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.
Originally Published in Today’s Veterinary Business, August 2018
Although plenty of businesses talk about change, and although many of them devote significant time to change management, too many efforts are still failing. An article in HR Magazine titled “Why Change Efforts Fail” analyzes why this is happening and offers suggestions to help make your next change management strategies take root.
The article cites a new study by Prosci that shares how 86 percent of 1,778 change leaders expect change initiatives to continue to increase over the next two years, with 55 percent expecting them to significantly increase. But, a spokesperson cautions, 73 percent of them also shared how their organizations are either approaching, at, or past change saturation, reaching the point where it’s difficult to absorb any more changes.
Tips to help prevent change initiatives from failing in this age of saturation include remaining visible and active throughout the entire process. Sponsors of the changes can’t abdicate responsibility if they want them to succeed. And, while it’s important to communicate the nuts and bolts of proposed changes, it’s also crucial to discuss adjustments that will need made and otherwise work through the emotional components of change. This will help to reduce resistance.
Share the rationale behind the changes because, when people hear why something is happening, it’s easier for them to adjust. And, be sure to model the behavior you expect from your team. If, for example, you want more collaboration to take place among team members, demonstrate that yourself first.
In 2018, one-way, top-down communication isn’t typically effective. So, communicate changes to your team as early in the process as possible, provide time for discussion, and don’t try to do too much at once. Prioritize initatives to help prevent saturation.
A July 2017 article in Forbes, titled “1 Reason Why Most Change Management Efforts Fail,” echoes the dangers of saturation, calling it “change battle fatigue.” Citing a McKinsey and Company study that shares how 70 percent of all transformations fail (with that percentage believed to be increasing), the article details how and why battle fatigue can set in. They include past failures that plague employees’ memories (“Oh, no! Not THIS again!) and the impact of sacrifices made through an “arduous” process. Discouragement further weighs down the process and, when transformation is poorly led, efforts are even more likely to derail.
When workplaces go through significant changes, employees can become fearful, especially when past attempts at transformation failed and perhaps led to layoffs or other negative consequences. When people are worried about their careers, they aren’t as open to learning or able to think as well. So, the article points out, right when management needs the team to be at their best, they are distracted, less productive and unable to focus as effectively.
Suggestions to break this cycle include the identification of early successes, and taking time to celebrate them, as well as ensuring that the vision continues to be supported. And, to effectively identify and then celebrate early wins, milestones and timelines need to be clearly defined. When a milestone is met, people responsible for this success must be acknowledged from the top. This will help to validate the transformation vision, keep the team energized, and spur the momentum on even further. Plus, careful monitoring of early milestones will highlight if and when the plan needs to be adjusted, and how.
To continue to support the vision, it’s important to determine what aspects of your workplace culture support it, as well as which ones don’t – and which ones don’t have a significant impact, either way. What do you keep? Only those elements that support the vision. As one example, the article shares how a company had a vision for collaboration. Yet, when you went into their offices, it was an “ocean of cubicles” with people listening to headphones. Although this setup may be effective in some workplaces, it does not support the vision of collaboration. After the office space was revamped, people stopped communicating via Google Chat to someone who was only two cubicle spaces away, and they began to communicate in person.
This challenge is not new. In fact, the Harvard Business Review identified reasons why change management fails in a well-thought-out article back in 1995. Titled “Leading Change: Why Transformation Efforts Fail,” the article lists eight different reasons, the first of which focuses on not establishing a significant enough amount of urgency. More than 50 percent of transformation failures observed by this expert were caused by this factor.
Other errors include not creating strong enough transformation leadership, a lack of vision and under-communication of the vision by a “factor of ten.” Some companies, the article notes, fail to remove obstacles standing in the way of the transformed vision. Obstacles can include the way the workplace is organized, poor compensation that causes people to focus on their own self-interest over the new vision – and, worst of all, the expert says, “bosses who refuse to change and who make demands that are inconsistent with the overall effort.”
Other errors noted include not creating short-term wins or declaring victory too soon. The article states that, while celebrating a win can be a plus, declaring all to be won can be “catastrophic.” Over the first five to ten years, it’s easy to regress to old ways, while the new vision is still fragile.
Finally, this Harvard publication notes, it’s important for leaders to consciously demonstrate how the new approach is improving performance. Don’t make the team members make those connections on their own (or not make them or misinterpret them). And, it’s crucial to ensure that top management continues to implement and use the new vision and approach. The article ends with this thought: “In reality, even successful change efforts are messy and full of surprises. But just as a relatively simple vision is needed to guide people through a major change, so a vision of the change process can reduce the error rate. And fewer errors can spell the difference between success and failure.”
When you’re new to the workforce, supervisors are typically older than you are, and that just feels like the way the world works. As time passes, though, you may find yourself in a situation where you are older than your boss. In fact, a Harris Interactive survey conducted on behalf of CareerBuilder found that almost four in every ten employees in the United States are now working for a younger boss. And, as increasing numbers of people from the Baby Boomer generation decide it’s time to retire, that dynamic is going to become even more typical.
If you find yourself in that situation, and it’s uncomfortable, what do you do? Here are six tips.
Tip #1 Is It Really Uncomfortable?
People you know may ask you if it’s uncomfortable having a younger boss, and you may be reading articles about how challenging it is to work with Millennials, much less work for a Millennial boss. And, you may subconsciously be connecting the concept of “younger” to “less qualified.” (If so, it may simply help to focus on not stereotyping based on age or any other demographic. It’s easy for anyone of any age to make assumptions based on demographics, but that’s seldom productive.)
The bottom line is that you may be framing your situation as more difficult than it really is. If that seems possible, pause, and really consider your boss and your situation. No perfect boss exists. Is your situation genuinely uncomfortable? If it isn’t, your problem is solved! If it is, tip number two may help.
Tip #2 Why Are You Uncomfortable?
If your discomfort is real, try to decipher why. Do you want to be in a supervisory position yourself? If so, what do you need to do to help make that happen? Or, do you not want a supervisory position, but your ego is bruised because someone younger is higher on your company’s hierarchy? If that’s the case, remind yourself that you don’t want this type of promotion and focus on finding satisfaction in your own job.
Compare your levels of discomfort. If you had the same degree of unease with a boss of an age similar to yours or with one older than you, would you feel this uncomfortable? If having a younger boss makes you more uncomfortable, it may be that this generation performs tasks somewhat differently from you. If that rings true, tip three can help.
Tip #3 Embrace Positive Change
Here’s a litmus test. If you find yourself saying, “But we’ve always [fill in the blank},” stop. Reassess.
It’s only natural to get comfortable performing tasks in a way you’re used to, no matter what age you are. But, it’s highly beneficial (again, no matter your age) to continue to embrace positive change. When you’re able to maintain this attitude, you’ll continue to learn and grow, and this will provide you with opportunities to appreciate the good changes your boss is implementing. If a new technology, process or philosophy feels too strange, try listing positive aspects of it and see if you can focus on them instead of how new and different these changes feel. And, number four can help when interacting with anyone new.
Tip #4 Find Common Ground with Your Younger Boss
Do you and your boss share a true passion for companion animals? If so, then find ways to bond together on that common interest. Also look for other ones, whether work-related or outside the scope of work. You may discover that you both volunteer for the same or similar causes, perhaps a local animal shelter, a service club or a hospice center; have traveled to some of the same fascinating places; or root for the same sports teams. It’s unlikely you’ll spend significant time discussing outside interests during a busy day at the practice, but they can serve as a wonderful wellspring of bonding and allow you to view your boss in a whole new light.
Tip #5 Communicate with Your Boss About Concerns
Despite commonalities you discover, you may also decide that, yes. There are genuine issues that need addressed with your boss. A face-to-face conversation may clear the air, but be prepared to communicate your concerns clearly, without being defensive. Perhaps, for example, you’ve always prepared written reports for company meetings, but now your Millennial boss wants succinct bullet-pointed PowerPoint presentations to share. If you feel, for example, that some information that had existed in your more in-depth reports is now missing or not given enough context, explain that concern and offer solutions. Maybe the PowerPoint slides, in your opinion, would work well but need more detail to share important information.
It’s also possible that your younger boss is using technology that’s new to you, or you aren’t as familiar as you’d like to be with its capabilities and use. If so, then the solution could be to get more training with this technology, either by doing so on your own or through resources offered at work.
Tip #6 Focus on Being a Partner or Collaborator, Not a Mentor
If you’ve worked at a practice for a significant amount of time, or if you’ve been in the veterinary industry for any length of time, you’ve gained valuable experience and knowledge. And, it makes sense for everyone at a practice to pool knowledge to provide the best experience for clients and their companion animals, and to run the practice as effectively as possible.
But, be careful that you don’t lecture or say anything that could reasonably be construed as condescending. Instead, understand what challenges your boss faces and empathetically reason through potential solutions. Share ideas in a way that makes your boss’s work life easier and maintain an attitude of teamwork to create the most productive working environment possible.
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.)
- 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.
- 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).
- 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.