Variety of Nurse Consults

RE: Variety of Nurse Consults

Alison Clare Hickman — Fri, 23 Aug 2019 15:38:45 GMT

Ooh, that's fab,.Anon... - yes, I can definitely see a place for after vet DX, appropriate RVN care and support.

So far, this post seemed to want to attract in itchy pets before any VS DX had occurred, hence my reservations and comments. I love dermatology and would leap at the chance to extend my knowledge and participation, to the best extent of my RVN remit. So, in a nutshell, my response to your post is Woop Woop!

RE: Variety of Nurse Consults

VetNurse Anon a/c — Fri, 23 Aug 2019 15:18:58 GMT

I did work at a practice where the nurse had completed the BSAVA MERIT award in dermatology! What they did was the vet did the initial consultation and diagnosis and then referred the aftercare and follow up to the nurse a little similar to a diabetic nurse where the nurse is there to offer advice, support, give medication if client struggling after the vet has already diagnosed!

RE: Variety of Nurse Consults

Alison Clare Hickman — Wed, 21 Aug 2019 17:20:07 GMT

emma horsey

Yes I agree with you that if there are clients reluctant to see.the vet (ime it's usually fear of cost or being 'told off' or unsure it's anything to worry about) and you can encourage those clients with their itchy pet into to see you, and then refer onwards to vet, fab!

However, ime it still remains that as said itchy pet will in (most cases) need a vet examination for a DX it can be frustrating for the client to have a delay in DX and have to make another appointment (and pay). If u charge for your nurse consults (and why shouldn't we?) it could be a double whammy payment for the client... Plus potentially the pet remains itchy for longer...

I think, for dermatology, as nurses we can and should report on incidental findings we come across in other discipline consults (weight, behaviour, dental, preventative and so on). It doubles up on our efficiencies. A separate itchy dog dedicated consult will nearly always end up as simply a gateway to a vet consult. Not necessarily a waste of everyones time, as you have got the client interested in visiting the practice, but I think could be managed differently? I am thinking straight off the cuff here ... Maybe have an Speak to your Nurse itchy cat/dog FB page for clients to pose their questions on /post photos which leads to you booking appointments for your vet? Maybe or maybe not, just thinking of minimising time and maximising efficiencies for clients, vets, pets and nurses...

RE: Variety of Nurse Consults

emma horsey — Wed, 21 Aug 2019 16:30:45 GMT

I some what agree to your comment Alison. When I was researching different nurse consults that can be sucessful I came across: https://www.vetnursedermgroup.co.uk/

A few years ago I was lucky enough to have a short lecture from the wonderful people at Onswitch who do award winning client care, reception and communiccation skills and one of their selling points of nurse consults is that clients do not find them intimidating and clients feel that nurses can gently highlight problems without any worries of immedate horrific diagnosis that happens on dramatised TV shows. Hence getting the animal in to a nurse consult with a basic question of "is my dog itchy" could (maybe sell some itchy coat product) report the findings back to the vet who can then progress on to further treatment.

RE: Variety of Nurse Consults

Alison Clare Hickman — Sun, 18 Aug 2019 01:02:59 GMT

apache|

Sounds great! Loving the support for your nurse. He/she will revel in it and get a very rewarding career with you as a boss.

The 'dermatology nurse consult' hmmm, yeah, I can see where you're coming from there... I know from when I worked with a dermatologist it's a very specialised area and apart from 'findings' from observation or a skin tape or scrape test result I'm struggling to think of anything further I can do that would help. I imagine the client would be very frustrated if they booked me and all I did was refer on and nothing else. Why not just have a vet appointment? In fact, here's the answer... Vet appointment and if skin scrapes or tapes or lab work is needed that is within a nurse remit, well that can be done by the nurse. Any other dermatology issues dealt with by vet. 1 consult, twin plate spinners...

However, I've recently seen CPD in this discipline aimed at nurses, so it's clearly a developing interest. Anyone else got a comment?

RE: Variety of Nurse Consults

apache — Sun, 18 Aug 2019 00:10:50 GMT

Alison Clare Hickman I'm hoping to have a dedicated nurse consult room by the end of the year, so I'm working on it!

I hope I come across as supportive to nurses consulting (because I am), I'm just not sure who books in for a "nurse dermatology consult". The cost difference to an experienced nurse or a new grad vet isn't that much, so the consult isn't going to be vastly cheaper. I agree wholeheartedly that nurses are better at some tasks, but then I'd argue a vet would be better than a nurse at dermatology! Until very recently giving the worm tablet would have been a vet job here as we didn't have any qualified nurses.

RE: Variety of Nurse Consults

Alison Clare Hickman — Sun, 18 Aug 2019 00:01:33 GMT

apache

Second part answer.

Yes, you are tying yourself up when your nurse could take over. It's a trust issue/habit. However it works really well if the team can take turns to spin the plates for one another (as is appropriate for their professional qualifications and experience).

Many practices I've worked at do exactly what you suggest in that the vet visits the nurse consult for their part and leaves the nurse to continue or wrap up. Similarly, if the procedure from a vet consult does not require a vet presence (nurses are ace at bandaging, for example) then vet leaves after vet has done vet required procedures and nurse takes over.

Team vitniry!

Helpful?

RE: Variety of Nurse Consults

Alison Clare Hickman — Sat, 17 Aug 2019 23:50:17 GMT

apache

It helps as follows:

I'm in a nurse consult, for example, application of prescribed preventatives or a dental check. During this consult I have other findings that need a referral to a vet. Patient is referred. Vet takes over and diagnoses. Patient is treated.

These are patients that otherwise get missed as they aren't booked in for the 'findings' I find.

I ask about the patient, the owner and their lives for a fuller health profile. Amazing what I find out that's not offered up unless I ask.

Latest finding was a geriatric cat booked in just for admin of a worming tablet that his elderly owner couldn't manage. Tatty ungroomed hindquarters, poor BCS and MCS. History of polydipsia, polyphagia. Tachycardic. An elderly owner who adored his chum but who had only really noticed that he wasn't as 'cuddly,' as he used to be. Our chat brought out more information useful for findings...

So. One patient receives supportive TX after vet DX. Is happier and his elderly owner gets more cuddles from his chum. The practice pocket received income from blood tests, vet consult fee, ongoing medication and prescription diet etc

Win. Win. Win.

Helpful?

RE: Variety of Nurse Consults

Nicola Smith — Sat, 17 Aug 2019 22:41:21 GMT

I used to do a lot of dental clinics. Pre procedure to discuss procedure and discuss homecare in advance, then after for homecare then regular checks for how owner is getting with homecare, any tartar reforming, could we make changes to homecare if compliance issues.

I also did travelling pet clinics, for holidaying pets. If abroad to see vet first to get everything in.place but then with nurse for travel tips, are they ok with parasite treatment prescribed and aware of what they need to do. UK travellers discuss parasite risk - may encounter different risks to normal e.g. ticks, travel tips etc.

RE: Variety of Nurse Consults

apache — Sat, 17 Aug 2019 14:39:13 GMT

[quote user="Alison Clare Hickman"]

Can't diagnose but can report to a vet on findings! |

[/quote]

Yes, but how does that help? I'm interested how that would help my workflow, as I'd still need to examine the animal and likely collect my own history.

I was thinking about this last night and the thing that would make the biggest difference to our workflow would be to complete the vet aspect of the consult and then leave the patient with the nurses to do their bit and then give back to the owner. In our practice (I may just be inefficient) what tends to happen is vet takes dog through to the back and the blood is taken/bandage applied/wound clipped and cleaned/claws clipped between vet and nurse and then vet takes animal back having being tied up for a while.

RE: Variety of Nurse Consults

Alison Clare Hickman — Sat, 17 Aug 2019 13:14:07 GMT

apache

Can't diagnose but can report to a vet on findings! |

RE: Variety of Nurse Consults

apache — Fri, 16 Aug 2019 20:25:07 GMT

Suture removal

Blood/urine/faecal tests

Chronic patient management - diabetics/arthritics

Zycotral/Depomed/Cartrophen injections

2nd vaccs - why with the vet?

Medicated bathing

Microchipping

Possibly even follow up consults at end of course of treatment, after otitis/conjunctivitis/ulcer

I'm not sure I like the concept of 'free' consults, I wonder if this devalues nurses. I can see merit letting people bring puppies in monthly for a weigh and to collect some parasite Tx.

What would you do in a dermatology or dental consult? Remembering you cannot diagnose.