VetScript Editor's Pick - A valued member of the team

ALLIED PROFESSIONALS

ALLIED PROFESSIONALS

A valued member

OF THE TEAM

The days of the New Zealand veterinary nurse being regarded as ‘just a nurse’ are numbered – and not before time. Meredith Crowhurst details the ongoing professionalisation of an historically underrated group.

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PHOTOGRAPHY: MARCEL TROMP

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Crystal Loh (centre, with Georgia Bayly [le!] and Natalie Miller) aims to create an environment of mutual respect, appreciation and collegiality.

VETERINARY NURSES PLAY a much broader role in countries such as the US and the UK than they do in New Zealand. Here, a 2015 survey conducted by the New Zealand Veterinary Nursing Association (NZVNA) found that a large proportion felt that their skills and knowledge went underutilised.

But New Zealand’s veterinary nurses are professionalising. They are striving to become more than assistants, kennel hands and administration staff. They want to be accepted as the professionals they are, and an important part of the veterinary healthcare team.

Jennifer Hamlin, a member of the executive committee of the NZVNA,

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The AVPRC is a constitutionally established working group of the NZVNA and covers all allied veterinary professionals – veterinary nurses, technologists, rural animal technicians, large animal veterinary technicians and veterinary nursing assistants. Working with VCNZ, it is developing the necessary infrastructure so that if and when the Veterinarians Act 2005 is amended to include allied professionals, they are in a position to register veterinary nurses, set and enforce standards of clinical practice and education, regulate the teaching of veterinary nurses, set a professional code of conduct, ensure fitness to practise, impose a disciplinary process and respond to public complaints.

Wayne Ricketts, VCNZ Professional Advisor, anticipates that if the Act changes it will be in a similar way to how the Health Practitioners Competence Assurance Act 2003 brought together all allied human health professionals.

Currently in New Zealand any person can be employed within a veterinary clinic and adopt the title of veterinary nurse (even if they hold no formal qualifications), according to Jennifer Hamlin. “There is no protection of the title of ‘veterinary nurse’,” she says. “This poses a potential risk to animal welfare and public safety, as well as threatens how the public perceives the quality of

“THE RELATIONSHIP BETWEEN A VET AND A VET NURSE IDEALLY SHOULD BE A SYMBIOTIC ONE, NOT ONE WHERE THE NURSE IS REGARDED AS ‘JUST A NURSE’ WHO SHOULD ‘KNOW THEIR PLACE’.”

says that initial steps towards professionalisation include the 2015 initiation of voluntary registration for veterinary nurses and the establishment last year of the Allied Veterinary Professional Regulatory Council (AVPRC), of which she is the chair.

veterinary care within New Zealand.”

There are many providers of veterinary nurse education, says Jennifer. “These providers’ programmes are required to meet graduate profile outcomes for the qualifications they offer and meet the consistency required

BACHELOR OF VETERINARY TECHNOLOGY The Bachelor of Veterinary Technology (BVetTech) is a three-year degree offered only

by Massey University and is one of four of its type in the world. According to acting Programme Director and veterinarian Robert Sawicki, the degree (which graduated its first class in 2011) slots between a veterinary nurse and a veterinarian.

While not able to perform surgical procedures or prescribe medication, holders of the BVetTech degree are more highly trained than veterinary nurses and are exposed to all species and a wider range of clinical and course work, including business and management subjects. Selected acceptance to the programme is competitive. Applicants must have University Entrance and are encouraged to have studied chemistry, biology and at least one mathematics subject to at least NCEA Level 3 (or equivalent) prior to enrolling in the pre-selection papers.

“Students train alongside veterinary students, and graduates hit the ground running,” says Robert. “They graduate equivalent to an experienced veterinary nurse.”

The programme also changes the experience of veterinary students. Having studied alongside BVetTech students and seen their capabilities and expertise up close, these veterinary graduates should be more comfortable using allied staff in a more robust way.

by NZQA/TEC. However, it is apparent that the current system makes it very difficult to ensure consistency between providers. Standardisation is essential for helping to facilitate international cross-recognition of qualifications as well as reciprocal agreements with international regulatory bodies.”

The Education Standards Committee of the AVPRC is looking to the standard of veterinary nurse/technician training in the US and the UK, with the eventual aim of veterinary nurses here graduating with a minimum of the day-one clinical competencies for veterinary nurses set by the Royal College of Veterinary Surgeons (RCVS) in the UK. “Developing a standard where all providers [show] evidence that they meet these specific competencies [for] their individual programmes and assessments will improve the opportunities for consistency in allied veterinary professional education within New Zealand,” she says.

This move is no surprise to Rachel Blackie, a veterinarian in mixed practice in Wellsford. Rachel previously worked in the UK, where she found veterinary nurses to be “a whole different ball game”, something she attributes to the UK having four different levels of training, giving clarity to what those at each level

are capable of doing. She suggests that this makes everyone more secure in their knowledge and limits.

While this clarity is currently lacking in New Zealand, there are many factors that contribute to our overall poor nurse utilisation. Partly it comes down to veterinarians and veterinary managers not realising the value of a qualified veterinary nurse, not understanding how much they are trained for or what they could be trained to do, and not recognising how they can increase profitability. This is especially so where only non-qualified nurses are employed, where a veterinarian has never experienced anything different, and where a clinic has not developed processes to establish an efficient working team.

Other factors creating resistance can include poor management, veterinarians wanting to maintain control or not knowing how to delegate, a lack of trust in nurses, inadequate training of nurses, and problems with nurse staffing in rural areas and in clinics with long hours.

Of course, there are some clinics that are ahead of the game.

“When I started [13 years ago], nurses didn’t do much at all and had really bad attitudes and self esteem,” says Katie Duncan, the Head Veterinary Nurse and

Team Leader at Rangiora Vet Centre.

“I really pushed to utilise the nurses. A veterinarian who had worked in the UK and who was used to utilising nurses well came on board. Once the vets saw the benefits and their workloads lightened, [the nursing role] really grew.”

When Katie started, the Rangiora practice employed 1.5 veterinary nurses; today, it has more than 20. “I think the nurses here feel well utilised – sometimes too much so! Put it this way, I never hear anyone say they are bored. I do think this equates to better self-esteem and job satisfaction.”

Crystal Loh, who received her veterinary degree at the University of Guelph and practised in the US prior to coming to New Zealand, says that clinics where nurses are not utilised to their full potential do not operate efficiently, and neither do they maximise veterinary and nurse time.

“Veterinary teams benefit from a mutually supportive environment. The relationship between a vet and a vet nurse ideally should be a symbiotic one, not one where a nurse is regarded as ‘just a nurse’ who should ‘know their place’,” says Crystal, who runs The Pet Dentist, a veterinary dental practice alongside CareVets Hamilton South. “I have found that when my team and I are on the same page, not only are clinic efficiencies improved, but patients and clients benefit by receiving a higher standard of care and service.

“Respect for each other’s roles is critical. I rely heavily on my nurses’ support. Each is a key player in ensuring that every step of a client and patient’s care is performed at a detailed and high level, from admission to discharge. Aside from the everyday nursing duties, my nurses are further advanced and trained additionally in anaesthesia (with special considerations for dental patients), are able to take dental radiographs, perform scale and polishes, as well as understand common disease recognition and have knowledge of specialty instrumentation.

I would not be able to perform my job to the best of my ability or as efficiently without such a devoted and

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ALLIED PROFESSIONALS

If you want happier and more efficient veterinary nurses, let them use the skills they were trained in, says Aurore Scordino, head veterinarian and clinical manager of Waikato A!erhours Veterinary Hospital and of CareVets Central (right, with veterinary nurse Erika Smith).

ELLIE CLARK, REGISTERED VETERINARY NURSE, THE SKIN VET I did my veterinary nurse training in the UK. To get a placement to train, I had to be gainfully employed in a veterinary practice. In the UK, training clinics must be approved by the RCVS to train students. These clinics have members of staff who are dedicated to training the students on site, and may have students of different years working at the same time. I found this an extremely effective way to learn. I did one day per week at college and the rest based at work. This was great for continuity and putting the skills I’d learned at college into practice in an environment where I felt safe and supported.

The nursing staff were much more widely used. We had nurses consulting daily, doing puppy/kitten checks, behaviour consults, dental checks, bandage changes, suture removal, flea and worm checks, senior checks, weight clinics etc. We were fully trained in dentistry and did all the scale and polishes. We also did any minor stitch-ups and lumpectomies, performed radiography, and undertook the collection and running of lab samples on blood, urine, faeces, etc, anaesthesia monitoring, pre- and postsurgical care, inpatient care, IV catheter placement, client interaction, and so on.

In summary, there are many more CPD opportunities and extended learning/qualifications in the UK than in New Zealand.

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“AS A CRITICAL CARE VET AND CLINIC MANAGER, I RELY A LOT ON MY NURSES. THEY ARE ALL HIGHLY SKILLED, HIGHLY TRAINED AND MOTIVATED. IT SHOWS.”

knowledgeable nursing team. Each of them is a valued member of the team.”

Aurore Scordino of Waikato After Hours Veterinary Hospital put her team together from scratch, and her first priority was that everyone got along well.

Aurore, who worked as a veterinary nurse for 10 years before attending Washington State University College of Veterinary Medicine, sympathises with the needs and desires of the veterinary nursing staff. Veterinary nurses don’t need to know everything, she says, but they need to be willing to learn. To that end, the clinic has a vigorous training programme and does a lot of team building, as well as giving responsibility to individuals in the areas where they feel comfortable.

A small pay rise comes along with increased responsibility. “This makes them

feel like an integral part of the practice, where they can help shape various aspects of the clinic and take pride in what they do.

They feel valued. As a critical care vet and clinic manager, I rely a lot on my nurses.

They are all highly skilled, highly trained and motivated. It shows. When locums come to work for us, their first feedback is, ‘What an awesome team of nurses!’

To create a team like that takes time and effort, but it always pays in the end.”

Sometimes there are hierarchical challenges in clinics, and some veterinarians are concerned about current legal restrictions on what nurses can do.

“A good veterinary nurse recognises that the veterinarian is the primary care provider who ultimately is responsible for clinical decisions and outcomes, and they will check in before making

any decisions or changes to plans,” says Crystal. “However, the opportunity to participate in discussion and patient care planning should not be regarded as one where the nurse ‘oversteps their bounds’, but should be recognised as necessary to developing teamwork and a complete care regime. Ultimately, vets must recognise that nurses are the ones responsible for most of the patient care through observation, maintenance of hygiene, administration of medications etc, and therefore have an intimate knowledge of changes in patient conditions. They are essential contributors in the delivery of healthcare programmes.”

The NZVNA’s Jennifer Hamlin says the eventual goal is allied veterinary professional regulation. This will mean, for example, that it will be

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Carol Adams (le!) says that her skill set is valued and that veterinarians (including Sid Taylor, below with Carol) encourage staff to further their education.

ALLIED PROFESSIONALS

unlawful to practise as a veterinary nurse or other allied veterinary professional without being registered, and registered veterinary nurses will need to demonstrate fitness to practise and will also be liable for any professional misconduct or negligence. The aim is not only that New Zealand veterinary nurses will feel empowered and confident to perform to a higher capacity, but that veterinarians will be able to trust that registered veterinary nurses are able to perform competently at the levels to which they are trained and that they are accountable for their professional practice.

When Rachel Blackie worked in the UK, she encountered no issues with nurses treading on toes. “You know what each nurse is capable of, and the nurse knows what he or she is okay to do. I believe it’s because their roles or expectations are well defined within the [UK] system.”

While in some cases it’s fair to use the US and the UK as models, New Zealand is unique in its need for rural veterinary coverage. The main problems are difficulties attracting both veterinarians and qualified veterinary nurses, and the requirement for veterinarians to provide after-hours and on-call services. A lack of funds and the necessity of having veterinary coverage around the clock mean that remote clinics may choose to employ

“THIS CULTURE KEEPS ME BOTH PHYSICALLY AND MENTALLY ACTIVE, AND ABLE TO MAKE A DIFFERENCE TO OUR TEAM ON A DAILY BASIS.”

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PHOTOGRAPHY: SHARRON BENNETT

SURVEY FEEDBACK When VetScript surveyed veterinary staff for this story, we asked: do you think veterinarians in New Zealand are ready for the professionalisation of nurses?

The standard answer: probably not.

Some comments made by veterinarians: Small animal veterinary nurse Erin Palle# (le!) assists veterinarian Isobel Topham at Clutha Vets’ Milton clinic.

“Problem is that I am liable if things go wrong.”

“The final responsibility lies with vets.”

“Clients expect that vets are doing it [dental scale and polish].”

more veterinarians to fill the roster, rather than hiring nurses. Robert Sawicki, the acting Programme Director for Massey University’s Bachelor of Veterinary Technology degree (see box on page 37), says that veterinary technologists can still fill a gap in that small rural clinic environment. They can be the first triage point for after-hours calls, thus relieving some of the pressure on veterinarians.

When it comes to larger rural practices, allied veterinary professionals can carry a lot of the load. Carol Adams, a large animal technician at Clutha Vets’ Milton clinic, says she feels valued not only by the veterinarians, but by the clients with whom they maintain strong relationships.

“In a dairy environment, technicians do routine seasonal work such as disbudding, metrichecking, calf weighing, lepto vaccinations, dry cow insertion, heifer teat sealing, in-house FEC, pregnancy test recording, and more. To some extent we self-manage our day. We schedule the seasonal on-farm visits, particularly those where a technician only is required.”

Carol credits veterinarian Sid Taylor for his role in her training, development and mentoring since she started at Clutha Vets in 2010. “He has a preference for employees not to be siloed, and

encourages us to utilise our skills, strengths and passions. This keeps me interested and very busy. As a result, I undertake a variety of tasks that are not specific to my role, but that enhance the overall service a technician can deliver to both colleagues and clients. This culture keeps me both physically and mentally active, and able to make a difference to our team on a daily basis.”

There will always be trailblazers and there will always be heel-draggers.

Veterinary nurse utilisation will likely improve significantly if they have a higher level of competence at graduation, a key goal of the AVPRC. As veterinary nurses and other allied veterinary professionals enter the workforce with higher levels of skill and expectations of more responsibility, clinics’ business models and processes will need to be adjusted. Some clinic managers may need guidance to take advantage of the new opportunities fully. Conversations around using allied veterinary professionals need to be normalised; the benefits and challenges need to be discussed and debated.

The good news is that the more highly skilled graduates will expect to work in nurse-centred clinics. They will bring about change.

“Are we ready to let go of all the extras?”

“Most of the nurses we interviewed [for a job] can’t even work out basic drug doses. How can we allow nurses like that to give pre-meds?”

“I prefer to have more contact time with the patient and owner. This allows me to bond more and to observe the animal for longer so that I may pick up problems.”

“Vets have attitudes that nurses aren’t capable of doing things, such as catheters and pain blocks.”

“We need a generation of vets who recognise that nurses can add value.”

“Vets are scared to trust nurses.”

“One thing that most frustrates vet managers is having to train these people. Most say they don’t have time” “Vets want things done perfectly.

They are control freaks.”

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