ABSTRACT: This is the second in a series of three scenario-based articles covering professional skills topics that are highly relevant to the veterinary nurse in practice today. The scenario presented is that of a client complaint following discharge of a cat after surgery.
The article explores the ethical, welfare, communication and professional aspects of the case. The purpose is to provide veterinary nurses with an outline of the considerations that should be addressed in order to deal with client concerns, nursing standards, and to create positive change to protocol.
In this second article on ‘Key Skills’ we shall explore how a problem can be dealt with and actually used to change protocol to reach the best outcome for the nurse, the client, the patient and the practice.
The aim is only to open up some of the processes necessary to move towards resolving the situation.
Who is in charge here?
It is important that a nursing manager/ head nurse understands the capacity of his or her role in this type of situation and is clear as to which responsibilities they have been designated, and which are the remit of the practice manager or one of the partners.
It is imperative that when offered a managerial or staff supervisory position, areas of responsibility are defined from the outset. Any discrepancies in this area may weaken the standing of the member of staff, the team, and ultimately the practice.
Sometimes clients will ask to speak to someone in higher authority, and whilst you should make it clear that you are empowered to deal with the problem, you should allow them this right if they persist. This is where teamwork is so vital, since you must communicate to the other staff member the situation and how you intend to deal with it; and they must back you up in advising the client that this is your area of responsibility and they are entrusting you to take the matter from there.
Client communication issues
When a client presents at the reception desk with any kind of complaint or complicated query, it is very important that a quiet and uninterrupted area – ideally a consulting room – is used to discuss it with them. This removes them from the public waiting room environment, enabling the problems to be discussed in private, whilst also creating a professional attitude towards the discussion.
"Don’t interrupt me!”
It is crucial that the client is permitted to describe his or her problem without interruption, and during this stage you should listen quietly, acknowledge that you are taking in what they are saying, but without interjection.
This is more difficult than it sounds; it can be easy to jump in with defensive counter comments, but this will only serve to exacerbate the situation. Generally anger will burn itself out if you give it the chance.
Is an apology admitting blame?
This is a question that frequently arises, and on initial consideration, an apology is admitting liability and should be offered with extreme caution. However, saying you are sorry that something has happened simply demonstrates that you have empathy for the situation, and this will undoubtedly help to placate the client. Conversely a lack of apology will only serve to indicate lack of understanding for their anguish.
Certainly in a scenario where the practice is actually to blame (as in this case, where pre-discharge checks were not carried out correctly) then an apology is a must. This does not have to be deprecatory, such as “I’m really sorry the nurse didn’t look after your cat properly”; but more in terms of the stress it has caused, for example, “I’m so sorry this has happened. It must have been very upsetting and I will look into this straight away, as our standard of care is very important to us”.
This not only shows empathy for the client but demonstrates you do not deem this to be acceptable, and something will be done, as of course it must be. (RCV5 Guide to Professional Conduct for Veterinary Nurses, (H:2) The handling of refunds is a topic that is too great to cover here. However, it should be noted that offering a refund following payment may be deemed as an admission of liability and should be handled with caution. In this case, the actual procedure that has been paid for has been carried out as described, and a refund is not necessarily appropriate.
Many practices would offer this as a measure of placating the client, but the key to resolving such a matter is not in reimbursing the client with the castration fee, but in handling their concerns promptly, professionally and with respect. As mentioned later, a letter to the client following the incident would also be very beneficial.
It may also show good faith to offer, for example, a service such as an extra post-operative check, at no cost to the client, demonstrating that you have the animal’s ongoing welfare as your primary interest.
What about the cat?
Clinical matters, such as whether that cat has recovered well and that the angiocath has been removed without detriment, should also be covered at this stage. It may also be beneficial to offer remedial measures, such as bathing the cat to remove any residual urine.
Personnel management
It is important that the complaint is raised with your colleague as soon as possible – certainly within that working day. Again, a quiet room should be used, where the conversation cannot be interrupted or overheard.
Explain clearly what the complaint was, and listen to what your colleague has to say. There may have been circumstances beyond their control – for example, an emergency, lack of training, lack of confidence in dealing with a fractious animal and so on. However, you must also make it clear that this is not an acceptable standard of care, and, if necessary, explain why.
Obviously there are implications for the cat’s welfare, such as hypothermia leading to poor recovery and haemorrhage from the angiocath, as well as the distress caused to the client and the resulting lack of confidence in the practice.
The Guide to Professional Conduct for Veterinary Nurses must be considered. Nurses have responsibilities to their patients, to the client and to the practice. With the regulation of Veterinary Nurses by the RCVS now a reality, nurses must be aware, that whereas previously they had a duty to adhere to this Guide when undertaking provision of care to animals, they may now have to appear before the Disciplinary Committee should any of the areas in the Guide be breached, and face the possibility of being removed from the Register should it be deemed appropriate.
In this case, the member of staff in question has been showing signs of stress, which can be exhibited in a variety of forms. You need to acknowledge that you have noticed this. As the nursing manager, you are responsible for the welfare of your staff, and your colleague may be suffering from problems of which you are not aware and that are not only affecting their work, but other aspects of their life.
The stress may be caused by work itself, such as over-work, training deficits, lack of support from other staff, and other such demoralising or de-motivating issues.
Using a problem to create positive change
In this situation, a ‘review of discharge protocol’ would be beneficial, and your colleague should be ‘briefed’ regarding this before it occurs, to make it clear that this is not a personal issue, but is vital in order to make the discharge procedure more structured for staff and to prevent problems for others in the future. A
gain, teamwork is the key.
The most successful method of instigating new protocols is to allow all those concerned to have an input, and the best time this can be achieved is at a (nursing) staff meeting. Depending on those involved and their personas and ability to communicate in these environments, different techniques can be used.
This could just be a general chat to give everyone an opportunity to offer solutions and ideas, or an approach such as using Post-It notes on a board where participants write down an ‘idea for improving the discharge protocol’. The most duplicated points are then used to form the basis of the new protocol.
It is vital that meetings are led well to encourage opinion and prevent the stronger members of the group from dominating a discussion.
Ideas must then be consolidated into a clear structure. Some useful points could be designated appointments for discharges with a ‘discharge nurse’ and measures to ensure equipment is removed from the patient. Other team members will also have a valuable input into this, and should be involved during some stage of the process. Any new protocols must, at all costs, be clearly communicated to every member of the team.
Once the protocol has been constructed, it should be closely monitored, and a further meeting arranged to discuss its success or any problems.
Just as a final point, a letter to the original client with the complaint, to outline the changes that have taken place since the incident, would invariably be gratefully received and seen as an extremely professional and positive measure on the part of the practice.
Summary
The discharge of animals following any procedure is a vital component of veterinary care, and should be handled as conscientiously as any other aspect of the procedure.
Complaints and their originating source can be invaluable tools for creating positive change.
Author
Jill Macdonald
OipAVNISurgl RVN
Jill was a head nurse and nursing assessor in small animal practice for 12 years prior to taking up her post as co-ordinator of professional key skills training at the vet school. Her role has been to develop and moderate the A module for the RCVS Certificate in Advanced Veterinary Practice (CertAVP) for vets using online delivery, as well as contributing to undergraduate teaching. Having run the module for vets, it became apparent how relevant the entire content also was for VNs.
To cite (his article use either
D0I: 10.1111/j.2045-0648.2010.00006.x or
Veterinary Nursing Journal Vol 26 pp 18-20
Bibliography
RCVS Guide to Professional Conduct for Veterinary Nurses lonline] [2007]
http.//www rcvs.org.uk/shared_asp_files/GFSR asp1 NodelD=96369
Note the Ten guiding principles: B la. make animal welfare your first consideration in seeking to provide the most appropriate attention for animals committed to your care e uphold the good reputation of the veterinary nursing profession |. respond promptly, fully and courteously to complaints and criticism C; Responsibilities to patients D: Responsibilities to clients H: Your responsibilities when things go wrong (particularly parts 1 & 21.
SHILCOCK. M and STUTCHRELD, G 120081 Veterinary Practice Management. A Practical Guide. Saunders. UK.
ACKERMAN. L 12007) Blackwell's Five Minute Veterinary Consult. Blackwell. USA
• VOL 26 • Januaiy 2011 • Velerinary Nursing Journal