After years of training, both at college and on the job, veterinary nurses are qualified to undertake many routine procedures unsupervised. Responsibility is what a nurse trains hard to achieve – the feeling of having made a real, positive difference to the lives of pets and their grateful owners is hard to beat.

And yet so many nurses appear to be under-valued by their practices, given roles made up entirely of advising rather than doing – covering diets, behaviours, dental care and the like. Of course, each of these is a perfectly valid area in which pet owners require education and guidance, and they are a necessary part of a nurses role. But it should be just that, a part.

Enlightened practices up and down the country are realising that giving nurses ‘bookable’ appointments in the consulting room is not only an obvious solution to the issues facing them, but also that it benefits everyone:

•   utilising available skills across the team more effectively

•   boosting nurses’ morale

•   retaining skill levels (‘use it or lose it’)

•   clearing space in the vets’ diaries to see more clients, and to undertake the more complex procedures for which they are trained

•   allowing longer appointments so clients can discuss other issues and concerns

•   improving the customer experience for clients

•   increasing word-of-mouth recommendations from delighted clients

•   ultimately bringing more paying customers into the practice…

•   … and happier staff, doing the job they love.

It is so obvious that it’s hard to believe that more practices are not giving nurses ‘consult time’ in the appointment diary. If it happens at your practice, you’re undoubtedly in the lucky minority.

More consulting nurses = more money

Now before you get too excited, taking responsibility for consultations is almost certainly not going to get you an immediate pay rise. After all, it’s only asking you to do what you’re trained to do anyway. The more pressing reason is that your practice simply can’t afford to pay you any more; it can’t afford to pay anybody more.

A practice is a business. Sure, the ‘caring for animals’ bit is fun and rewarding, but unless it brings in enough money to pay all the bills, then its a hobby, not a business.

Forty per cent of the practices turnover goes into wage packets and another 25 per cent to wholesalers, so that by the time 20% VAT is added on, there's not much left to pay for rent, training, equipment, insurance, electricity, phones… You get the idea. Just like your household budget, the practice purse is pretty empty come the end of the month.

But, many of those outgoings are fixed, regardless of how many clients you see. So bringing in more clients who spend more money brings in more funds to the practice. Which in turn may deliver more profit and secure everyone’s jobs. Then, and only then, maybe you can have a little chat about that pay rise!

In this context, nurses running diarised consultations is not only ‘nice to have’ – it becomes pretty much essential for the health of the practice. Your practice nee3s you.

Time to change the status quo

In the past, many vets have not supported the idea of nurses taking booked consulting slots. Perhaps they felt that nurses couldn’t be trusted to express that anal gland quite as well as they can. Perhaps it’s a pride thing. Perhaps they don’t want to admit that there isn’t enough of the big, meaty surgical work to keep their days filled (which is a whole other problem).

Whatever the reason, practices no longer have the luxury of hanging on to processes and opinions that don’t make financial sense. There are almost twice as many practices in the UK now than there were ten years ago. Pet owners have more choices when considering where to take their pets. And they demand much higher standards – if the whole customer experience is not perfect, they’ll not only go elsewhere, but they’ll advise their friends to do the same. Suddenly nobody’s diary is quite as full anymore.

The fact is that there are plenty of procedures that appropriately qualified veterinary nurses can undertake, which include tasks such as:

•   administering second vaccinations

•   pre- and postoperative checks

•   nutritional support

•   expressing anal glands.

For every one of these that is allocated to a nurse, another appointment with the vet is made available for another paying client. Most practices have three or four consulting rooms, and at least one is probably empty whilst vets are consulting, so it’s an effective way to utilise both staff skills and practice resources.

With additional longer, 20-minute appointments offered throughout the working day, the practice could bring in 18 to 20 extra ‘paid-for’ consultations from every nurse every day, at no additional cost. The maths is very simple. Blindingly, obviously simple in fact.

Make it happen

Nurses clearly possess all the clinical skills to undertake consultations, but the interpersonal skills required can always benefit from a little polish! Unlike our clients, their owners answer back!

Following the seven key principles of the Calgary-Cambridge consulting model (Google it!) along with regular training and role-playing can greatly improve a nurse's self-awareness and confidence, as well as productivity.

Booking onto a ‘7 Steps’ consult skills course designed specifically for the veterinary sector will pay dividends both for the nursing team and the practice. So make that your first appointment… and the rest will follow. 

Case study: Ark House Vets, Leighton Buzzard

For the last three years, nurses at this Bedfordshire practice have been allocated consulting time. Nurses are rostered on to regular days of booked appointments, and the diary is always full. Considering that the income from each of these appointments is all incremental, it's no surprise to learn that the practice is doing very well in every area – finances are healthy, footfall is increasing year on year and clients are delighted with the friendly and personalised care they receive.

Kate Semple, principal of the practice explains, "Ark House has seven vets and three fully-qualified nurses (ably supported currently by three additional student nurses), so we already have plenty of staff. We also have plenty of clients needing appointments for their pets, and so it made sense to us to allocate more roles to our highly skilled nursing team.

“In an average week, all our nurse 'consult slots' in the diary are full, which has freed up time for our vets to see the increasing numbers of new clients who are registering with us. The nurses are motivated and enthusiastic, and our clients are building strong friendships with the nursing team."

Case study: NuVet, Peterbo
rough

Offering nurse consultations is a relatively new development at the practice, but then NuVet has only been open for three years! Marwan Tarazi, director of the practice, felt that employing more vets was not the most effective way to handle the increasing client numbers, especially when the nursing team is already motivated and highly capable.

"We realised that we had to organise our workload better, and as there are many tasks that the nurses were keen to take on, that was the perfect place to start. We've allocated consult time specifically for nurses in the practice diary, so now when a client phones for an appointment we are able to offer them a slot with the nurse sooner than they would otherwise have to wait to see a vet.

"Obviously it depends on the patients need, and so our reception team are trained to allocate procedures to the most appropriately qualified person. We've lots of new clients registering with us. and 97 per cent of them have found us through recommendation, so it's safe to say that our clients are more than happy to see our nurses where they can."

Author

Alison Lambert BVSc MMRS MRCVS

Alison is a well-known and thought-provoking speaker. Following qualification as a veterinary surgeon from Liverpool University, she worked in small animal practice for several years prior to leaving to pursue a business career, first with Hill’s Pet Nutrition and then MARS. Alison is a visiting lecturer at Nottingham University vet school covering customer understanding and sits on the Royal College of Veterinary Surgeons communications committee.

As founder and managing director of Onswitch she and her team are constantly provoking new thoughts and ideas for the animal-care professions.

To cite this article use either

DOI: 10.1111/j.2045-0648.2012.00239.x or Veterinary Nursing Journal Vol 27 pp 426-428

• VOL 27 • November 2012 • Veterinary Nursing Journal