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Better utilising your nurses

01 May 2020, at 8:35am

No practice can work efficiently without veterinary nurses – so why are so many practices still not maximising their potential?

Despite the excellent work of the BVNA and others, there is still a public perception that an RVN’s job is simply cuddling pets. This is frustrating for nurses and stifles their career development – a serious business issue given the shortage of RVNs. To offer a higher standard of service – and a more profitable one – and to give your nurses the job satisfaction they deserve, you must utilise them more effectively.

First steps

  • Do: talk to your nursing team to refresh yourself as to their clinical skills – whether clipping pre-op (let’s face it, they are usually much better at this than the attending vet) through to stitch ups, stitches out, expressing anal glands and some dental work. Then discuss what you need to change to utilise these skills better
  • Don’t: cut your nurse clinics – even if you are short-staffed. This will impact your bottom line in a few months’ time as your nurses would have been recommending your neutering services, your foods, your dental treatments and other services. It will catch up with you

Golden rules

Run more nurse clinics

Not only should you prioritise nurse clinics, you should charge for them. Your nurses’ time and expertise are valuable and your clients will pay with one exception to the rule.

Free puppy/kitten clinics should be offered until they are six months old as part of your pet health plan. Keep them free because encouraging new owners to come into the clinic once a month at this early stage gives your nurses a great opportunity to:

  • Weigh them, apply weight-appropriate flea/worm treatment and recommend future treatments
  • Discuss the importance of an appropriate diet, highlighting the diet that you stock and explaining how owners can get better value by joining your Pet Health Club
  • Discuss the importance of neutering/vaccination and the cost benefits offered through the Pet Health Club

These “free” consults will pay for themselves as non-bonded clients are more likely to shop around. Nurses are great advocates for your practice. If you don’t use them in this way, you are throwing money away.

Make full use of your nurses’ clinical skills

Take a proper look at the Schedule 3 procedures and make sure you’re working them to the full.

For example:

  1. Get both your vets and RVNs to feel comfortable with RVNs performing second vaccinations (when appropriate). This will free up your vets to do more profitable work. This can be particularly helpful, for instance, if you run a vaccination amnesty and are overrun with appointments
  2. Stitch ups/stitches out. Many practices now routinely have all post-operative checks carried out by an RVN, including the removal of stitches. If the nurse has concerns, they alert the vet. Stitch ups may be a bigger leap, so have a discussion with your RVNs and your wider team
  3. Consider aural hematoma/lipoma removal

I know that the procedures in the second and third points are carried out less frequently by nurses, possibly because they are considered grey areas. If they are carried out under general anaesthetic then a vet would need to be present and would then feel justified to carry out the procedure themselves.

In October 2019, the RCVS released some useful guidance to help vets considering delegating Schedule 3 work.

They set out some principles to consider:

  • Specific procedure – is the procedure medical treatment or minor surgery, not involving entry into a body cavity? RVNs and SVNs are not allowed to perform certain things, such as major surgery, independent medical treatment, diagnosis, certification, etc
  • Under care – is the animal under the vet’s care?
  • Person – can the vet delegate to this person (only RVNs and SVNs)?
  • Experience – does the RVN/SVN feel capable, and have sufficient competence and experience? Have they had the right training, and if there is a problem, do they know what to do?
  • Risks – has the vet considered the risks specific to this case? Does the RVN/SVN understand the associated risks?
  • Be there – is a vet available to direct or supervise, as necessary? RVNs do not have to be under a vet’s direct supervision. As long as the RVN is trained and understands the risks, the vet doesn’t actually have to be in the building. However, an SVN must be under a vet’s direct supervision

Only if a vet can say yes to all of the above, can they delegate to RVNs and SVNs.

This means that, for instance, in the case of a potential lipoma diagnosis, an RVN can take a fine needle aspiration. When the results are back from the lab, a vet can check and confirm that the nurse can proceed, then a nurse procedure appointment can be made.

Coombefield Veterinary Hospital’s head nurse, Naomi Ashby-Pickford, recently told me that their nurses are increasingly under-taking all of the six- to eight-week post-operative orthopaedics X-rays for their resident orthopaedic vet to check. They are also considering splitting dental procedures into two appointments: the first a dental radiology/scale and polish with an RVN and the second with a vet to undertake more complex work, including extractions.

I like this idea; the client will have a better understanding of the costs because the need for extractions can be clearly demonstrated following the first appointment. They will also get better value as the patient will spend less time under anaesthetic – a tick in the box for patient care. Nurses meanwhile retain charge of a service they are qualified to deliver. This will also generate greater use of the dental X-ray equipment, helping the balance sheet.

Remind your vets to refer to nurse consults

Do remind your vets to refer patients internally to nurse consults. I was pleased to hear that Naomi’s practice now has a waiting list for their nurse consults – and these are chargeable consults!

Free up your nurses to do more rewarding work

Give your RVNs time to do work that is rewarding for them and more profitable for you. For instance, hire and train a suitably qualified person from your lay team to be a pharmacist/dispensing technician. If you make balancing the CD/DD book and stock their prime responsibility, you will free up your nurses to focus on clinics and consults.

Many practices take on work experience students, usually year 10s on placements. You can take this one step further. If any are keen to train as nurses, offer them a paid Saturday job. If all goes well, suggest the Level 2 Veterinary Nursing Assistant Qualification – with you as their sponsor and host practice. You can then influence and support the development of their career in nursing. You would be building your workforce in an affordable way, using your nursing assistants to support your nurses, allowing them more time to do more of what they are qualified for and future-proofing your business.

To summarise

  • Talk to your nurses
  • Develop your nurses
  • Promote your nurses and their skills
  • Value your nurses

Get this right and you will retain your nurses who, in return, will help build your bottom line!

Stuart Saunders has been a practice manager for more than a decade and currently fulfils this role at Fitzpatrick Referrals. He has been a board member of the Veterinary Management Group since 2016.

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