The case for advanced practice veterinary nursing

Kenichiro Yagi, MS, RVT, VTS (emergency and critical care) (small animal internal medicine)

Ken Yagi is chief veterinary nursing officer for Veterinary Emergency Group and program director for the RECOVER Initiative (Reassessment Campaign on Veterinary Resuscitation). He writes and speaks internationally on topics in emergency and critical care, transfusion medicine and the veterinary nursing profession, and he has served in a variety of leadership roles for the National Association of Veterinary Technicians in America (NAVTA) and other professional associations. Yagi invites everyone he works with to continually pursue new limits as veterinary professionals and individuals.

As my colleagues have explored elsewhere in this issue of the Bowman Report, the veterinary technician profession is currently facing a number of major issues. First of all, there is a shortage of veterinary technicians — some people even call it a crisis. One reason for this shortfall is that not enough people are entering the field. Career counselors who are concerned about financial futures do not recommend that young people pursue veterinary nursing as a career.

But the bigger issue is attrition, with people leaving the field. Technicians exit the profession for a number of reasons, including underutilization, feeling unfulfilled, low pay — all of the problems we've been dealing with for many years. But in addition to that, many technicians hit a ceiling working in practice and have nowhere else to go.

"Currently, veterinary technicians who want to expand their career often go into management or education. But an advanced practice veterinary nursing pathway would allow them to stay in a clinical role working directly with animals and still experience career satisfaction and fulfillment."

These folks often look to human medicine for career growth. After all, if they go into human nursing, they can get paid better, do more things clinically, and have a growth pathway that's already established. They can obtain different kinds of advanced certifications and even become nurse practitioners.

We're missing that advanced level of nursing in the veterinary field. Extending our pathway in a similar fashion would help us keep the people who are experienced, skilled and looking for the next step in the profession. Currently, veterinary technicians who want to expand their career often go into management or education. But an advanced practice veterinary nursing pathway would allow them to stay in a clinical role working directly with animals and still experience career satisfaction and fulfillment.

First things first: Utilization

Currently, only licensed veterinarians can diagnose, provide a prognosis, prescribe medication and treatment, and perform surgery on veterinary patients. That means technicians are technically able to do anything other than those acts under the supervision of a veterinarian (whether that's immediate, direct or indirect supervision, depending on state regulations). Technicians working at the top of their license can legally perform thoracocentesis, conduct ultrasound exams, unblock a cat, perform parts of the physical exam and work with the veterinarian to create and execute a treatment plan.

However, these high-functioning technicians are extremely rare. It's quite uncommon for a technician to do any of those medical tasks, let alone all of them. That's why utilization is so important. There's an immense amount of room to elevate current veterinary technicians so they're functioning at a much higher level.

At this high level, the job involves more cognitive thinking and not just performing tasks — even advanced tasks. Sure, advanced tasks are great. They allow a technician to feel they are being utilized to a higher extent. But at some point they will be able to use their critical thinking abilities, develop clinical judgment, contribute to treatment and nursing care plans, assess patients for how they're responding to treatment, and make appropriate recommendations. They can also lead clinical teams dedicated to CPR, anesthesia, dentistry, ICU care and so on. The best-utilized technicians, in addition to being "doers," also become "thinkers."

So there's lots of room for technicians to be more fully utilized before we talk about a nurse-practitioner-like role. But those high-level technicians who do develop their clinical faculties and become excellent critical thinkers often want to do more — and stay in veterinary medicine. In human medicine, nurse practitioners can provide a diagnosis, prescribe treatment and medication, and even do some light surgery. There's no reason an advanced practice veterinary nurse wouldn't be capable of doing the same.

Helping practices become more efficient

Let's flip our perspective now from how an advanced practice role could benefit individual technicians to how it could help veterinary clinics, as well as clients and patients. I work in emergency practice, so let's look to that context as an example.

Right now, with the amped-up demand we've seen during the COVID pandemic, many urgent care cases are being diverted to emergency practices because general practices simply can't keep up. However, those cases are often less critical and don't necessarily require a veterinarian's training to resolve. If a general practice had a veterinary nurse practitioner on staff, that person could see these urgent-but-less-serious cases in a timely way. This would allow the team to provide patient care more quickly, protect clients from long wait times and high emergency fees, and keep revenue in the practice.

The advanced practice veterinary nursing pathway would help us create a better division of labor in practice, thereby enhancing practice efficiency. Different kinds of expertise would be directed to different levels of veterinary need, helping us accommodate all the patients we're trying to see.

Thoughts on potential issues

I know the idea of an advanced practice veterinary nurse role causes some anxiety. After all, nurse practitioners on the human medicine side can practice without being under the supervision of an MD. Does that mean veterinary nurse practitioners will be opening their own practices and taking business away from veterinarians?

I don't think so. That was a fear in the early days when this idea was first brought up in the 2000s. But now that there's a shortage of veterinarians as well as technicians, more people are open to having this conversation to make sure there are enough veterinary professionals to meet the needs of society.

The goal is not for veterinary nurse practitioners to have independent practice rights. The veterinarian–veterinary nurse relationship is extremely important. We're simply talking about creating another type of professional who can take care of animals at a higher level than they currently do so practices can see all the patients.

Some people have criticized advocates of advanced veterinary nursing by saying we're distracting from other important issues facing technicians. And I agree there are many problems we need to focus on right now — things like utilization, low pay, credentialing standards, title protection and scope of practice. I don't blame these critics because these are the issues of today.

But we've known about these issues for decades, and I'm confident we can solve them with all the great work currently happening. Creating an additional pathway for technicians to grow is a solution for tomorrow.

Black-and-white thinking where we say, "We have to focus on this, not that" is short-sighted. We need to look at both short-term and long-term solutions for our profession, and I consider this a long-term solution. If there are enough people trying to do good work all around, let's put the effort in all the places it needs to go.

And to be 100 percent clear, the veterinary nurse practitioner role should not be established in a manner that suppresses the utility or growth of veterinary technicians. The solution is to keep working on utilization and related challenges while we do the initial work on solutions for the future.

"Black-and-white thinking where we say, 'We have to focus on this, not that' is short-sighted."

The path to reality

So how do we go about creating this advanced practice pathway for technicians? First off, we need an educational component. This is a professional role likely requiring a master's-level education, and this master's degree will need to emphasize clinical decision-making. I would rather see this degree build on current veterinary technology and nursing degrees rather than establish a nonveterinary degree as a prerequisite (this is a physician's assistant–like model, which requires a science-related degree), but both are likely being considered.

Next, we need a certification process and exam that allows people to show they have met the requirements and possess the knowledge to perform at an advanced level. We will also want to determine how the Veterinary Technician Specialist (VTS) certifications recognized by NAVTA interplay with the new role. And finally, certification needs to be recognized by the states in a way that allows advanced practice veterinary nurses to function with an expanded scope of practice. So those are the steps: establishing a degree, creating an examination and modifying state laws to allow for advanced practice.

Let's debate this

The stresses of today in the veterinary field are reaching the highest levels we've ever experienced and are coming from every direction. Frustrations surrounding persistent issues in our profession and seemingly slow progress add to the stress. While it can be easy to be dismissive of new ideas, we need discussion and debate to refine our thinking. Let's put our energy toward solving our problems, not tearing each other down. When different people can direct their energy toward the issues they want to focus on and have the capacity to pursue, we can all work on building a better future together.

Join the conversation

What is your view on the creation of an advanced practice role for veterinary nurses/technicians? Share your thoughts by leaving a comment below.

- Djana

Great article, thank you so much, Ken! I feel this is a great idea. I like your last paragraph, let’s have a productive discussion, let us not use this to beat each other down, that’s so easy. I personally feel that creating such a degree would also help towards getting more recognition for vet techs and will emphasize the need for veterinary education of people in the field.

- Katie

I feel like this is a proposed solution that misses what is causing the problems. We have a shortage of vets causing GP cases to end up at the ER. We have a shortage of vets due to high attrition from burn out – combination of high client demands, poor work life balance, and lack of flexibility for working mothers, not to mention the corporate practices that have created poor working environments (not all but we’ve all been in some). Then, we as veterinarians are not encouraging others to pursue vet med because of the ridiculous debt to income ratio. Many of us GPs get mental fatigue when we see super involved cases all day long, we’re not specialist so most of us don’t have hours to work up a case. Having the easy appointments like annual exams and ear infections throughout the day leads to less mental exhaustion. Rather than create a new mid-level education system, in my opinion we should overhaul our entire college programs and make a veterinary degree a max of 5-6 yrs combined undergraduate and graduate program. Most of our international counterparts operate like this for all professional degrees. This allows graduates to enter work earlier and with considerably less debt. While of course continuing to support our current vets with things like flexible hours or on-site child care.

- Brittany

Coming from a background in Emergency Medicine, I can say I have met some amazing techs that are so skilled. I have seen them help newbie Dr’s in their diagnosis, or quickly triage a patient and have a pretty good idea what’s going in within minutes. I think this would be a great avenue for technicians who have the experience and discipline. I hope there will be more opportunities for technicians who want to advance and never stop learning.

- Saara Ronan

What an amazing article! I feel this will help so many techs advance their futures. Thank you Ken!

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