By Ailish Copp BSc RVN

Ailish Copp is a 4 year qualified RVN from South Wales with interests in diabetes, orthopaedics, pet weight clinics and staff wellbeing. She lives in South Wales with her partner, snakes and cat, but spends many weekends with Rupert, her parent’s golden retriever. She enjoys her spare time crocheting, sewing, and going to concerts and music festivals with her partner.

Introduction

Chronic illness impacts around 26 million individuals in the UK, with 10 million experiencing multiple conditions. A chronic illness is characterised by having health issues for which there is currently no cure, necessitating ongoing medical treatment and management using a variety of therapies and medications [1].

In the veterinary sector, approximately 1 in 14 veterinary professionals report having at least one disability or chronic illness that hampers their ability to perform daily tasks. There are likely many more who may feel uncomfortable disclosing their struggles [2]. Why is that? Is it fear of judgment, embarrassment, a lack of support, or concerns about job security?

It’s crucial to recognise that admitting to having a disability or chronic illness carries no shame or embarrassment – These challenges are simply the cards we’ve been dealt. Personally, I am living with hypermobile Ehlers-Danlos Syndrome (hEDS), which brings fluctuating symptoms, primarily chronic joint pain and hypermobile joints. For years, my symptoms went undiagnosed and were attributed to “growing pains” during my teenage years – Only now do I realise that real growing pains shouldn’t be painful. Unfortunately, hEDS has led to joint damage in my left hip, requiring surgical procedures such as hip arthroscopy and potentially a hip replacement down the line. (At just 29, I often feel like I’m going on 79, complete with a walker and walking stick).

Click each of the sections below to open them.

Understanding the Spoon Theory

Those who live with chronic illnesses are often referred to as “spoonies” or “spoonholders.” Unlike individuals without chronic illnesses, who possess an unlimited supply of spoons [3]—representing energy and opportunity—spoonies must manage their finite resources carefully.

Imagine waking up after a restless night filled with discomfort, and instead of the typical 12 spoons, you only have 10 for the day (Figure 1).

Figure 1 12 spoons of energy [4]

That’s 11 spoons used and leaves you with just one spare spoon, which sets you up for ‘borrowing’ energy from the next day. If you exceed your spoon budget, it could trigger a flare-up of your symptoms, leading to the necessity of calling in sick the following day.

I recently listened to a thought-provoking podcast by Clare Hodgson, who notes that individuals experience spoon theory differently depending on their particular illness, pain levels, and energy levels. For those interested, the British Chronic Veterinary Illness Society offers this podcast along with many other valuable resources [5].

Addressing Research Gaps

Research highlights a significant gap in support for colleagues and employers grappling with chronic illnesses. A questionnaire shared by the author, indicated discrepancies between the adjustments employees needed and those employers provided. This suggests that both parties often lack clarity about what support is available and necessary. Organisations like the BVCIS offer extensive support and resources for both employers and employees, including a Facebook group called “Veterinary Spoonholders” for anyone seeking advice or community support following a new diagnosis or in navigating workplace challenges [4].

The BVA’s 2021 report on discrimination pointed out a bias against individuals with disabilities in the workplace compared to other forms of discrimination. Employees with chronic illness or disabilities may often be viewed as “problems” due to misunderstandings and rigid expectations about job performance [6].

Understanding Your Rights

The research by the author also indicates that inadequate support, coupled with discouraging comments from colleagues or management, can lead employees to question their fit within their current role or the veterinary profession as a whole. If you’re in this situation or have unintentionally made an insensitive comment, it’s crucial to know your rights and options.

Consider requesting an occupational health assessment, which can provide your employer with recommendations on necessary adjustments to fit your needs for a safer working environment. Understanding legal protections under the Health and Safety at Work Act 1974 ensures that your employer has a duty to maintain workplace safety and accommodate your health needs [7].

While asking for an assessment might seem intimidating, it’s a proactive step for your well-being and that of your coworkers. Employers must prioritise creating an inclusive culture where understanding and support are foundational values [7].

Recognising Discrimination

Discrimination, as defined by the Disability Discrimination Act 1995, occurs when disabled individuals are treated unfavourably for reasons related to their disability without justification [8]. To adequately carry out your day to day work tasks, your employer has a duty to ensure that the environment you work in is safe. Whether that’s the right equipment or by ensuring that everyone is well informed on disability discrimination and bullying. This is regardless if you have a disability/ chronic illness or not. Far too often, we have all heard of a good vet/ vet nurse/ veterinary care assistant etc, leaving the field because of a toxic work culture and it has to stop [9].

The Research Findings

To investigate the challenges surrounding reasonable adjustments for employees in the veterinary sector, a small anonymous study was conducted by the author. The aim was to assess whether there exists a gap between the adjustments employees require and what employers are currently providing, particularly for those with chronic illnesses.

The study included 134 participants, with 38.8% aged between 26-35 years. While 133 participants responded to questions regarding their location, the vast majority (77.4%) were based in England. Notably, 98.5% of participants identified as female, and a significant portion, 50.7%, were registered veterinary nurses, with 78.4% working in the small animal sector (Figure 2).

Figure 2 Roles of respondents

When asked if they remain in the veterinary field, 82% responded affirmatively, while a smaller percentage noted they work in non-clinical roles (Figure 3). Alarmingly, 15.5% of respondents who left their roles attributed this decision to their chronic illnesses, with 90% of those stating that discrimination played a role in their departure. This underlines the critical impact of workplace culture and behaviours on staff retention in veterinary practices.

Figure 3 Number of respondents in clinical and non-clinical roles

The Impact of Chronic Illness

The study revealed that 92.5% of participants acknowledged that their chronic illness affected their job performance. When queried about adjustments made at their workplace due to chronic pain, 127 participants provided insights. Among the reasonable adjustments identified were:

Altered Roles: Transitioning to less physically demanding tasks during flare-ups.

Reduced Hours: Moving to part-time roles or ensuring adequate rest between shifts.

Microbreaks: Short intervals for rest, medication, or hydration.

Interestingly, while some might view microbreaks as unproductive, research suggests they can enhance overall employee well-being and reduce sickness absence [10]. This study with 36 students over 6 weeks demonstrated that microbreaks improved staff’s overall physical health and improved staff efficacy leading to increased patient bonding and improving the client experience.

An additional aspect of the study involved regular check-ins with managers to discuss how adjustments were impacting employees and what further support might be required. Such dialogues are crucial in fostering understanding and promoting a culture of support [10].

The Need for Practical Adjustments

In examining the final question of the author’s study, regarding reasonable adjustments; 12.6% of respondents answered they hadn’t been provided with responsible adjustments or they were still waiting for their occupational health assessments after a rather lengthy amount of time.

Reasonable adjustments don’t need to be expensive, but will vary between practices as it depends on facilities available. Examples include; a mat for kneeling on when restraining patients, a standing aid to help you get up from the floor, and orthopaedic stool when monitoring anaesthetics and adjustable brightness screens.

From the author’s survey, it emerged that many employees felt they needed the option to sit down or use a stool for daily tasks. A concerning 38% reported that such an adjustment would significantly alleviate their pain. It’s important to recognise the cognitive strain chronic pain can impose, affecting attention and processing speed.

Implementing simple solutions, such as providing seating, could substantially improve not only the physical comfort of employees but also their cognitive function, ultimately enhancing patient care [11].

Research centred on the HALT initiative, conducted at the Guy’s and St Thomas’ NHS Foundation Trust, underscores a multidisciplinary approach with an emphasis on physical and emotional well-being. However, it doesn’t include pain. How often do individuals dismiss physical pain or simply take a dose of painkillers and carry on? Perhaps an additional letter should be added to the HALT acronym to address this oversight. Could the acronym evolve into PHALT, or is there a need to create an entirely new term? [12].

Table 1 Physical and emotional wellbeing

PainAre you in pain? Are your painkillers not working?
Hungry and/or thirstyTake a microbreak and have a snack or a drink
Anxious and/or angryTake some time to decompress
Late and/or lonelyAre you late for work which leaves you flustered, which may lead to mistakes – take time. At the start of the day, plan breaks with the team.
TiredAccording to Dr Mike Farquar, a consultant at the Guy’s and Thomas NHS foundation group, unless critically ill patients require immediate attention, patients are better served by clinicians who have adequate rest and sleep during their shifts [12]

Moreover, the study highlighted the importance of understanding from colleagues and managers. About 23.6% expressed that simply having their challenges recognised would make a significant difference. Chronic illness often varies day by day; thus, flexibility and empathy from employers and co-workers are invaluable.

Unfortunately, having a chronic illness is often associated with chronic pain, something I, myself am all too familiar with. It varies from day to day, so one day I’m able to do one thing and the next I’m not. But it doesn’t make me any less valuable of an employee. And I’m sure the same applies to many, many others. We still have a lot to offer in the veterinary field, we just have a different way of doing things.

Chronic Illness/ Spoonies are often flexible, empathetic, kind, understanding, patient and our calm nature often helps stressed out pets. For example, understanding how living with pain can feel, allows us to give a bit more leeway with patients showing fractious behaviour due to their symptoms.

There are also areas where we may not be able to be as flexible such as short notice for changing hours or a rota. These changes may impact on timings for taking medication or mean cancelling a medical appointment; which can be difficult to arrange.

Conclusion and Acknowledgements

Overall, the findings of this study illustrate a significant disconnect between the adjustments needed by employees and those currently provided by employers. The most common requests were for practical solutions like seating and increased understanding from colleagues.

To bridge this gap, it is essential for veterinary practices to foster a more inclusive environment. Engaging in open discussions about needs, seeking occupational therapy assessments, and embracing a culture where employees feel safe to express their requirements are crucial steps. Also, co-workers need to be aware that their colleagues may not ask for help due to judgement and embarrassment but being open with your employer and co-workers will lift some of the expectation that we can do the jobs that non spoonies can. It’s a road that may be paved with ups and downs, but it also may be a road that may have doors that have solutions for us. It’s a path that may come with its share of ups and downs, but there may be simple solutions to smooth the working environment for all staff.

As we navigate these challenges, let us remember that those with chronic conditions bring invaluable insights and qualities to the veterinary field. With the right adjustments and support, we can create a workplace that benefits both employees and the animals in our care.

I’d like to thank all those who participated in the study as it provided invaluable research to living with a chronic illness in the veterinary field.

References

1 Huitson, Kelly. (2022). Chronic illness and resilience in the veterinary industry. The Veterinary Nurse. 13. 114-118. 10.12968/vetn.2022.13.3.114

2 Cawston R. Chronic Illness: Professional Barriers. bvacouk [Internet]. 2021 Jan 20 [cited 2021 Feb 1]; Available from: https://www.bva.co.uk/news-and-blog/blog-article/chronic-illness-professional-barriers/

3 Miserandino C. The Spoon Theory written by Christine Miserandino – But You Dont Look Sick? support for those with invisible illness or chronic illness [Internet]. But You Dont Look Sick? support for those with invisible illness or chronic illness. 2013. Available from: https://butyoudontlooksick.com/articles/written-by-christine/the-spoon-theory /

4 Johnson C. Spoon theory: What is it and how can it help people living with chronic illness? – Carenity [Internet]. www.carenity.us. 2022. Available from: https://www.carenity.us/condition-information/magazine/advice/spoon-theory-what-is-it-and-how-can-it-help-people-living-with-chronic-illness-1414

5 Hogdson, C. Gomez, F. Spoonies and Spoonholder Theory. More than Just a Vet: British Veterinary Nursing Association [Internet]. North Yorkshire, England: Soundcloud, 2021 [11/09/2024]. Available from: https://soundcloud.com/user-689463605/spoonies-and-the-spoonholder-theory-by-claire-hodgson

6 BVA (2021) BVA discrimination in the veterinary profession statistics 2021. Available online: https://www.bva.co.uk/media/4393/bva-discrimination-stats-2021.pdf

7 Legislation.gov. health and safety at work act [Internet]. 1974. Available from: https://www.legislation.gov.uk/ukpga/1974/37/contents

8 Disability Discrimination Act [Internet]. 1995. Available from: https://www.legislation.gov.uk/ukpga/1995/50/section/3A

9 Disabled employee retention | Disability charity Scope UK [Internet]. Scope. 2023 [cited 2024 Sep 11]. Available from: https://www.scope.org.uk/campaigns/research-policy/employee-retention

10 Grünwald J, Licka T. Health (2023) Promotion for Students of Veterinary Medicine: A Preliminary Study on Active Microbreaks and Ergonomics Education. Animals. 2023 May 15;13(10):1641–1.

11 Möller MC, Berginström N, Ghafouri B, Holmqvist A, Löfgren M, Nordin L, et al. Cognitive and mental fatigue in chronic pain: cognitive functions, emotional aspects, biomarkers and neuronal correlates—protocol for a descriptive cross-sectional study. BMJ Open [Internet]. 2023 Mar 1 [cited 2024 Sep 5];13(3):e068011. Available from: https://bmjopen.bmj.com/content/13/3/e068011#

12 Vetled (2022) Championing safe, efficient and effective veterinary care [Internet]. VetLed. 2022 [cited 2024 Sep 5]. Available from: https://www.vetled.co.uk/halt