115 | The real difference veterinary nurses make to medical patients (when we get the chance)
Today I want to show you what happens when we GET to do more as veterinary nurses and technicians.
I’m very aware that, as primarily a referral RVN, there are differences in what I do in referral vs what I do when I work in GP. However, there’s one thing that remains the same regardless of the clinic I’m working in that day - I still get to use my skills with medical patients.
Internal medicine sounds fancy, but it just means ‘medicine’. We all see medicine every day. I was nursing CKD patients, diabetics, dyspnoeic cats, dogs with diarrhoea, etc, WAY before I went into referral.
So if you’re thinking there’s less you can do with your patients because you’re in general practice, I want to challenge that thought today.
In this episode, I don’t just want to tell you what you can do, I want to SHOW you. And to do that, I’m bringing you the real in-clinic stories from the over 200 nurses and technicians that I’ve worked with inside the Medical Nursing Academy.
Those nurses have all done things they should be incredibly proud of. They’ve helped their patients in new ways, they’ve changed their clinic culture, and they’ve indirectly helped the rest of their nursing team develop and cultivate their passions, too.
It doesn’t matter where you work - you can still use more of your skills and make even more of a difference to your patients, your clients, and your colleagues. So grab a cuppa and let’s talk about how.
You don’t need inpatients to give great care as a veterinary nurse - you can do it in lots of different ways.
One of the most common things I hear from nurses who want to do more is this: they don’t see many inpatients, so they don’t get the chance.
I’ve also been there because I trained in a branch clinic and spent some time working in a clinic located within a pet shop, where overnight patients went to an out-of-hours provider.
And yet, there are more ways we can support patients than inpatient care - it just takes a little creative thinking and the confidence to speak up for yourself and suggest change.
One way (and yes, I know I talk about this a lot, but it’s important) is through nurse-led clinic support.
We touched on this back in episode 110, where we discussed quality of life and our role in advocating for it as RVNs. But, even if you hate consulting, this is an area where we can make an enormous difference - and it’s really rewarding.
I used to HATE nurse clinics with a passion. In my GP hospital, I was in my element on an ops shift. I didn’t particularly enjoy post-op checks or dental checks, and I spent most of my time worried that, on some level, I was giving the wrong advice.
But if this clinic-hater can think differently about them - and see them for what they are, which is just a different way to care for our patients - so can you.
Clinics are also one of the areas I’ve seen my community champion the most.
I’ve seen several nurses go to their vet teams with suggestions for implementing medical clinics, particularly for CKD and diabetic patients.
Those nurses - 4 spring to mind immediately, all working in different GP clinics - created protocols, put together a proposal outlining why their practices needed to offer them, and took that information to their team.
With an idea, passion, support, and the desire to use their skills differently, their patients now get improved access to nursing care, even if they’re not sick enough for admission.
One now has over 50 diabetic patients whom she’s seen for clinics over the past 3 years. Another began doing the diabetic discharges for their practice, then had them return to see them for ongoing consults. That’s expanded well beyond diabetes, with them now running quality-of-life support clinics for many patients.
Another created an entire promotional campaign for senior pet clinics to improve early disease detection - and with things like CKD often diagnosed quite late, this will benefit chronic disease patients massively.
And another developed both thyroid and CKD support clinics, working with the vet to increase the support for her senior cats.
The benefits of this are huge - not just to the patients.
Every single one of those clients knows those nurses by name. They know their skills and their knowledge, and value their expertise in helping their pet.
And given that in the not-so-distant past, most people didn’t know what vet nurses did, this is huge.
Perceptions and the importance of our role won’t change if we aren’t out there confidently showing clients just how much we know. And the reality is, we’re just as important as any other member of the team caring for that patient.
Clinics give our patients another layer of support. They help our clients feel supported and improve access to treatment options that work for them; they allow us to spot subtle changes because we truly know our patients and their families; and they help our vets manage complex medical cases without feeling like they’re shouldering all the pressure.
Even if you dislike clinics, I’m willing to bet I could change your mind with medical patients because they’re not boring. They’re relationship-building, incredibly rewarding ways to make a difference.
And if you don’t have this in your practice yet, but you want to start, please know you don’t need to start with something big, fancy, or complex. Just pick a condition you’re interested in, where you feel like your patients would benefit. Then speak to your vet team and build it out from there.
Taking a nurse-led role in auditing, quality improvement and raising veterinary clinical standards
Another area I feel especially passionate about - and one where I’ve seen so many nurses champion - is improving clinical standards.
Every single clinic can find ways to improve things - even the best ones. So please don’t think I’m saying clinics are ‘bad’ for needing to improve. And ongoing auditing and clinical improvement, moving away from ‘we’ve always done it this way’ to a data-driven approach, is essential.
It’s also an area I think we’re instrumental in as veterinary nurses.
Think about it. We’re the people in the ward, spotting when things could be improved or done differently. We’re the ones trying to get inappetent patients to eat and feeling like there must be more we can do. Or trying to warm recovering patients and wondering if our temperature management protocols can be improved.
So it makes sense that we champion this - and when we do, our patients significantly benefit.
I’ve seen several nurses in the community do this in different ways.
One ran a nutritional audit that earned her an RCVS award. And I know that I bang on about nutrition a lot, but the reality is that if our patients don’t take in sufficient calories to heal, they end up in hospital longer, and with this, they have higher risks of things like hospital-acquired infection - so it’s important.
If you feel like your clinic could do more to support your inappetent patients, try this.
Review your hospital sheets over a set time period. It could be two weeks, or a month (I’d recommend a month, maybe longer if you don’t have many inpatients).
Ask yourself:
How many have clear feeding instructions?
How many can I clearly see their calorie intake?
How many consumed <33% RER per day for two or more days in hospital?
Then, once you’ve reviewed the current situation, ask yourself what improvements are needed. Then you can implement change and reassess to see if things improve.
This is exactly what one of the nurses in my community did. And she didn’t do this because she was asked to - she did it because she identified a potential gap in the care they were providing, she knew why it mattered, and she wanted to use her skills to give better care to her patients.
There is nothing stopping any of us from doing the same. And since then, I’ve seen other nurses do this too. Between them, they’ve seen reductions in in-hospital weight loss, an improved % of patients meeting their RER, more patients with clear feeding plans, and increased feeding tube placement.
And the feeding tube placement, in particular, is something I want to highlight because it is often an area where many VNs feel frustrated. I definitely remember many times where I felt like asking for a tube just went ignored, or feeling like I couldn’t push for a tube even though I knew my patient would need one.
While these decisions need to be made by our vets, they can’t make those decisions if they don’t have the clinical information to back them up - and THAT is where we can use our nursing autonomy to do more. So look at what your patient is taking in, make feeding plans, calculate their intake, and then ask for that tube - confidently, with the data.
And if it’s a nasal feeding tube, see if you can place it - because that’s another important nursing skill.
That’s also what I’ve seen more of my community do - placing these tubes for themselves, under vet direction - all because they identified a need and spoke up.
Another important area I’ve seen nurses do more with is anaesthesia.
We know that anaesthesia is a huge part of our day-to-day role. And medical patients, just like any other, require nursing support throughout this process.
Medical patients aren’t always easy to manage under GA. They’re, by definition, not healthy - they have some kind of disease, often increasing their anaesthetic risk and bringing with it specific considerations.
And while these patients aren’t ‘cookie-cutter’ and don’t fit nicely into a set anaesthetic management protocol, there are ways we can use more of our skills to support them as vet nurses.
For example, I had one nurse in my community develop, with the vet team, of course, anaesthetic protocols for their diabetic patients and their Addisonian patients.
Two patient populations whose conditions carry additional anaesthetic risk, and who need careful support. There are specific considerations around things like glucose management, steroid administration, fluid therapy, blood pressure support, etc.
So the nurse looked at the current evidence, put together some suggestions, and went to their vet team. They worked with the vet team to create a protocol everyone could use (as a baseline, adapted to each individual patient) when anaesthetising these patients.
And now, that team can approach those high-risk patients more confidently, know exactly what their patients need, and feel better equipped to handle complications as they arise.
Whether it’s nutrition, anaesthesia, or anything else, the principle behind improving standards is the same.
We need to audit what we’re doing, understand what the evidence tells us to do, and advocate for change. Everything improves as a result, and this is an area we’re ideally suited to champion as VNs.
Stepping into our power as patient advocates: the role of veterinary nursing in clinical decision-making
Probably the thing that makes my heart the happiest is what I’ve seen vet nurses do with patient advocacy.
Because for a long time, I think many of us, myself included, didn’t feel like vet nurses could really have a voice, or ask for change, because it was ‘outside the scope’ of our role.
But even if we can’t prescribe, or diagnose, or treat, we can DISCUSS those things. We can advocate for our patients and ask for change on their behalf.
And this is an area I’ve seen countless nurses inside the community step into.
Here are a few examples of what this has looked like with medical patients, across out-of-hours centres, GP clinics, and referral centres.
Analgesia CRIs
Multiple nurses have discussed with their vet team about enhanced analgesia protocols for patients where needed. For example, escalating intermittent methadone dosing to CRIs in patients with marked acute pancreatitis, or adding multi-agent protocols with things like ketamine and lidocaine. Or utilising local blocks where they perhaps would not before.
Not a single one acted outside of the legal remit of their role, even though we’re talking about medications here.
But what they did was observe their patients and identify a need for change, think about different ways they could support their patients, and then take that information to the vet for collaboration.
And in each case, it happened.
This seems like a tiny thing, but it’s an enormous win - for us, our vet team, and our patients.
Sampling lines
Another area I’ve seen at least 8-9 RVNs champion is alternative IV access. Especially in patients who require long-stay IV access, multiple samples, or who are critically unwell, I’ve watched RVNs discuss with their vet about sampling lines to preserve veins and minimise needle sticks.
This has resulted in easier IV access, increased use of schedule 3 skills, easier blood draws, and more comfortable patients - all because we’ve asked.
Continuous glucose monitors
Unsurprisingly, with the way diabetic monitoring has evolved over the past 5-10 years and the number of nurses in the community keen to champion it, we’ve also seen lots of RVNs advocate for continuous glucose monitors.
And while we use these a lot for outpatient diabetics, an area I’m excited by is watching nurses advocate for these in-house too. I’ve seen RVNs ask for them in hospitalised DKAs, or complex diabetics, where frequent monitoring is needed for several days. And instead of performing countless ear pricks, making patients uncomfortable and head-shy, they’ve had easier, less invasive monitoring while remaining happier in the hospital.
I’ve also seen clinics where these were literally never used do a complete 180 and use them all the time now, both on inpatients and in lieu of glucose curves in their diabetic outpatients. All because an RVN brought the information to their team and asked the question.
What all of these examples have in common is that a nurse saw something, understood the evidence behind a better approach, and used that knowledge to change what happened for their patient.
This is not us overstepping or acting outside of the scope of our role. We’re not bypassing the vet, we’re working together - with nurses contributing clinical knowledge and observations, and vets making the final call based on better information than they had before.
Using our practical skills to the fullest extent as veterinary nurses - confidently.
The last area I want to highlight is what happens when we get to use our practical skills. I’ve scrolled back through years of community posts watching nurses share their wins, and one thing from what they’ve shared really stands out - everything gets better when we get to do more.
There are countless ways we can use more of our practical skills to enhance the care our patients receive.
If we think about where we’ve previously been for a second, our skills usually aren’t fully applied because the opportunity hasn't come up, because we haven't felt confident enough to step forward, or because the clinic culture hasn't been one where those skills are routinely used.
But this IS changing.
I’ve watched as vet nurses have:
Unblocked cats under vet direction
Placed naso-oesophageal tubes when they weren’t doing it before
Decided to start looking at blood smears, then took the information to the vet, and set up and ran transfusions as a result of their findings
And many more
And another really important area I’ve seen VNs champion is mentoring their teams.
Not just taking their knowledge and doing more, but teaching their colleagues, supporting their students, and explaining WHY all of this is needed - then helping them do the same.
I firmly believe that no good comes from gatekeeping our skills and knowledge. More patients benefit when we create environments that help our colleagues ask questions, feel confident, and develop their skills.
What all of this means, and what to do with it in your clinic right now
As part of the preparation for this episode, I sat back and looked at all the community posts inside the academy, every win the members have shared since 2023, and all the wins they’ve logged in their skills trackers.
And it’s reinforced two things to me. First, we can do a LOT more than we think, we just need the opportunity. And second, magic happens when nurses get together and make change.
None of what these nurses have done is impossible. All of these things I do in practice too - and across all 200+ of us who have been inside that community, we’ve done this in a ton of different clinics, from small branches to huge specialist hospitals.
All we need to do to get started is take action. Ask questions even if it feels uncomfortable, do research and ask yourself if there’s a different way of doing something out there - to use what you’re learning to positively impact your patients every day.
If you're in a practice where none of this is happening - where nurses aren't leading clinics, or contributing to clinical decisions - it just means it hasn’t happened yet. It means someone needs to go first, and that someone might as well be you.
So go out there, advocate for change, do more, and remember that everything gets better when you do.
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!
