Beyond the Basics: Elevating Veterinary Nursing for Financial Success

Julie South [00:00:06]:
Welcome to Veterinary Voices episode 208. I'm your host, Julie south. With listeners in over 1400 cities around the world, veterinary Voices celebrates all that's great about working in New Zealand's veterinary industry. I'd love to know where in the world you're listening to right now, so please feel free to let me know. And you can do that at veterinaryvoices dot NZ. It's at veterinaryvoices dot NZ. You can also find back copies as well. Veterinary Voices is brought to you by Vet staff, New Zealand's only recruitment agency, specialising in helping veterinary professionals find jobs that they're excited about going to on Monday mornings in Kiwi.

Julie South [00:00:47]:
Vet clinics Vetstaff dot co dot NZ. It looks like last week's episode, which was the first of the two part series with Michelle Cameron, who's an executive member of the NZV and a the New Zealand Vet Nurse association, looks like their episode really touched the spot because in this last week it's been listened to from Auckland to Aberdeen and from the Deep south of Invercargill, New Zealand, to the midwest in Ohio. In the US today we continue that chat with different ways in how vet nurses can up the ante and raise a perception of their professionalism by including their fees and clinic invoices. Stay tuned because for proactive nurses and supportive clinics, hidden in today's chat is a way for nurses to increase their hourly rate. I'm going to rattle the cage a little bit here and say that I believe it's pretty much within every vet nurses, or most just about 99.9% of every vet nurse's ability to raise their hourly rate by $5, a whopping $5 an hour, which is around $10,000 per annum. Now, it's not going to happen overnight, but listen up because Michelle and I talk about ways that that can happen. It's not an overnight thing, but it can happen for someone who's prepared to get off their tush in a supportive clinic and show their professionalism. If you haven't listened to the first part with Michelle yet, then go back and listen to episode 207 at VeterinaryVoices NZ.

Julie South [00:02:20]:
As I said last week, you'll notice the audio isn't as good as it usually is. Unfortunately, Michelle and I had heaps of technical issues getting the episodes recorded. I apologize in advance for that. We joined the conversation here where I asked Michelle about how vet nurses can earn their keep in clinics. Oh, and quickly. If the term Voi is a new one for you, it stands for veterinary operating instructions.

Michelle Cameron [00:02:52]:
It's just like when we had, someone was asking for a, you know, one of those patient warmer blanket things. Probably costs about two grand or something like that from a supplier. They weren't allowed it because it costs two grand straight up. How do you work around that? You put it in a fee, patient fee warmer. It could be $10, could be $15. How many times do you have to use that in your surgery? How many times do you do a surgery a week when we're out in the hospital? What do nurses do all day with the cat that's anorexic? They're going to sit there and they're going to syringe feed it. They're going to try and give it some warmed fish. They're going to try all day.

Michelle Cameron [00:03:35]:
Not necessarily all day, but they're going to spend at least three or four times during that day to give that cat some assisted feeding. Got the little dog that is recovering from the foreign body doesn't really want to eat because it's a small fluffy. What are we going to do with that one? We're not going to make it starve. We know that we need to make them eat. We're going to offer it food. We're going to try syringe feeding if we need to. We're going to do that three or four times a day. Assisted feeding is a fee that we can add onto as the existing hospital fee because this is over and above what they would normally do.

Michelle Cameron [00:04:12]:
Yes, they're there all day. The nurses are there, they're doing their job, but it is over and above what is required of a general hospitalization. General hospitalized patient. I had one where we were nebulising a patient that had pneumonia and that nebuliser was used three or four times a day. There was no fee associated with that. I asked the question, and I think asking questions is really important. And being in a good environment where we can ask questions within the clinic and say, why was that not charged? Why was there no fee associated with that nurse that had to sit there for ten or 15 minutes, three or four times a day for that patient? I don't know how often that would get done, but, you know, it's still time. It could still be invoices time for that patient as well.

Michelle Cameron [00:05:02]:
And if we're informing clients of the costs and daily costs with regards to our hospitalizations and what we're doing with the patients, which is what we should be doing anyway, they should be well aware of how much things are and what we're doing and why we're doing it. We use nurse fees, obviously, in consults quite a lot. The consultations. We can do a dental check. With the dental checks we can look at their teeth and see that they need a dental. A vet doesn't need to do that. It's very difficult for anyone to say whether they need extractions or not with a patient that is awake. So that's not something that we can say.

Michelle Cameron [00:05:42]:
Your dog needs to have teeth removed unless it's very obvious they're trying to fall out with someone and they can be, but that dental consult can be have a fee associated with that, with the nurse rather than a vet. It's probably twice as expensive and just going to say, yeah, you need a dental and book it in as well. So a nurse can do that. The nurses can also do post op dental checks and with that create a better client bond. We're talking about their dental prevention. So they've had a dental because they've had bad teeth and now they want to prevent having that happen again. Likely if they've had a dental, they were going to have to have another one. But we can give the client options, being a pet parent, to avoid having to do it quite so soon again, or at all, depending on what was required of them, by offering them things that are over the counter, dental prevention sort of treatments that even trained admin staff can do at reception as well.

Michelle Cameron [00:06:44]:
If it's over the counter, they're quite happy to go through things, certainly as well. The nurse senior checks are other consults that we can do. The senior checks in the past have often not been something that's been invoiced. And now, because nurses are consulting more, this is something that we can do. We can recommend in consultation with the vets, blood samples in house. Point of care blood samples can be run in house. Your own samples can be run in house. The nurse can go out with a kidney dish, the same as the vet can, and collect the urine and then run it.

Michelle Cameron [00:07:21]:
And then, you know, the vet will do the looking at it and making sure that everything's okay. But we can do that initial consultation with the patient and the client and then go from there. Basically, depending on what the results are.

Speaker C [00:07:36]:
Obviously as well, there'd also be diabetes, weight management, weight management.

Michelle Cameron [00:07:43]:
Yeah. Very difficult to get clients to come back for weight management consultations. Most of the time we're found. But even the ones that are like that puppy preschool. Puppy preschool often has been something that's maybe been something provided or not even provided in clinics as a free thing or as a cheaper thing or whatever. And. But why shouldn't we be invoicing, you know, that whole hour of time that you're spending with those patients? Often we can get reps that can help with getting free stuff, merchandise or whatever, I suppose, depending on which food companies that you guys are working with in clinic reps are great at getting stuff for those kinds of things. They love it.

Michelle Cameron [00:08:25]:
Good free exposure preschool, puppy preschool is a really good one for nurses to get into as well, if you haven't already got that going. And that can be nurse led as well, because the vets don't have time for that at all. The big one recently, I suppose, with a lot of clinics, is the vaccinations. Nurse Vois sort of came into play last year, the year before, mostly. So the nurse. So the injections, so the vaccinations that the nurses are doing was brought about because of the vet shortage. The vets. We didn't have enough vets to be able to do the regular health checks that nurses are out the back doing other things where they could quite easily do a head to tail health check on a patient and give a vaccination as a subcutaneous injection under the direction of the vet to be able to do this.

Michelle Cameron [00:09:22]:
They've been trained in what vaccinations they can use in particular patients, and it's not a first vaccination. The vets always do those ones. Check, do all the health checks and things. The vets will also put in their clinical history exactly what is prescribed, when, how often, what vaccine and the frequency, whether it's an annual or biannual sort of one, and what they should be getting and the nurses are able to do that. I would say that if you're looking in your clinical diaries, how many second vaccinations onwards is a vet doing that a nurse could be doing? How much time would that free up your vet to do other things that vetshehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehehe need to do? You might have lots of medical cases or sur degree that the vet needs to if you're in a single vet practice, lots of things that they need to get through before they can go and do their operation on the foreign body or the stitch up that's been waiting since 10:00 in the morning to get done. Nurses are able to do that for them. And provided they've been trained well within the clinic and the vets have directed them, then the fee associated with that is the same as what a vet would be as well.

Julie South [00:10:46]:
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Julie South [00:11:46]:
now let's get back to today's show.

Michelle Cameron [00:11:53]:
Would you? When you go to the doctors who gives your baby their vaccination, it's not a doctor. Generally, it's going to be a nurse. Nurse practitioners have been around, and all of my babies have been vaccinated by nurse practitioners, certainly never a doctor. So why would it be any different in a vet clinic? We've got vets. We've got vet nurses. So vet nurses are quite capable of doing these vaccines provided those steps have been in place. Obviously, everyone's under the direction of the Vet council and you know, things as well. So they do need to make sure that they're doing things properly.

Michelle Cameron [00:12:36]:
But with good communication and direction, they'll be able to follow that through and, you know, become much more job satisfaction and professional satisfaction with regards to these fee earning things that they can actually do. The vets don't have to do all of them.

Speaker C [00:12:52]:
No, no, they are not. And I say this with respect, they're not indispensable, in a way. Michelle, before we wrap up, is there anything else that you especially, you would like to say?

Michelle Cameron [00:13:10]:
I think the main thing is we're trying to turn our old way of thinking from the person that used to be out the back holding an animal, cleaning out cages, was off the street with no qualifications whatsoever. Nowadays we have veterinary nurses who are qualified, registered, able to do a lot more than just clean cages, just hold animals, those sorts of things. And we are aware of this, but we need to make sure that everybody's able to voice their opinions and offer their skills and where they can help with these fee earning potential in the clinic with everybody, and I think that's the main thing, is that often it's been an old way or old school way of thinking with regards to vet nurses. And now we've got that ball rolling and thinking, hopefully that's going to change. The change is coming. We're already here, we're already in clinic, we're already registering. The AVPRC is up and running, the NZVNA is helping, starting those conversations, which I think is kind of what we want to cover with everyone, and helping with job satisfaction and making time for vets, freeing them up, getting them to do the things that they need to do. Where the nurses are in good working environments, they're able and ready and geared to do their own responsibilities with regards to consultations and fees, it relates directly back to them.

Michelle Cameron [00:14:58]:
Most clinics these days are able to sort out where these fees are coming from and they'll be able to see exactly where they're coming from under the nurse umbrella, as I've been saying, as well. So I think. I think the main thing is we want to try and change that way of thinking and start that conversation with the nurses being able to speak up and say, why can't we do this? Why is there no fee associated with this? Where there's a nurse, there's always a vet. Where there's a vet, there's always a nurse, generally. So their time also matters as well, I think is probably the main things that we'd like to cover.

Speaker C [00:15:36]:
In order to charge, there needs to be codes entered into the PM's. Where do you suggest that people start? Is there like a vet nurse only range of codes and chargings, or do you bundle them up into a procedure, for example, overnight stays?

Michelle Cameron [00:16:00]:
It depends on where in the clinic. Again, as well, we have probably about 30 over 30 different fees associated with nurses, and one in three out of four of our clinics, another one has 20, so they're slightly different. The codes often repeat, though, as well. So if you've got a ten minute time, you might have a 30 minutes time of the same sort of nurse preparation kind of thing as well. So some of them are repeated in that way. So they are often under a specific code for that. Definitely.

Speaker C [00:16:40]:
And would you have obviously got them, I hope, set up so that they're easy to find and they all make sense because I know, talking with some vets and some nurses, that some things get left off bills because it's just too difficult to find the code or the treatment or the meds or whatever it is in the PM's and it gets too hard. So it's, I will just, you know, we'll waive that. And every time that's waived, every time that's written off, given away for free, that's money that the clinic is missing out on the.

Michelle Cameron [00:17:18]:
Absolutely. In my line of work, I am the person that goes through all those bills and finds all those things and I add them back on. But we use a lot of formulas already. So in the formula, we might have like a stitch up formula or a gdv or caesarean, and within that is everything associated that needs to be charged. So it has all of those fees already in it. And the stuff that you can swap in and swap out are your drugs or your time that it actually takes to do that. And that way, it also gives us a quick way of estimating for the client as well. So we build it into each procedural thing, which we call formulas as well.

Michelle Cameron [00:18:10]:
So in order to make up that entire invoice, it's under that one, each individual bracket of stitch up or GDB or something like that as well. So it's already there, and it gets put in there when we come up and come across something new or something that we haven't thought of as well. And even with formulas themselves, we'll make new ones. Why don't we have a bilateral cherry eye formula? Why don't we have an anal gland flush that the vet did on a dog the other day? Why don't we have, see, these are all questions that I like to ask because I see them happening, and I'm the one that's checking the invoices after they've done them. You know, I come across they had a, like a prolapsed dog that had been on heaped and had a prolapse. And I spent an hour trying to put the prolapse in and keeping it, you know, shrinking it down and putting those stitches in. But they didn't charge that time that it took. Why was there no charge for that? Why wasn't there something that we could create for that, you know, particular procedure? And that also goes against the vet as well.

Michelle Cameron [00:19:18]:
You know, that time should be also vet time that they should be invoicing themselves as well, because that's, you know, something that they'll spend time doing and saying things like that after hours as well. We do a lot of after hours, and that is, again, another kettle of fish with regards to fees and time. That also has lots of things associated with it as well, with nurses being called out and spending time trying to recoup fees and things like that as well, which is interesting. Another day conversation, probably.

Speaker C [00:19:47]:
I'm going to ask you a question that I don't know whether you'll be able to answer. You mentioned just now that it's you that goes through to see where money is lost. My words, not yours. Approximately how much do you think on a weekly or a monthly or a quarterly basis? And you've got a pretty advanced system. You know, you are pro charging where possible, but how much money do you catch that's fallen through the bottom, that's come through the holes, do you think?

Michelle Cameron [00:20:22]:
For me, we do do a spreadsheet every month. I probably can't disclose how much it is.

Speaker C [00:20:27]:
Okay. Can I, are we talking thousands?

Michelle Cameron [00:20:31]:
Yes.

Speaker C [00:20:32]:
Yeah. So that's pretty serious. Yeah.

Michelle Cameron [00:20:36]:
It started off by missing hospitalizations. So we noticed that hospitalizations weren't being invoiced. So we went back and we checked to see where we were missing things. And so we're like, right, well, we're missing those. What else are we missing? Well, that dog had a rimidol injection. That dog had an extra pain relief relief. That was an invoice. So it just built from there, basically.

Michelle Cameron [00:21:04]:
And we have lots of different people, lots of different ways of charging, but we still have formulas and we started off very bad, but we talked about it. We've got our estimations up better. We're informing the clients better in that way that we're able to discuss it with our team. We're able to start invoicing better as well. So I would say we started, I like to call them what you would say, a good side and a bad side of my spreadsheet. We started off with a very long bad side and a very short good side. So the good side is anything that I didn't need to add anything to or take anything off. And now we've flipped a switch and we are now way better at invoicing correctly than we were before.

Michelle Cameron [00:21:55]:
And that's, it does take time, but fees and things that we're losing often in the, in the beginning were nurse fees that were being taken off. So we stopped that pretty quick. And now, now we've got other things that we finding as well, though.

Speaker C [00:22:10]:
But, yeah, because it doesn't take much to, let's say a nurse wants a $5 an hour pay rise, $10,000 a year, say, plus or minus. Now I can imagine, because I believe that in most cases, that's the shortfall for many nurses right now, $5 an hour. It doesn't take much stopping the holes in clinic to recoup $5 an hour for each nurse.

Michelle Cameron [00:22:49]:
That's.

Speaker C [00:22:50]:
I don't know. You know, maybe I'm being too naive here, but that to me sounds absolutely achievable. And you're nodding.

Michelle Cameron [00:22:59]:
Yeah, I would. I would say that it is achievable. Probably asking for $5 an hour is going to make your boss go, oh, what's going on there? That's quite a jump. But it's not just $5 an hour. You also have to have those competency skills and skill sets and time experience to be able to fit that bill as well. You need to not just say, I want $5 an hour, and then not do anything about it, not do any extra. It's about being able to show that you're able to bring something to the clinic to show that you're able to do extra, not just say, I want it without accepting anything else as well. So they do.

Michelle Cameron [00:23:46]:
And competencies are another thing that, again, the NW and a have been working on. And I know that they are on the website and I'm pretty sure that they're on the non member part of it now as well has changed. That competencies and the levels at where they should be at is probably something that clinics can look at and work together with their nursing teams in a way that they can build up to that wage that they're wanting. Might not happen in the first wage rise, but, you know, as they get along and to be at that skill set, they need to be able to do such and such kind of things and be able to do those kind of skills and whatnot. So our nurse vaccinations are for nurses that have been with us for over two years. They need to have had that experience before they can do that kind of thing. So those, you know, we've got brackets of the way that they're paid and things as well. So they are not able to do those bois on their own until they've got those skill sets or whatever, you.

Speaker C [00:24:47]:
Know, but they do clean cages that they're not getting any acknowledgement for.

Michelle Cameron [00:24:54]:
Absolutely.

Speaker C [00:24:55]:
Straight away, there's a charge straight away.

Michelle Cameron [00:24:58]:
But I think that with us being proactive and asking questions and finding those holes is where we start to build our sort of nursing fee earning professionalism with everyone, basically.

Julie South [00:25:24]:
I hope you found these last two episodes really helpful. Regardless of your role in your veterinary clinic, there's something here for everyone. Until next week, this is Julie south signing off and inviting you to go out there and be the most fantabulous version of you. You can be kaeketi ano.