Exam room one is waiting on vaccinations, exam room two needs a toenail trim, and you’re trying to examine your emergency broken leg before surgery. If the clinic is so busy, why does it seem like you’ve been tripping over groups of chatting veterinary nurses all afternoon? You make a mental note to bring that up with the nursing team when things calm down a bit, for now you have to focus on your patients.
Several hours later, with team members gathered in your office, you express your disappointment at the lack of help this afternoon. There are many sideways glances amongst the group until finally one of your nurses murmurs that they didn’t know what to do. What?! With a feeling like getting struck upside the head you try to think through how that could possibly be true—after all, these are trained professionals. Gathering courage, the group admits that they feel their skills are underutilized and that there is no order or rhythm to the day. A light bulb goes on, and you immediately implement changes in your clinic to not only utilize your nursing team’s talents but to increase your revenue as well.
Expanding the Schedule
The simplest way to increase your revenue is to increase the number of patients that are seen in a day. When veterinarians are trying to go at it alone, appointments every half an hour is about as much as can sanely be handled. Even then there can be some piling up if radiographs or blood work are needed, so where are those extra patients supposed to fit in? The answer lies in utilizing veterinary nurses.
To be the most efficient, veterinarians should focus on diagnosing and treating health conditions and performing surgical and medical procedures. Your veterinary nurse team can handle everything else, including collecting vitals and samples, educating clients, and providing discharge instructions. Veterinary nurses can even handle the majority of the record keeping by dictating what you are discussing with the client into the record in real time. Not only does this increase the number of clients you see per day, and therefore your revenue, but it also allows you to focus more on what you went to veterinary school for.
Configuring Your Nursing Team
This all seems great, but how exactly do you make it happen? The key lies in your staff roles. According to a recent Benchmarks survey, increased staff-to-doctor ratios promote productivity and revenue. This study found that the highest-performing practices sported ratios of 4.7 staff members to each veterinarian. This number included two nurses, one assistant, one receptionist, and 0.7 practice managers. While the make-up and number of your support staff may differ, the goal to effectively utilize everyone’s talents in order to increase efficiency and revenue.
Outpatient vs. inpatient: We all know that people are most productive when they know what to do and when to do it. Each day, you can divide your crew into an inpatient and outpatient team. Inpatient staff members are in charge of all things surgical, sample collection and lab work, radiographs, and hospitalized patient care. The outpatient crew takes on appointments, admissions and discharges, filling medications, and medical records.
Doctor-nurse teams: Once your inpatient and outpatient teams are determined, assign those outpatient nurses to specific doctors. For maximum productivity, include two nurses per doctor. This will allow the veterinarian to have two active exam rooms going at all times. One nurse can be taking vitals and histories in one exam room while the other nurse is assisting the vet’s exam in the other room. The assisting nurse can then educate the client and reiterate instructions while the vet moves to the first room. Inpatient staff will take care of any tests or samples necessary for diagnosis, allowing the vet more client time.
Surgeries: Using the same nursing team configurations allows veterinarians to perform more surgical procedures as well. Nurses and assistants can anesthetize and prep animals for surgery, making it so that veterinarians don’t even have to step out of the surgical suite. The inpatient team takes care of the recovery and nurses can discharge patients later in the day. Take a little lesson from the Oregon Humane Society where, as a veterinary student on clinical rotation, I was able to spay and neuter eight to 10 dogs and cats per morning even at student surgical speeds. The veterinary nurses at this facility did everything so that the surgeons only needed to change gloves in between procedures and then move on to the next animal, which was ready and waiting.
The Dynamic Dental
We’re all aware of the need for regular dental cleanings for our dog and cat patients. However, if the veterinarian is doing anything other than extractions and oral surgery, you’re not reaching your full income potential. A veterinary nurse and assistant team can perform the majority of the dental procedure, including pre-anesthetic blood work, radiographs, cleaning and polishing, and recovery. The vet only need be present for the initial exam, review of blood work and radiographs, and any extractions, with periodic check-ins of course. This allows the doctor to see appointments or perform other surgeries at the same time, a great two-for-one deal.
An additional, possibly untapped, source of revenue is scheduling nurse-only appointments. These are the procedures that don’t require a veterinarian’s oversight. Anal gland expression, toenail trims, suture removal, and sample collections can all take place after the busy part of the morning is over and require no time from a veterinarian at all. Not only can this type of appointment increase your revenue without taking any extra time from you, but it can also increase your veterinary nurses’ skills and confidence, leading to an overall higher job satisfaction for them.
Let’s revisit the scenario from the beginning. If you were utilizing your veterinary nursing team, exam room one would have a nurse taking vitals and a history and readying the vaccinations, while the toenail trim in exam room two would be taken care of by a nurse and assistant. That would leave you to freely examine the dog with a broken leg and then move on to give the vaccinations while your team anesthetized and prepped the dog for surgery. Your nurses would then educate the clients about vaccinations and assist you with the fracture repair.
Just like that, three appointments and transactions completed in the time it took you to worry about how you were going to get it all done by yourself.