Over the years the role of the veterinary nurse has evolved with treatment and procedure advances, greater client awareness and expectations, as well as a vast array of educational and professional growth opportunities within the field of veterinary medicine.
We feel a responsibility to educate clients and treat their pets with the latest and greatest in care more than ever before—all while restraining anxious pets, calming concerned owners, gathering patient history, processing paperwork, taking vitals, giving injections, drawing blood, processing urine and feces for evaluation, and the list goes on.
The common denominator of our multitasking is, simply put, communication—both verbal and non-verbal. Our tone of voice, eye contact, body language, clothing, vocabulary, and voice inflection all affect the sending and receiving of multiple messages to both the client and patient throughout each visit.
Then Came COVID-19
Prior to the COVID-19 pandemic, we took face-to-face client communication for granted. The thought of learning to communicate through a face mask and trying to hear a client from their car while talking on the phone never entered our most distant dreams. For the purpose of this article, I will highlight some of the communication challenges faced by triage veterinary nurses during this pandemic at my clinic, the Animal Emergency and Referral Center (AERC) of Minnesota. I am confident that many of the items reviewed have been, and will continue to be, experienced by day practices and specialty/referral clinics as well.
AERC began curbside service on March 13, 2020. We have a total of 275 employees dedicated to emergency and critical care and 9 different specialty and referral services. Looking back, that transition seems like ages ago. Each day has been a new adventure working to find more efficient and effective ways to communicate with clients while maintaining social distancing and using personal protective equipment to maintain a safe environment for employees and pet owners.
Our first line of customer interaction for our standard protocol involves a combination of customer service representatives and triage veterinary nurses (TABLE 1).
Triaging On the Fly
Our triage protocol was turned upside down starting with client arrival (TABLE 1). We still use the census for estimated time arrival tracking; however, the client now remains in their vehicle until given the go-ahead to leave after their first consult (via telephone) with the veterinarian. They only enter the building under special circumstances (BOX 1). This creates the following challenges:
- The owner and pet experience increased anxiety after being separated immediately upon arrival.
- It is our responsibility to develop trust and client confidence upon greeting them in our parking lot. In this role, we establish the first impression. Our tone and body language immediately set the stage. Oftentimes, clients will say, “My dog doesn’t like masks.” Our speaking volume beyond the mask can scare the pet. We need to be consistently aware of personal space for both owner and pet when removing the pet from the vehicle.
- Emergency visits are always scary for owners and pets. With this, we are charged to replace the separation anxiety with a sense of calmness by immediately bonding with the owner so the pet can see there is no threat. Pre-COVID, trust was developed while rooming the client along with their pet. The patient could sense that their owner was approving of this stranger by watching and listening. They know when a friend is in the room. Creating a connection with the owner as soon as possible is a key factor in setting the tone for the visit.
Upon arrival, the client is greeted at their vehicle by a triage veterinary nurse or customer service representative. The client is provided 2 ways to complete the admission form and patient history:
- Standard paperwork (2 pages total)
- Electronically via email. This new process (via JotForm, jotform.com) has proven to be efficient and effective. Upon their initial phone call, clients are emailed the paperwork in an easy-to-read, intuitive electronic form that can be accessed on a smart phone, tablet, or computer. The form is sent back to the AERC via email prior to their arrival. We then copy the data, update the census, and print relevant documentation for the veterinarian.
By utilizing this process, we have successfully limited fomite transfer (pens, paper, and clipboards) between clients and personnel. It provides a quick way to have all administrative work completed in advance of arrival.
The Out-of-Sight, Out-of-Mind Trap
The remaining steps are conducted through a combination of telephone and email. The next step is for the veterinarian to call the owner and review the history, symptoms, and comments. This is followed by a proposed medical plan (by the triage veterinary nurse) that is reviewed with the client and signed electronically.
Not only has this process enhanced the verbal communication skills of our customer service and triage personnel, but it has also demonstrated that the old “Telephone” game is alive and well. Client questions, medical plans, financial questions, and discharges are all performed without subsequent face-to-face time with the owner. It is imperative that we communicate clearly and accurately so that we can build upon the trust being developed with the client (and their pet) upon arrival. With this, the following skills are proactively fine-tuned daily:
- Active Listening: Understanding, empathizing, and responding
- Clarifying Questions: Confirming what you think you are hearing
- Review: Repeating back to them what you just said
In this era of streaming, social media, and texting, the opportunity to hone our verbal communication skills with live human beings has proven to be well received.
Just When We Thought It Was Safe
With COVID-19 protocols implemented at clinics throughout the country, it was only a matter of time until emergency clinics would be called upon to handle the overflow from referring veterinarians who don’t have the staffing due to illness or quarantine.
With this, our increase in emergency and critical care exams has grown by 56% from March to October 2020. For the same period, phone calls rose a staggering 234%. This places an inordinate amount of stress on all clinic personnel to maintain quality and professional care, while conveying a calm demeanor to clients. The urge to rush and think about what to do next is constant. Staying in the moment while speaking to clients helps maintain focus. In addition, post-shift debriefing with coworkers proves beneficial in helping keep perspective and lessen stress and anxiety.
The increase in volume (incoming phone calls and on-site visits) packs more pressure in less time to answer client questions, explain treatments, review medical plans, and discuss discharges. Thus, the need to be concise and to the point is mandatory.
Economic Stress Hits Home
In the ER, finances are consistently under the surface of every visit. Talking money is challenging in the best of times, let alone during a pandemic when unemployment and business closings are increasing daily. We have seen this firsthand while working out financing options for clients concerned about how to pay for their visit or hospital stay. While this has always been part of our role as veterinary nurses, compassion and understanding are paramount in working with clients and their pets now more than ever.
What Happens Down The Road?
With every challenge comes an opportunity. We can already see processes we’ve put in place remaining as part of our triage protocol when the virus has run its course.
- Pre-Arrival Electronic Intake Forms: JotForm email check-in has proven highly efficient in helping to streamline the intake process, while maintaining social distancing and safety guidelines.
- Communication Skills Have Been Fine-Tuned: COVID-19 has provided each of us an intense crash course in one-on-one communication, all while wearing a mask. The listening skills of everyone in the clinic has been taken to a new level in terms of utilizing active listening, asking clarifying questions, and reviewing the discussion accurately. In a world where text messaging rules the day, I have faith that verbal one-on-one communication isn’t going away any time soon.
- People Are Hurting: Because fees are payable upon rendering of services, we have always been up front about the payment options we have for clients. However, we are now seeing a greater number of individuals negatively affected financially by the virus outbreak. This is another challenge in what can be a heartbreaking experience. It is another communication opportunity to provide empathy, compassion, and possible solutions/alternatives outside of our normal areas of influence.
- The Real Meaning of Teamwork: Having spent 34 years in corporate America, I have never witnessed such camaraderie, unselfishness, passion, and empathy. This includes every aspect of our operation, from the veterinarians to facilities to human resources. I can only imagine the thousands of times this is seen at clinics nationwide during these unprecedented times.
At the end of the day, no matter how technologically advanced we get both in our personal and professional lives, we are dependent upon clear and concise communication in order to successfully serve our clients and their pets. Sometimes challenging experiences provide us the opportunity to get back to basics while also stretching ourselves to take continuous learning to the next level.