Management of Chronic Medical Cases – the Veterinary Nurse’s Role

How can we step-up veterinary nurse involvement in chronic disease management?

In general, the current approach to pet care in consultations in practice is that veterinary surgeons manage disease conditions, and veterinary nurses offer clinics for preventative health-care advice and other routine care. There are exceptions to the rule of course, and in this blog article, Nicola Ackerman, Head Medical Nurse at The Veterinary Hospital in Plymouth, shares her experiences and ideas on how nurses can play a greater role in long-term disease management, and how this works in her practice.

Nicola Ackerman

Initial diagnosis – then what?

Nurse clinics for animals that have been newly diagnosed with any disease process should ideally be instigated as soon as the animal is diagnosed. All patients should be referred to a veterinary nurse, to discuss diet, medications (if required), compliance and any future requirements for diagnostics and reviews of the patient. The nurse is also well placed to answer any questions that the owner may have.

What should be routinely covered?

At each clinic the animal’s weight, body condition score, muscle condition score and hydration level need to be assessed and recorded. Parameters such as blood pressure and blood haematological and biochemical levels need to be performed on a regular basis as set out and directed by the veterinary surgeon within the clinical history.

What about more complex conditions?

There are some medical nurse clinics that do lend themselves to a more formulaic setting; diabetic clinics being one of these. A clinical protocol, developed through discussion with the clinical team, and including issues such as what needs to be included in these clinics can easily be achieved.

Another example is a medical clinic for a cat diagnosed with urinary tract issues – which can be more problematic, due to the wide nature of environmental aspects that influence the cat, behavioural aspects, alongside medications, diet and water intake.

The content of the medical clinics will very much depend on your practice’s protocols for the treatment and management of certain diseases/disorders.

Veterinary teamwork

Discussion with the veterinary team is required to develop a protocol, so that everyone the Veterinary surgeon, veterinary nurse and client can see what is expected. A protocol will also help the receptionists know who to book in appointments with.

Summary

• Medical clinics can be run for every medical condition – as soon as any patient is diagnosed it should be referred to a nurse clinic.
• RVNs need to have a good underpinning knowledge of the condition and have good up-to-date knowledge on new treatment and management regimes.
• Improving compliance and helping to educate the owner to care for their pet makes a big difference to patient outcomes.

Blog supplied by:

Nicola Ackerman

BSc(Hons) RVN CertSAN CertVNECC VTS(Nutr) A1 V1 MBVNA Head Medical Nurse

Key factors in ‘making it work’

Jill Macdonald offers her thoughts on the benefits of increased utilisation of veterinary nurses, and some key factors that should be considered when setting up such a system in your practice.

Jill Macdonald

Communication

As Nicola has mentioned, team discussion is an essential step in creating clear protocols for disease management, that everyone agrees on. It is also vital that the communication between the directing Veterinary Surgeon and Veterinary Nurse is exemplary. This will ensure that delegation can be performed with confidence, from the perspective of both parties.

Understand limitations

Understanding the limitations of the veterinary nurse, and staunch adherence to the Code of Professional Conduct, will ensure that nurses are not practising outside of their level of competence, and are confident to refer back to the veterinary surgeon when required. That level of competence will vary from nurse to nurse – depending on qualifications, experience and further training undertaken; and how many cases of a particular nature have been managed by that nurse.

Additional CPD 

As Nicola has mentioned, comprehensive CPD in particular disease condition areas will be required to ensure that nurses are up-to-date on current evidence, and practising evidence-based nursing. Any CPD undertaken should then be fed back to the team, preferably during a lunch & learn or a presentation (rather than just written material) with opportunities for questions. This will ensure that new learning is shared with the whole team.

Who benefits?

Everyone benefits from a scenario where veterinary nurses play a more active role in patient care, as long as it is managed correctly.

Nurses

It utilises nurses and their skills and expertise effectively – getting nurses doing what they were trained to do.

It creates higher job satisfaction for veterinary nurses! SO many nurses feel they are not utilised properly, and nurses are leaving the profession because of it. Taking a proactive approach could potentially do so much to help nurses enjoy nursing again.

Patients and clients

Approaches such as this can improve the client and patient experience (and also possibly the clinical outcome). The nurse has more time to spend with the client, discussing any issues with medication, increasing client motivation in adhering to treatment plans, supporting the client through any difficulties, and seeing the patient more regularly.

The practice

Using nurses effectively, seeing patients more frequently, achieving improved adherence to treatment, and potentially improved patient outcomes – benefits the practice too. It can free up your vets to do the things that ‘only vets can do’, and creates more responsible and rewarding roles for the nurses.

Client education about ‘what nurses do’

It’s also important that client education and an understanding of the role the nurse plays in management of chronic disease in their pet is addressed. This can be done via your website, through social media, through practice displays, and most importantly, through talking to your clients about the role that nurses will play.

Teamwork!

Team work is vital.  This should be achieved through inclusion of the whole team in any discussions, achieving their understanding and support for this approach to long-term disease management.

Additional information written by:

Jill Macdonald DipAVN (Surgical) RVN FHEA