The 3 skills you need to perform in your medical patients
Do you ever feel like you don’t get to use all of your veterinary nursing skills in practice? I bet you do, and I get it. Why? Because I’ve been there. I too have felt frustrated because, as nurses, we have so much untapped potential - so many skills we could be utilising in practice to help our patients and team, whilst improving our job satisfaction.
I’m here to give you three examples of how we can use more of our nursing skills when caring for medical patients. These are areas where veterinary nurses can shine - making a huge difference to patient care and the smooth-running of the practice, by freeing up vets to focus on tasks only they can complete.
The result? Happy patients, happy vets, a happy practice and most importantly… happy nurses!
PS. If you want to learn even more about caring for medical patients and using your nursing skills, make sure you sign up for my upcoming free webinar here.
#1: Laboratory nursing
Our medical patients require a huge number of different tests. Now it’s not all running samples through analysers or submitting external tests in internal medicine… There are a lot of manual laboratory tests and nursing skills for us to develop and perform, too. These include:
Making, staining and evaluating blood smears
Performing manual platelet counts
Performing differential white blood cell counts
Performing urine chemistry strip and specific gravity analysis, and manual urine cytology testing
Performing cytology of fine-needle aspirates and skin scrapes/hair plucks
Preparing diagnostic cytology slides from samples such as bone marrow and synovial fluid
Performing and interpreting in-saline agglutination testing
Performing and interpreting in-house blood typing and cross-matching
And many more!
These tasks are often performed by veterinary surgeons, but with training, there is absolutely no reason veterinary nurses can’t perform these tests!
Get yourself a good laboratory guide and pop this in your in-house lab to help with sample preparation and slide interpretation. Lots of reference laboratories provide practices with posters for things like white blood cell and urine component identification, and you can even access free online webinars from places like the Idexx Learning Centre.
Also, if you come across a good slide whilst reviewing samples, keep it to one side and have a practice session with your nursing team on the next ‘Q’ day!
#2: Diagnostic Imaging
Imaging is another area where nurses can make an enormous difference. This is performed by vets very commonly - but is a great way for us to develop our skills whilst freeing up the vet to perform role-critical tasks (such as getting on with the next surgery!)
We rely on diagnostic imaging hugely when working with medical patients. Radiography and ultrasonography are performed most commonly, but if you’re lucky enough to work in a practice with a CT scanner or fluoroscopy unit, these can also be run by the veterinary nurse! We don’t use MRI commonly in internal medicine, but - yes, you guessed it - veterinary nurses can, with the proper training, run these too.
Several imaging techniques also include the administration of contrast agents to highlight specific areas - such as lower urinary tract radiography, and assessment of gastrointestinal motility. Having a nurse well-trained in performing these contrast studies is of huge benefit to the practice.
The veterinary nurse can acquire images for the veterinary surgeon to interpret, but cannot diagnose based on imaging findings. A basic ability to interpret common results is beneficial for the nurse, though, so that urgent changes can be identified and the veterinary surgeon alerted ASAP. For example, a nurse who obtains thoracic radiographs may identify evidence of a pneumothorax on the images. They can then alert the vet, provide emergency oxygen therapy, and prepare equipment for thoracocentesis whilst the vet reviews the images - saving time, and improving patient care.
The nurse’s role in diagnostic imaging is not limited to acquiring images for the vet to review. Several procedures are performed under the guidance of ultrasound or CT - such as the collection of percutaneous needle-core biopsies, fine needle aspirates from internal organs, or prostatic wash sampling. The nurse plays a key role in assisting with these procedures, including ensuring the necessary equipment is available, monitoring the patient and handling and preparing samples, as well as things like urinary catheterisation and sample aspiration during a prostatic wash.
#3: Inpatient Care
We all know that inpatient care is a very nursing-heavy area of practice. In addition to administering medications and performing general patient care, there are several practical skills we can perform in our hospitalised patients. These include the placement and management of various tubes, lines and catheters.
Feeding tubes are commonly placed in anorexic patients; depending on the type of tube, these can be placed (or assisted with) by the veterinary nurse. Naso-oesophageal or nasogastric feeding tubes can be quickly and easily placed in conscious patients by veterinary nurses, and oesophagostomy and gastrostomy tubes can be placed by a vet and nurse team working together. The daily care and management of these tubes, including site checks and maintenance, cleaning and re-dressing, and tube aspiration (if the tube enters the stomach) are vital nursing skills.
Intravenous access is key in all patients undergoing general anaesthesia or receiving intravenous fluids or medications, or in critically ill patients where emergency medications will be required. Securing and placing an appropriate IV line is a fundamental nursing skill and should be delegated to nurses by the veterinary surgeon. Additionally, advanced venous access techniques such as placing central venous catheters and sampling lines are a fantastic use of our nursing skills!
Management of eliminations is another core aspect of inpatient nursing. Many medical patients will require placement of a urinary catheter, either as part of their disease process (e.g. due to urethral obstruction in cases of lower urinary tract disease), to monitor urine output and fluid balance (e.g. in patients with acute kidney injury, where urine output may reduce), and to improve patient comfort levels (e.g. in recumbent patients who cannot urinate outside). Urinary catheterisation of both male and female patients can (and should!) be performed by veterinary nurses - it’s another great way for us to develop and use our skills, whilst allowing the veterinary surgeon to focus on other tasks.
So there are three ways for us to develop and use more of our nursing skills! Whether working in the lab, the diagnostics areas or your ward, identify tasks you could perform and discuss these with your vet team. The result will be happier, utilised nurses, a vet team with more time to dedicate to other tasks, and huge benefits to patient care.
