nurses do. I asked him if he had nurses to do certain true nursing tasks which I enumerated one by one, tasks that are often not done at all in practices but which seem to me the main reason for wanting a training and qualification structure for nurses. Did every surgical operation have an anaesthetist nurse, a scrubbed nurse and an unscrubbed nurse? Was there constant supervision of the recovery ward by a nurse appointed to that task? Could true intensive care with a dedicated nurse attending to no more than four patients be guaranteed? Was it possible when the necessity arose to have true one-to-one nursing , one nurse with one patient non-stop? Were nurses on these tasks actually dedicated, or might they be called on to answer the phone, answer the door, clean up blood splashes in the waiting room, as well? The answers were no, no, no, no............

If the nursing isn't getting done, the VNs are being wasted. It's wasting a VN to dedicate her to floor mopping, but it's also wasting her to use her as cheap substitute for a vet.

Re: Nursing support

Evelyn Barbour-Hill — Mon, 22 Feb 2010 19:06:15 GMT

[quote user="Gillian Mostyn"] In a competitive market, I have to be aware of how I market my practice. It goes hand in hand with client and animal care.[/quote]

I agree entirely.

Re: Nursing support

Richard Carter — Mon, 22 Feb 2010 18:46:36 GMT

[quote user="Adi Nell"].

What makes less sense to me is the guidance I've received from the RCVS - no nurse not formally enrolled in training or registered as a VN with the college may give a tablet to an animal, let alone administer an injection or take blood/set up an i/v line.[/quote]

I sincerely hope the unspoken addition to this advice was 'if not under the supervision of a vet'.

Re: Nursing support

Adi Nell — Mon, 22 Feb 2010 11:20:19 GMT

I agree with you ref the role of nurses - I think it's common sense.

It seems to me that this, if enforced across the profession, would result in a crisis in animal welfare. I'm also sure that this was not the intention of drafting the Schedule 3 procedures for nurses, just one of the unintended consequences.

Another example of how "road testing" regulations prior to publishing them might be a good idea!

Re: Nursing support

Gillian Mostyn — Mon, 22 Feb 2010 11:02:34 GMT

Currently, with training as it is and numbers as they are, any suitably trained person is, and should be, able to carry out any task they are given. I just feel that we should be working towards a qualified workforce for the future.

I've made my view clear about the nursing role already....