See the Full Issue
January 2023
Sharing the Load with Techs
Credentialled technicians are notoriously underutilized in most practices. All-star technicians Stephen Cital and Tasha McNerney offer tips on actions that practices can take to improve collaboration between technicians and veterinarians.
Better Care, Better Minds, and Better Economics
Credentialed veterinary technicians are undoubtedly the most versatile and valuable investments for your practice. Unfortunately, poll after poll and a few studies demonstrate a lack of utilization of and interprofessional collaboration with these key team members and veterinarians. This has become such a problem that, in May of 2019, the American Veterinary Medical Association (AVMA) voted unanimously to create a Veterinary Technician Utilization Task Force to look into ways to use staff more efficiently, minimize turnover rates, and elevate patient and client care.
In January of 2022, the task force submitted its final report. Here we examine some of those findings and, more importantly, expand on the report with practical solutions every practice can adopt today.
The report highlighted six main areas of attention and future research for both the AVMA and the National Association of Veterinary Technicians in America (NAVTA) to address further. These areas include education, licensing and regulation, economics, availability and attrition, wellness, and community.
Unfortunately, the task force’s report provided few action items practices could institute right now. Although public-facing technician visibility was another key area of interest for the task force, the above-listed primary areas deserve attention immediately, particularly interprofessional collaboration, meaning a veterinarian working closely and collaboratively with a credentialed veterinary technician on their team.
In order for any practice to function at its highest level, the relationship between the credentialed veterinary technicians and veterinarians must be based in collaboration and trust. When researching for this article, the authors found six key areas that support collaboration and are easily implemented with dedication from management and decision makers in the practice.
Safety
“Learning to work closely and collaboratively with every member of the team also improves interpersonal efficiency and communication.”
Most would not argue that two sets of eyes, hands, ears, etc. are better than one when it comes to patient safety. That’s not just an opinion, it’s science! In human medicine, a 2015 study from the Joint Commission of Nurses found that both patient safety and the quality of care patients receive depends upon the quality of relationships in the healthcare practice environment where care is provided.
Creating an environment for team members where they can share their knowledge and expertise with mutual trust and respect is critical. Patient care suffers when credentialed veterinary technicians feel excluded from the conversation regarding patient care.
One way to address this issue is to institute standardized patient rounds or more informal huddles throughout the workday. These are valuable opportunities to allow the team to understand the concerns of each professional caring for the patient while ensuring that changes in patient status or treatment plan are communicated in a timely fashion.
In the surgery department, a “time out” before beginning any surgical procedure is key to ensuring patient safety. This brief team check-in enhances patient safety by making sure that every person participating in the surgical procedure knows the role of each team member, along with any patient-specific concerns and contingency plans for emergencies.
Fulfillment and Retention
A 2020 veterinary-specific study showed a direct correlation between poor technician utilization and suboptimal Maslach Burnout Inventory-General Survey and Stanford Professional Fulfillment Index scores. When credentialed veterinary technicians who have mastered advanced skills are not allowed to use those skills or demonstrate their advanced knowledge, researchers found decreased job satisfaction and professional disengagement, both of which lead to rapid burnout and increased turnover.
It would behoove all practice owners to review their state’s Veterinary Practice Act and take note of the few things credentialed veterinary technicians are prohibited from doing, as well as job tasks that must be performed by either a credentialed veterinary technician or a DVM.
Identifying skill or knowledge gaps in the team can help practice owners support their team members through on-the-floor clinical training or third-party continuing education to fill in those gaps. This will also allow veterinarians to focus on their own professional development by learning advanced procedures or other skills because they should no longer be performing tasks more appropriately delegated to credentialed veterinary technicians such as anesthesia induction, IV catheter placement, treatment administration, etc.
“In order for any practice to function at its highest level, the relationship between the credentialed veterinary technicians and veterinarians must be based in collaboration and trust.”
Learning
Continuing education for anyone working in the medical arts is critical. Given the pace of science, we must constantly keep abreast of evolving thoughts and practices. This education is enhanced when the entire team is learning alongside or from each other. Both parties can then describe their perspectives on care for the patient, which will result in overall elevated care. Also, rounding patients together has been shown to increase team member satisfaction and overall patient care outcomes while improving patient safety as mentioned above.
Partnering with and engaging credentialed veterinary technicians in shared decision-making and care planning is a shift in culture and workflow within the veterinary team, given the traditional idea that only veterinarians are qualified to make care decisions. When a team-based approach was instituted in human medicine, improvements were seen in utilization, management, and appropriateness and timeliness of resource use because of better communication and understanding of care plans by both nurses and physicians.
Social Resilience
Compassion fatigue and burnout are very real threats to every member of the veterinary team; however, research suggests strong social resilience in the form of a close colleague can mitigate these threats and offer mutual resilience through rough days or difficult cases. Learning to work closely and collaboratively with every member of the team also improves interpersonal efficiency and communication.
When creating this type of collaboration, it’s important for both parties, particularly for those on the veterinarian side, to eliminate possessive pronouns when speaking about their colleagues. Although often not intentionally offensive, using possessive pronouns, like “I asked my technician to do XYZ” can be demoralizing and introduce a toxic imbalance of power. Instead, one can say, “I asked (insert name) to do XYZ” or “The veterinary technician was asked to XYZ.”
Economics
If the overall wellness of your team isn’t as concerning to you as it should be, its impact on your finances certainly should be of concern. Every day we are inundated with discussions about the shortage of veterinarians and credentialed veterinary technicians.
However, we do have mature data on the cost of veterinarian and credentialed veterinary technician replacement, and the financial benefits of appropriate use of credentialed veterinary technicians. For veterinarians, credentialed veterinary technicians, and experienced veterinary assistants, practices can expect to lose about 66% of an employee’s fair market annual salary in costs incurred to replace that individual.
The cost of staff turnover is estimated to be twice the loss from production with an average of 5.7 weeks to hire a new veterinarian as reported from a 2022 study. In addition, the absence of a credentialed veterinary technician will stack on an additional $35,000 in losses. However, according to a different study, we have an estimated increase in a veterinarian’s gross income by $93,000 for each credentialed veterinary technician per veterinarian. That figure would be about $127,000 in today’s dollars.
Advanced Certifications
Advanced certifications to become a board-certified veterinarian specialist (Diplomate) or a certified veterinary technician specialist (VTS) can be seen as the culmination of the practices listed above. But, if a residency or a daunting application packet does not interest you, there are several other certifications both the veterinarian and credentialed veterinary technician can attain together, individually, or mutually with each other’s support. Certifications like Fear Free or the Certified Veterinary Pain Practitioner (CVPP) are offered to both veterinarians and credentialed veterinary technicians alike and will inherently elevate your level of care while providing opportunities for mutual learning and marketable additions to the practice.
Action Steps
So, how can we start to foster this in our own veterinary practices?
First, ask yourself if your team is one that operates on psychological safety. In other words, does your team feel safe to speak up and share ideas without negative repercussions (such as bullying, belittling, or threat of job security). A team that has psychological safety often encourages members to view failure as an opportunity to learn and underlines the importance of every team member’s voice.
Anyone in a position of responsibility or authority should set an example for the rest of the hospital regarding psychological safety, and it should be emphasized throughout the practice: from practice managers, medical directors, associate veterinarians, supervisors/leads, credentialed veterinary technicians, veterinary assistants, and front desk team members. If done properly, the set of behaviors should become a norm across the practice.
Second, put these principles into actions that your team sees everyday such as acknowledging your mistakes, being open to opinions that are different from your own, and encouraging people to ask questions. You can’t expect team members to perform a certain way or feel safe if upper management doesn’t lead by example.
Third, let credentialed veterinary technicians practice to the full extent of their license, their education, and their experience as co-equal members of the veterinary care team. Let credentialed veterinary technicians develop their skills to help improve practice efficiency and patient care. Sit down with each team member to review their skill set and inquire about their career goals.
Are there skills allowed by your state’s Veterinary Practice Act that credentialed veterinary technicians in your practice want to learn? These might be things like ultrasound-guided cystocentesis, triple-lumen catheter placement, urinary catheter placement, dental prophylaxis, and so many others!
Photo credits: ©AAHA/Robin Taylor, AnnaStills/iStock via Getty Images Plus, Morsa Images/E+ via Getty Images