Veterinary nurses – The heart of quality veterinary medical care

Veterinary Nurses – The heart of quality veterinary medical care

Veterinary nurses are the key to quality care within our hospitals.   They provide communication to clients, laboratory skill, surgical assistance, anesthesia monitoring, in hospital treatment, and warm hugs to patients.  They do all of this while helping to keep veterinarians on task and on time.

Experienced veterinary nurses keep patients safe, especially with new veterinarians or during a busy day.  My first year in practice, one excellent veterinary technician would keep me in line, by saying, “Hmmm. . . I haven’t seen another veterinarian do it that way.  Have you considered this instead?”  When I owned my practice and hired new veterinarians, I always told them to really listen when one of the experienced nurses gave them input because it would probably save their patient’s life.

A crisis in the industry

When I talk to veterinarians across the country, one of their biggest concerns is not having enough veterinary nurses to staff their hospitals.  This is especially a concern in veterinary emergency hospitals around the country.  In one Puget Sound hospital, the severity of the technician shortage has led to intermittent closures.

The problem is likely to get worse.   A working group of the Veterinary Emergency Critical Care Society (VECCS) recently surveyed veterinary emergency technicians, emergency doctors, and practice managers.  Of the over 900 technicians who answered the survey, 37% plan to leave the profession in the next 5 years. When asked why they plan to leave, compensation was one reason.  However, many mentioned that lack of support in caring for patients was an important reason they were considering leaving the profession. Technicians reported that they only had the tools and support to care for patients 40% of the time.

Nurse to patient ratios are crucial for quality care

              I think most veterinarians know that not having enough staff can lead to a breakdown in patient care. This is especially true in the emergency and ICU settings where things happen rapidly.  Human healthcare studies have demonstrated the importance of adequate nursing care.  In a large study involving 6 million hospitalized human patients treated at 799 hospitals in 11 states, increases in nursing hours per patient:

• Decreased the hospital length of stay
• Lowered the rates of urinary tract infections
• Lowered the rates of pneumonia AND
• Lowered the rates of new shock and cardiac arrest

A study of nursing workload at four Finnish hospitals showed that patient safety incidents and patient mortality increased when nurses had more patients to care for than recommended optimal levels.

New study confirms the importance of veterinary nursing levels for quality care

At IVECCS 2019, Dr. Galina Hayes presented her study, sponsored by the ACVECC research grant, examining the impact of veterinary patient to nurse ratios on incidence of adverse events in the ICU.  This study was a prospective observational study that took place at Cornell University, University of Guelph, and Angell Animal Medical Center.  Trained observers watched over 1000 hours of ICU care.  They documented patient number, patient illness severity, ICU staffing levels, ICU technician experience levels, and the incidence of adverse care events.  They found that the risk of a major error doubled and the risk of a minor error tripled when the ratio of patients to nurses was over 4 compared to under 4.  Their analysis concluded that maintaining ICU staff levels at no higher than 4 patients per nurse could reduce the incidence of major errors by 60%.

Inadequate Veterinary Nursing care levels also contribute to burnout

In a companion study also presented IVECCS this year, 344 ICU technicians from 4 large hospitals were recruited for a study on burnout.  256 participated and completed an anonymous Maslow burnout inventory survey.  Burnout scores in this group were higher than in a contemporaneous group of human nurses in a level one trauma center.  Burnout scores were associated with an increase in the number of self-reported medical errors.  The factors that that had the most strongly explanatory power for burnout were interpersonal conflict at work, inability to get support with increases in workload, and a perception that patient load was too high to provide quality care.

Will Consolidation affect Veterinary Nursing Level

These studies provide important evidence that quality care relies heavily on our veterinary nurses.  This is crucial to realize in this era of decreased state budget support for veterinary colleges and in the era of private practice consolidation.  Staff cost percentage is a line item target of many administrators at large veterinary entities.  I worry that this is getting worse as many of the entities buying veterinary hospitals are backed by private equity finance.  Studies have shown that private equity owned businesses have lower employment and lower wages post buyout.

Veterinarians need to advocate for Veterinary nurses

If veterinarians want to provide quality patient care, we must be active advocates for veterinary nurses. We need to treat veterinary nurses as valued team members. We need to use their skills and ask their opinions on how to improve patient care. We need to insist upon appropriate ICU staffing levels and make sure nurses have the tools they need to care for our patients.

As I stated last year, I strongly believe that veterinary organizations, large and small, will not truly provide quality care unless both veterinarians and veterinary nurses have a seat at the decision-making table.  Will this be the year when we might see Chief Veterinary Technician Officers? Will the newly developing veterinary technician unions instead be the ones to advocate for the patient to technician ratios needed for quality care?

During this National Veterinary Technician Week, thank the veterinary nurses in your hospital. Tell your clients about how nursing care makes a difference for their pet.  Most importantly, advocate to your employer for appropriate compensation for your nurses, appropriate nursing input in decision making, and appropriate staffing ratios for quality veterinary care.