WHY?

Re: WHY?

Tracy Windler RVN — Sun, 19 Dec 2010 22:07:40 GMT

I enjoyed reading this thread. Some really well-structured, though-provoking posts. And I don't disagree with anything!!

Re: WHY?

Gillian Mostyn — Sun, 19 Dec 2010 16:43:05 GMT

VS and VN are totally different jobs that (hopefully) compliment eachother. In my experience (11 years as a vet but also 9 years before that as a 'gofer/Saturday girl/general lacky') I haven't seen much conflict.

(( Wow - I've only just realised I've been in vet practices for 20 years......now I feel old!!))

There may be the occasional member of staff - either VS or VN - who cannot see life from the other's perspective but I'd imagine they would have a difficult time in any other workplace too. I do agree with Sal though that this forum does indicate that we may need to worry about whether this harmony is threatened. My own take on it is that some people entering nursing are a bit too idealistic. It appears to me that many of the people who challenge their vet (and I may be wrong) are people who have gone into the VN profession, done their training and then feel that they are armed with all the information they need. What they lack is experience and business sense. This isn't helped by the high turnover of staff meaning the VN profession is very weighted to people WITHOUT experience. It would be better if there were more VNs of 20 years+ working to advise the newer nurses. It isn't anyone's fault - it is also well known that vets graduated just a few years can be lethal because they have gotten over those first few terrifying years, feel they are doing great, and haven't yet realised how much they DON'T know! The senior vets soon put them straight!

I also think V Nursing is subject to the same recruitment issues as V medicine - that it attracts sentimental people who 'love animals' (Grrrrr - I hate that phrase when I see it in a CV!) The difficult and thorough university admittance system hopefully screens out most people who are unsuitable to be vets. As we all know, this is a job where empathy and a passion for animal welfare are essential but where sentimentality usually gets in the way of good decision making.

When I mention a lack of business sense, I don't mean to offend, but it is apparent sometimes that some people have a poor grasp of it. For example, on the thread about IV catheters....if it costs £5.00 to place an iv and use IVFT, then assuming 3 ops per day in a small practice, that will cost the practice almost £4000 per year. A nurse may request this become routine for all ops - but not understand that fees would need to go up to accommodate that, which may jeopardise the practices ability to compete with local practices. That £4000 is also coming DIRECTLY out of the pocket of the partners. They don't get a salary - they get what is left once all the bills are paid. How many nurses would be so keen to use catheters and IVFT in every single patient if they themselves paid for them? Would it still be gold standard, or be more of a 'when needed' approach? Sorry if I sound in any way patronising - I don't mean to - I have just met a lot of staff (nurses, vets and even assistant vets) who have never considered the practice income in this way.

Anyway, I'll stop rambling now...sorry!!

Re: WHY?

Maisy — Sun, 19 Dec 2010 12:43:31 GMT

[quote user="loobylou"]

I love case discussions and will often say 'so why have you done it that way that instead of this way?', the vets always take time to explain and we can always have a good chinwag about it. [/quote]

Agree with this. Nurses can learn and its good teamwork to have these discussions.

[quote user="loobylou"]

On the other hand the vets will also ask the nurses for suggestions if it;s a particulalry tricky case or they want to ensure they've not forgotten anything. This has always made me feel very valued as a nurse.

[/quote]

Agree with this too. Sometimes it helps to put forward your point from a nursing perspective as this is equally as important as treatment once diagnosis has been confirmed.

I have worked with nurses (luckily few of them) who seem to second guess the vet, tell them what tx should be prescribed or disagree with a diagnosis. Regardless of how long a nurse has been in practice/qualfied, or how long the vet has been an MRCVS for, it is down to the vets judgement as they have overall responsibility for the case-our training is nowhere near equivalent to that of a veterinary surgeon and our roles are completely different. I find it quite cringe-worthy when I see/read up on how nursing staff are telling the vets to do their job as if the roles were reversed, they would be incredibly irked if it was the vet telling them how to nurse a patient correctly.

Its great that so many nurses are passionate about their job and we have moved away from the days where nurses were little more than cleaners and there to mop the vets brow. I imagine the training SVNs receive now is possibly of a higher level (don't shoot me if it isn't! ), or at least a different standard than the first training course for VNs so nurses do feel confident in asking questions about cases to help with their learning and as mentioned, its good teamwork to have case discussions and great for increasing morale for nursing staff.

Discuss cases, yes. Tell the vet their job? Definitely not otherwise we are heading back into the subject frequented in the letters page of the Vet Times as to whether VNs want to be mini vets

Re: WHY?

loobylou — Sun, 19 Dec 2010 11:33:34 GMT

I think alot depends on the vets and nurses you are working with and how they might interpret a comment. I've always been very lucky to work with vets that are willing to explain their reasons for treating a case a specific way without taking offence. I love case discussions and will often say 'so why have you done it that way that instead of this way?', the vets always take time to explain and we can always have a good chinwag about it. It may be that they haven't been confident with a certain procedure or they've seen more success with a particular treatment and it always puts my mind at ease as a nurse that they are doing the best for that animal.
On the other hand the vets will also ask the nurses for suggestions if it;s a particulalry tricky case or they want to ensure they've not forgotten anything. This has always made me feel very valued as a nurse.

Re: WHY?

Mac Feather — Sun, 19 Dec 2010 10:27:13 GMT

Very thought provoking thread.

Sometimes I think theres a lack of understanding as to what everyones job role/responsibility is- I dont think that solely applies to the veterinary practice, its probably the same in other jobs. I mean how often do you hear people saying of their colleagues 'Oh I dont know what she does all day'. But if they swapped roles or shadowed each other then they would have a truer picture of what they do.

I suppose alot of it comes down to communication and that was one of my bugbears in practice. People stomping around barking (no, I dont mean the dogs!) at others and then theres a bad atmosphere when maybe all that was needed was an explanation like 'Sorry I was up all night with this case/Ive got a headache/Im worried about...' etc and then we all know its not personal.

Ooops- kind of wandered off subject! Sorry!

I do think that perhaps there are different teaching styles regards vets and vet nurses.

Im also thinking back to when I first started out- nauseatingly keen and wanted to help but often suggested things without running them past my brain or saying it in away that didnt come out right,i.e in a way I didnt mean that more than likely bugged the vet tremendously!

You are always learning in the job and in life, no one is perfect and hindsight is a great thing.

Feel that the vet practice is a team and we all need to work together, no one person is more important than the other and at the end of the day, no practice = no jobs!

Re: WHY?

Sal the 1st — Sun, 19 Dec 2010 00:30:05 GMT

No I cant say that this has happened all that often in practices I have worked and if it has happened in most cases has been resolved pretty quickly by sitting down and talking it through ( I have seen it more when I have been doing locums in high staff turnover practices) but if the posts on here recently are anything to go by it seems to me that this challenging behaviour is on the increase, and whilst it is good that everybody is aware of different ways of doing things I dont feel comfortable with some of what I have read.

I agree with you that if you find fault /are annoyed with somebody it then makes it easier to continue finding fault/ annoyance with them and I also agree that some of the posts on here are made looking for support of an argument ( and yes I am guilty of that too)

I dont feel that this a massive problem (yet) but if posts on here are truly representative of what is happening in practice then I feel it has the potential to become a problem unless it is addressed.

Re: WHY?

Tracy Windler RVN — Sat, 18 Dec 2010 21:14:25 GMT

I think, and, its just a theory! That this site, as useful, supportive and informative as it is, sometimes fuels this sort of attitude. We have a gripe, so we come on here (I say "we", as I've done it too!) and post a thread about it, then 20 other people endorse what you say with similar stories of their own. Sometimes there's the opposite effect, with a barrage of criticism, but usually its supportive, so confirms that we were right and justified, perhaps even backing up our arguement with anecdotal evidence and facts.

Perhaps this is exacerbated within unhappy teams by an underlying animosity in some working relationships, where nurses feel unappreciated / under-valued and employers/line managers get frustrated with staff mistakes / complaints / issues etc. If someone annoys you, you tend to focus on every little thing that they do wrong or that you disagree with. i.e One of our irritating dog breeders could tell me puppies were black and I feel like swearing they were white sometimes, just to disagree with her!

It makes it sound like I'm suggestng that this is always the case, or that we're all petty, vindictive types, I'm not, but I know how easy it is to get stuck in this situation and not realise what is happening. Having seen quite a few different practices in my career, I don't get the overall impression that it really is a major issue within a large number of practices, on a regular basis.

Re: WHY?

Steph Worsley — Sat, 18 Dec 2010 18:22:26 GMT

I think it is possibly the different ways we are taught and different approachs to different aspects.

I hope that everyone can be professional enough that we can resolve conflicts.

I know when the vet I am working with approaches a case differently to the way I have expected them to, I have simply asked why, in order to learn more about cases and different approaches I think communication is the way forward. I may be lucky where I work that I can approach the vets and ask them things about the way cases are dealt with and also feel I can ask them why they are approaching that way and not in a different way.

I agree that everyone who works in this industry is passionate about animal welfare it is just that some people have their emotions in check and therefore may appear not to be as passionate as those who wear their heart on their sleeve, I think sometimes I must appear hard hearted but if I got emotionally involved in every single case I deal with I would have a nervous breakdown within no time, this does not mean I am not passionate about their welfare.

Re: WHY?

Sal the 1st — Sat, 18 Dec 2010 17:57:43 GMT

Thank you for your input as well Gillian - I was hoping there would be a vet response.

would it be possible to explore how some of these conflicts arise? Is it down to vets and nurses being taught different stuff that doesnt easily synchromesh? Is it because there is a greater availability of information on treatments/techniques through the internet? Is it because people generally have less respect for their vets/employers these days? Is it something else really obvious that I am missing? Or is it just that I am an old git that doesnt understand the younger generation?

Any more opinions - anybody?

can we start resolving some of these conflicts at all? or at least looking at ways we can prevent them in future before we end up with both sides entrenched?

Re: WHY?

Steph Phillips — Sat, 18 Dec 2010 17:11:24 GMT

Didn't intend to offend with that comment Gillian, apologies if it seemed that way.. maybe your right, maybe most vets do 'hide their emotions' .. the vet i work with certainly does! lol

[quote user="Gillian Mostyn"]At the end of the day the vet holds ultimate responsibility for protocols and treatments and any resentment of that is pointless and counterproductive.[/quote]

very true!

Re: WHY?

Gillian Mostyn — Sat, 18 Dec 2010 16:30:57 GMT

[quote user="Steph Phillips"]Nurses (thats ALL nurses: Qualified, trainee, auxiliary asst etc..) are more pationate about animal welfare than (some) vets[/quote]

Most vets I know and have worked with keep their emotions very hidden and, as Sal has said, try to keep their treatment of a case as objective as possible. I hope some nurses aren't mistaking this for a lack of concern or passion. Everyone is aware of how difficult it is to train to be a vet - no one will put themselves through that without having the necessary passion to help animals.

I have also noticed that there do seem to be a lot of posts where some nurses question and challenge treatments and protocols within practice. I assume most of these to be people genuinely wanting to see if things can be approached differently. I would hope that in these circumstances the nurse is going to get some ideas to take back for discussion. However, there are occasions when nurses seem to lock horns with their vet and the degree of challenge becomes inappropriate. At the end of the day the vet holds ultimate responsibility for protocols and treatments and any resentment of that is pointless and counterproductive.

Re: WHY?

Sal the 1st — Sat, 18 Dec 2010 14:51:05 GMT

yes I purposely didnt differentiate between different nursing staff because I feel we are all in this together.

I dont feel that nurses are more passionate than vets about animal welfare on the whole I feel that both sides are equally looking out for the welfare of their patients but maybe in different ways - whilst its true that as nursing staff we may spend more time with hospitalized patients and have greater contact with a particular case the greater majority of vets I have met and worked with will do their utmost to try an ensure a good outcome for a patient. I do feel that nurses tend to expend more emotional energy with an in patient and vets have a better chance ( but doesnt always work out this way) of remaining objective, but that objectivity is vitally important in the patients treatment.

I dont feel its a bad thing to discuss cases as a team and between the team come up with the best treatment possible for that client and patient but I am having a problem with all this questioning of a vets treatment which keeps cropping up, some of it sounds quite aggressive and seems to be becoming more and more common - have been wondering about this quite a bit in the last couple of months.

when a vet's judgement is questioned how is it being done and how is that leaving the vet feeling?

And when challenging a vets treatment is the person making that challenge qualified to be doing so? ( qualified as in fully understanding the case(s) and understanding the vets reasons for a particular course of action) - and does this always result in the best outcome? or does it result in a different approach which is just more acceptable to the nursing staff/ owner but not necessarily the best for the animal?

I appreciate your input

From what I have been reading on here I do feel that there are cases were nursing staff are intentionally telling vets how things will be done

Re: WHY?

Steph Phillips — Sat, 18 Dec 2010 13:35:56 GMT

IMO - Nurses (thats ALL nurses: Qualified, trainee, auxiliary asst etc..) are more pationate about animal welfare than (some) vets - In no way I'm saying vets dont care.. just that nurses seem more pationate and therefore might question a vets method of treatment to make 100% sure in their own mind that thats the right thing.. and sometimes.. when a nurse questions a vet, it can make a vet re-think if they need too, while explaining - like thinking out loud - and possibly make the world of difference if a vet was to change his/her mind!

Also I don't think that Nurses are intentionally 'telling a vet what to do' ..