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Vet, VN and a dog

The value of veterinary nurses to practice – changing the mind-set

Stephanie-Writer Davies is a veterinary surgeon and a member of the VN Futures Career Progression Working Group.

Stephanie has always been very supportive of the veterinary nursing profession, recognising the value of veterinary nurses to practice and being keen to see them performing broader and more challenging roles and improve their status and job satisfaction. She is a previous SPVS President, and is currently the SPVS VN Liaison.

The Career Progression Group is working towards several ambitions which form part of the VN Futures Report and Action Plan; including maximising the value of veterinary nurses in practice, and encouraging charging correctly for nurses’ skills and time. Stephanie discusses some of these issues in this short blog – to which we welcome input and comments from our readers.

Veterinary surgeon, Stephanie Writer-Davies
Stephanie Writer-Davies

There has been some debate in recent months over the value of veterinary nurses to practices, and the ‘cost’ to veterinary businesses of their veterinary nursing staff.

So, how should practice owners think about their nursing teams in terms of cost vs value? Are they an ‘overhead’ that has to be factored into the business’ ‘Profit and Loss’ (P&L), one which provides useful support for patients and clients, but which doesn’t contribute to the financial health of the practice?

I make this somewhat controversial comment to stimulate debate because I hope that everyone who knows me (or knows of me) is aware that this is in direct contradiction to what I actually believe! Veterinary nurses are never, to my mind, a net cost to practices, but to accept this I think we have to look at things in a different way.

Veterinary practices contain a team of staff members with different roles, all of which contribute to the practice income. No single group can manage without the help and support of the others, and that should be acknowledged. In relation to veterinary nurses in particular, it’s important to recognise that veterinary surgeons cannot work effectively without nursing support – and that’s not just in relation to the ‘stuff out the back’; veterinary nurses play a big role in the consulting room, not only as ‘assistants’ for the vets, but also as consulting professionals in their own right. Both these aspects of the role of veterinary nurses include income generation but the difficulty is that practices often don’t show how veterinary nurses generate income in a transparent way.

I believe we should change our mindsets about this and recognise the financial contribution that veterinary nurses make to practices as well as their clinical contribution – and in doing so we must change the way we talk about veterinary nurses. Veterinary nurses are not just ‘the staff out the back’ whose time is given away for ‘free’ in nurse clinics; they are expertly trained professionals who provide a necessary and valuable service for animals and their owners and their time is therefore worthy of a professional fee! We should show the nursing charges on our bills for surgical, diagnostic and in-patient care – after all many practices itemise things such as surgical kits so why not anaesthetic monitoring by the RVN, for example? We charge hospitalisation fees but why do we not list nursing care as part of this cost? And what about the admission and discharge appointments that are often done by veterinary nurses – why do we not show the costs of those amongst the surgical or other charges? If we don’t, then we should!

There is a view that Nurse Clinics don’t generate income but, in my opinion, this is flawed. Many of the consultations that nurses do are ‘pre-charged’ by the veterinary surgeons (eg 2nd vaccinations, post-op checks, repeat medications etc) so the charge for the nurse’s time gets ‘lost’ in the initial veterinary surgeon fees. Additionally, of course, if these appointments weren’t carried out by the veterinary nurses they would have to be done by the vets, so these clinics free up the vets’ time to be used for consultations on new cases or additional surgical procedures, for example, which generate new income. In effect, this vet-led income generation is facilitated by the veterinary nurses taking on the nurse clinics. Then there’s the thorny issue of how to charge for tasks such as emptying anal glands or clipping nails… is it cheaper if a veterinary nurse does it? Absolutely not! ‘Task-led’ procedures of this type should be charged at a set fee – after all a nail clip is the same whoever does it – and they should be done by veterinary nurses to free up veterinary surgeons’ time. If clients insist on seeing a vet for something of this nature, then they should be charged a consultation fee. And no more ‘free’ nurse clinics please! They can perhaps be complementary for patients on health plans but otherwise nurse consultations should be charged appropriately!

I don’t want you to think that I consider veterinary nurses as ‘mini’ or ‘frustrated’ vets because I don’t. To me, they are skilled co-professionals important for veterinary businesses and patient welfare and they should be proud of the role they play and the financial value they bring. However, this should be acknowledged and promoted by the other members of staff within the practice so that clients see the veterinary nursing profession in a new light. With enhanced public respect and an acceptance of their value should come the potential for enhanced roles in practices for veterinary nurses which should also result in improved salaries!

VNs looking to themselves for change

Daniel is Operations Manager at Dick White Referrals and a practising RVN. Daniel began his career as a Saturday receptionist at a small clinic and became a veterinary nurse in 2007, moving on to become Head Nurse at a large 24-hour veterinary hospital in East London.

Daniel holds the A1/V1 Clinical Coach qualifications, Level 3 in British Sign Language and is currently completing a Chartered Management Institute Level 7 qualification in Strategic Leadership. Daniel works across HR, strategy and development, facilities management, health and safety and leadership.

Daniel Hogan

Daniel Hogan

My current role is Operations Manager at Dick White Referrals. Starting my career as a veterinary nurse in a variety of roles, and moving to senior management positions, I have always been passionate about the profession and my role within it, but felt that the nursing profession was under-valued and lacked recognition for the important roles RVNs play. I also believed that this attitude towards RVNs restricted our full potential.

Having not previously been engaged with the RCVS and other professional organisations, I felt it was time to play a more proactive role in influencing the future of our profession and joined the Vet Futures and VN Futures projects. Immediately it was clear that a large amount of work had already been started, but there was still a substantial task ahead of us.

Both Action Groups contained a fantastic mix of professionals from an array of backgrounds with a variety of experience, but the real challenge was capturing everybody’s thoughts and ideas and placing them within the context of a working document; a challenge I hope we have met.

It was fantastic to see that everyone shared the same passion for the profession and, more promisingly, that the veterinary nursing profession could address its own issues separately.

VN Futures hosted several evening meetings to meet RVNs from around the country to obtain feedback about their priorities for the future and discuss what were felt to be the biggest issues in the profession. The response was incredible and covered a range of practical, current and future issues. More importantly, we discussed where we wanted our profession to be!

Initially I was apprehensive that the ambitions were too big and not manageable and I had a genuine concern that it was the same issues being addressed by the same organisations. We have, however, engaged with people from across the entire veterinary and veterinary nursing professions and, crucially, those outside the veterinary world.

Many in the VN profession are unhappy and we would be naive to assume everything is perfect. Whether it is low salaries, poor working conditions, lack of training opportunities, disappointing progression routes, absence of support from the employer, or a lack of recognition for the work that we do, we now have an opportunity to make a change.

So I truly believe that both the Vet and VN Futures plans will modernise and develop our professions for the better and, importantly, that we will achieve this within a credible timeframe.

I urge everyone who works in the veterinary team to engage with the action plans. This is our profession and our opportunity to contribute to its future.

Helen Ballantyne

Blog asks if veterinary nurses are strong enough advocates for the profession

A new blog has been published on the Vet Futures website asking if veterinary nurses are being strong enough advocates for the profession.

The article is written by Helen Ballantyne who is both a veterinary nurse and a medical nurse and also a member of the VN Futures Action Group. VN Futures, which is run jointly between the Royal College of Veterinary Surgeons (RCVS) and the British Veterinary Nursing Association (BVNA) and was launched earlier this year, aims to draw up a blueprint for the future of the veterinary nursing profession.

In her blog Helen argues that, while veterinary nurses have always been strong advocates for animal welfare and patient care, they have not always advocated the profession in such a strong way. She posits several reasons why this might be the case including it being seen, historically, as a ‘subservient’ role, the fact that the vast majority of the profession are women, the profession’s relatively young age, busyness, and the fact that veterinary nurses may not necessarily know where to turn for advocacy.

However, she says this is all beginning to change: “There are clear barriers to engagement and yet, there is a change in the air.  In the past, debating sessions have been hosted at BVNA Congress, a forum in which experts were brought together to initiate discussion on various issues. For several years it was poorly attended, there were a few voices, a titter of applause and then the room would empty.  Last year, feeling that the time might be right, the session was reintroduced and the debate on small animal nutrition that ensued was energetic, knowledgeable and passionate.  It showed that veterinary nurses have started speak, to use their knowledge and expertise to form valid relevant opinions.

“This year the RCVS announced an increase in the number of candidates standing for its VN Council showing that more members of the profession want to speak out. Each year the BVNA sees more and more of the profession work on projects for Veterinary Nursing Awareness Month in May.

“This means that each year the word spreads among the general public that veterinary nurses are not just ‘a cheaper substitute vet’ or an ‘aspiring vet’ but a professional member of the team with different responsibilities to the veterinary surgeons.”

She encourages veterinary nurses to use the VN Futures project as an opportunity to stand up and be counted and help influence the future of the profession adding: “It’s time to get involved, it’s time to get interested, for ourselves and for our patients. For if we don’t speak, then we lose the right to say ‘our profession’. It’s time to stand taller and speak louder, because crucially, there are people listening.”

Members of the profession who would like to contribute to the project can attend the upcoming VN Futures roadshow meeting at Edinburgh Napier University on Wednesday 11 May or either of the two upcoming Regional Question Times which take place in Nottingham and Cardiff on Tuesday 17 May and Tuesday 31 May respectively. To attend any of these events visit www.eventbrite.co.uk/o/vn-futures-9802034279

The VN Futures Action Group will also be launching its Action Plan at the Vet Futures Summit on Monday 4 July 2016. Tickets to this event cost £20 each and can be ordered at https://vetfutures.org.uk/event/vet-futures-summit/

Any veterinary nurses, or other members of the practice team, who wish to comment on the blog can do so by visiting www.vetfutures.org.uk/vnfutures where there will also be a poll to answer asking whether veterinary nurses are strong advocates for the profession.

 

 

Why aren’t veterinary nurses better advocates for the profession?

Helen Ballantyne BSc (Hons) PG Dip RN RVN

After graduating with a degree in Pharmacology in 2002, Helen qualified as a RVN in 2005, she then began a six year stint as a locum nurse working nationally and internationally in a variety of settings. She spent five years on BVNA Council.

In September 2013 she qualified as a human centred nurse, after two years in intensive care, she moved to the transplant team where she cares for patients post-transplant. She is also part of the organ retrieval team, who are on call to attend hospitals across the UK to facilitate the collection of organs from deceased donors.

Helen is really enjoying her change in career, although her passion for veterinary nursing remains. She has developed a strong interest in the idea of sharing medicine, applying concepts used by medical staff to the veterinary profession and vice versa. Her family and friends take delight in asking ‘Is it humans or animals today?’ as she goes to work….

What is it exactly that makes veterinary nurses such strong advocates for their patients, but feeble advocates for their profession? As you read this, veterinary nurses across the country are caring for their patients, ensuring their needs are met. There are veterinary nurses spending their annual leave working with charities, helping to improve the lives of animals facing pain and suffering. There are veterinary nurses setting alarm clocks and disrupting their home life by voluntarily hand rearing litters of puppies or kittens. Veterinary nurses love their job, thrive on the professional satisfaction it gives them and enjoy being the person fighting for, quite literally, the underdog.

So why is it hard to get them to talk about themselves and about their profession? Why is it that VNs don’t often come to the table and offer an opinion? If we look back historically, there is a clear background of subservience, of doing what we are told and not questioning the veterinary surgeon when, traditionally, he, told us what to do. Is the profession still suffering a hangover from those days, do we still feel we must take a step back and walk behind the vets?

Data from the RCVS Register of Veterinary Nurses in November 2015 tells us that 98% of the profession are female. In her recent book about women in the workplace, Sheryl Sandberg (2013) highlights that women consistently fail to push themselves forward, seldom negotiate their pay and often counteract professional praise by shifting it to someone else, saying ‘it was a team effort’ or ‘I couldn’t have done it without my partner’. Is being a female-dominated profession holding us back?

Perhaps it is to do with the average age of the VN. At a young 31, (Williams and Robinson 2014) is it possible that we are still part of a generation grateful to find employment in a job we love? Do we look to our mothers and see that we have choices they didn’t have before? Are we feeling grateful for those choices, honoured to care for our patients and anxious that if we make a fuss it might all disappear?

As a relatively young profession, do we have the tools to come to the table and speak? Do we need educating on how the profession is run? On who makes the decisions and how an opinion may be submitted or shared? Are vet nurses aware of what the BVNA and RCVS do and how they can get involved?

The RCVS Survey of the Veterinary Nursing Profession (Williams and Robinson 2014) tells us that a fifth of the UK profession have a second job. So, are we simply too busy for politics and discussion?

There are clear barriers to engagement and yet, there is a change in the air. In the past, debating sessions have been hosted at BVNA Congress, a forum in which experts were brought together to initiate discussion on various issues. For several years it was poorly attended, there were a few voices, a titter of applause and then the room would empty. Last year, feeling that the time might be right, the session was reintroduced and the debate on small animal nutrition that ensued was energetic, knowledgeable and passionate. It showed that veterinary nurses have started speak, to use their knowledge and expertise to form valid relevant opinions.

This year the RCVS announced an increase in the number of candidates standing for its VN Council showing that more members of the profession want to speak out. Each year the BVNA sees more and more of the profession work on projects for Veterinary Nursing Awareness Month in May. This means that each year the word spreads among the general public that veterinary nurses are not just ‘a cheaper substitute vet’ or an ‘aspiring vet’ but a professional member of the team with different responsibilities to the veterinary surgeons.

There is so much more that can be done, there are so many veterinary nurses who are not standing up, who don’t volunteer, who blend into the background. Winston Churchill once said, ‘history will be kind to me, for I intend to write it’. Now is the time for us to start writing our history and our future. It doesn’t take much. It’s an email, sent to the right person to start a conversation instead of simply posting on an anonymous internet forum. It’s learning what the VN Futures project is about and taking the time to participate. It’s talking to your manager and asking how you can work with them to develop your career and fulfil the needs of the business at the same time. Any of these small steps contribute to the future of our profession. It’s time to get involved, it’s time to get interested, for ourselves and for our patients. For if we don’t speak, then we lose the right to say ‘our profession’. It’s time to stand taller and speak louder, because crucially, there are people listening.

References

Williams M and Robinson D (2014) The survey of the veterinary nurse profession. Institute for Employment Studies.

Sandberg S (2013) Lean In. Random House Group, New York

VN Futures project launched

The Royal College of Veterinary Surgeons (RCVS) and the British Veterinary Nursing Association (BVNA) have launched VN Futures, a companion project to Vet Futures, which aims to draw up a blueprint for the future of the veterinary nursing profession.

One of the recommendations of the Vet Futures report (Taking charge of our future: a vision for the veterinary profession for 2030), which was published in November 2015, was to “encourage veterinary nurse leaders to develop a report and recommendations which are directly relevant to veterinary nurses and their future…”.

Following a joint meeting between the RCVS VN Council and the Council of the BVNA in October 2015, it was decided that a ‘VN Futures’ project would provide the relevant leadership and engagement to achieve this.

An initial meeting with a broad range of stakeholders took place at the RCVS on 7 January 2016, and, following this, a VN Futures Action Group has now been established to take the project forward, with the aim of delivering an action plan at the Vet Futures Summit in the summer.

The Action Group includes a mix of individuals involved in the training, representation, regulation, employment and management of veterinary nurses.

The timeframe under consideration for Vet Futures is until 2030, however, it was considered that a five-year timeline may be more appropriate for veterinary nursing, given that it’s a younger profession, the retention rate is lower, and the training cycle is shorter.

The VN Futures project is running a series of evening meetings to engage with VNs and those involved in the profession, as follows:

  • 14 March, University of Bristol, Langford, Bristol BS40 5DU
  • 18 April, the College of Animal Welfare, Topcliffe Close, Capitol Park, Tingley, Leeds WF3 1DR
  • 11 May, Edinburgh Napier University, Sighthill Campus, Edinburgh EH11 4BN
  • 17 May, Nottingham Belfry Hotel, Mellors Way, Notts NG8 6PY, this will be a discussion stream within an RCVS Regional Question Time meeting
  • 31 May, SSE SWALEC Stadium, Cardiff CF11 9XR, this will be a discussion stream within an RCVS Regional Question Time meeting

The meetings are free to attend and will start at 6.30pm, with a buffet supper. To register visit the VN Futures Eventbrite page.

“The VN Futures project aims to deliver an action plan that will help take the veterinary nursing profession into its next phase of development. With the new Charter now in place, and a willingness from Defra to review Schedule 3, the time is ripe for us to take control of what happens next,” says Liz Cox, Chair of the RCVS VN Council.

“The key to VN Futures’ success will be collaboration – I am delighted that we are working with the BVNA on this, together with other representative bodies – and also engagement: we want to hear VNs’ aspirations for their profession to ensure our action plan is as relevant and far-reaching as possible. I look forward to seeing a good turn-out for our roadshow events,” she added.

Sam Morgan, BVNA President, says: “BVNA is delighted to be working alongside RCVS VN Council on this project. We fully believe in the importance of the veterinary nurse within practice and think this project can help shape the future of the profession. Being involved in the Vet Futures project, via BVA, was an eye-opener, and that only just touched on our own profession; we now have the chance to look at veterinary nursing specifically, and it is an opportunity not to be missed. Knowing where we want to take the profession will make it so much easier to reach the goal.”

How can we increase the number of veterinary nurses entering and staying within the profession? asks guest blogger

‘Where are all the veterinary nurses?’ is the opening gambit of the September 2015 guest blog, which examines the current undersupply of veterinary nurses in the industry and examines what more can be done to increase the number of students and retain experienced nurses.

This month’s blog was written by Laura Kidd, a veterinary surgeon, VN lecturer and clinical skills tutor for veterinary students.

In the blog she argues that, despite year-on-year increases in the number of veterinary nurses, this seems to be insufficient to meet demand and that, furthermore, there is a trend towards people leaving the profession relatively early, with the average age being just over 30.

“Identifying the reasons for VNs leaving the profession at a young age and addressing these, is one potential way of increasing VN numbers in the future,” she writes.

She argues that poor pay, stress, not feeling rewarded or valued and perceived lack of career progression all contribute to people leaving the profession, although she welcomes initiatives from the BVNA, BVA, RCVS and others to increase the status of the profession, create more diverse career opportunities and improve the profession’s mental wellbeing.

However, she adds that “perhaps we may, reluctantly, have to accept that, for the time-being, veterinary nursing is a young profession with a high turnover.”

With this in mind she suggests that training more veterinary nurses will be the key to increasing the number of qualified members of the profession in the immediate future. In order to do this she believes that more practices need to be supported to become RCVS-approved Training Practices offering clinical training and work experience for student veterinary nurses and that an alternative training pathway for veterinary nurses may need to be looked at.

She adds: “The entry requirements for the VN Diploma are relatively low, yet the qualification is academically demanding: the volume and depth of knowledge is considerable for the level and qualification and the requirement to demonstrate critical reflection through academic writing can be challenging.

“It is regrettable that some student veterinary nurses, who appear to have the qualities to be very good VNs, are lost to the profession, unable to pass awarding body exams. Should we be developing an additional VN training pathway which allows more students to demonstrate they have the required skills to provide high quality nursing to their patients?”

In response to her proposal, this month’s poll asks visitors “Is there a need for another VN training option?”

Last month’s poll asked if vets always acted as animal welfare advocates. This was in response to an article by animal welfare expect Professor David Main in which he argues that the profession should do more to demonstrate its animal welfare credentials and introduce safeguards against excessive profit-seeking. Although just 22 people took part in the poll, around two-thirds (67%) of them said that vets do not always act as animal welfare advocates.

Where are all the veterinary nurses? Is there a need for another training option?

Laura Kidd is a qualified veterinary surgeon, VN lecturer and educational consultant who tutors on a post-graduate VN qualification, as well as teaching clinical skills to veterinary students.

Each year the actual number of veterinary nurses (VNs) in the UK increases (RCVS, 2014) yet, anecdotally, there seem to be insufficient veterinary nurses to meet demand.

The 2014 RCVS Survey of the Veterinary Nurse Profession (Williams and Robinson, 2014) indicates that over the next 10 years the demand for VNs will increase: with members believing that there are not too many VNs being trained (Williams and Robinson, 2014, p88).

Veterinary nursing is a young profession: the average age of VNs in full-time employment is only 30.8 years (Williams and Robinson, 2014, p15). Identifying the reasons for VNs leaving the profession at a young age, and addressing these, is one potential way of increasing VN numbers in the future.

Laura Kidd

Laura Kidd

With the main reasons cited for VNs leaving the profession continuing to be poor pay, stress and not feeling rewarded or valued (Williams and Robinson, 2014, p 43), it is to be hoped that the combined efforts of RCVS, VN Council, BVNA and BVA, in introducing a new Royal Charter (RCVS, 2015, a) and  campaigning  to have Parliament change the law to protect the title ‘veterinary nurse’ (RCVS, 2015, b), will  increase the status of the VN profession. As stated by John Blackwell, President of British Veterinary Association (RCVS, 2015, b), this could lead to increased recognition of ‘the skills of qualified veterinary nurses and the unique contribution they make to the veterinary team’.

The VN profession has changed and evolved significantly over the last 20 plus years, with many more postgraduate qualifications and options for career development. However, whilst the number of VNs who think there are opportunities for career progression has increased, many still do not believe this to be the case (Williams and Robinson, 2014, p82). Additionally, for many, the profession is not considered to provide part-time working opportunities or to be ‘family-friendly’ (Williams and Robinson, 2014, p82).

Most VNs surveyed (Williams and Robinson, 2014, p75) felt that their work gives them satisfaction and variety, but is stressful and the majority of VNs also feel that newly qualified nurses need more support in practice (Williams and Robinson, 2014, p 81). When considering these factors, maybe it is not a surprise that VNs leave the profession at a young age. Perhaps we may, reluctantly, have to accept that, for the time-being, veterinary nursing is a young profession with a high turnover.

However, the current focus on wellbeing within the profession, with attempts to identify and address the causes of the stress which makes some VNs leave the profession, and the stage in their career at which this develops, is to be welcomed.

Furthermore, it is promising that 83% of VNs surveyed (Williams and Robinson, 2014, p43) indicate their intention to remain in the profession for the foreseeable future. Is it therefore possible to improve the salary, work-life balance, career progression (Williams and Robinson, 2014, p93) and professional recognition so that even fewer VNs will leave?

The other main way to increase VN numbers is, of course, to train more students; and increase the numbers qualifying annually.

The VN professional qualification has a very strong emphasis on vocational training, encouraging the development of practical skills and Day One Competences. The broad syllabus and rigorous training are of a very high standard: ensuring that VNs acquire the required knowledge, understanding and research skills for veterinary practice. It is essential that these high standards of training are maintained and developed in order to produce veterinary nurses with the skills required for working within the profession, now and in the future.

Yet, in spite of the huge demand and competition for places on further and higher education VN courses, there appears to be insufficient VNs to meet the requirements of the profession. This is not a new problem but, anecdotally, the situation is worse than it has ever been.

The number of students able to commence VN training annually is limited by the availability of Training Practices: this is considered to be one of the main challenges to the VN profession (Williams and Robinson, 2014, p94). While it is admirable that so many approved practices support VN training, many cannot, for various reasons. Can we support more practices to become Training Practices in the future?

Furthermore, while the entry requirements for the VN Diploma are relatively low, the qualification is academically demanding. The volume and depth of knowledge is considerable for the level of qualification and the requirement to demonstrate critical reflection through academic writing can be challenging. It is regrettable that some student veterinary nurses, who appear to have the qualities to be very good VNs, are lost to the profession at this stage; unable to pass awarding body exams. Should we be developing an additional VN training pathway which allows more students to demonstrate they have the required skills to provide high quality nursing to their patients?  Without lowering the standards in any way, can we identify a way of increasing the numbers of students who can start and complete VN training?

The future of the VN profession is exciting: it is hoped that the title ‘veterinary nurse’ will become protected and that there will be more stress-free, valued, competent VNs, providing optimum nursing care.

BUT the issues that are facing the profession need to be addressed now: we need to train more VNs and keep the ones we’ve got!

References:

RCVS (2014) RCVS Facts 2014 (accessed 22.8.15)

RCVS (2015, a) New Royal Charter Comes into effect (accessed 22.8.15)

RCVS (2015, b) Protect the title ‘veterinary nurse’! (accessed 22.8.15)

Williams, M. and Robinson, D. (2014) Vet Futures: The 2014 RCVS Survey of the Veterinary Nurse Profession (accessed 22.8.15)


Read more about Laura Kidd→

The views expressed here are those of the author and do not necessarily reflect those of either the RCVS or the BVA.

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