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Featured, Summer 2021, Personal/Professional Development

Back to Basics

"No matter how cutting-edge veterinary medicine gets, no multi-parameter monitor will be able to replace a skilled set of hands and close observation."

Megan BrashearBS, RVT, VTS (ECC)

Megan graduated in 2000 with a BS degree in Veterinary Technology. She has enjoyed working in emergency and critical care since 2000 and is currently the Small Animal Veterinary Nursing Manager at the Purdue University Veterinary Teaching Hospital in West Lafayette, Indiana, where she oversees the technician supervisors as well as teaches and trains technicians and students on the hospital floor. She loves the opportunity to travel and lecture, sharing her knowledge with veterinary nurses and technicians around the world.

Back to Basics
Jarom Vogel
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My first job as a newly graduated, freshly credentialed veterinary technician was working the swing shift at a fast-paced emergency and critical care hospital. I did well in my veterinary technology program and assumed I would continue to quickly learn and assimilate information, but then reality hit. The term “drinking from a firehose” seems perfectly applicable when thinking back on my first few years on the job.

I remember feelings of frustration and failure as every single case felt brand new. I struggled to master the art of dehydrated cat veins and felt panicked at the thought of emergency anesthesia. I was in awe of my more experienced teammates and worried that I would never catch up to their level of skill and knowledge. 

A few short years later I was studying for my Veterinary Technician Specialty exam and was shocked at how much basic information I was learning in the process. The very simple connection between tachycardia and hypovolemia or vasodilation and hypotension was finally becoming clear. In my quest to be the best, I had skipped over the most basic knowledge. I had mistaken technical skill for medical knowledge and assumed that once I could place a catheter 100% of the time, I would be an amazing veterinary nurse. What I learned is that while placing IV catheters, drawing blood, perfecting radiographs, and learning new and advanced techniques are obviously vital to the practice, they are also the “fun” part. Fewer people want to put in the continued work and study required to master physiology, pharmacology, the understanding of disease processes, and learning to look for subtle changes in the patient. These skills are what set stellar veterinary nurses apart from merely good ones. True advancement comes from learning and building on the basics. 

Trust Your Senses

If you’re new to the profession and overwhelmed with everything you don’t know, think about what you do know. Take that critical patient and break the problems down to what you understand. Start with the basic monitoring parameters and work through them. If the patient is hypothermic, why? What other changes can we see from hypothermia? Next, check the heart rate and feel the pulse quality. What reasons might be causing a change in heart rate? Why be concerned if you cannot feel strong femoral pulses? Oftentimes we get distracted by all of the new toys with all the bells and whistles that we forget to use our eyes, ears, and hands to determine what is going on with our patient.

The  veterinary nursing process first asks us to look at each patient and assess their status, gathering a history and collecting vital signs. Then we analyze the information, giving our observations and information to aid in the diagnosis. Next, with the veterinarian, we plan the order of diagnostics and treatments, paying attention to changes that may require reprioritization. Then, veterinary nurses get to implement the plan and engage all of our skills to provide care to the patient. Lastly, and continuously, we evaluate the patient and the results, making adjustments to our training, our staffing, and our care to ensure the best outcome possible. Implementing the nursing process may seem tedious at first and take more time than you may have available. The more you think through the process, the closer to second nature it becomes. Each step is an opportunity for learning. Each new skill learned or disease process better understood adds to the bank of knowledge to be accessed with additional patients.

Remember the Human Element

No matter how cutting-edge veterinary medicine gets, no multi-parameter monitor will be able to replace a skilled set of hands and close observation. A monitor can only tell what is happening now; a veterinary nurse can anticipate what is coming next. Rely on your observations. Are the gums less pink than they were an hour ago? Do those pulses feel weaker than when the patient came in? Is that breathing pattern different? These are clues that no monitoring equipment will be able to detect. A skilled veterinary nurse can never be replaced if they are using their critical thinking skills.

Leverage the Little Things

One of the benefits of being a veterinary nurse is our focus on basic practicality. Nothing a veterinary nurse does is wasted energy. Every interaction with a patient—even something no one enjoys, such as cleaning up diarrhea—is for the patient’s benefit. Tender loving care is included in Kirby’s Rule of 20 and is performed by the veterinary nursing team with every patient.1 Every snuggle in a kennel is an opportunity to evaluate pain scores, respiratory status, and patient mentation. Every walk outside is an opportunity for patient enrichment and to examine urine output and character. Charting and rounding gives the opportunity to record important bits of information for the next shift to remember and to keep continuity of care. When we really dive into the basic reasons we go to work every day, we see that no minute throughout the day is wasted—every task is an opportunity to better the patient and learn more information about them and their status. Take pride in that work and what it means to the patient, the client, and the veterinarian. Veterinary nurses contribute every minute of every day.

We all want to be better. We want to be able to place every catheter, be confident monitoring every anesthesia, and easily calculate the most complicated dilutions. In our quest to be the best, be careful not to skip over the fundamental knowledge. One of the most difficult parts of being new to a career is the overwhelming amount of experience and knowledge everyone else seems to have. Be patient with yourself and with those around you. Ask questions, even if they seem silly. Pay attention to how an experienced veterinary nurse prioritizes and can multitask through a busy shift. Remember to spend the time on the basic patient interactions to notice the subtle changes. If you build a solid base of both understanding and skill, you will soon enough be the one setting the example. 

Additional Reading

Davis C. The nursing process and nursing models. In: Mullineaux E, Jones M, eds. BSAVA Manual of Practical Veterinary Nursing. 1st ed. BSAVA;
2007:95-104. 

References

1. The Veterinary Nurse. Kirby’s rule of 20: the veterinary nurse’s critical patient checklist part 1. theveterinarynurse.com/review/article/kirby-s-rule-of-20-the-veterinary-nurse-s-critical-patient-checklist-part-1. Accessed March 2021.

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