MS, RVT, VTS (ECC, SAIM)
Ken has spent nearly 20 years in practice. He obtained his VTS certification in emergency and critical care, as well as small animal internal medicine, and earned his master’s degree in Veterinary Science. He served as ICU Manager and Blood Bank Manager at Adobe Animal Hospital until 2018, and is now Program Director for the RECOVER CPR Initiative and simulation lab manager of the Park Veterinary Innovation Laboratory at Cornell University. He co-chairs the Veterinary Nurse Initiative and serves as a board member of the Veterinary Emergency and Critical Care Society, the Academy of Veterinary Emergency and Critical Care Technicians, and the Veterinary Innovation Council.Read Articles Written by Kenichiro Yagi
“We utilize our veterinary nurses at the top of their license,” is a phrase that is commonly used these days to indicate that a practice uses their veterinary nurses to the fullest extent possible. But what does that really mean?
The Importance of Appropriate Utilization
Utilizing veterinary nurses at the top of their licenses means using them for everything they are legally allowed to do. By doing so, a team should be able to provide the best care to as many patients as possible in an efficient manner, which should lead to growth and fulfillment for the veterinary nursing team members.
Where Is the Top of Our License?
I would argue that there are very few veterinary nurses truly being utilized at the “top of their license” today. To better understand this concept, let’s focus on tasks that are generally not delegated to veterinary nurses. There are advanced procedures that carry a higher degree of patient risk and not commonly performed by veterinary nurses in practice. Generally speaking, the field of veterinary medicine is set up in a way in which the liability of patient risk is taken on by the veterinarian and their license. Unblocking a cat, suturing laceration wounds, and endoscopic gastric foreign body removal fit into the category as procedures many teams perform that are not considered the act of diagnosis, prognosis, prescription, or surgery. Should veterinary nurses be able to perform these procedures?
Key Questions to Ask
When considering whether or not a veterinary nurse should be able to perform a particular procedure, there are a few key questions to ask:
- Is it legal? The Veterinary Practice Acts and some state veterinary medical boards specify the tasks that can be legally performed by veterinary professionals. Generally, veterinary nurses can perform tasks as long as they do not provide a diagnosis or prognosis, prescribe treatment, or perform surgery.
- Is the veterinary nurse qualified? It takes an educated and trained person to perform a specific procedure without compromising patient safety. We need to be confident that the person can be trusted to carry out the procedure.
- Is this the right patient? The patient’s condition should allow a qualified individual to attempt the procedure without increased risk of complications.
- Is there appropriate support? The equipment and supplies to perform the procedure appropriately should be available, as well as someone who can provide assistance and coaching if needed.
- Are the expectations clear? Veterinary nurses should have a clear understanding of what best practice looks like for the task, whether it is through common understanding, guidelines, or established protocols.
Applying These Questions
Let’s apply these questions to the task of unblocking cats. First, this task doesn’t generally fall into the legally restricted categories of diagnosis, prognosis, prescription, or surgery. However, it is important to seek legal guidance. The simplified expectations for unblocking cats are usually clear: pass the catheter while noting the characteristic of the blockage without causing excessive trauma to the urethra or tearing it. Whether the equipment and supplies needed for the procedure are available varies by practice. Whether the veterinary nurse is qualified is variable. Not many veterinary nurses have experience unblocking cats. Avenues for formal training are rare. However, some experienced veterinary nurses have assisted in unblocking cats countless times and often guide doctors who are unfamiliar with the procedure through the process. These experienced veterinary nurses are the most ready to be trained to perform the procedure themselves, albeit on the right patient (i.e., a patient expected to be uncomplicated) by a team member skillful at teaching and giving guidance on this procedure.
If your answer to these questions are still “No. It’s too risky,” are the veterinary nurses in your practice performing all procedures with acceptable level of risk? What is the most advanced procedure and task they take on? Is that truly at “the top of their license”?
Having veterinary nurses perform advanced procedures when all the factors are not in alignment is reckless utilization. However, when done appropriately, it can lead to superior patient care, better fulfillment, and improved team efficiency.
The following situations should be avoided:
- Tasking veterinary nurses with a procedure they are unready or unprepared for
- Having or pressuring veterinarians who are not comfortable delegating or teaching oversee veterinary nurses as they complete a new task or procedure
- Limiting a veterinary nurse’s growth through the establishment of policies that prohibit their participation in legally allowed procedures
Veterinary teams should take state regulations into consideration and provide guidance on what the veterinary nursing team should or should not perform in practice aimed at minimizing risk without unnecessarily limiting growth and efficiency. Both the veterinary care team and patients would benefit from a structured training process for each skill performed in the hospital.
A lifelong career does not have artificial ceilings. Showing veterinary nursing team members how to responsibly advance their skills through supportive doctors, colleagues, and leadership is critical in developing and keeping the fantastic members of our profession who practice at “the top of our license.”