Veterinary Nurse Versus Technician: the Pros and the Cons

The Veterinary technician profession has been subjected to variability since birth. Today, it faces a new, and hopefully positive, change with discussions about modifying the profession’s title to “veterinary nurse”. A movement lead by the National Association for Veterinary Technicians in America (NAVTA) has illuminated differing opinions between those in and outside of the profession.

Veterinary Technician History

The profession began in 1908 when the Canine Nurses Institute made its first organized effort to train English “Veterinary Assistants”. Over the next eighty years, the profession grew. First, the American Association of Laboratory Animal Science created three different levels of “animal technician” certifications at research institutions. Next, the US Army, Purina, and State University of New York (SUNY) established “animal technician” training programs in the 1960’s, which the AVMA then began regulating in 1967. The AVMA waited until 1989 to adopt the term “veterinary technician”, feeling until then that people would be confused with the “veterinary” modifier.

Michigan State University and Nebraska Technical Colleges were the first animal technical educational programs accredited by the AVMA. There are now 230 AVMA accredited veterinary technician education programs. Of these, 21 offer four-year degrees and nine offer distance-learning (online) options. Even before the AVMA adopted the term, the North American Veterinary Technician Association (now called the National Association of Veterinary Technicians in America) was formed in 1981. It works alongside the AVMA to protect the profession and encourages veterinary technician specialty developments. However, the profession has not grown uniformly across the United States.

In the United States, 37 states have established “veterinary technician” licensure, 10 states have non-profit organizations that implement voluntary credentialing, and 5 states/territories do not have any credentialing systems. This means that being a veterinary technician today could mean that either the state government regulates your credentialing, you are privately credentialed, or someone gave you the title “veterinary technician” when you started working at a veterinary practice and there is no credentialing system in your state.

Pros of “Veterinary Nurse”

The profession is fragmented by more than their state’s accreditations. Depending on their location, Veterinary technicians currently have varying titles. There are 19 states that use “certified veterinary technician”, 15 states that use “registered veterinary technician”, 14 states that use “licensed veterinary technician”, and Tennessee uses “licensed veterinary medical technician”. With this amount of fragmentation within the profession, how do we as veterinary professionals expect the general public to understand or trust a veterinary technician’s job description? As such a close-knit profession, we forget the foreignness of our commonly-used terms. Most clients underestimate the value of their veterinary technician simply by not knowing the education process. In fact, in a NAVTA survey to human nurses, 71% did not know the difference between veterinary assistants and technicians. Yet, we are baffled when we find that credentialed veterinary technicians are repeatedly unhappy and facing low income, compassion fatigue, lack of recognition and career advancement, underutilization of skills, and competition with individuals trained on-the-job. Due to this culture, the profession has incredibly high turnover rates despite its increased demand by the growing veterinary industry; veterinary technicians are projected to grow 30% by 2022.

How can we, without spending incredible amounts on advertising, uplift our veterinary technicians in the public (and practice’s) eye? Many have suggested using the familiar and applicable “nurse” title. The word “technician” implies an individual who has mastered veterinary science and technology, while “nurse” incorporates caring for animal patients into the description. Heather Predergast, RVT, CVPM, SPHR, a specialist with Patterson Veterinary Supply, Inc., discussed the need to abolish the profession’s fragmentation. She noted that “there has long been a need for common credentialing in this area. The responsibilities and job tasks of a veterinary technician have evolved over time and are inaccurately described by the term ‘technician’, implying a definition of their identify based on technical tasks. The term ‘veterinary nurse’ will incorporate the art of caring for patients from a patient-centered perspective, in addition to the science and technology.”

For these reasons, NAVTA has launched the Veterinary Nurse Initiative in an action to unite a single title, set of credential requirements, and scope of practice. This movement would hopefully provide recognition to the profession and elevate its credibility by requiring further education. Like human nurses, differing titles would recognize individual’s efforts for further education. To distinguish associate and bachelor’s degrees, NAVTA has proposed designating Registered Veterinary Nurse for associate degrees and Bachelor of Sciences in Veterinary Nursing for bachelor’s degrees.

Australia and the United Kingdom have already changed the name to “veterinary nurse” with large success. As the movement poses potential in the States, many academic institutions and corporations, such as Purdue, Midmark Corporation, and Patterson Veterinary Supply Inc. have published endorsements for its change; however, the initiative does face fair opposition.

Cons of “Veterinary Nurse”

Many veterinary technicians still opt to keep their current title. When questioned in a 2016 NAVTA survey, the majority of veterinary technicians (54%) favored the term “veterinary nurse”, over a third (37%) wanted to keep the title “veterinary technician”, and the remaining surveyed were undecided. Most of the pro-technician responders attributed their answer to disbelief that it will be possible to change the title. Some current veterinary technicians have voiced unease at their unsure futures after working their entire careers in a state that does not require licensure. Another similar situation arises for those that have passed the veterinary technician national examination but have not graduated from a school accredited by the AVMA committee.

While, ideally, this veterinary nurse initiative works to unify the profession and ensure quality standards, we must realize that we may be alienating a population of technicians at the end of their careers that would be offended if required to pay for an accredited teaching program and learn alongside new, inexperienced future technicians. Another important consequence to consider is liability. Currently, liability for veterinary technicians falls to the veterinarian on all cases; however, human nurses have their own liability to practice under their license governed by a separate board. This is a consideration essential to address as we raise the accountability of veterinary nurses.

The Veterinary Nurse Initiative has faced opposition outside of the profession as well. In fact, the veterinary technicians initially opposed to changing the name also noted conflict with human nurses in any past attempted title changes. The Veterinary Nurse Initiative investigated this further by sending a survey to three nursing groups. Two of the three declined to even acknowledge the survey, potentially indicating apathy for veterinary-related topics. Of the one group that did complete the survey, 66% did not object to “veterinary nurse”; however, regardless of whether or not they were opposed to the title change, almost all of the responders incorrectly assumed a veterinary technician’s educational requirements. An analysis of the opposed responses to the nurse title found that the objectors believed technician education was subpar to human nursing and the title was not deserved by veterinary technicians. It suggests that the human nursing profession worries about maintaining the quality of its own title and hopes to avoid misrepresentations.

In the past, other professions, not similar in scope to human nurses, have attempted to claim a “nursing” title. For example, a Christian medical community attempted to title their “spiritual healers” as “nurses”; however, they did not share nearly the same amount of education rigor. When confronted with a potential title change in the veterinary profession, human nurses mistakenly worry that the term “veterinary nurse” will also encompass veterinary assistants. This confusion highlights the need for public awareness of technicians – if the closest human counter-part profession does not understand a technician’s role or certification, how can we expect the general public to know any differently? The veterinary profession must raise awareness to the public about the differences between its assistants and technicians.

Currently, as the veterinary nurse initiative gains a foothold in Ohio, the Ohio Nurses Association and its 170,000 members have fought its new legislation, arguing that the state legally defines the term “nurse” as caring for humans and that no other person or profession may insinuate that they practice as a nurse. With similar nurse title protection in about 24 other states, the veterinary nurse initiative is likely in for its fair share of conflict as it continues to grow.

The debate over the title of veterinary technicians remains controversial both in and outside of the veterinary community. As with any impending change, it is important to recognize its potential benefits and shortcomings in order to formulate the best strategy to improve the profession. If the Veterinary Nurse Initiative ends up being successful, the change will likely empower today’s veterinary technicians and reduce the profession’s current high turnover rates.

 

Modern Mentoring: How Mentoring Has Evolved and 7 Keys to a Good Program

Originally Published in Today’s Veterinary Business October 2018

Although mentoring is not a new concept in the workplace, modern partnerships are not necessarily like those in the past. According to HR Magazine, formal mentoring relationships in previous eras would have typically lasted at least a year. Informal ones? They could last a decade. In today’s workforce, though, these relationships are often shorter and more specialty-oriented than before.

Because of this shortened timeframe and accelerated pace, lines between mentoring and coaching can be blurred. Increasingly, mentors are no longer necessarily higher on a company’s organizational chart. In fact, reverse-mentoring now exists. In reverse-mentoring situations, newer staff members are teaching older, more experienced ones about new technology, as just one example. As one scenario, a Millennial employee may be teaching her Baby Boomer supervisor about how to effectively use social media and crowdsourcing, while also sharing insights into new ways of thinking about business.

According to a survey taken by the Association for Talent Development in 2017, 29 percent of organizations have a formal program in place for mentoring, with 37 percent of them having an informal one. Mentoring opportunities are also available through professional organizations, either online or in person.

A skilled mentor can help the mentee become his or her best possible self. This happens when a mentor takes the time to really understand the person he or she is mentoring, including where the person is in a career path – and where he or she wants to go, career-wise. Once this is discerned, then each of the actions by the mentors should help the mentees participate in the types of behaviors that allow them to become aligned with their own best selves.

Now, here are seven keys to creating the best possible mentor/mentee relationship.

Key #1 Be very clear about the goals established for the mentoring program.

Are there specific job-related skills that the mentee needs to gain? If so, what are they? Is the mentor guiding someone to an understanding of a practice’s culture? Perhaps the mentee worked for a private practice that was recently bought out by a corporate one, and the mentor is serving as a guide and sounding board to an employee during a transition period. Whatever the goals are, make sure they are clearly defined and understood by all involved parties.

Key #2 Make sure the two participants are well matched.

Synergy and mutual commitment fuel mentoring relationships, so it’s crucial to put the right pairs together. As mentioned above, mentoring is no longer limited to an older and/or more experienced person at the practice mentoring someone younger and/or newer. The goal of this evolving process is to have one member of the team fill in gaps of the skills and/or experiences of another employee, so form your pairings for that purpose. It can be tempting to put together people because they’re so much alike that they’re sure to get along. They probably will get along, but that alone doesn’t fulfill the purpose of mentoring. Remember: fill in experience and skillsets through mentoring opportunities at your practice.

Key #3 Mentoring usually takes significant time and energy, so don’t expect quick results.

There are exceptions to this rule, of course. If a Millennial is paired up with a Baby Boomer to teach the use of Instagram, this can all come together rapidly. If, though, that same Millennial is paired up with that same Baby Boomer to help transition the mentee to a telecommuting role at the practice, this can take time and energy for mindsets to evolve.

Key #4 Multiple mentors sometimes make sense.

Some companies pair up a mentee with a primary mentor and are then open to people having numerous more informal mentors to boost the diversity of the learning experience. It can be very helpful, even enlightening, to have mentors from different demographics – whether that’s age, gender or something else. Being exposed to different points of view from thoughtful members of the practice can be quite beneficial.

Key #5 Mentors should provide guidance rather than setting strict requirements.

Your practice will create an overall structure for its mentorship program and, yes, participants should follow the structure you set. But, a mentor is not there to enforce rules or to lecture. Rather, a quality mentor may spend more time asking questions and listening to answers than speaking, offering advice rather than rock-solid answers. Mentees should be encouraged to listen closely to what a mentor has to say and then carefully evaluate how it fits into his or her life and career path.

Key #6 Mentees should prepare and ask questions.

The best mentoring relationships are two-way streets, with the mentee being an active partner in the relationship. Passive listening will only go so far in helping a mentee develop skills and gain knowledge. Instead, engaged mentees should share what has been helpful, what gaps exist in his or her knowledge base and skill sets, and so forth. In a sense, being mentored should also empower the mentee to pass on knowledge to the next person in the practice who needs assistance.

Key #7 Effective mentoring focuses on relationship development.

Near the beginning of this article, we shared how modern mentoring resembles coaching, at least more so than in the past. But, at its core, mentoring has been and should remain relationship-oriented. The mentee should feel safe and nurtured as he or she learns professional skills through mentoring. Although this knowledge will likely enhance the mentee’s ability to perform tasks, mentoring is not as task-oriented as coaching.

Mentoring should help employees at your practice become more self-confident and able to juggle his or her work/life balance. While coaching can be performance-driven, mentoring focuses on developing the employee, both to improve his or her skills and knowledge today and to prepare him or her better for the future.

Starting a Mentoring Program at Your Practice

Be very clear about what you want to achieve through this program and have a plan in place to measure its effectiveness. Determine who can participate, both as mentors and as mentees. Can someone, for example, volunteer or will you select them? Decide how formal or informal the program will be, how often you expect partners to meet and so forth. Explain the program to your team, adding specifics to the employee manual, and strategically pair up mentors and mentees. Invest enough resources to allow the program to be successful, be available to mentors if they need guidance, and use this program to develop your team in a way that dovetails with practice goals and dreams.

Link to the article on Today’s Veterinary Business: https://todaysveterinarybusiness.com/modern-mentoring/

Residency Retention Agreements

Finding the right resident for your practice is a lot of time and work.  Protect your investment and keep your resident from straying to other practices by including proper retention provisions in your residency agreements.

The basic bargain you make with your resident is simple: you agree to pay all or part of your resident’s training and residency living expenses; and your resident agrees to work at your practice for a minimum period—the “retention period”– after  she is board certified.

To implement this bargain, residency provisions typically use a stick and/or carrot approach.  The stick requires your resident to pay back the residency expenses you fronted if she fails to timely pass her residency or if she leaves your practice before the agreed upon retention period expires.  The carrot, which is optional, pays your resident a bonus at the end of the retention period.

Here’s a list of the principal issues your residency provisions should address, bearing in mind that the main variable affecting their structure and content is whether or not the residency will be in-house.

  1. Residency Rules.  If you are sponsoring the residency, both you and the resident should agree to respectively follow the residency rules and guidelines set by the applicable veterinary college (“Residency Rules”).  Accordingly, you would be prudent to ensure that compliance with Residency Rules will not unduly burden your practice before you commit to sponsoring the residency.  The residency provisions should also: (a) require the resident to keep track and inform you of any rule changes; and (b) allow you to terminate the residency without penalty in the unlikely event a rule change makes compliance too burdensome for your practice.
  2. In-House Residencies.  With  in-house residencies, your resident will invariably be your employee during the residency period, so all the usual employee issues relating to compensation and benefits apply.  However, you will need to adjust your standard employment agreement to give your resident time to: (a) complete whatever externships are required by the Residency Rules; and (b) study for her boards.  (In this regard, you may consider reducing her compensation accordingly.)  Do not forget to check that your insurance and benefit plans will cover your resident during this period.
  3. Off-Site Residencies.  If a veterinary school or other hospital is going to sponsor the residency, you need to consider whether you want your resident to be your employee during this time.   If the resident will be attending a veterinary school or other hospital far from your practice, you may not want her to be your employee, since an employer is generally liable for their employees while they are acting within the scope of their employment.  Since you have deeper pockets than your (normally) impecunious resident, plaintiffs will be motivated to sue you if your resident gets into trouble.

If this liability worries you, then you will need to loan your resident the amounts she needs, with the understanding that you will employ her as soon as she is permitted to take the boards (and then forgive the loan at the end of the retention period).

Loaning residency expenses to your resident with an employment agreement to follow will be more complicated to structure, negotiate and document, than simply employing your resident from the outset.  This will take more time and cost more in legal fees.  You will need to balance this increased cost against the risk of incurring liability for your employee’s acts and omissions while a resident.  Such balancing will require weighing various factors, including the extent to which the veterinary school or other institution is liable for their residents and to which  your resident employee will be deemed to be acting within the scope of her employment.  Common sense would indicate that the school or institution should be primarily liable for all resident activities and that the risk of your incurring such liability is remote.  But all bets are off in our sue-happy society.  It may also be possible to cost-effectively insure against any residual liability.  As a precaution, your resident should agree to seek your permission before engaging in any remunerative activity while a resident, (e.g., working at a shelter or temping at an emergency clinic), so that you can evaluate the risk thereof.

Finally, depending upon the residency program’s schedule and how far away it is from your practice, consider whether you want your resident to work for you during week-ends, holidays and/or residency program breaks.

  1. Ensuring Diligence.  Whether or not your resident will be completing her residency at your practice, she should agree to diligently pursue her residency to completion, which will include studying and sitting for the boards as soon as she is permitted to do so. Your resident should commit to become board-certified by a certain deadline (which can be extended for a limited time if your resident becomes disabled).  If the residency program is held off-site, your resident should agree to provide you with adequate documentation to monitor her progress.
  2. Residency Expense Tracking. Your residency provisions will also need to specify the residency expenses for which you will be responsible and how they will be documented and paid.  Consult with your tax advisor to ensure that this is done in a tax efficient manner.
  3. Residency Expense Repayment.  Now for the stick. The residency provisions typically will provide that the resident will repay the residency expenses you have advanced, unless she works at the practice through the end of the agreed upon retention period.  In essence, your resident is “working off” her “debt” to you.  (The “debt” being your advance of residency expenses to her.)  Thus, during the retention period, your former resident’s compensation should be less than market to reflect this “repayment.”

This loan analogy cuts both ways however, because a savvy resident will demand that the repayment obligation be suitably pro-rated, so that if she leaves, say, in the middle of the retention period, she need reimburse only half of the residency expenses.

The provisions should provide for a repayment schedule and an interest rate (or specify that the resident will owe no interest).  In attempting to reduce interest as much as possible or eliminate it all together, a savvy resident will argue that the practice is benefiting from the services of a “captive” specialist, who cannot leave without incurring a substantial reimbursement obligation.   This benefit is above and beyond what an un-affiliated lender would receive, and in consideration for this benefit your practice should not charge interest.  (Be advised, however, that charging below market interest or no interest may subject you to tax liability.)

  1. Disability and Early Termination.  Proper residency provisions must also cover life’s more foreseeable contingencies. The two principal intervening events that should be addressed are disability, and employee termination before the expiration of the retention period.

7.1.  Resident disability generally will extend the deadline for obtaining board certification and also length of the retention period.  If your resident’s disability lasts longer than this extension, she normally would be terminated, just like any other employee subject to long-term disability.  But what about her repayment obligation?  Should she still owe you for the residency expenses you advanced?  If you’re tough you might say yes.  If you’re nicer you might want to forgive your disabled resident’s repayment obligation in whole or in part.  (Note that you might be able to insure against this risk.)

7.2.  What happens if you terminate your resident before the end of the retention period?  If you terminate for the usual “for good cause” reasons, then the resident should still repay you for the residency expenses you advanced.  In this regard, the residency provisions should allow you to terminate your resident “for good cause” if she fails to become board-certified by a specified date.

But if you terminate your resident at your discretion, i.e., for any reason other than “for good cause”, then the provisions should extinguish your resident’s obligation to repay you for the residency expenses.

If your resident leaves before the end of the retention period she will owe you the residency expenses you advanced. That is after all the whole point of having retention provisions in the first place.  But heads up: a savvy resident will require the provisions to address what happens if she terminates her residency agreement because of your breach of that agreement.

  1. Retention Bonus.  If you wish to motivate your resident with a carrot in addition to the stick, the residency provisions can provide that you will pay your resident a specified bonus if she stays through a specified date (which need not coincide with the end of the retention period, and could even be paid periodically in installments).  As with your resident’s obligation to repay residency expenses, the bonus provisions will need to deal with disability and early termination (either implicitly or explicitly).
  2.   Residencies as CLE.  Residency programs at veterinary schools or other institutions can constitute a valuable educational resource for your practice.  Accordingly, do not forget to require your resident to provide copies of all interesting residency documents and give your practice periodic presentations of residency activities.

Like many things in life, residency provisions are simple in concept but complex in implementation.  You will need to invest some time and effort, and incur some expense in preparing a proper residency agreement.  Accordingly, it makes sense to temporarily employ your future resident at your practice before committing to any residency obligation—just to make sure that she is worth the investment.