Is it time for the veterinary nurse practitioner?

Is it time for the veterinary nurse practitioner?

Could this new role solve a host of problems facing the veterinary profession?
May 02, 2016

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When veterinarians and veterinary technicians become credentialed and take their posts, we take a professional oath expressing our commitment to benefit the society through better animal health and welfare, preventing and relieving animal suffering, promoting public health and advancing the field through lifelong learning. The field currently faces challenges preventing us from completely fulfilling our oath.

The challenges—and a possible solution

Rising costs mean many pet owners perceive veterinary care as unaffordable, and this triggers negative opinions of veterinary practices. Pet owners are often unaware of the validity of these costs, even as veterinarians and veterinary technicians earn a salary significantly lower than our human medicine counterparts.

Graduates struggle to pay off their debts from rising tuitions while working longer hours or multiple positions, making burnout and compassion fatigue common. The result: many leave the field. In the meantime, the employment gap between small animal veterinary professionals in populated areas and large animal veterinary professionals in rural areas is widening, making veterinary care in some areas inaccessible.

One solution: a midlevel veterinary professional program proposed by Colorado State University, designed to train veterinary professional associates (VPAs) serving the role of a physician assistant (PA) to a physician or dental hygienist to a dentist.

The goal of a midlevel professional is to allow practices to generate more revenue while keeping costs low and create capable professionals who will reach underserved areas.

But how do we get there?

A first step: NAVTA recently announced their effort to establish a nationally standardized credentialing requirement for veterinary technicians and a title change to veterinary nurse. As the association explores these changes, it’s pertinent to look further ahead and think of a possibility of a nurse practitioner-like role in veterinary medicine.

Both PAs and nurse practitioners (NPs) in human medicine are able to examine, diagnose and treat patients for both acute and chronic conditions. NPs practice independently of physicians or under a physician’s license, depending on the state’s regulations, and they tend to specialize in specific areas.

Veterinary technicians in the field today bring a significant amount of education, experience and value to a practice, performing tasks that can start with taking a history and performing physical exams to implementing complicated treatment plans for hospitalized patients and managing the care while consistently reassessing the patient to be the hands, eyes and ears of the veterinarian.

What could a nurse practitioner do for the profession?

What if our profession created a structure to train veterinary nurse practitioners (VNPs), where the brightest of these team members were given a path to contribute further?

What if VNPs were able to perform wellness exams, prescribing preventive medications to keep our patients healthy while the veterinarian is able to focus more time on the treatment of complicated cases that require dedicated attention?

These individuals would also increase the pool of professionals who will serve the large animal and rural areas. They could also help alleviate some of the overtime veterinarians feel forced to endure with additional help of higher capacity.

What if VNPs became a contact point for veterinary technicians and assistants to seek advice regarding continuation of therapy for existing patients, without the veterinarian being required to approve it? For example, they might refill a prescription of a nonsteroidal anti-inflammatory drug after reviewing liver and kidney values, or modify a pain management protocol for a hospitalized postoperative patient by adding a constant rate infusion to overcome breakthrough pain.

What if VNPs specialized in anesthesia were able to apply their education to maintain the septic patient suffering from a surgical accident during an abdominal exploratory leading to severe hemorrhage and hypotension—without the veterinarian’s intervention—through the use of intravascular volume replacement, blood transfusion and implementation of partial to total intravenous anesthesia, so the veterinarian could focus on the surgery?

All of these examples currently require a second veterinarian to fill the role.

The right steps

VNPs should be adequately regulated with a clear scope of practice to serve a role that integrates into the current team and delineates them from the role of veterinarians and veterinary technicians. Establishing academic pathways similar to RNs, requiring a master’s or doctorate degree to become NPs, is a critical step to ensure appropriate education. There are currently individuals practicing as veterinary technician specialists through a rigorous certification process and those who have achieved master’s degrees in related fields who are prime candidates to practice at a higher caliber.

I’d like to pose a challenge to those within the veterinary field to take a close look at the veterinary technicians on the team, utilize them to their fullest potential, provide them with the opportunity to obtain further continuing education and imagine a future where some of these individuals will serve in the midlevel role to expand the veterinary team. The path to this future seems a vast challenge. But, as the veterinary technician profession is on a path to rapid progress, now is the time to start the conversation.

Kenichiro Yagi, BS, RVT, VTS (ECC, SAIM), practices at Adobe Animal Hospital in California as an ICU and Blood Bank Manager. 

It Sure Is

Veterinary Nurse Practitioners can prescribe medicines and not require tests when clients cannot afford blood tests. Pets did not used to have to have blood tests and it is cruel for vets to refuse to give medicines to pets when owners cannot afford hefty prices for blood and other tests. It is a crime to cause pets to suffer and owners pay to bring them in and for their medicine and will pay for tests when and if they can. The pets have homes and are alive and happy. They do not need to be treated like human medicine and in fact, many humans do not want tests at all as much as medical doctors want. We can know when we are healthy and we are not always having side effects and many medicines work and we need and want them. We do not feel like offering our blood and it is our blood and we do not have to. Give us real nurses, not technicians, there is too much tech today. We want real nurses to care about us, as we are and how we are happy, spend a few minutes with us, and give us simply medicine to make us better. This works a lot and it not outdated, old fashioned, and it is better than the rip off overcharging, excessive testing, or we are all no good as we have going on today. Do not threaten to make our pets suffer because you demand and try to force money from our wallets that is not there for stupid blood tests. We do not keep needing our whole insides evaluated chemically at all, leave us alone, and look at blood from patients who show signs of illnesses. Allergies are not such an illness you need blood before giving us prednisone to relieve our suffering that is intense continual itching that never goes away except with a tiny prednisone tablet piece that takes it all away and makes us fee fine. Do not torture us, give us prescribers who use no excuses over their risk or for money or for anything except caring. Turn off the hugely scientific academic perfection approach, and just care about others and their pets. Let owners take care of their pets as best they can because it works and stop robbing while predicting our deaths all the time and overcharging us for only that. Vet techs are as terrible as vets and we need a gently caring go between to prescribe. cc

doesnt solve anything

There are a couple of obvious problems with this.Firstly the VPAs are going to have to work under a vet and if the vet doesnt want to work in a rural area how does having a VPa help? Why would the VPAs not want to work in big cities like the vets? They are the same generation and if the desire to move away from rural areas is generational you will end up training VPAs that end up in the already saturated urban environment.Secondly there is a huge gap between a human nurse an MD with what they can do so a PA fits that gap.We also have a shortage of MDs-That is a definite probelm, NOT a manufactured shortage and the PAs can help decrease the workload on the MDs.Finally how are they going to pay back their debt? How much can you pay a VPA before they are priced out of the market.If you say a vet tech makes $30-$40K and the starting salary for a new vet is $65K there is not much room for a VPa salary that will be able to pay back their loan.Bottom line we will end up with another layer of vet professional that have insufficient employment and a debt burden that they cant pay back.And this is progress?