Veterinary Voices

Unlocking the Hidden Value of Veterinary Nurses: A Revenue Revolution - ep 207

• Julie South of VetStaff & VetClinicJobs • Episode 207

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Discover how to maximise the value of your clinic's Veterinary Nurses and boost your clinic's revenue in this ideas-packed episode of Veterinary Voices.

Julie South catches up with Michelle Cameron, a New Zealand Registered Veterinary Nurse with extensive experience in emergency and critical care (ECC), and an Executive Member of the New Zealand Vet Nurse Association (NZVNA).  

Michelle shares valuable insights on leveraging the skills of veterinary nursing professionals.

Key topics covered:

  1. Implementing nurse fees: Discover about charging for services such as overnight patient care and surgical preparation, which are often provided by nurses but not billed separately.
  2. Overcoming resistance: Understand the challenges of introducing new billing practices and how to address concerns from both staff and management.
  3. Improving clinic culture and profitability: Explore how recognising and valuing nurses' professional skills can positively impact both team morale and the clinic's bottom line.
  4. Practical examples: Gain specific ideas for billable nursing services, including hospitalisation fees, surgical prep, and nurse-led consultations.

This episode offers valuable insights for Veterinary Nurses looking to increase their professional value, Practice Managers seeking to optimise clinic operations, and Veterinarians interested in maximising team efficiency. 

This episode can seriously be revolutionary in regards to how you approach veterinary nursing and clinic billing practices!

Contemplating your next career move?
Tania Bruce - VetStaff's passionate kiwi recruiter - would welcome the opportunity to have a 100% confidential chat with you. Tania's a former Ortho Head Vet Nurse so speaks your language!

How to get more bang for your recruitment advertising buck
This is what VetStaff is really good at so if you'd like to stretch your recruitment dollar, please get in touch with Julie because this is something VetStaff can help you with.

Committed to DIY-ing your own recruitment?
If so, then shining online as a good employer is essential to attracting the types of veterinary professionals who're a perfect cultural fit for your clinic.

The VetClinicJobs job board is the place to post your next job vacancy - to find out more get in touch with Lizzie at VetClinicJobs

Revive Your Drive - daily 2-minute videos for veterinary employers and employees to help revive their drives at work and at home.

Speaker 1:

Welcome to Veterinary Voices Episode 207. I'm your host, julie South, with a bit of a croaky voice. With listeners in 1,400 cities around the world, veterinary Voices celebrates all that's great about working in New Zealand's veterinary industry. You can find back copies at veterinaryvoicesnz. Veterinary Voices is brought to you by VetStaff, new Zealand's only recruitment agency specialising in helping veterinary professionals find jobs that they're excited about going to on Monday mornings in Kiwi Vet Clinics, vetstaffconz.

Speaker 1:

This episode goes to air the week after Veterinary Nurse Awareness Week in New Zealand. By the time you're listening to this, the NZ VNA will have announced this year's Vet Nurse of the Year. Whoever you are, congratulations. I look forward to having you as a guest on this show in the not too distant future. Today, I'm really excited to share the chat I had with Michelle Cameron. Michelle's an executive member of the NZVNA, the New Zealand Vet Nurse Association, and because she talks about something close to my heart and to the two vet nurses on my team, which is how vet nurses can up the ante and raise the perception of their professionalism by including their fees and clinic invoices. I'm really excited to bring this show to you, vet nurses. Stay tuned, because if you want ideas on how you can earn more for you and your clinic. This is one of the episodes that tells you how to do that.

Speaker 1:

So who is Michelle Cameron? She's a registered veterinary nurse who graduated from Massey University with a diploma in veterinary Nursing in 2002. In 2016, she gained her VN CERT, ecc, which is the Veterinary Nursing Certificate in Emergency and Critical Care in the UK. Michelle worked in New Zealand for a few years before heading off on her OE to the UK and Europe, where she ended up spending most of her time in Glasgow, scotland. As a veterinary nurse. She locummed in many different clinics across the UK the RSPCA, an orthopedic specialist clinic and an after-hours emergency clinic. Michelle undertook assessor training whilst in the UK, which is now a clinical coaching which the New Zealand version is based on. Michelle currently works in a busy as in busy mixed practice in New Zealand's rural North Island under the job description of clinical operations and administration. As well as being a registered veterinary nurse working in a four clinic practice, michelle is also an executive member of the NZVNA. When she's not busy at work, she's busy at home, being a mum and a wife. Her family consists of two human children, three feline fur babies, as well as Michelle and her husband. Stay tuned, because Michelle delivers heaps as in heaps of value, both this week and next week. She talks about ways that nurses can start including their time on bills, about how they can help pay for some new kit, new gear in their clinic, how to overcome resistance when they're sometimes seen as being perhaps a little bit less than the highly skilled veterinary professional that they really are.

Speaker 1:

This is part one of two Heads up. You'll notice that the audio isn't as good as it usually is. Unfortunately, michelle and I had heaps of technical issues getting this episode recorded, which was a little while back, and the 200 plus episodes that I've recorded of this podcast. I've never had a show with the issues that we experienced here. It was pretty obvious to me that when we had those experience that Michelle had worked in ECC, emergency and Critical Care, because she didn't get flustered once. Even when the first recording platform developed attitude, we failed on Zoom, ended up on Teams, which failed a few times as well. All through that, michelle maintained her cool and calm.

Speaker 1:

We joined the conversation here where I asked Michelle about how vet nurses can earn their keep in clinic. And oh, quickly. If the term VOI is a new one to you. It stands for Veterinary Operating Instructions. Michelle. We are talking about, to put it pretty crudely, pretty bluntly, nurses earning their keep. Now, we all know that they do that. I hope I hope listeners have that same respect as well, and we all appreciate that there is lots of potential, lots of untapped potential in clinic with veterinary nursing skills. What do you think could be the first step in a clinic where nothing that a nurse does is being charged for? Where do you think they could start?

Speaker 2:

for where do you think they could start? Where they can start is depending on what their skill sets are and where the nurses are being utilized. In the beginning you will have a nurse that's interested in surgery or a nurse that's interested in consulting, and those are two completely different areas in which fees can be associated with the nurses under that kind of umbrella, where they are pulling in those fees or fees associated with them as well. So I would say likely it's going to be in clinic, out the back, where they've got their prep room and the hospital and we have patients that stay overnight. The patients that stay overnight will generally have a fee associated with a hospitalisation stay and this is where often in the past is a charge or a price that is removed when people don't feel that their invoice is correct with the estimations and they take off that hospital overnight stay.

Speaker 2:

That hospital overnight stay in my experience is used for the person that gets up in the morning, goes in first thing before everybody else goes in in the morning. They check all the animals, make sure everyone's okay. They will take the dogs out and walk them. They'll clean out those kennels that they've been in. They'll take the beds out. They'll wash them, remove all the bowls, clean them all up and then they'll start with their medications and their feeding and that sort of thing. And that's also sort of during the day that hospital care walking the dogs, feeding, toileting, et cetera. Cats again litter trays and all that kind of thing as well. And that fee is not a vet fee is that that's all done by a nurse. At this stage, and in the past I suppose this has always been a job associated with someone that doesn't have any qualifications or skills, and now we do have those qualifications available for the nurses or veterinary nurses, I should say that they can be bringing in those fees for them as well. So when the charge is removed from that hospitalisation, it means that basically you're saying that all that time that that person has spent on that patient means nothing, means absolutely nothing that could be. You know there's lots of different ways, prices and charges and numbers and you know money value to that and it means something different to each practice as well. So I'm not going to go into exact money, but just the fact that it is time and it is money, creating fees where that can be taken away from the veterinary nursing sort of side under that umbrella bracket of the fees that they can create as well.

Speaker 2:

So a starting point is making sure that we're invoicing that hospital stay for that patient, because that's the be all and end all At the beginning. We have patients that stay overnight, we have patients that stay during the day Again, hospital stays often will get removed as well for that and that's that person again walking, feeding, medicating, recording all the things that they do as well. That would be one of the things that I would start with. And also the other thing that we're doing in all of our practices is, generally patients will come in and have surgery and the surgery you have a vet that will do all the veterinary kind of things with regards to operating, making decisions on what medications they're using, etc. And then you'll have a nurse who's going to be monitoring the anaesthetic, gathering everything ready, preparing that patient, preparing that surgery ready, and that can also be created into a fee for the nursing side, a nurse preparation fee for surgery, or it could be a nurse preparation fee for a procedure as well. So usually the fee can be associated with time. So 10 minute units is a good way to start and depending on how long that procedure takes. You know they can increase that time component with it as well.

Speaker 2:

Associated with the other things that we're doing is that I've always said the um, you know the when you're doing a bandage on a conscious patient, sometimes the nurses will do it in pairs a nurse will hold the patient and then the nurse. The other nurse will put the bandage on, or you're the nurse is holding the patient and then the vet's putting the bandage on. The time associated with that procedure would always go to the vet, so the vet time would always be associated with that bandage. Putting that on it could take 20 minutes, depending on if they're doing a splint and waiting for it to dry and things, but you always need a nurse to hold that patient. Sometimes you need two as well. So wherever there's vet time there should always be a corresponding nurse time as well, and that is associated in the fees.

Speaker 2:

With regards to in the background fees, I suppose, as well. Those are the main ones that I would start with and then, depending on if people are doing consulting and allowing their nurses to do consults, that's a whole nother bracket of fees where they are actually doing their own consulting with the VOI training under the direction of a vet and being able to start doing their vaccinations, or pen stands, cytopoint injections, those repeat ones, not the initial ones, where the vet needs to prescribe them initially as well. So that's probably where I would start.

Speaker 1:

Begin with, julie, you raise some great points there as I was listening to you. To downplay, to not include work that a vet nurse does is almost insulting for him or her and it's not a great way to build great culture.

Speaker 2:

No, not at all, and that's why we fight so hard to make sure that the nurses are having their time valued as well as a professional. All of the nurses that I work with are registered vet nurses. They're not just people off the street, as they were in the past. I've been a nurse for a very long time and the stigma that still comes from way back 20 years ago plus is still with us today with regards to nurses not being recognised with their professional titles, not being recognised with their qualifications and things like that as well. So it's something that we feel quite strongly about that. You know we can help, and in ways that is beneficial to everyone, to the practice. They're part of it. They, you know. Often we hear people saying that we'd fall down without them. You know you don't have a vet and a nurse. You know it's not.

Speaker 1:

It's not going to last. When you've introduced this, what kind of resistance or obstacles have you had to overcome in clinic and how did you get over them?

Speaker 2:

I think the main resistance is worked through. Sometimes we've had within clinic we may have. For instance, we have different admin teams, we have small animal teams, large animal teams, etc. We have small animal teams, large animal teams, etc. We are looking at resistance within teams with regard to something that we've never charged for before, but did the consult or something like that and now we're charging. There's always a question raised about why we're doing that now, and the response generally is because why shouldn't we? Why are we doing a consultation with a patient and a client without having a fee associated with it? With a consultation fee With the nursing sort of consults versus a vet consult, it's a lot less, but it's still a fee that we can use for the nurses in valuing their time, I suppose as well, and their skills, which then frees up the vet to do other things.

Speaker 1:

Also with that though and I'm wearing my former business coaching hat here there is a cost. There's a direct cost to the clinic to provide that service. Yeah, there's all the overheads that go with turning on the lights and opening the doors in a clinic, and then there's the overheads of what it actually costs to staff the clinic. So it's got to be good for the clinic to start recouping some of these costs, and also it's good for the clinic because it, I believe, live according to Julie, it improves the morale and shows respect for the professionally qualified people that work out the back.

Speaker 2:

Absolutely. We have had many times throughout the years where we've had different you know how you have your wellness webinars and things where they will show us on our screens various people talking, and usually it's some sort of American one. It was talking about fees and showing value for your fees, and this wasn't just for vets, it was for nurses, it was for the admin staff at reception, because if they don't believe what we're doing and they can't explain to the client that's standing on the other side of the counter why we have charged what we have charged, then it's falling apart. If they can understand where that total amount comes from and they can have that explained to them right at the start, before they get that big bill, as they put it. If we can explain that to them, then the client is always much happier. They're well informed. That communication has happened really well. The estimation at the beginning has happened and then the fees are able to be included in that as well and it can be explained why that's there.

Speaker 2:

Why is there a nurse fee associated with my surgery for my dog that had, I don't know, a toe removal, something? There's also a bandage fee there. That can be explained because the nurse is there holding that dog, putting that bandage on or using their skills. The nurse was there monitoring your patient the whole time for the anesthetic. What would happen? What do you think? When you're talking to people, how else can you explain it? Would you rather them not have somebody there watching them? I'm not sure. I think that we all know what that answer is, but they don't understand because they don't go out there. They don't see it as well. So using that tool, I suppose for people is that making the entire clinic understand where these fees are coming from, is a big thing before you can start putting it on people as well, on the on the clients end and things as well, I would say Julie.

Speaker 1:

I just want to interrupt this chat for a very brief moment to share something important for clinics doing their own recruitment vetclinicjobscom. You probably already know and agree that well, traditional recruitment methods just aren't cutting it anymore, which means a new and a different approach is necessary. New and a different approach is necessary. This means that you need to differentiate and showcase what makes your clinic a great place to work. Vet Clinic Jobs is all about boosting your clinic's employer brand not to be confused with your clinic's client brand and VetClinicJobscom is totally affordable brand and vetclinicjobscom is totally affordable. Give your recruitment marketing the oomph it needs through vetclinicjobscom.

Speaker 1:

Now let's get back to today's show. I would just like to say something quite, I think, provocative here, and this is something that I have been saying for the last five years and I honestly believe, hand on hearts, that hand on my heart that clinics will function a lot better and they will be a lot more profitable. Even though it doesn't sound like it, it If and when clinics have dedicated receptionists who are not nurses, and the reason I say that is I could be a receptionist. I would be a really good receptionist. I believe I can do that job. I cannot do your job. The skill set is completely different. I don't have the training, and yet I think that when clinics put highly qualified, highly skilled nurses at the front of house which is great because they've usually got the people skills house which is great because they've usually got the people skills but they're putting them front of house, the clients that come in kind of discount the skills, the medical skills. If you go to your doctor, your doctor is not going to put one of his highly skilled registered nurses manning the phones on the front desk, absolutely. And yet that's what happens in a veterinary clinic.

Speaker 1:

When Tanya and I are working with clinics in a consultancy type capacity, one of the first things that we try really hard to get them to do is to look at how they can get their receptionist as a dedicated, non-nurse receptionist Unless it's a nurse who might be returning to the workforce. Perhaps they are one of those 20 years ago nurses that pre-diploma, pre-certificate and they are absolutely happy to be on the front desk. They don't want to do surgical nursing again. That's different, but I do think it's a total waste of skills. I'm not discounting the skills that receptionists have, because it's a skilled job as well.

Speaker 1:

I had a conversation a few years ago with a principal. It was a small, independent. Well, it wasn't so small, but it was an independent clinic. I was talking with one of the directors and I was saying to him that you need to start charging for your nurses. It was almost insulting to him. He could not get his head around the fact that nurses are valuable. How do you suggest if there's a nurse listening here or a practice manager and wants to put it to their principal? How do you suggest that they broach that?

Speaker 2:

it to their principal. How do you suggest that they broach that? Well, I would first of all come up with a list of things that you could bring to the clinic. First of all, there's lots of different ideas up on you know, I suppose, the NZVNA website. There's lots of things on social media and things that people are doing as well.

Speaker 2:

People are talking quite a lot with regards to nurses and them feeling that they're not being well utilised.

Speaker 2:

So there's lots of different ideas that you can bring to the table, sound them out, and if you are able and competent to be able to do these things, then why shouldn't you? We have these veterinary nurses as professionals in their own right, basically, and they have a fee earning potential so you can bring revenue into the clinic. So how can that be bad? At the end of the day, we can have nurse fees under that umbrella, where it can cover their entire wage or even supersede it, depending on how many nurses you've got in the clinic that works with you. So I would say, get your list ready, see what you can do, even if it's if they're not going to give you consulting time, maybe out the back, you know things where you can be monitoring anesthetics and things like that as well. That can all go under a nurse umbrella kind of fee and you can build. It doesn't have to start with 50 different fees as well. Start with two or three. See what happens.

Speaker 1:

I hope you found this really helpful. Regardless of whatever role you have in your veterinary clinic, there's something in this episode, I believe, for everyone, and the same for next week as well. So make sure you tune in next week as well, because Michelle talks about different invoice line items that not only make a difference to a veterinary nurse's self-esteem because they're being recognized as adding value, but also make a positive difference to a vet clinic's bottom line. So stay tuned for that Until next week. This is Julie South signing off and inviting you to go out there and be the most fantabulous, resilient version of you. You can be Kakiti Ano.

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