Stephanie-Writer Davies is a veterinary surgeon and a member of the VN Futures Career Progression Working Group. Stephanie has always been very supportive of the veterinary nursing profession, recognising the value of veterinary nurses to practice and being keen to see them performing broader and more challenging roles and improve their status and job satisfaction. She is a previous SPVS President, and is currently the SPVS VN Liaison. The Career Progression Group is working towards several ambitions which form part of the VN Futures Report and Action Plan; including maximising the value of veterinary nurses in practice, and encouraging charging correctly for nurses’ skills and time. Stephanie discusses some of these issues in this short blog – to which we welcome input and comments from our readers.
There has been some debate in recent months over the value of veterinary nurses to practices, and the ‘cost’ to veterinary businesses of their veterinary nursing staff. So, how should practice owners think about their nursing teams in terms of cost vs value? Are they an ‘overhead’ that has to be factored into the business’ ‘Profit and Loss’ (P&L), one which provides useful support for patients and clients, but which doesn’t contribute to the financial health of the practice? I make this somewhat controversial comment to stimulate debate because I hope that everyone who knows me (or knows of me) is aware that this is in direct contradiction to what I actually believe! Veterinary nurses are never, to my mind, a net cost to practices, but to accept this I think we have to look at things in a different way. Veterinary practices contain a team of staff members with different roles, all of which contribute to the practice income. No single group can manage without the help and support of the others, and that should be acknowledged. In relation to veterinary nurses in particular, it’s important to recognise that veterinary surgeons cannot work effectively without nursing support – and that’s not just in relation to the ‘stuff out the back’; veterinary nurses play a big role in the consulting room, not only as ‘assistants’ for the vets, but also as consulting professionals in their own right. Both these aspects of the role of veterinary nurses include income generation but the difficulty is that practices often don’t show how veterinary nurses generate income in a transparent way. I believe we should change our mindsets about this and recognise the financial contribution that veterinary nurses make to practices as well as their clinical contribution – and in doing so we must change the way we talk about veterinary nurses. Veterinary nurses are not just ‘the staff out the back’ whose time is given away for ‘free’ in nurse clinics; they are expertly trained professionals who provide a necessary and valuable service for animals and their owners and their time is therefore worthy of a professional fee! We should show the nursing charges on our bills for surgical, diagnostic and in-patient care – after all many practices itemise things such as surgical kits so why not anaesthetic monitoring by the RVN, for example? We charge hospitalisation fees but why do we not list nursing care as part of this cost? And what about the admission and discharge appointments that are often done by veterinary nurses – why do we not show the costs of those amongst the surgical or other charges? If we don’t, then we should! There is a view that Nurse Clinics don’t generate income but, in my opinion, this is flawed. Many of the consultations that nurses do are ‘pre-charged’ by the veterinary surgeons (eg 2nd vaccinations, post-op checks, repeat medications etc) so the charge for the nurse’s time gets ‘lost’ in the initial veterinary surgeon fees. Additionally, of course, if these appointments weren’t carried out by the veterinary nurses they would have to be done by the vets, so these clinics free up the vets’ time to be used for consultations on new cases or additional surgical procedures, for example, which generate new income. In effect, this vet-led income generation is facilitated by the veterinary nurses taking on the nurse clinics. Then there’s the thorny issue of how to charge for tasks such as emptying anal glands or clipping nails… is it cheaper if a veterinary nurse does it? Absolutely not! ‘Task-led’ procedures of this type should be charged at a set fee – after all a nail clip is the same whoever does it – and they should be done by veterinary nurses to free up veterinary surgeons’ time. If clients insist on seeing a vet for something of this nature, then they should be charged a consultation fee. And no more ‘free’ nurse clinics please! They can perhaps be complementary for patients on health plans but otherwise nurse consultations should be charged appropriately! I don’t want you to think that I consider veterinary nurses as ‘mini’ or ‘frustrated’ vets because I don’t. To me, they are skilled co-professionals important for veterinary businesses and patient welfare and they should be proud of the role they play and the financial value they bring. However, this should be acknowledged and promoted by the other members of staff within the practice so that clients see the veterinary nursing profession in a new light. With enhanced public respect and an acceptance of their value should come the potential for enhanced roles in practices for veterinary nurses which should also result in improved salaries!