112 | Talking about ‘utilising vet nurses’ isn’t enough - we need to ACTUALLY use our skills. Here’s how to do exactly that.

Happy Vet Nurse Awareness Month.

Yes, this week is the first full week of VNAM, a month where we come together to celebrate all the good our profession does, and shout loud and proud about the difference we make.

VNAM is one of those rare times of year where we’re not just focused on shouting about vet nurses within our profession, but outside of it too. 

The focus becomes increasing public perception of our role, ensuring our clients and caregivers know who is really looking after their pet when they’re in the hospital, and moving away from vet nurses being ‘just helpers’ and highlighting our role as skilled, knowledgeable professionals in our own right.

And this week, in episode 112 of the Medical Nursing Podcast, I want to bring together a lot of what we’ve spoken about recently, and - along with a solid stack of peer-reviewed evidence - look at HOW to utilise more of our knowledge and skills in practice.

Last week's conversation with Alyssa was one of those episodes I keep thinking about. If you haven't heard it yet - go back and listen, as it really lays the foundation of everything we're doing today. We talked about the role of the vet nurse (or technician) in the bigger picture, that persistent gap between what we're trained to do and what we're actually asked to do on any given shift. That gap has a name - utilisation. There’s data behind it. It's been studied across multiple countries. And even more importantly, we’ve got published guidelines on how to fix it.

Utilisation can feel like a bit of a buzzword in vetmed. It’s thrown around a lot - and it should be, it’s an important term. But it needs to be treated with the importance it deserves - we can all talk about utilisation until we’re blue in the face, but that’s different from ACTUALLY setting up systems in our practices that properly respect and utilise our skills.

So that’s what we’re talking about today. In this episode, we’re going to talk about what the evidence really says about utilising VN skills, and particularly the AAHA technician utilisation guidelines. 

You’ll leave the episode with a clearer understanding of why this is so important, what it looks like in practice, and how to make change happen - along with something we don't talk about enough: our own role in advocating for ourselves as VNs.

Why do we need to talk about utilisation (and how should we talk about it)?

Our profession is, by historical standards, very young. ‘Registered animal nursing auxiliaries’ (RANAs) - the first veterinary nurses - began training in the early 1960s. In the US, the story is similar - ‘Animal technicians’ graduated in the early 1960s, with ‘veterinary technicians’ appearing in the late 1980s. 

In the UK, Veterinary Nurses were not legally recognised until 1991, when the Veterinary Surgeons Act was amended to include our role.

Why am I telling you all of this? Not just because I think veterinary history is interesting (though it is) - but because we are, in many ways, still a profession finding its feet - still establishing what we are, and what we deserve to be.

Our Veterinary Surgeons Act is still widely outdated. Our title protection is still lacking. Compare that to human nursing, where professional registration and title protection were introduced in 1919 - and we still have a way to go.

A lot has changed for the better in the last 60 years of veterinary nursing. We train our SVNs to a really high standard, we have professional registration and accountability, we’re a fiercely passionate bunch of highly skilled professionals, and we have more advanced and even some specialist-level qualifications available to us than ever before.

And yet. Despite all of that momentum, we haven't managed to consistently use our knowledge and skills to anywhere near our full capacity. And let me be clear, this is not just my frustration talking - it’s what the research consistently shows, across countries, over many years.

The AAHA sum this up in one word: a crisis.

In fact, they say that by 2030, veterinary medicine in the US is projected to need 132,885 credentialled technicians just to keep up with demand for pet healthcare. 

At current graduation rates, the projected shortfall is more than 50,000. And simultaneously, the profession faces a shortage of up to 15,000 veterinarians by that same point. 

This means that we’ll have more and more patients needing care, but less people available to provide it - and the people that we DO have, are systematically not able to use their knowledge and skills to the full extent of what they're trained and licensed to do.

We have all previously discussed the ‘recruitment problems’ facing this profession - but are we REALLY dealing with a recruitment crisis?

The AAHA describe this crisis, first and foremost, as a UTILISATION problem. 

Because if veterinary nurses and technicians are genuinely working to the fullest extent our skills and legislation allow - and if vets were able to just focus their time on diagnostics, surgery and prescribing, rather than the nursing tasks they often perform - every team would work more efficiently.

Our capacity to see more patients, provide better care, and support more clients would all increase significantly, without hiring any additional team members. And there’s a long list of studies that prove this.

And while that data comes out of the US, the data in the UK paints a similar picture. A 2022 study published in The Veterinary Nurse on skill utilisation in UK small animal practice found that veterinary nursing is consistently described as a misunderstood profession - not just by clients, but by veterinary professionals too. And where there’s misunderstanding of our role, we cannot utilise our skills fully. It’s that simple.

While the legal scope of our role as RVNs is set out in Schedule 3, we’re not limited by it. That’s something I think we’re all guilty of feeling at some point in our careers - myself included. However, I’d really encourage you to reframe this belief, because the truth is we can do a lot more than you might think.

According to Schedule 3 of the Veterinary Surgeon’s Act (the UK legislation that sets out the legal scope of practice for UK RVNs), we cannot:

• Diagnose

• Prescribe

• Perform major surgery, or surgery entering into a body cavity.

When we think about it, that’s actually a pretty short list - and I don’t know about you, but I’m not really that bothered about doing any of those things as an RVN. There are TONS of ways I can use my knowledge and skills to help my patients outside of diagnosing, prescribing, and major surgery.

The VSA does not define us. Often, the real ceiling on what we can do is cultural and psychological - not legal. If your clinic doesn’t realise the skills you can perform, they won’t give you the opportunity to perform them. And if you don’t speak up and ask to learn or perform a specific skill, you won’t get the opportunity to. A lot of the time, we end up putting limitations on ourselves without even realising - so standing up and speaking out for what you want in your career is essential.

This issue is what tools like the AAHA technician utilisation guidelines address. And it’s up to us to use them to get more from our RVN qualification.

Why is RVN skill utilisation so important, and why should every clinic be talking about it?

The evidence behind skill utilisation is really clear. And on top of this, it’s also what you’ll use in your clinics to put forward your case to do more - so let’s get into all of it now.

The AAHA guidelines organise the benefits that come with technician utilise into three categories: professional longevity, economic impact, and patient care. 

Let’s start by looking at professional longevity.

Studies have found that attrition rates for credentialled veterinary technicians increase significantly between the five- and ten-year career mark. 

This means that most people who leave our profession are doing so in what should be their ‘prime’ years - where they’ve invested lots of time into developing their knowledge, skills and confidence, and when they’re able to provide huge benefits not just to their patients, but to their colleagues too - particularly younger team members, or students who may rely on their mentorship.

When researchers have asked why, the same themes come up, regardless of whether we’re talking to veterinary technicians in the US, or veterinary nurses in the UK. These reasons include:

• Low pay

• Lack of recognition

• Burnout

• A workload not comparable with the opportunities for development and progression

• Toxic work environments

And consistently, underutilisation. Not being permitted to use the skills you spent years developing.

A study in JAVMA in 2022 showed that credentialled veterinary technicians measure their intrinsic and extrinsic motivation and job rewards not just by salary, but by the value and meaning of the tasks they perform. 

When you’re a professionally accountable, registered, highly skilled and educated, and generally capable individual, and you’re regularly asked to do things below your training, there is a disconnection between your skill set and your daily work. Over time, this damages your professional identity, and ultimately damages the purpose and the reason why so many of us got into this field - to use our skills and get better outcomes for our patients as a result.

This is reflected in the evidence on burnout, too. Now I’m not going to spend too long talking about burnout, because we chatted about it a lot in last week’s episode with Alyssa - but I will say, from my own experience, that burnout isn’t always dramatic. In my case it was a gradual change, costing me the warmth and love for the profession, and the passion for patient care - and time away brought all of that back.

Burnout doesn’t ‘just’ come from working too many hours or skipping breaks. One of the most important drivers of burnout in veterinary nurses and technicians is the absence of appropriate recognition and meaningful work. Put simply, when we don’t get to use our skills in a meaningful way and feel like we’re making a difference, we burn out.

The NAVTA 2016 survey found the number one reason veterinary nurses leave is insufficient pay, followed by lack of respect from the employer, burnout, and a lack of respect for the profession itself. 

Underutilisation creates this self-fulfilling cycle, and when people leave, that increases the loss and compounds the problem - because workload increases, stretching the existing team.

One study estimated vet technician turnover costs associated with burnout at approximately $933 million annually across the US veterinary industry. The individual cost of a single credentialled technician turnover is around $24,000 - plus another $35,000 in lost income during the vacancy. And the study's authors said those figures were likely undervalued.

On the other hand, when people’s skills ARE utilised properly, in collaborative and supportive environments, job satisfaction increases, career longevity improves, and our professional identity strengthens.

All of this is connected - and it all starts with recognition and utilisation.

Now let’s look at the economic impact of underutilising veterinary nurses.

Again, the studies we have surrounding economic impact of utilisation come from the US and Canada, but they’re comparable worldwide as we’re all facing the same issues - and importantly, they all share the same clear message.

Underutilising veterinary nurses and technicians costs our clinics huge amounts of money each year.

Two studies - one using 2007 data and one from 2020 (and again, all linked in the show notes for you) - found that full utilisation of a credentialled technician generates a revenue benefit of between $105,000 and $137,000 per technician, per veterinarian, per year. 

The 2020 Canadian study also showed a median 36% increase in revenue per veterinarian for those vets who rarely or never performed tasks a credentialled technician could legally handle, because that freed-up time got redirected to things only veterinarians can do.

One study found that even investing as little as $1,500 per employee per year in training correlated with a 24% increase in profits. So if you’re in a clinic with a limited CPD/CE budget or you’ve been arguing over a training course outside of your budget, know this - investing in training helps clinics make more money in the long run. And, of course, encouraging RVNs to utilise the skills they’ve learned only helps that revenue generate faster.

In the UK, a Veterinary Record survey on recruitment and retention in 2022 noted that vet nurses in the UK have remained significantly below the national average salary for over a decade. 

And when we look at how RVNs are utilised in practice, I’m not surprised about this. Because think about it - our names rarely appear on invoices. Our time is bundled into a ‘procedure’ - clients know their pet is having an anaesthetic and that the GA time is charged for, but do they really know how much RVN monitoring and care that includes? Our nurse clinics are frequently offered for free.

The financial value we generate is often made invisible, and this only increases the feeling of undervalue we often experience. Every practice can choose to change this - incorporating RVN time/skills on an invoice, for example, or choosing to charge for nurse clinics (and explain why) - and the more that make the change, the more the view of our role begins to shift.

Now let’s talk about the value of veterinary nurse skill utilisation on patient care.

Because this is of course what REALLY matters most to us. 

And again, the evidence is clear: when credentialled technicians are empowered to take on roles commensurate with their training, patients benefit and access to care improves. 

For example, a 2022 study in JAVMA found that veterinary technicians contribute meaningfully to shared decision-making during companion animal appointments. In plain English, this means that including a technician/nurse in client conversations significantly increases client education, incorporates client preferences better (meaning we’re establishing more manageable everyday treatment plans for our patients and clients), and leads to better patient outcomes.

There was also a really interesting study that came from New Zealand that I want to mention - again, linked in the show notes for you. In this study, both veterinary nurses and vets were surveyed about the clinical tasks nurses were expected to perform. 

Of the nurse respondents, 80% took blood samples, 78% placed IV catheters, 97% monitored anaesthetics. All what most of us would consider ‘foundational’ nursing skills.

And these numbers sound good - don’t get me wrong. I’m happy that 97% of veterinary nurses are monitoring anaesthesia, it’s a great use of our skills. However, when we look at the vet’s expectations, it says a LOT.

100% of vets said they expected veterinary nurses to be placing IV catheters, but only 78% of nurses reported actually doing it. 96% of vets supported nurses performing microscopy, but many fewer nurses were doing it in practice.

If our vets think we’re performing more of these tasks than we are, that tells you all you need to know. We’re trained in tasks we’re not getting to perform - and to me, 1/5th of veterinary nurses not placing IV catheters is a big problem.

That’s the gap in skill utilisation right there.

And while we’ve mentioned that there ARE tasks we can’t legally perform - in the UK that’s prescribing, diagnosing and major surgery, in the US that’s prescribing, diagnosing, any surgery and prognosing - that’s only 3-4 things we’re not allowed to do.

There’s a far longer list of skills we CAN perform than skills we can’t perform.

Central line placement. Urinary catheterisation, including unblocking male cats. (some) Locoregional anaesthesia. Point-of-care ultrasound. Endotracheal intubation. Chest tube management (not placement). Placement of (some) feeding tubes. Wound management. I could go on. These skills are all things we can - and should - do in our clinics right now. 

How to actually utilise your skills in practice right now as a veterinary nurse

We know why utilising our skills is so important - let’s talk about how to utilise them.

What I want to do in this section of the podcast is give you the exact framework the AAHA provide in their utilisation guidelines. Now before we get into this, I will say that each of the elements within it is big - so much so that they could each fill an episode themselves - but I want you to have enough information to get started TODAY, so you can spend this month pushing to use more of your skills.

So here’s the top-level overview on how to do more with your patients in practice. 

First, build the culture.

You can’t make lasting change without a clinic culture that supports it. A culture that celebrates and encourages growth and development is essential, and this needs to come from the top - your leadership.

Speak to your head nurse, practice manager, or a member of your vet team who you work closely with and who understands your skill set. Tell them you’re keen to do more and seek advice on how to go about that.

The foundation of growth is a psychologically safe working environment - one where people can ask questions without fear, or highlight gaps in how things are done, or request training, or receive honest and constructive feedback. A culture where mistakes are opportunities for learning, not blame. That’s the kind of clinic that encourages utilisation of all team members, regardless of their role.

The guidelines also describe something called the five rights of delegation. I found this really interesting when I read it, as I’d never heard it before - it’s similar to the five rights of medication administration:

• Right person

• Right circumstance

• Right task

• Right supervision

• Right direction and communication

So when you’re asking to perform a task, ask yourself ‘am I the right person to carry this out?’ ‘Are the circumstances appropriate - eg is it an emergency situation, where time for training may be limited?’ ‘Can I perform this task confidently?’ ‘Will I need to be supervised, and is the vet around for direction or to ask questions if I need to?’

Delegation isn’t just about handing a task off to someone because they legally can do it - it’s about making sure they’re the right person for that particular task/scenario. That way, all parties involved have the highest chance of success - and both vets and nurses have an important role in delegation. By delegating smartly, we have better opportunities to use our skills properly.

Next, know your scope.

The guidelines themselves contain a really comprehensive assessment tool which I’d recommend everyone reads. In this tool, nursing tasks are listed and categorised from basic to advanced. The idea is that the team work through this list, determining which tasks are usually performed by RVNs/VTs and which are performed by vets. If your vets are currently performing too many ‘nursing’ skills, this tool highlights that clearly - allowing you to look at why that may be the case, and shift those skills to the nursing team.

Many practices don't realise how much scope-drift there has been, and I’m not saying this is done on purpose at ALL. Often, some tasks will quietly drift to the vets over time, maybe because staffing meant that was necessary to begin with - but over time it can easily become habit. 

I’d really encourage you not just to look at this on an individual clinic level, but to share your findings with others, too. This isn’t just about each clinic - we know these issues face our entire profession. This means our profession as a whole benefits when we share this information and have transparent discussions on what veterinary nurses are and are not doing. So don’t just think ‘how can I do more as an RVN’ - think about how WE can do more collectively, and how your experience can help improve that for RVNs everywhere.

Now, build your training and development programme.

This is the biggest investment, and we know that most clinics don’t do it because it takes time (and we’re all busy), money, and a person to put the programme together. But in reality, practices that invest in training and development have better retention and generate more money. It pays off in the long run - and I’ve yet to meet many RVNs who wouldn’t be keen to help develop this if it meant their skills would be utilised and their recognition would increase. 

It doesn’t need to be as complicated as it seems. Create a list of tasks and divide them into tiers or levels depending on their difficulty and how often they’ll need to be performed in your practice.

Show and explain the task, then have the person do it - in a psychologically safe environment, where they can ask questions and receive feedback. Then repeat that process, then get that person to train the next person - and repeat.

It is THAT simple, we just need to set it up.

The guidelines also recommend what they call a ‘levelled skills approach’ - where  skills are divided into progressive levels, with pay increases tied to demonstrated competency at each level. 

This way, you have something to work toward, and your development is rewarded and directly valued by your clinic. 

Lastly, set SMART goals and assess them regularly.

Any goal you set should be SMART - that is specific, measurable, achievable (accountable), resourced, and time-bound. And as someone who has just finished their mentoring module of the education and leadership course I’m doing, I’ve got a particular appreciation for their importance right now!

SMART goals allow us to work towards clear goals, achieve a specific outcome, with the information, resources and support we need to do it successfully, with clear points for reflection and evaluation.

The reason good intentions don't become lasting change in most practices isn't a lack of desire. It's a lack of structure. The moment the clinical floor gets busy, or another emergency arrives, or someone ends up off sick, most training goes out the window. A SMART goal helps ensure that training happens regardless.

For example - ‘I want to learn how to place a central line’ becomes ‘in the next 4 weeks, I will place a central line in an IV access model’.

Now you don’t just have a ‘nice to have’ goal - you know how you’ll achieve it, when you’ll do it, what you need (the CVC kit and the model), and you’ll have a finished product, in a model, ready to show your mentor. THAT is how you develop your skills.

How to bring all of this together and advocate for yourself as a veterinary nurse

I want to add one more section that wasn't explicitly in the original guidelines document, but that I think is absolutely essential - especially this week, this month - and that’s self-advocacy.

We are responsible for the utilisation of our skills.

We’re not going to get as far in our careers if we don’t take an active role in championing ourselves.

We could wait for our vets to learn what we can do, or we can speak up for ourselves and tell them - and we’ll be using more of our skills a lot sooner if we do. 

I think that there’s something inherently ingrained in us as RVNs - maybe because we’re caregivers by nature, or maybe the fact that historically nurses have been ‘subordinate’ to doctors/vets - that makes us less confident in speaking up for ourselves.

Like somehow it isn’t our place to push for more, or advocate for ourselves. But if we don’t do it, who will?

We need to explain what we can do, what we’re capable of, what we’ve learned, and what we’d like to do with our knowledge.

Our vets aren’t out there genuinely wanting less from us - using our skills doesn’t take away from their role. Most of the time, underutilisation happens because there isn’t open conversation between vets and nurses. So have the conversation, raise the point, ask the question - even if it feels uncomfortable. Communication, not resentment, is what will close that gap and allow us all to work together, for the good of us, our colleagues, and our patients.

This month, for VNAM, please promise me you’ll do one thing. I want at least one of you to have a conversation in your practice that you've been putting off. About a skill you want to use more, or about a role you want to take on, and about what the evidence actually says about what you're capable of.

The AAHA guidelines are free. Print off the utilisation assessment tool in Table 5.3 of those guidelines, sit down with your team, and go through it honestly, then let me know what you find, because I’d be really interested to see what you could do more of in your clinic.

I want to finish the episode today with a really important point. The panel who researched and wrote those guidelines found in their entire review of ALL the evidence surrounding utilising our skills, not a single disadvantage to optimal technician utilisation.

Not one evidence-based reason why we shouldn’t be doing more with our patients. So go out there, have the conversations, advocate for yourself, and do more.

Did you enjoy this episode? If so, I’d love to hear what you think. Take a screenshot and tag me on Instagram (@vetinternalmedicinenursing) so I can give you a shout-out and share it with a colleague who’d find it helpful!

Thanks for learning with me this week, and I’ll see you next time!

References and Further Reading

• Boursiquot, N. Prendergast, H. Boudreau, L. et al. 2023. AAHA Technician Utilization Guidelines [Online] AAHA. https://www.aaha.org/wp-content/uploads/globalassets/02-guidelines/2023-aaha-technician-utilization-guidelines/resources/2023-aaha-technician-utilization-guidelines-new.pdf

• Driscoll D. C. (2022). Credentialed veterinary technician intrinsic and extrinsic rewards: a narrative review. Journal of the American Veterinary Medical Association, 260(9), 1069–1075. https://doi.org/10.2460/javma.22.01.0023

• Fullerton, E. 2019. How to avoid burnout in veterinary nursing [Online] Today’s Veterinary Nurse. https://todaysveterinarynurse.com/personal-wellbeing/burnout-in-veterinary-nursing/

• Harvey, L. and Cameron, K. 2019. Comparison of expectations between veterinarians and veterinary nurses in tasks and responsibilities in clinical practice. The Veterinary Nurse, 10(6). https://doi.org/10.12968/vetn.2019.10.6.327

• Schofield I, Jacklin BD. Identifying factors associated with UK veterinary nurse resignations through examination of veterinary practice data. Vet Rec. 2023;e3165. https://doi.org/10.1002/vetr.3165 

• Shock DA, Roche SM, Genore R, Renaud DL. The economic impact that registered veterinary technicians have on Ontario veterinary practices. Can Vet J. 2020;61(5):505-511.

• Vivian, SR. Dumbbell, L. and Wilkinson, K. 2022. Veterinary nurse skill utilisation in small animal practice. The Vetarinary Nurse, 13(6), https://doi.org/10.12968/vetn.2022.13.6.283