Good morning, everyone, and welcome to colourful CPD's first virtual roadshow, making nurse consulting work for you and your practise. So we've got some great speakers for you today. We've got colourful CPDs, Steph writer Davies, and Brian Faulkner, as well as Claire Hemings from Royal Cannon.

We've also got two lovely guest nurse speakers, Samantha Payne and Christy Paul. So in this morning's session, we'll be covering legislation with Steph and then the approach to a consultation with Brian. After that, a quick coffee break, returning with Claire for remote consulting.

Then just before lunch, our first guest speaker of the day, Samantha will be talking us through life as a consulting nurse. So if you have any questions as we go along today, pop them in the Q&A box at the bottom of your screen, and, our speakers will, try their best to answer them at the end of their session. If not, we've also got a Q&A at the very end of the day with all our speakers back, so they'll be able to answer them for you.

Don't worry if you need to step out as well at any point, the recording will be made available to you within 48 hours of today so you can catch up at your own leisure. So to kick things off this morning, I'd like to introduce you to my colourful CPD colleague, Steph Wrighter Davies. So Steph is a veterinary surgeon with 36 years' experience who has owned her own practise, which was also a vet nurse training practise.

She was on president in 2016 and was the. Nurse liaison for 10 years. She's a strong supporter of the vet nurse profession, believing in the important role they play in our practises, and is keen to see nurses performing broader and more challenging roles to improve their status and job satisfaction.

Steph also developed the colourful nurse Consulting skills training course alongside Bri. So without further ado, I'll hand you over to the capable hands of Steph, and she'll get us started for the day. OK, right.

Let me see. Hopefully, I can there, can you see me? Is it working?

We've got you, Steph. I can see you. And have I unmuted myself.

OK. So, good morning, everybody, and, thank you very much for joining us today. I have to confess that this is the first, remote, type of, of talk that I've, I've given where videos on and everything else, and I feel ridiculously, nervous.

So please bear with me if I make some fluffs here. I'm gonna say just before you start, we can't see your screen just that, yeah, just wanted to let you know, so. OK dokey.

The joys. Right. Let's try sharing again.

There we go. Can you see it now? Can you see it now?

Yeah, lovely. I will leave you to it. Sophie.

You see, I told you it was gonna go badly wrong. OK, should we start again? Thank you very much, everybody, for joining us, and, hopefully, that will be the only technical hitch that we will have all day.

So to kick off the day, the first talk this morning is all about legislation. So legislation affecting the veterinary professions. And, the reason that I think it's, it's quite important that We have our legislation, we talk about legislation, is that I think there's quite a lot of confusion about the sort of legislation, and the way that it impacts what veterinary nurses and veterinary surgeons can legally do in practise.

And I think the problem is that that then affects how much veterinary nurses are allowed to do by veterinary surgeons. So, in theory, I've got about 50 minutes, to talk to you about this, but what I'm intending to do is try and talk for a bit less than that, and then following it, we'll have a sort of multiple choice questions, type session, just to see how much everybody's understood. And then at the end of all of that, any questions that you may have, posted during the course of the talk, or that you think of at the end, we can go through those.

So, over the next 40 minutes or so, I'm gonna talk about, oh, no, my stupid thing doesn't want to work. I'm going to talk about the relevance of Schedule 3 of the Veterinary Surgeons Act. I'm going to talk about the regulation of the veterinary nursing profession.

I'm gonna talk about the veterinary medicines regulations. I'm gonna talk about competence and conduct and negligence and misconduct. It wasn't actually until 1948 that we had a Veterinary Surgeons Act that actually made it unlawful for anyone to practise or aspire to practise or put themselves forward as practising as a veterinary surgeon in the UK unless they were a registered member of the RCVS.

And that was regardless of whether or not they intended to charge for their services. Now that Act has been amended a few times to leave us with the law that we currently work under today, which is the 1966 Act. And that states quite clearly that no individual shall practise or hold himself out as practising or being prepared to practise veterinary surgery unless he is registered in the register of veterinary surgeons or in the supplementary register.

And of course, it's always been necessary for people who are not vets to be able to treat animals in at least some small way, because, of course, we've needed to have owners or keepers of animals being able to legally treat them. So as a result of that, we've had a Schedule, Schedule 3, which is the exemption from restrictions on the practise of veterinary surgery. And that originally applied simply to people like farmers or keepers of animals, who, of course, needed to be able to give their, their cattle, injections, for example, or to perform certain other non-surgical based farm procedures, so things like docking of lamb's tails.

It also allowed owners to give their animals medication, so if, for example, an owner of a diabetic animal needed to be able to give their animal injections, it allowed them to do that. It allows anybody to provide treatment with the intention of saving life or relieving pain, in an emergency, and it allowed certain treatments of animals in laboratory type situations. Now, of course, veterinary surgeons haven't been able to do everything entirely on their own, and they've always had people who helped them in their practises.

But the qualifications, training and skills that those people had were not recognised for a long time. And it wasn't actually until 1961 that the RCVS approved some training for what were then then termed animal nursing auxiliaries. And finally, veterinary nurses, as professionals, were actually recognised in law in 1991.

Now, once we've got veterinary veterinary nurses recognised in law, it became necessary to make some amendments to Schedule 3. And I apologise because the next couple of slides are an awful lot of words. But the next slides are what these, exemptions, as far as veterinary nurses are concerned, actually states.

And I think because of the confusion, it's sensible to physically read the law. So we have paragraph 6, which applies to qualified veterinary nurses and exempts as any medical treatment or minor surgery, not involving entry into a body cavity to any animal by a veterinary nurse if the following conditions are complied with. So if the animal is for the time being under the care of a registered veterinary surgeon and the medical treatment or minor surgery, it's carried out by the veterinary nurse at the direction.

That the registered veterinary surgeon is the employer of or is acting on behalf of the employer of the veterinary nurse, and that the registered veterinary surgeon directing the medical treatment or minor surgery is satisfied that the veterinary nurse is qualified to carry out the treatment or surgery. And then we have paragraph 7, which expands on paragraph 6 and applies to student veterinary nurses, making it clear that the work that the student veterinary nurse is directed to do must be undertaken in the course of that nurse's training, and that the treatment or surgery that they're performing must be supervised either by registered veterinary surgeon or veterinary nurse, and in the case of surgery, that the supervision must be direct, continuous, and personal. So what this means, in effect, is that under these exemptions, veterinary, qualified veterinary nurses, registered veterinary nurses and student veterinary nurses have more legal rights to perform treatments and procedures to animals than lay people.

But it's really important that we remember that that only applies if the veterinary nurses are undertaking or have undertaking and our CVS approved course. And if you're a a qualified veterinary nurse, then you must be registered with the Royal College of Veterinary Surgeons. So if you have undertaken some sort of strange online course to become a veterinary nurse, and believe me, there are some, which is not approved, or if you are a, a qualified nurse, but you have not registered or haven't paid your registration fee, at that point, you are no longer, you have no longer have any more legal rights than lay people.

You become, you default back to being a layperson. So, when it comes to to talking about what veterinary nurses are and are not allowed to do, the RCVS has helpfully provided some definitions that make it a little bit clearer about what the, what it means to direct things to a veterinary nurse. So what they say is that with direction, a vet will instruct the veterinary nurse or the student veterinary nurse, as to the tasks to performed, but they don't necessarily have to be present.

And you'll remember that in paragraph 6, there was nothing about qualified veterinary nurses needing any supervision. And what that means in principle is that actually a veterinary surgeon can ask a qualified veterinary nurse to perform tasks under Schedule 3, and they don't even have to be in the same building. With student veterinary nurses, it's slightly different because supervision is required.

And supervision is defined by the RCVS that the vet is on the premises and able to respond if needed. But again, the vet doesn't actually have to see the student veterinary nurse doing things. Although, while we're talking about performing surgery, direct and continuous supervision, a vet or RVN must give the student veterinary nurse his or her undivided attention.

So it's slightly different. But what it does mean that if a student veterinary nurse is, for example, doing some stitching, the veterinary surgeon doesn't have to be there. The veterinary surgeon can be somewhere else in the building, as long as the registered veterinary nurse is monitoring the student.

When deciding whether or not to ask a veterinary nurse, to direct a veterinary nurse to perform a task to delegate it, the RCVSS's code of conduct for veterinary surgeons advises us that we need to consider how difficult that procedure is, whether the nurse is qualified to treat the species concerned, so it wouldn't be appropriate to ask someone who has an equine qualification to treat a dog or a cat, for example, whether they understand the associated risks, and whether or not they have the necessary experience and good sense to react appropriately if something goes wrong. And the veterinary surgeon also needs to make sure that they will be available to answer any call for assistance and be satisfied that the nurse feels capable of carrying out the procedure competently and successfully. And what that implies is that the veterinary surgeon has to somehow have some sort of knowledge of the veterinary nurse.

They have to be, be able to feel that they're actually capable. They're not just directing any task to any veterinary nurse, which suggests that, in fact, the veterinary surgeon needs to trust the veterinary nurse. But of course, trust may be different in different situations, and, and we'll come on to this in a little while.

So, what does Schedule 3 include? Are there legal definitions? Well, I think part of the problem that with what the, the Schedule 3 allows and what veterinary nurses are allowed to do, is that as part of the code of conduct, the RCVS advises veterinary surgeons that with the Schedule 3, Amendment order of the 1966 Veterinary Surgeons Act, veterinary surgeons are allowed to direct veterinary nurses to perform limited veterinary surgery.

And I think unfortunately, that wording tends to make people think of surgery itself. In other words, operating. But the simple fact is that the definition of veterinary surgery in the 1966 Veterinary Surgeons Act is actually much wider than that.

And veterinary surgery means the art and science of veterinary surgery in medicine and shall be taken to include the diagnosis of diseases in and injuries to animals, including tests performed on animals for diagnostic purposes. The giving of advice based upon such a diagnosis, the medical or surgical treatment of animals, and the performance of surgical operations on animals. So the definition of veterinary surgery, what it includes is actually much more than simply operating.

And if we remember what the Schedule 3 exemptions allow, they allow veterinary nurses to perform medical treatment or minor surgery not involving entry into a body cavity. And so in reality, veterinary nurses are only allowed to perform parts C and D of what the Act defines as veterinary surgery. In other words, limited veterinary surgery.

It doesn't just mean limited surgical procedures. So, is there a list of tasks? Well, the simple answer is no, there isn't.

Because when a veterinary surgeon makes a decision to delegate something to a veterinary nurse, that becomes a matter of professional, decision. It's down to the veterinary surgeon, and it is very much about delegating that task to that specific nurse. But the guidance states that we must understand, we must think carefully about it.

So we must trust the nurse, as I said earlier. But how do you trust somebody that you don't know? For example, if, if it's a situation where you have somebody who perhaps is a locum, or somebody who's only just recently joined the practise, how do you trust that person?

Well, I would suggest that veterinary surgeons and veterinary nurses are both professionals. And as professionals, we have a, a duty to behave in a certain way. We are certain behaviours are expected of professionals.

And I think it would be important, therefore, when we, when we're considering how we trust one another, to consider how are the professions regulated, how are our behaviours controlled. So in the UK, the Royal College of Veterinary Surgeons is the governing body that's responsible for regulating both veterinary surgeons and veterinary nurses. And as far as veterinary nurses are concerned, that regulation is done through VM council, which sets and upholds standards.

It also supervises veterinary nurse education. It advises on and recognises veterinary nurse qualifications, and that's both within the UK and elsewhere in the world. It regulates the veterinary nursing profession, including providing that code of conduct that tells veterinary nurses how they should behave, and it supervises the professional conduct of veterinary nurses.

And being a professional brings with it certain responsibilities. And veterinary surgeons are responsible for, complying with the standards that are set by our CVS council. And for veterinary nurses, it's the same, and they need to comply with the standards set by VM council.

And that includes following the code of professional conduct, fulfilling certain CPD requirements and making certain disclosures, which usually relate to things like health problems or convictions, because unfortunately, both of those could affect our, our rights to practise our fitness to practise. And in the UK, veterinary surgeons can't work as a vet unless they're registered with the college, and veterinary nurses must be registered to have professional status. So BM council, when it's talking about behaving professionally, talks about certain principles of practise, and it it advises that veterinary nurses should adhere to these in everything that they do.

So the first thing is they need to be aware of professional competence. The second thing, they need to behave with honesty and integrity. Independence and impartiality.

They should be aware and respect client confidentiality and trust, and they should be aware of professional accountability. And when it comes to interacting with co-professionals, the guidance very much is that we should treat co-professionals with courtesy and respect. So if we think about those things there, that the top one is professional competence.

So what does that mean? Well, let's have a little look at that. Competence is basically the ability to do something successfully or effectively.

And if you think about that, in order to be competent at doing something, not only do you need the skills, but you also need to be prepared to apply them. And the RCBS considers that competence is a concept which integrates and applies knowledge, skills, and attitudes. So it allows somebody to apply what they've learned to different situations and to have that flexibility to respond if things change.

And the RCVS defines as job competence, the ability to perform the roles and tasks required by your job to the expected standard. And as veterinary surgeons and veterinary nurses, we are expected to at least maintain, if not improve our competence throughout the course of our working lives. And what it means in sim in simple terms, if you think about this, is that competence, it's very different from just doing something.

It's not about just doing something, getting on and doing it. It's about really thinking about what you're doing. So, for example, if a veterinary nurse were asked to give an animal an injection, I would expect a veterinary nurse who was competent at giving injections to consider and select the appropriate size of the syringe for the amount of drugs that needed to be injected.

To check the root and the site of injection, so does it need to be intravenous, subcutaneous, intramuscular, and obviously, check where you're going to be giving that for the species concerned. To make sure that you use an appropriate type and size of needle. You're not going to be choosing a tiny little thin needle if you're going to be injecting a great big horrible sick solution.

And to make sure that if necessary, you have some assistance and some additional equipment. So if you're giving something intravenously, or if the animal is a little bit grumpy and a bit difficult to handle, you might need a colleague to help you to hold it. And of course, you might need things like clippers or surgical spirits.

And if you were doing it during a consultation, you would explain to the owner what you're going to be doing and perhaps warn them if the animal was likely to cry, if it was going to sting or something. So if you think about it, being competent at something actually includes an awful lot more than simply having the skills at giving that injection. So if we think about professional behaviour and, and being aware of our competence, how does this work in a situation where, for example, as we talked about, a veterinary surgeon and a veterinary nurse don't know one another.

So the scenario I'm going to give you is we have a veterinary surgeon, Liz, and we have a veterinary nurse, James. They've never met one another before. Liz works part-time at the practise and James has only just joined recently.

And during a busy afternoon consulting session, which is the first time that the two of them are working together, Liz has become typical vet, got behind and has noticed that ahead of her in one of the, the, the slots coming up is a post-doc check for a mastectomy. And she thinks that that would be a perfectly reasonable thing to delegate to a qualified veterinary nurse, and she asks James if he would do it. Now James in his previous practise has never done any consulting.

They didn't do any. And he's not really comfortable trying to manage a case like that. He hasn't been at the practise very long, and he doesn't know the protocols.

So he feels uncomfortable. He doesn't actually feel that it's within his competence. Unfortunately, Liz is really frustrated.

She's running late. James is a qualified veterinary nurse, for heaven's sakes. Why can he not just go on and get ahead and do this?

And the difficulty is that because James doesn't know Liz and he's trying to make a good impression, he feels a bit backed into a corner. He doesn't feel that he can turn around and go, well, I really don't feel comfortable. And so what he ends up doing is he says, Well, OK, I'm not terribly comfortable, but if it comes to it, OK, I'll do it.

And you can see here that what's happened is that, unfortunately, Liz has perhaps, encouraged James, shall we say, to perform something or do a task, which he doesn't necessarily feel he's completely competent to do. And the problem is that that could land both of them in hot water, because if something were to go wrong, or if the animal were to have a problem, then of course, James has done something which is outside his competence. And this isn't how things should go.

This is a much better scenario. The same thing happens, the same question, can you see my postop mastectomy? James declines for the same reason.

Liz then affords him that professional courtesy. James is an RVM. He understands that he must work within his competence, and he's presumably declining, not just because he wants to be difficult, but because he actually recognises that he isn't able to or doesn't feel comfortable doing that procedure.

So Liz affords him that professional courtesy and respect. She assumed that he would be able to do the procedure, but he has said he, he doesn't feel comfortable, and so therefore, she's respected him. And she asks if there's another nurse who could do it.

And James knows that Emma is in the kennel room and she's treated. A patient out there, perhaps she would be able to do it. And so he asks her, and actually, he suggests he goes in and he sees what she does.

And that's an awful lot better, isn't it? A, James and Liz, neither of them are being put in a difficult situation. But B, James actually gets to learn.

So this is the way that we can work out how a veterinary surgeon can understand how to delegate to a veterinary nurse that they don't know. We have to afford one another that professional respect and courtesy. And there should be no bullying either way, either from a veterinary surgeon to encourage a veterinary nurse to do something that he or she is not comfortable with, or the other way from a veterinary nurse to encourage a veterinary surgeon to delegate something to them that they don't feel is appropriate.

So what can veterinary nurses actually do? Let's see if we can put some meat on the bones of this. Well, the problem is that the legal definition is vague.

But the RCVS has been quite helpful and the RCVS suggests that it's reasonable for veterinary surgeons to be delegated procedures for which they receive training during their qualification. But that's, that list isn't going to be exhaustive, because, of course, as they go through their working lives, veterinary nurses are going to learn to do other things. They're going to have additional training.

But that at least gives us a starting point. So when we think about the laws relating to treating animals, the only people who have the rights to perform all aspects of veterinary surgery are people who are members of the Royal College of Veterinary Surgeons. So people who have got the relevant qualifications and who have been able to become members of the college and have paid their membership fee.

And then we have the standard Schedule 3 exemption, which allows minor medical treatment and certain non-surgical procedures to be done by lay people. And in the middle, we have veterinary nurses. Veterinary nurses are legally allowed to perform any of those treatments that lay people can perform, but they're also allowed to perform other things.

So the procedures that are included within their veterinary nurse training. So that would include things like giving intravenous injections, taking a blood sample, collecting a sample of of perhaps skin or hair, putting placing intravenous catheters, placing urinary catheters, and then, of course, there are so term inpatient type treatments, such as helping with anaesthesia. Performing surgery or helping with surgery and performing minor surgery themselves, doing radiography.

And importantly, when we're talking about consulting, they have the rights to perform a full clinical examination and to report on clinical findings. That's not included in what lay people are allowed to do. And the RCVS has provided some very specific advice about dentistry, stating that scaling and polishing teeth is OK, but dental extractions is not considered a Schedule 3 procedure unless the tooth is so loose that you can pull it out with your fingers.

And the really, really good news for you is that they have also confirmed that it's perfectly OK for veterinary nurses to empty anal glands, which I'm sure you're all thrilled about. They've also made it clear that microchipping is considered a Schedule 3 procedure, and that veterinary nurses are allowed to undertake that within a veterinary practise. But outside a veterinary practise, of course, that task wouldn't be being delegated to them by a veterinary surgeon.

And as a result of that, if they wish to perform microchipping outside a veterinary practise, they do have to have an additional qualification to allow them to do it. So I think when we're thinking about what veterinary nurses are allowed to do, it actually helps sometimes if we think about what they're not allowed to do. So what was it that the Schedule 3 exemption didn't include?

Well, it doesn't include Part A, which is the diagnosis of diseases or injuries in animals, and Part B, which was the giving of advice based upon such diagnosis. So, veterinary nurses are not allowed to prescribe, diagnostic tests or diagnose the cause of symptoms. So what does this mean in practical terms?

So let's assume that you're doing a, a consulting session, and during that consulting session, you have an elderly cat who comes in for a nail clip. And the owner, as she comes through the door, said she's just a little bit worried because she thinks the cat might be losing weight. What are you legally allowed to do?

Well, of course, you're legally allowed to clip the nails. Weigh the cat. You're allowed to obtain a full clinical history.

You're allowed to ask the client for additional information. Discuss those clinical signs. What's the cat doing as far as eating and drinking is concerned.

You're allowed to perform a full clinical examination. Now, let's assume that during that clinical examination, you notice that the animal is in fact, has in fact, lost a significant amount of weight, that there's an elevated heart rate, that the coat doesn't look in particularly good condition. You might well be thinking, oh, I wonder if this cat might have an overactive thyroid.

What are you allowed to tell the owner? Well, what you're allowed to do is comment on those clinical findings. So you can tell the client that you've noticed that the cat's coat is not in particularly good condition.

You've noticed that she has lost weight and that she has an elevated heart rate, and you can say, With those clinical signs, which were not what you were expected, they were unexpected clinical findings. And the fact that the owner has told you that she's eating more than normal and drinking more than normal, it's really important that the cat must see a vet, because this is not normal and the cat needs to be checked out. Now, if the client presses you to try to ask you, What you think might be going on.

It's really important to be aware of the subtle but significant differences in the language that you might use. Because if you're not careful, you can stray into that boundaries of potentially giving, either a provisional or a definitive diagnosis, which, of course, Schedule 3 does not allow you to do. So it's perfectly safe for you to provide useful information in the form of a, a list of potential, differential diagnoses that it might be.

So you would be OK to say the most common causes of weight loss in a cat of this type of age are an overactive thyroid, chronic kidney disease, diabetes, for example. And then you would have to say to them, it's important that you go and see a vet. The vet will check her over, and the vet will sort this out for you and book an appointment.

It would be risky to say the cat could have an overactive thyroid, because that suggests a provisional diagnosis and you're not allowed to do that. And you absolutely must not say the cat probably has hyperthyroidism. And when you see the vet, they'll be taking bloods and they'll almost certainly put, put you on some medication to control it.

If you do that, that's Suggests a definitive diagnosis, and it advises on potential tests that might be done and potential treatments. And that is beyond what that Schedule 3 allows. So, the, the, the take home message is that when you're talking about possible symptoms and, and how an animal should be treated, make sure that you steer an owner towards a vet rather than a diagnosis.

But we also need to consider the veterinary medicines regulations because they come into play as well in terms of what veterinary nurses are and are not allowed to do. And the veterinary medicines regulations state that only a veterinary surgeon may prescribe so termed POMV meds, that's prescription-only medicines, and they can only be prescribed after a clinical assessment of an animal. So, veterinary nurses must not prescribe or authorise prescription-only medicines.

But nothing in life is ever simple. And there's a whole load of other different classifications of veterinary medicines. It's not just as simple as POMVs.

There are also POMVPS, NFAVPS, and AVMGSL. I I don't think it really matters that you don't necessarily know what those initials stand for. The ADMGSL medicines are the easiest ones to think about, because they're what's called general sales medicines.

They're the types of things that we would maybe see in the, in the, in the pet food, section of the supermarkets. And there'll be things like, nutritional supplements, perhaps, there'll be things like shampoos and, and there'll be things that some of the more shall we say, basic parasite control treatments. Some things of which have no parasite control in at all, as we know.

And the point about AVMGSL medicines is that they can be provided or sold to anyone. By anyone. So you don't have to be a veterinary surgeon, veterinary nurse.

And in fact, you don't have to have any knowledge of the animal. All you have to believe is that the person to whom you're selling the medicines will use them for, the, the, what they're aimed for, and will be able to apply them, effectively, quite how you do that at the checkout in the supermarket, I don't know. But those are nice and easy.

Anybody can give them to anybody. The POM VPS and the NFA VPS medicines, they can be supplied by a veterinary surgeon, a pharmacist, or a suitably qualified person. And it isn't necessary to examine an animal before you do that.

Now, frustratingly, veterinary veterinary nurses are not automatically, STPs when they qualify. And so what that means in practise, because quite a lot of the parasite control that we use, if it's not a POM Ve, may well come from one of these two categories. It unfortunately means that in order to supply those, unless you have somebody in your practise who's undertaken the additional training and become an SQP, unfortunately, a veterinary surgeon is likely to be, need to be around at the point at which those, those, control products are, are supplied.

However, veterinary nurses are allowed to legally dispense prescribed medications. So if a veterinary surgeon has prescribed some medication, the supply of that medication, dispensing and supply is a subtly different act to prescribing. After all, if you think about it, it's what happens when a veterinary surgeon writes the prescription.

And then, the, the client takes that to a pharmacist or uses it an online pharmacy. That's a separate thing, and veterinary nurses are considered competent to dispense prescribed medications. So, let's think about how, what this would be like in practise.

And I think when we're thinking about medicines and what you are and are not allowed to supply, what easier to talk about than a kitten, for example. Let's assume again, during a consulting session, you're seeing a kitten for a second vaccination. It was seen by the vet 3 weeks earlier and it had its first vaccination.

There were no clinical notes at all about parasite control and nothing at all about the vet having seen any fleas. But whilst you're examining the kitten, you see some fleas in its coat, and you notice flea dirt. What are you allowed to do?

Are you allowed to diagnose fleas in that kitten? Well, the answer is, you're not allowed to diagnose a skin problem, but you're not doing that. You're allowed to report on a clinical finding.

And the fleas are a clinical finding. It's something that you have noticed. You can see it.

They're there with the naked eye. It's not making a diagnosis, it's reporting a clinical finding. And if, for example, somebody were to take that kitten into a pet shop, a non-qualified person would be able to see those fleas and would absolutely be able to say, your kitten has fleas and it needs some flea treatment.

So ultimately, you are allowed to do that. Similarly, if you saw some ticks or if you saw some tapeworms, again, it would be absolutely fine to say that you had seen them. Now, whether or not you can provide treatment, that depends a little bit on what you have available and also on any practise policies or protocols that you may have.

So as I've just said, products from the AVM GSL category, they can be provided by anyone, to any person. So if you had something like that available at your practise, you as a veterinary nurse, are perfectly legally allowed to say, this kitten has fleas, here is some flea treatment, and to provide that. But of course, that's not ideal, because it would be much better for you to encourage the client to use something from your preferred preventative healthcare regime.

And that's much more likely either to be a POMV or one of those NFA or POM VPS medicines. So if you want to provide one of those, you do need veterinary research and input. But do you need to have it at that precise moment?

Well, that will depend very much on whether or not you have any policies or whether you have things like health plans. So, if you have a very defined policy in your practise, for example, something that states that any animal that has been seen by a vet within 6 months can be provided with 3 months' worth of the practice's preferred parasite control. If you have a policy which says that, then you can provide it.

You're not making a decision to supply that medication or to prescribe it. It has been, in effect, pre-prescribed and supplying it has been directed to you by that very clear policy. Equally, if the kitten is on your health plan, And your health plan allows that, that kitten to have 12 months' worth of parasite control.

In effect, that parasite control has been pre-prescribed by your health plan. And so it would be perfectly reasonable for you to supply any parasite control that would be due. And to be frankly, if they've already been supplied it, then you'd be wanting to ask them whether or not they managed to apply it appropriately and, and, and whether or not they've used it.

If you have neither a health plan, which is very clearly defined nor a policy, then you would at that point have to ask the vet. But then it's down to the vet to decide whether or not they need to see the animal. They may choose not to, and they may choose to direct you to supply some, some medication.

The problem is that despite everything that we've gone through, I do think there is still an awful lot of schedule 3 confusion. And unfortunately, an awful lot of vets are reluctant to delegate tasks to veterinary nurses, partly because they don't really understand what's it, what it's OK for them to delegate, and they don't really understand what Schedule 3 is, but they also have this worry that if they were to delegate a task to a veterinary nurse, and if a veterinary nurse makes a mistake, That actually, what we will end up with is the veterinary surgeon will be the ones who are held responsible. But that is not the case.

That's absolutely untrue. As you know, we've talked about the regulation of the veterinary nursing and the veterinary surgeon professions, and veterinary nurses, registered veterinary nurses are associates of the RCVS. And there is a disciplinary process for veterinary nurses.

If a veterinary nurse were to have a negligence claim made against them, then that would be covered by the nurses professional indemnity insurance. And veterinary nurses are responsible for their own actions and inactions. They have accountability.

So if there were any negligence or misconduct by a veterinary nurse, then it would be the veterinary nurse who would be responsible. So those of you who are still awake will have noticed that I've highlighted negligence and misconduct. So what are those?

Let's see if we can clarify that. Let's look at negligence first. Negligence, in essence, means carelessness or irresponsibility, but it does have a legal definition in law.

And negligence is defined as a failure to behave with the level of care that someone of ordinary prudence would have exercised in the same circumstances. The RCVS considers that negligence is a civil wrong and that it exists when there is a breach of a duty of care owed by one party to another that results in harm. And what the college warns us is that there will always be a duty of care, where one person in the relationship has more knowledge or influence than the other.

So in the case of a veterinary surgeon or a veterinary nurse who is dealing with a client, we will always have that little bit of extra knowledge, hopefully a little bit more than a bit of extra knowledge than the client, and we will be in a position of influence. And so we do have a duty of care to that client. Now, the good news is that the law doesn't expect perfection, and neither is every type of resulting harm necessarily, possible to prove the subject of a negligence claim.

And in order to prove negligence, what we have to prove is that there was a duty of care. It did exist. It was breached, and the resulting harm was a direct result of that.

And what would happen if a negligence claim were approved was that the client would receive financial compensation. So let's look, for example, about what could possibly be considered negligence. Let's look at this veterinary nurse, Amy, who was asked to give a dog an injection of meloxicam, a 1 mL injection.

And unfortunately, Amy makes a mistake. She's obviously having a little bit of a bad day, and she gives the dog 10 mLs instead of 1 mL. Now, we all know that non-steroidals can potentially cause problems in higher doses.

It can upset the animal's kidneys and it can upset the animal's gut. And so that dog is likely, therefore, to require some treatment to protect it against that. So, maybe some intravenous fluid.

And it might need to be hospitalised, and that would incur additional financial costs to the client. So, in other words, the client is going to suffer a loss. And that client would be able to claim the the costs of that loss to basically, shall we say, sue the veterinary nurse for that, that, that financial loss for that, that loss that they've suffered.

And they would do that. Through the professional indemnity insurance. And that's why it's very important that as veterinary nurses, you make sure that you do have that professional indemnity insurance in, in, in place.

Now, I would suggest it's worth just asking your your management team in your practise. In the vast majority of cases, veterinary nurses are automatically covered under the insurance that veterinary surgeons have, but it is worth just checking, because if you make a mistake, then it is any, any claim is made against you, not the veterinary surgeon. But the good news is that even if you were found guilty of negligence, a veterinary nurse would not be struck off.

They would not lose their right to practise. And that's a really good thing. It's not nice, but you would still be able to practise.

So now we come to conduct and misconduct. So, you'll remember that competence was, when we talked about competence, we were looking at our ability to do something, the skills that we had. Conduct is our attitude towards doing something.

It's, it's the way that we behave when we're, when we, when we're thinking about doing things. And misconduct, basically, is generally considered a poor standard of behaviour. So usually that's considered to apply to either an employee or to a professional.

So what it means is misconduct is doing something unprofessional. You're unlikely to do it by accident. It's talking about behaving in a way that is, against what the code of professional conduct says.

So it's almost an active decision. You know you're going to be doing it. You're not gonna just do something unprofessional by accident.

It's not about making a mistake. And the RCVS talks about gross or serious professional conduct as being conduct that falls below the minimal acceptable standards defined within the college's code of professional conduct, which exists to protect the college's reputation and the public. And the college does have a legal duty as our regulator.

It has a legal duty to investigate any allegations of professional misconduct. And there is a disciplinary process. There's one for veterinary surgeons and one for veterinary nurses.

And that exists to investigate behaviour that's fallen far short of expectations. Very poor professional performance. A serious departure from the code of conduct, fraud or dishonesty, and a criminal, criminal conviction or caution.

So if we think back to that poor veterinary nurse who gave that dog 10 mLs of meloxicam instead of 1 mL, that doesn't come under any of those. It would only be considered, possibly misconduct if either the veterinary nurse had chosen to lie about it or cover it up. So if, for example, they'd said that the vet had told them to give them 10 mLs or actually it wasn't them that gave the injection at all, or that somebody else measured it out, or they just pretended it hadn't happened and didn't do anything.

All of those would constitute dishonesty. The other possibility is that if in fact this veterinary nurse had given us, had made the same mistake, had given an overdose, shall we say, of meloxicam on multiple different occasions, and hadn't recognised that, in fact, it was important that she did some additional training in order to be able to, to, you know, work out what the dose is and how to give the right amount, then that could be considered very poor professional performance. Because Actually, we are required, you'll remember I talked about veterinary surgeons and veterinary nurses being required to maintain or improve our competence throughout our lives.

If this veterinary nurse has made the same mistake multiple times, then in reality, that suggests she's not maintaining her competence, she's not aware of it, and she's not maintaining it. And at that point, mistakes or negligence can potentially become misconduct. The Royal College of Veterinary Surgeons does not investigate negligence, though, unless it's repeated or severe.

And frustratingly, clients often think that that that that that that's what the. And clients will often threaten to report a veterinary surgeon or a veterinary nurse to the RCVS when something has gone wrong with their animals treatment, which actually is far more likely to be a simple mistake or possibly negligence rather than misconduct. And it is frustrating because once a client has reported a veterinary nurse or veterinary surgeon, the college does have to investigate it.

Now, if they investigate it, it works a bit like a police investigation. The college collects information, they take interviews from, obviously, the owner who's making the complaint, and for the people within the veterinary practise, including the veterinary surgeon or veterinary nurse themselves. And if it is considered that it, it needs to go the whole way to what we term a disciplinary committee hearing, that's a little bit like a court.

And once all the evidence has been heard, the disciplinary committee then make their decision. And if they decide that a veterinary nurse has been found guilty of serious professional misconduct, then they can potentially be what's called struck off. The, the, the committee have various sanctions that they can impose on the veterinary nurse.

Starting from, closing the, the, the, the case with advice, so giving them advice about the way they should behave in future, right the way through to removing them from the register permanently, and there are various ones in between. Now, being the subject of a of a disciplinary process for alleged misconduct is very, very stressful for veterinary nurses and veterinary surgeons alike. But to be fair to the college, they do aim to investigate quickly.

And to reassure you, 80% of the cases are resolved. Usually, just after they gather that information, they have a look at it, and the preliminary investigation says, actually, there's no case to answer. And only a very small number, probably only about 1%, will go as far as reaching a full disciplinary committee hearing.

So that brings me to the end of, of what I said I was going to talk about. And just before I finish my talk now, what I'm going to do is think about how legislation might apply as far as remote consulting is concerned. Because, of course, I think these days with, with the, the, the new way of life that we seem to be experiencing, courtesy of Coronavirus, remote consulting is something that some of us may be doing, and it may possibly become something that's perhaps a A more standard feature of veterinary life.

I think some clients are, are quite liking it, and some veterinary practises are finding it's quite useful. And there are certainly opportunities for veterinary surgeons to delegate appropriate consults to veterinary nurses to be done remotely. But we do have to remember that Schedule 3 allows veterinary surgeons to delegate to veterinary nurses, but only when the patient is under the vet's care.

So what that means is that veterinary nurses can only should only be consulting and providing remote consulting to animals that are registered at practise. And the other thing to think about is that, of course, detailed clinical notes are going to be particularly important. If you are consulting remotely, of course, the amount of information that you're going to be able to get is going to be an awful lot less.

Of course, if you're only relying on a telephone conversation, that's really hard. You're only relying on what the client is telling you. And even if you've got video, you're still not going going to be able to do a full clinical examination.

And so as a result of that, the amount of information you can get is less. And that means, therefore, that there is the potential for mistakes to be made slightly more easily. So it's really important to write detailed clinical notes.

So if, for example, you were doing a consultation and a client wanted a wanted some additional parasite control treatment, and they were absolutely determined that their little Chihuahua, previously on your clinical notes, being down as weighing 2.5 kg, actually had gained a lot of weight and weighed 5 kg, and the client was absolutely determined that that was the situation, and therefore, you chose to go ahead and give something for a dog that weighed over 4.5 kg.

Well, obviously, in the vast majority of cases, the chances of there being an adverse reaction are low. If you Unlucky enough, and that animal did have an adverse reaction and suffered some sort of illness as a consequence, as long as your clinical notes make it clear that the reason that you chose that higher dose of medication is because the client was absolutely certain that the dog weighed 5 kg and not 2.5 as it previously had, then it can easily be seen that that was a simple mistake and and and not negligence or making a decision simply because you thought it would be a good idea.

And the other thing is, do remember that even with remote consulting, the medicines regulations do still apply. Now, they have been slightly amended by the RCVS. The RCVS has allowed us to be a little bit more flexible, shall we say, in our approach to prescribing medications to try to make veterinary practises lives a little bit easier, but they do still apply.

So it is important that if you are providing repeat medications perhaps for animals that are on long term medicines, or you're providing more parasite control for animals, make sure that you follow whatever practise policies you have. So I think that brings us to the end of this session. Welcome back, everyone.

I hope you had a good break. So next up this morning, we've got colourful CPD's co-founder, Brian Faulkner. So Brian graduated from Edinburgh Vet School in 1995 and worked in mixed practise before studying for an MBA at Nottingham Business School in 2001.

He set up, developed and exited a cluster of veterinary practises in Suffolk between 2002 and 2009, during which time he also completed a master's in Applied Positive Psychology, as well as general practise certificates in business and professional studies and small animal medicine. He's also honorary associate Professor in veterinary Business at Nottingham University Vet School. So over to you, Brian.

Thank you very much, Sophie, and good morning everyone and thank you for joining us. On this and thank you, Steph for that going through the technicalities of the, the legal field with respect to what we do in nurse consulting. So, What I'm looking at here, in this session is the approach to the consultation with some of the, some of the phraseology and some of the practical aspects of consulting with.

Clients and it can be a bit daunting or intimidating whenever you go into the consultation room. I remember, as it happens, I'm graduated 25 years today. Today is my silver anniversary, I guess you call it if such a thing exists.

And I certainly remember that first day going into the room and just wondering, will I have anything to say. And I appreciate some of you, I know some of you, maybe all of you, I'm sure. Consulting to some degree, but it's where it's pushing it to the new boundaries of talking about things that you haven't talked about yet in relation to consults.

So let's have a little look at the various types of nurse consultation. This is my categorization of them. I call them perio-operatives, so peri meaning before, during and after.

We've got growth, maintenance and preventative healthcare consultations, and then we've got ones where you're involved in the therapeutics. Perio-operative, the pre-op, of course, the admit. And the admit tends to be the first consult that a lot of veterinary nurses, student veterinary nurses tend to do.

It's very common, of course, it's one that we do every single day. It's got a nice process, a beginning, a middle and an end with the consent form. So, then we've got the postop, you've got the immediate post-op, of course, discharging that patient, that tends to be another very early consultation that we do, and that gets us used to speaking to clients, asking, answering basic questions.

And then there's the post-op check, and that can be post-op for neutering and post-op even therapeutic. Steph used the example of when the vet was getting behind that maybe asking the nurse to look at the post-ops mastectomy. So, You know, more decision making and more observation required.

So they tend to be the basic initial consultations that we get involved in growth and prevention and maintenance. So I put these in terms of preventative health care, nurses can do second vaccinations. They can be delegated to by the veterinary surgeon, and in relation to the delegation, that all depends on what Seth was saying.

The next phase after 2nd vaccination, I refer to as the growth one phase. That's from the second vaccination phase, which is normally, you know, isn't it 10 to 12 weeks, depending on the vaccine type and the species, up to 6 months old, and then I call it growth to from 6 months to adulthood. In some animals that might be 3 months, perhaps in larger giant breeds that could be 6 months further, but that, second phase.

And again, I'm not going to go into all the detail of what we cover regarding those, but there's lots of little templates on our courses that you can use. Sometimes preventive healthcare, so pre-breeding advice, if we think about it, veterinary nurses should be the midwives in inverted commas of, of the veterinary practise. So we should be able to give clients all that advice about .

Timing of mating, pre-mating checks, you know, nutrition, all those things, welling parturition, just giving people the expert advice. Chemical vaccination can also be delegated, so that can be administered, nutritional advice, of course, and microchipping. Socialisation through puppy parties or socialisation classes depending on what you call them nowadays.

Maintenance ones are the clipping the claws, expressing the anal glands, even dematting consciously in some animals, ear cleaning. Therapeutics, the administration of pre-prescribed therapeutics, so for example, involved in giving a car friend course of pre-prescribed things. Immunotherapy is a common one that I have in my practise, or the, the second ceria application, for example.

Laser treatments, acupuncture, it can be done by veterinary nurses, hydro and physio, even, I appreciate a lot of those end up coming in as inpatients, but certainly some of the physio can even be done on an outpatient basis with the client present. And then involvement in chronic long-term medical cases. MMM stands for monitor, measure, and Medicate.

What we have to do with respect to monitoring the status of the patient so we can decide whether the vet can decide whether to change the prescription-only medicines. But certainly the veterinary nurses can be involved in doing a lot of those monitoring samples, be they laboratory samples or physical ones like blood pressure. Obesity, of course, behaviour.

So going on to another realm I always suggest having some sort of further education or qualification for behaviour. So there's the consultation types that we have just in a nutshell. They, they basically fall into two types of consultation for me.

They fall into the doing and the thinking. Of course, you're thinking as well, but some of them are just tasks doing what I know I'm, I've been told to do, shall we say, or delegated to do by someone else in the practise, usually vets, or the, the consultations where you're making the discretionary decision making. Before we go into that detail, I want to start by big picture.

Colourful CPD's philosophy is based on the pursuit of 4 outcomes by the 4 rules in practise. And these are the four outcomes that I believe every veterinary practise must pursue, and every individual must contribute to an individual role. So the big 4 roles are vets, nurses, reception, and management.

So clinical resolution, of course, that's the technical aspect of what we do. We're trying to prevent and resolve disease. And of course, you're involved massively in the resolution of disease with respect to the inpatient veterinary nursing component, which is the vast majority of what the veterinary nursing training course focuses on.

Whereas I think the outpatient context is so, so important as well. Client satisfaction is an emotion that occurs when a client perceives that what they've been told and sold by anyone in the practise, what they've been told, what they've been recommended, they perceive as the right thing and what they perceive they've been charged for it is a fair price. And those words right and fair are very subjective, and that's the challenge of working with people, is that what we think is double blind randomised placebo controlled, evidence-based right.

The clients can say things like, yeah, but my breeder said, or I read on Facebook. So the subjectivity of right, and it can be technically right as well as just what's physically or should we say practically right. Fair is very subjective.

Again, people compare prices, be comparing prices to the internet, or they compare prices on previous experience, or they just go, do you know what, I was in such a panic. I was delighted to pay for it. I just don't want the dog, to be in trouble.

Financial resolution Billing and banking, so billing up the work, and we very much encourage veterinary nurses to be charging for their consultations as much as possible and virtually every consultation can be charged for except I think the ones, the two toughest ones to charge for are the post-spay check. Very, very hard to because it's very fixed price and the post D scale if you see those patients back. But building it up and making sure according to the practises charging and pricing protocols and banking means getting it paid as opposed to physically putting the money in the bank.

And then doing it in a way that we don't stress out ourselves or stress out those that we work with. I'm sure we don't mean to do it deliberately, but for example, timekeeping or not communicating with folks or maybe explaining to receptionists about what follow-up is happening can cause uncertainty. My stress equation is stress equals uncertainty multiplied by urgency.

The more unsure we or anyone else feels, the more anxious we'll be, the more time pressure we or anyone else has, the more anxious or pressure or stress we will perceive. So we want to work harmoniously as teams, and we want to feel happy and satisfied for doing it. So they're the 4 outcomes that every person in practise must contribute to, and that's what they mean.

So here's the model of that. Don't worry about trying to take it in too much at this stage. We're gonna go through each step, one at a time during the session, but ultimately we need a model that says what are we trying to achieve?

And that so we need a good clinical outcomes or resolution. And very much do that, even checking that that wound is fine, for example, or getting that dog back to more ideal weight, that's a good clinical resolution outcome. Doing it in a way where the client goes, OK, yeah, right thing, fair price, getting paid for what we have, the advice we've given or the products we've sold, and doing it in a way that doesn't stress anyone else.

So it looks a bit of a complicated model, but let's break it down to the more simple one to start with. And this is the task-based consultation. And we'll look at each one of the, so what I mean by a task base is.

The client books up for something specific, nail clip would be quite a good example, or you're checking a post-op stay. So you go in, there's a task to do, and then we, we work through it, and then we'll look at the second half of the presentation. We'll look at the ones where you have to make decisions and you have to discuss with the client what they're going to do because there's options.

And that becomes more, more tricky. So the client phase, that movie Jerry Maguire, you had me at hello. I realised when Jerry Maguire came out, I think it was in the mid-nineties, that many of the people I speak to now, and I wonder why they don't have a clue what I'm talking about, weren't even born.

But you had me at hello. In other words, the client bonded with you. You had, there was a sense, you may not get a client at hello.

You can never guarantee you'll have a client at hello for many reasons, but you can certainly lose them at hello. And if you've ever done any interviewing, you'll know the sensation. Sometimes when you meet the person for the first time, go to shake their hand, you're almost sort of thinking, oh, it's not what I was expecting or hoping for, and your mind, it sounds really unfort, you know, horrible to do this, but our brains do this.

They make impressions and then we work out of the impression we have. So I refer to, let's not be one nil down before we get into the room. Because then clients are much more likely to say no to our proposals in 10 or 15 minutes' time.

So making sure, and we'll look at some of the things in a moment what that means. So the meet and the greet is really important. So in that consult room, we, we need to be prepared and be ready before we even open the door for the client.

So what does that mean? Is our room tidy and stocked? Have we got everything we need?

It may not be your job to do it, but you're going to be the person that's going to perhaps, suffer the consequences of things not being ready. So this is one of my former consultation rooms and the little board on the right. Right hand side, I call it my OCD board.

Everything is there and there's a little pencil mark around every one of those items, such that when it's not there, I know what's missing at a glance. And when I or anyone else is tidying up, it's got a place to be. Because this is so important that we're not running around trying to find the claw clippers or if we're looking for the flea comb, for example.

One of the best ways to diagnose fleas, diagnose an inverted commas, as Steph referred to earlier, is having a flea comb, doing that sort of going through the fur and trying to find the flea is one, you often don't find one and two, the client doesn't see it whenever you point. Out. Whereas if you've got fleas, dancing on a flea cone, it's over.

There's no dispute on your observations because fleas are the most commonly disputed diagnosis in veterinary practise, but they're one of the most common causes of disease and debilitation. So having this equipment to hand and everything there and our is so important. I'm just showing you the scales.

I appreciate, you may not be able to change your setup of your consultation room quickly, but having scales in the consult room has been invaluable, for those patients for whatever reasons. You really don't believe the weight that's been done, maybe there was a leg off and it just seems a bit of an odd weight, or it wasn't done on the the way in. The Burton's consulting table with the integrated scales are useful.

Are we personally clean, tidy, and identified? I think it's really important to have two forms of identification. One, our practise identification on one side of our tunic and our name on the other.

People connect and trust people they know their name to. So we would like to know the name of the client. You may want to go more formal, Mr.

Jones, Miss Smith to begin with. I personally prefer getting to first name terms as soon. It's appropriate because people connect better on first name terms.

But either way, we clean, tidy, making sure that we're not covered in hair, are we, basically li rollered ourselves to be clean and tidy, because you may have just walked out of doing an operation, clipping a rabbit, and you get all the fur connected. What's the purpose of the consultation? So, with the diary, guide your receptionist colleagues to make sure that the, the consultation is clear, that you know what you're going to see.

So one, you can have an anticipation of whether you feel comfortable with it, and two, you can anticipate common challenges with that consultation. So for example, clip and claws, even the most common challenge is restraint. That's the challenge you have.

So what's the reason? Ask your receptionist colleagues to make them as clear as possible and give them guidance as to what to say. Reading the history if it's relevant, knowing what you're going in.

So sometimes when we feel a bit on the back foot with the case, there's a temptation to go, oh well, I, I wasn't in last week, and clients hate that. Even though what you're saying to them is, oh, I'm sorry, and the reason why I'm looking a bit silly is because I wouldn't, couldn't possibly know. Whereas it's much better, of course, to have that little bit of a read and say, OK, so you were spayed last week, nothing unusual in that, no particular comments, or we know what the last weight was or we know what the pattern of weight has been is where we're on the ball, looking on the ball and even saying to the clients when they come in, OK, I had a little look at Scooby's record and I understand, blah, blah blah.

They go good, right? You know what you're doing. All right.

What breed, gender and age of patient are we going to greet in the waiting room? We know that clients do not like getting the gender wrong, just because we're expected to know better. And if we're not on time, how do we apologise?

Of course, we apologise. I'm not a big fan of saying thank you for your patience. I've had somebody in my career say, I haven't been Beijing, mate.

So let's not be presumptuous. I tend to say to them, OK, I'm sorry to have kept you waiting. I appreciate you're busy, but please come through.

Appreciating that people's times as important as our own usually does the trick. And of course, we are getting behind again and again, we have to think about how to address that. And then we greet the client.

I tend to call the client and the patient through Scooby Lewis, please. So the first name or the name of the pet and the name in which it's registered, because Mr. Lewis, he may be Mr.

Lewis or actually his partner may be Miss Lewis, and he's Mr. Smith. Whereas I'm sure we've all, I've certainly had it in 25 years where you go, Mr.

Lewis, please. And he looks at me and you go, Scooby Lewis? All right, it's under her name, is it?

And then you get this sort of, oh, OK. And it just makes it look a little bit clunky. So Scooby Lewis normally is a way to get around.

All right. So that's how I tend to greet them. If I haven't seen a client before, I'll very clearly introduce myself at hello.

I personally shake hands. Some people, do that, some don't. Of course, I'm not doing with COVID at the moment, but I tend to, greet and say, I don't think we've seen before.

Every now and again, of course, the client will say, oh yeah, I saw you last week. OK. So how do we look, and I appreciate this is a picture of a receptionist, but I'm making the point of having a logo of the practise on one side of the tunic and having the name on the other.

But what sort of things can we do to build the report to make the connections with other people? Veterinary is a people business. Now of course it involves animals, and that's often what attracts us to it.

But any business or the organisational part is people oriented, and consulting is a people task. We must want to help people equally as much as we want to help animals, and we're helping animals through helping people. But the buzz of helping people, and we understand the personalities, the moods, the autonomy that human beings have can make them very unpredictable and difficult, with respect to always just going the way we want.

But that's just part of the, the, the process. So what sort of things can we consider about when trying to Get someone at hello, smiling gently. So the picture shows what I would call a 2 or 3 out of 10 smile.

It's quite a gentle smile. It's not a big Indian grin that actually looks, you know, manufactured or, or inappropriate if a client comes in with tears in their eyes and all of a sudden you go, oh, hang on. So using open body language, so not looking defensive if we're nervous, either because we're nervous about what we're doing, or perhaps we know this clients in a bit of a mood or angry at having been kept waiting.

So hands are open and reaching towards people offering to help them carry buggies, babies, pets, whatever it might be. When speaking to people, try and maintain an eye contact for 60% of the time. Now I don't expect you to put a stopwatch on it, but the point is a little bit more than half as you're doing tasks, check in with people if you're doing the the claws and you're working, you get, and then you can check in, check in with them.

So, but about 60% of the time. Nod and gesture as people are talking to you. So the best way of empathising, so people getting that you get, how they feel is nodding and gesturing.

OK, OK, OK, I see. OK, I see. Far better than I can understand how upsetting that is for you, which sounds robotic and weird.

So nodding it better. You can even hear it on the phone, of course, when we're speaking to clients, that inflexion change comes across. Asking open questions at least to start with, open questions, I'm sure you're aware of those that don't have a yes or a no answer.

They're much more exploratory. They're the how, who, what, why, where and hows. So, how can I help you today?

Or maybe even a better question is, so I understand with, we're checking Scooby, Scooby was spayed last week and we're checking Scooby's wound to see and how are we getting on. So a nice open question. I like that word we, by the way, how are we getting on?

It means that I decrease the probabilities that I get the gender incorrect. And also it's collaborative. So how are we getting on is a wonderful, that's my phrase that I open every recheck consultation with.

Use the other person's name in the way that it's appropriate. If you're in first name terms with someone, use the first name, but use their name, at least tore with them. It builds a bond and it builds trust and also encouraging them to use your name.

If you say hello, I'm Brian. You're effectively giving them permission to use my name as Brian. If I say hello, I'm Brian Faulkner, some clients will go, oh, do I call you Mr.

Faulkner or do I call you Brian? So I make it very clear that it's comfortable to call me Brian by just saying, hi, I'm Brian. Refer to the other person's point of view, especially when there's disagreement or difference of opinion, I would often say, yeah, you know what you said about such and such, I absolutely agree with that.

It's a wonderful way of finding common ground. And be genuine. We're not trying to, you know, it's not a date.

We're not trying to impress anybody with, you know, fake behaviour, it's just being yourself and acknowledging, you know, offering compliments. I offer compliments to the pet all the time and congratulate them in not too sacr ways for being good, for tolerating an uncomfortable procedure or even complimenting the, the client by, you know, appreciating being on time. If somebody says something that you don't agree with, I tend to send a doubt signal as opposed to a blunt contradiction, you know, whatever it might be.

You got to feed the raw diet because wolves eat it and they're the strongest form of dog there is. I don't know how you feel about raw diets, but I'm just using it as an example, and I might go, well, OK, we'll, we'll have a look at that, or whatever it might be. I find that's, better than saying rubbish.

OK, I'll kind of go, oh, OK. And when a professional sends a doubt signal to someone, you know, who knows they're not as qualified as you, they're much more accepting of it rather than kind of being shot down. And if you don't know the answer to something or you're not sure, just say, OK, not sure about that.

I certainly don't want to get it wrong for you. Let me check. So basically little greasing the wheels of things that we can do.

Let's look at some of the opposite. I mean, some of them are the direct opposite, appearing stressed. I know some people who, and I've probably even done it myself, you appear stressed almost as a way of trying to provoke sympathy and, and also a little bit of give me some slack.

You didn't see that I could screamed that an hour ago by some client that was very unfair. And sometimes that sort of sense of appearing stress is a way, but of course the client, it just makes them feel uncomfortable. So taking that big deep breath and getting comfortable, be careful of the fake smile without thinking we're just gonna put it on our face.

They call it in the airline industry, they call it the Pan Am smile because of the airline idea that it's this fake report. And speaking in a sickly sweet voice, when I observe, I've observed thousands of vets consulting, and some of them, you know, speak normally before you go into the consult, and then they go into the consult and all of a sudden they turn into Mickey Mouse. And the problem, I call it the Disney vet.

When we start speaking like this, clients can also assume that our advice is a bit Mickey Mouse as well. It's always a symptom of nervousness and a lack of confidence. So therefore, that's just be careful, of that voice.

It comes across as a bit sing on me. We've already talked about getting ourselves the room tidy and cleared up. Be careful of getting the client's name wrong, and what I mean is, for example, calling him Mr.

Lewis when actually he's Mr. Smith because of the registration. Getting the pet's gender wrong, we've referred to.

Be wary of turning your back on clients, especially if your consult room is set up badly, to be honest, with the, the computer is at the back wall, and you have to turn your back. I hate consult rooms where the computer is, makes an automatic barrier. The, the computer should be at 90 degrees to where you are, so you can look at the computer screen if you have to, and then look at the client, OK.

Be careful of cutting the person off the sentence. We know clients can go on. So if you do feel you have to interrupt them, the way to do it is by agreeing, and say, just to, sorry, sorry to interrupt you there, but you know what you said about such and such, I really agree with that.

So you're kind of cutting them off but doing it in a way that makes them feel appreciated. Be careful of dismissing their ideas, and I've already talked about insufficient eye contact. So there's some of the things that help make that impression, and they're so important because if we make a good first impression early and we get off on the right foot, clients are much more likely to say yes to what we want.

So then we move on to the history. Now, the history can be involved or it can be just how we're getting on. We don't need to take massive detailed history.

We don't have to ever ask interrogation questions, because of course that's more appropriate to the vet context, but you will want to ask whether the patient is doing what we expected. So what's the objective of taking a history? It's to identify problems.

That's why we're doing it. We're doing an audit to say, is there anything this client tells me that kind of goes, OK, that's odd. And a problem is defined in any sphere of life.

It's defined as a deviation from a desired or an expected state. It's not what I want. It's not what I expected.

So therefore, it registers as a problem. What causes it, of course, is a whole other things. And as Steph said, you can identify clinical symptoms from the history, but you can't pronounce the diagnosis or prescribe a medicine or prescribe an active surgery.

Perhaps one of the ones we come closest to the wind on that is the dental check, dental surgery. Perhaps when you recommend getting an animal in with extractions, you're getting, you're effectively prescribing surgery there. So we have to be careful on that where, where, how we do that.

I'm not saying that you're not capable of knowing when a cat's got obvious neck lesions or resorbive lesions that they're gonna have to come out, but it's how we just manage the intricacies of that. So, What we can, and if clients ask you, what do you think is causing that is, again, be very careful, you'll know this, you don't need me to tell you this, but you can make a suggestion and the client will walk out the door and say, yeah, the nurse thinks she's got diabetes. You got one say that.

I made a suggestion that it could be, and that's where Steph said that word, use of the word could be comes across as that's what you think it is. The, the phraseology is so important. If you are going to give suspects, say, well, statistically, the most common causes of this are 12, and 3.

Never give one because they'll. Assume 1 equals, that's what it is. So the most common causes are 12, and 3.

Now, it's not possible to say, with the information we have, and I can't diagnose it as a veterinary nurse either, but statistically, these are the sorts of things that the vets, I suspect will, will mention, when, when you see them, which is kind of code for it, you will. So, when we're speaking with clients, we should always have this idea of what would I do with this patient if the client lets me. If I've got a patient coming in for its post vaccination check or it's growth check, what do I want to do with it?

Want to get it while it's already vaccinated hopefully external parasite control, internal parasite control. We're going to be talking about neutering if it's not already microchipped, it will be as if it's a dog, cat, maybe not. Is it on our healthcare plan?

Is it insured? You know, these sort of things, that's what I want them to do. But clients, of course, don't always comply.

So we listen when we're clients are speaking, especially during that early history phase, and I refer to icebergs, and the proverbial iceberg is they say one thing, but it reflects a lot of what they're thinking below the surface. But remember, you went to that nurse school, you didn't go to mind reading school. So you don't know what people mean with a lot of these ambiguities, but I'm going to use, suggest you the use of the word, the acronym icebergs.

I love my acronyms, is icebergs as a way of remembering some of the information they give us. So I stands for ideas and hypotheses that the client brings as their explanation, and they feel compelled to tell us. So the raw diet, for example, is best because wolves eat it.

That's the theory, that's what they think. Or for us and vets, most dogs are vomiting because they've been poisoned or whatever kennel cough symptoms classically come in as suspicion that something stuck in the throat. So they have their hypothesis.

They often mention it early, so be very careful to dismiss it. This is where the doubt signal's useful and you go, oh, we'll have a look. OK, we'll have a look.

It's a gentle way of saying we shall never talk of this again. Concerns. I'm worried about how much this is going to cost, very common.

Be very aware what the client did not say was, I want the cheapest possible. They said, I'm terrified I'm going to be shocked by a big bill. That's really what this is called for.

So sometimes we do, and I've even seen this in notes where it said, I'm worried how much it's going to cost, and the vet or the nurse even has written money concerns. I've seen a lot of clients who say, let's go on and spending 1000 pounds. So when the client says this to me and I say, oh yeah, of course, don't worry.

I'll give you all the options or I'll tell you all the prices and see what appeals you, see what suits you. Never say what your budget is to judgmental clients don't have budgets really for pets and see what you can afford, way too judgmental. Say, see what suits you.

I'll give you the options. I'll give you the prices and you can see what suits you. So for example, pre-anesthetic bloods, fluids under anaesthetic may be relevant in your context.

Expectations the clients might say, OK, well I'll I'll pick him up around noon. And you're kind of thinking, he ain't gonna be done by noon. I don't know why you're picking him up around 12.

And they say, OK, well, actually, you know, just gently redirecting on that beliefs. So I recommend a pre-anesthetic blood sample, for example. Yeah, he had a blood sample about 3 years ago and it was all fine, or he had a blood sample last year and it was perfectly fine.

And you kind of, you kind of go, OK. So the way I use this now and I do do this, I say, you know the way they say 1 year in human is equivalent to 7 years in dog. I I kind of, or sorry, 1 year in dog is equivalent to 7 years in human, as I say, it's a bit like that, to be honest, even having a blood sample last year is equivalent to us having a blood sample about 6 or 7 years ago.

So I know it's not very much time for us, but it's a lot of time for the dog's body to change. And they kind of go, OK, that makes sense. So it's a kind of gentle way of making them rethink, reframe it.

The evidence base they use, the breeder said this, the breeder said that. And sometimes it could be that we totally agree with what they're saying, but they don't tend to read the journals that we have access to, so they use the evidence bases that they have access to. Sometimes we don't agree with it.

The risks, oh, I'm worried it won't survive the anaesthetic. I'm gonna jump beyond that one because we're gonna look at it specifically, later. Goals, they can be ambiguous.

I don't want them to suffer. And that can be code for. Do you know what, I really don't want to put him through all this operation.

I haven't had the courage to say to the vet, and you can pick up on the vibe and kind of go, do you know what, this client, I'm not convinced this client. Ready yet for this procedure or is totally on board with this, but rather than you're admitting, hammering on with it, getting it done, and maybe something happened, the client goes, you know what, I just never felt comfortable with this. So you can be the vibe back to the vet and saying, you know what, I'm not sure, Mrs.

Smith's just totally comfortable with this. I don't know if you want to have a word. And you know what the vet will do?

Too busy to call her. But it's better having that one call. Strategies.

The last time we did this, it worked, so why not just do that? Because they think, well, for example, all situations are the same. So it's a really useful little acronym just to listen to the things and it helps you get inside of that proverbial iceberg that helps you understand and be able to redirect things without saying that's wrong.

So then we move on to the examination phase. What's the point of the exam? The exact same as a history to identify problems with form and function.

In other words, a problem, something that's not normal or desired. Can you detect symptoms? Yes, you can.

Can you say the exact reason why they're there? No, you can't. But you can at least say the most common causes are da da da ta da.

The vet will have a look. So you can detect nothing wrong with that. When you're doing your exam, remember as veterinary nurses that you're the most qualified and capable people in the world at restraining dogs, cats, and rabbits, and any other species you work with.

The problem is, the rest of the world isn't as good at you as, as you, and you kind of forget. So, direct them gently, direct clients. I'm always directing clients, OK.

So here's me and Bear, me wearing a very dodgy polo neck several years ago. So here's my dog Bear, and I, the point I'm making is a lot of clients when they put their pets on the table, especially dogs, they don't take the lead off. They hold it.

So I disconnect the lead from the collar. And almost automatically, they set it on the table, and that second hand that's doing nothing comes into play and they hold the pet better. Sometimes they hold the lead in midair and I count and wonder how long it's going to take for them to set it down.

The worst ones, of course, are those extended leads, those big heavy sort of clunky extended leads. They hold them down by their side, and, if you want to be really naughty, you don't clip it and it slings back and nearly takes the fingers off. I'm not encouraging you to do that.

But take the lead off and then the client will more naturally hold them. Direct them, depending on the size of the dog and the state, as I say, OK, pop one, give him a nice hug around his neck, and, pop your hands underneath his belly and hold them up. So to hold them, because if you're gonna do that dog's anal glands, your hands are going to be both occupied, one's holding that tail up and the second one you're doing the anal glands.

You just cannot restrain that dog. So you want the client to do it, and of course they don't want them whipping round or them letting go. So a good hug, make your decisions as to whether you think you need a colleague to help you do that.

But if restraint is so, so important for bigger dogs that don't come onto the floor, I go, grab a seat, elbows on your knees, one hand either side of the collar, please. So having them sitting, most people can't stand to bend over an animal for 30, 40 seconds without letting it go. So sitting down, they're much more secure.

One hand either side of the collar, elbows on your knees, and they can hold their dog forward. So when you're doing the claws or the anal glands, you've got, you know, much more security. One hand either side of the collar implies it's wearing a collar, you will get plenty of dogs like staffies in particular in common, where they wear their chains and it's like trying to hold them.

A little pig, it's impossible. There's nothing to hold on to, and of course, staffies being staffies. So sometimes you don't need a muzzle, you just want a collar.

So I will often have a series of large, medium, and small collars in my muzzle drawer to be able to put onto the path. I make them particularly bright to remind myself to take them off so they, they don't walk out of the surgery with them. If you do have muzzles, I hate miki muzzles with a passion.

That dog probably still bite you if it wants to, and if it's so tight that that dog, can't bite you, it's gonna get stressed because of course, dogs when they get frightened, get stressed and therefore I worry they're going to keel over. I hate them. So basket muzzles with the quick release straps better every time, just hit the muscles.

So we've done the history and exam. We're now moving on to the task. What are we actually going to do in this console?

What sort of tasks are there? There's treat, there's sample, and there's advice, treatments, what sort of things are you going to be possibly doing? You might be administering a cap, a worming tablet or any sort of tablet.

An injection, of course, inserting a microchip, changing a dressing, clipping claws, anal glands and ears, you may be doing laser and acupuncture, technical things, you know, I'm not going to go through them with you, you know how to do them, but just a treatment consult and asking the question, what's relevant or appropriate to charge for. Samping, you may be taking a blood sample. So blood sample, because the cardiovascular is a body cavity, we have a Schedule 3 alert here.

So therefore, how do we manage taking that blood sample under the direction of a veterinary surgeon? It may, so what I'm really talking about here is a sample that's been booked directly in with you in the consult. Well, when might that happen?

Progesterone for premating. So I think it's appropriate if qualified veterinary nurse working in my practise, and it's a client that I know, I know just like you. I know the client's a reasonable client.

I might look at it and go, OK, John, you're seeing Scooby Smith for progesterone at 11 o'clock. That's fine. Just do the usual checks, but yeah, I delegate that to you.

OK, so for me, that's fine. So that, the receptionists know they can book that directly in with you as opposed to having to do this, see the vet, get charged to consult, take it to you at the back and do the blood sample. There's no reason why this can't be done on an outpatient basis.

Ear swabs, you may be involved in taking an ear swab for whatever reason. It wasn't taken on the primary consult with the vet, urine sample, maybe collecting or even expressing, fine needle aspirates you can take and, you know, so some of these samples you may be involved with less so, I mean less so. Advice.

You'll be giving advice and admits and discharge and post-ops in terms of instructions if you like, as much as perhaps, making recommendations. You'll certainly be giving advice and recommendations during the growth and maintenance phase regarding preventative healthcare, and you may or may not be involved in long-term medics. I have never really seen senior clinics work consistently well in a practise where clients request them.

So I think the massive opportunity for veterinary nurses to get involved is the long-term medic, but it's the one the vet seems to resist giving to the nurses the most because of the whole POMB problem. And I'm not saying you prescribe POMVs, but I'm saying you can be involved in taking a lot of those diagnostic monitoring tests. You're better at taking them than I am.

OK. So we've done our task, and whatever it may be, and then we go to finish and follow up. How do we close this and increase the probabilities that the follow-up is going to be as expected?

Are we charging for something? Are we expected to charge? What do we charge?

How do we direct them towards payment is an outcome we'll look at in a moment, and getting the second appointment or the follow-up appointment booked before they leave the building very much increases the chances of two things that the client comes back and secondly, that they get to see the right person for case continuity. I call the space between the consultation room door and the reception desk, the Bermuda Triangle. Things disappear without trace.

You know, clients, if they don't get escorted back to reception, they just walk out the door or they say things to reception that actually, you just go, that's not what I wanted, that's not what I said, for whatever reasons. Let's look at the probabilities that a client makes their appointment regarding how we try and facilitate it before they leave the building. If you ask the client to go out to the desk and book an appointment now, only 25% actually book it before they leave the building.

They may go to the desk and reception may say, Do you need any appointments? And they say, oh, I haven't got my diary. It may be true, not sure, whatever, but only 1 in 4 book, and we know that if they don't book, it decreases the chances that they continue or comply.

You may send an electronic note or in the clinical record to reception. Please book a follow-up with me in 2 weeks' time. Only 50% doing that actually converts into an appointment on the diary with the right person.

Advising receptionists verbally, go out and actually say, you know, Mavis, please can we book us a Scooby in to see me for the follow-up we check in 2 weeks' time. 80% then will book and the vast majority will achieve the booking if you do it in the consult room. And if you have your little appointment cards in the room, but actually saying, OK, let's have a look, 2 weeks' time, I'm here on such and such, and it increases the continuity.

OK. So just, you look at the difference there. Asking a client to do it versus you doing it in the consult room with those two options in between is 4 times almost 4 times more likely to retain and then we wonder why clients, the compliance doesn't work.

So we take control of it, not controlling, but control of the process. So that's our simple four-step console, the meet and greet take a history and the exam. We do whatever it is we have to do, and then we finish and follow it up.

They're not all as simple as that, but they're the ones that you start with. There are two stages that I showed earlier that these are the decision-making ones, and I call them the consultation crossroads because you may have, I could, you could do A, you could do B. And I'm going to give an example.

You could do no pre-anesthetic bloods that this admit. Which the alert sign is there for, he's 12 years old, really would prefer if we did pre-anesthetic blood on a 12 year old animal or yep, the client says yes to the pre-anesthetic blood. But the client has now got a choice, and it's a crossroads.

And how do we increase the probabilities that they do it without coming across as pushy or manipulative. So, phraseology, I refer to preferred approach. Our preferred approach would be to take a blood sample.

Now even that potentially sounds too weak for a 12 year old dog. I'm going to show you specifically how I do pre-anesthetic bloods in a moment. But whatever you make a recommendation of or a suggestion of, you're going to get 4 reactions.

You're, you're basically, you're gonna have to, sorry, let me just, go back on the slide is to get yes, we need consensus, to get consent. We get a a form called a consent form. To get that signed meaningfully, we need to have consensus.

I, we both agree this is a reasonable way to go forward. So when we ask clients things, make a proposals, you're going to get 4 reactions. You're going to get the, yep, fine.

And if a client says yes. Avoid this wee tactic or habit perhaps that we all do sometimes of explaining it all over again, because we're so amazed. They said yes.

We go, OK, fine, great. Said yes to the bloods. It's like when you were a kid and your mom said yes to something you want to and, ah, you said yes, it's the law, you have to do it now.

OK. So when clients say yes, you just, OK, great, move on. Some of them will kind of go, not sure about that, or they'll ask the question, is it necessary?

Is it necessary? Pre-anesthetic blood classic. Is it necessary?

And you kind of go, well, I'll tell you when I see the blood results, whether it's necessary or not. You don't say that, of course, but that's really the logic of it, and I'm going to show you in a moment. You'll get the blank response.

You ask a question, they look at you. Nothing. The temptation here is we keep talking and talking and talking, hoping to get a glimmer of an emotional response.

And you end up 10 minutes later with blank again. So what I tend to say to them, Tell me what you think. Tell me what you're thinking.

Don't say, do you understand, you sickle, because that's what they'll hear, and they'll be offended. Just tell me what you're thinking. Tell me what you're thinking.

And people would say all sorts of things. I was proposing a dental to somebody a while back and they went, oh yes, sorry, Brian, I'm trying to work out where I am and my shifts, whether I can do it on Monday or Friday of next week. They had booked the dental in in their head.

I thought they were resisting dental. So I sort of said, tell you one thing. You went to veterinary school, you didn't go to mind reading school.

So don't pretend that you can go. Or the, what would you do if it was yours? Now, Many vets and veterinary nurses, when they hear this, they go, oh, responsibility alert.

I can't possibly make a decision because actually I'm going to be held accountable. First of all, if they ask you what you do if you're such a wonderful sign of trust. If they say, what will you do, it means they care about your opinion enough to ask it.

So first of all, you're in the good books. How do you answer it depends on you. I tend to use the, what would I do if this was my mom's joke?

That's always my acid test. I wouldn't do anything. You know, hopefully anything inappropriate to my mom's dog.

So therefore, why would I do it to yours? I'm gonna ask that question, what would I do if that was my mom asking the question? I'd say, yeah, I take the blood, I'd do the pre-anesthetic blood.

I put it on fluids. So let's look at the most common is it necessary with regard to anaesthetic risk, and they say, is it necessary? Now this is how I describe pre-anesthetic blood samples, and I've got a very, very high, success rate in getting them.

First of all, I take the, the, the default response or position is that any dog or cat over, 8 years old, dog or cat over 8 years old is having a pre-anesthetic blood. The client's going to have to talk me out of it as opposed to me talk them into it. The default is I do not want to anaesthetize that pet without knowing what's going on at a sub-clinical level, OK?

But, so that's the first default. I go in with I want, this is what I'd like to do. But of course, the client has to comply because they have to pay for it.

So when they say, well, is it necessary? I'll say, OK, let me talk to you about anaesthetic risk. I don't say, let me talk to you about pre-anesthetic bloods.

I go back a bit. Let me talk to you about anaesthetic risk. This is the amount of information we have right now.

This is the amount of information we need, so I put my hands out and I go, this is what we have right now. This is what we need to guarantee that your dog or cat will survive the anaesthetic. Unfortunately, I can never guarantee it, but hypothetically, this is the information we need.

So I would rather work on the risk gap that's this than that. So there's 6 things I say there's 6 things we do to decrease and mitigate the risk of an anaesthetic with your pet. The number one is we take a history.

Is there anything you've said to me that rings alarm bells? Yes, he has a fit, a fit every day. It might be a worry.

OK. He had a big belly full of food this morning because my husband fed him. OK.

It's always the husband, isn't it? So the, take the history, is there anything that worries me? Then we take an exam, temperature, heart rate, TPR all that basic stuff.

Is there anything that sort of says this is a bit of an alarm bell. Now this is as far as our physical senses can go. We're out now.

We're done. We don't have microscopic fingers or phenomenal, you know, diagnostic imagery eyes, so we're right. That's as far as our physical senses could go.

So the first thing we want to do to explore under the bonnet, if you like, is a pre-anesthetic blood sample. So we reduce the gap a bit more. We're going to put that patient on perioperative fluids.

By the way, in my surgery, we don't give clients a choice on perioperative fluids. We incorporate it into the price of the anaesthetic. We don't have conversations with them and and that admits it's totally irrelevant.

It's our decision. We just put them on. Don't worry.

Incorporate into the price, not even a question. We choose our anaesthetic agent, with our pre-med or induction and our maintenance, and that of course makes a difference. And we're going to monitor the patients who you course of veterinary nurses you monitor, so the expertise skill in doing that, plus as well, we've got, you know, our capitalgraphs, clients like machines that go beep.

We've got a machine that goes beep, it costs us 300. I even say that we've got a really impressive machine that goes beep, it costs us 300, really impressive that must be very good. And we've decreased our risk gap now to this.

We can never guarantee. There's always things beyond our observation and control and knowledge, so we can't, we know this, you know this. But I would much rather walk into this level of risk than than having a total blind risk.

And the phrase I say to clients is, if we do these 6 things, if I'm feeling particularly manipulative, I mean even say if we're allowed to do these 6 things, but if we do these 6 things, our anaesthetic success rate here is 99.9% in dogs and cats. And I say that because that's true.

In fact, it's not 99.9%, it's 99.99%.

1 in 10,000 dogs, or one in 1000 dogs, 10,000 dogs think they published that 1 in 5000 cats. I, I don't say 99.99 because it sounds too good.

Actually 99.9 is perfectly fine. We know in rabbits, it's not the same.

I say to clients, as rabbits, as a prey species, unfortunately, they're more vulnerable to things that we can't control, and our anaesthetic success rate in rabbits is 98%. And when I'm talking about rabbits, including the 6 month old castrate admit, it's perfectly healthy, I'll say 99 sounds very, very high, doesn't it? But actually, compared to dogs and cats, you know, who are 99.99, I just want to tell you that.

And I say that at the 6 month admit. I say, our anaesthetic success rate in rabbits is 98%, which means unfortunately, 2 out of 100 don't make it. And the reason why that is, unfortunately, they are a prey species and there's variables we can't control.

But of course, we do our best, to minimise the stress and the risk for that. So I find that really successful, that little, closing the risk gap tactic to help them go for pre-anesthetic bloods and incorporated into a wider technical assessment and mitigation. So when I'm talking about options, I'm always, promoting their value in terms of their effectiveness, more or less effective.

Avoid judgmental language like it's right or it's wrong, because it makes people feel guilty, even though we kind of go, well, that's not the right, even technically right, morally right, you know, I kind of go, let, let me talk to you what works. Let me talk to you what it takes away the emotion and the judgement. I never use the phrase the gold standard approach.

We know what it means. We know it means evidence-based, double blind randomised placebo controlled evidence. We know that.

Clients hear the word gold, and they, kind of go, OK, I, I just can't afford gold, and thanks. I now feel guilty for not affording gold. And if it dies, it's my fault, or thank you for making me feel cheap.

Or if they can't afford gold because it's insured, they go, OK, gold, great. OK, perfection then we're gonna have perfect, perfect service as well. They mistranslate, they take that word gold in what we mean evidence base and they kind of go, oh, I'm going to have petals thrown in my path and it's going to be phenomenal service.

And you go, I just meant stuff works. So I avoid it and I use the phraseology preferred approach, our preferred approach, OK? So, I find that works much, much better.

So here we have it. That's our little model, that's the full expanded version. Some of the consult you'll do is have a crossroads and whereby you have to create a consensus and agreement with the client.

And I'm going to emphasise again, your ability to get to yes with a client starts at hello. If we get off on the right foot and we kind of keep clients the way we want and empathise with them, they're much more likely to say yes. And you know this yourself.

If you're being served by somebody and you don't quite like their approach, you know that your moment to say no is coming in the next 10 or 15 minutes and you're going to take it because they annoyed you at all. So we looked at the four outcomes, which in other words, the process of the consult, we looked at the model, we talked about some of the principles of each stage, and we hope, I hope that's useful for you. So thanks for joining.

We don't have very much time, before tea, but because we have a break, we have a bit of a buffer. If you want to ask any Questions, I'm certainly very pleased to take them. So, Sophie, any questions coming through?

We haven't yet, but, I'll give everyone a little chance just in case I've been a bit shy. But yeah, feel free to pop them in the Q&A box if you do have any for Brian. OK, no problem, .

Yeah, so, our breaks now, Sophie, isn't it? Until, what time we go back. Sophie's gonna put a little slide up for you.

You're maybe aware that we do a non-clinical certificate in veterinary nurse consulting, RBN consulting, and that information will be on for you. And, this is just to give you this. Specific skills of what we talked about as well as, that you get the postnominals, you get cert NCS RVN cons for having completed it.

And, should I say to myself, there's a lot of really good information on that, in, in that and useful and people are very much enjoying, working through it. So, I'm gonna connect with you again. Later on for the panel questions.

I hope you have a good day in between this and that. I'm sure you will with all our speakers, and unless there's any questions at this stage, I guess we have a break, Sophie. Yeah, no questions, but yeah, Brian will be back at the end of the day, so you can always save them up for them, if you do have any.

And then we'll go for a break now and be back at 11:50 a.m. OK, well thank you very much.

See you later. Welcome back, everyone. I hope you've had a sufficient break and managed to grab a coffee or a tea or anything.

So I'm excited to introduce you to our next speaker of the day, Claire Hemmings from Royal Cannon. Claire qualified as a vet nurse in 1995 and worked at a multi-discipline referral centre. Although no longer on the register, she keeps up to date with the latest developments and pass the certificate in clinical nutrition with distinction.

She has also been running first aid courses for dog owners and pet professionals for over 12 years. In 2003, Claire won Pett Health counsellor of the Year for her work with arthritic patients and joined Royal Canon in 2004, where she now works full-time in the scientific communications department. She has had articles published in Vet Times, Vet Nurse Times, Your Dog, Dogs Today, and other veterinary and pet publications.

Claire has two children and a naughty little dog called Chess. And love skiing and reading with her book club. So I'll hand over to you, Claire, for your session.

Thanks, Sophie. OK, so I'm gonna, not go through any specific clinics today because, I will this afternoon, but this morning, I just wanted to see how we can adapt just the broadly the, the, the, the things that you've learned from Steph and Brian so far, how you can adapt those for this world that we're living in at the moment. And you'll probably agree we've all been through quite a steep learning curve recently.

So you'd be glad to know that the UK is already leading the way in terms of veterinary consultations that are being done remotely. So this study, it was a, was a global survey that was done in April, and it was as a response to the COVID crisis we find ourselves in. And, I mean, the results here of the, the, the, the way that UK, vets have embraced telemedicine is astonishing compared to the rest of the world.

So I would say I've spent a lot of time working with nurses, On clinic training, and I've also attended international events where we've been training nurses globally, and I would say that hands down, the UK has the best that nurse clinics around the whole world, you know, and they really are world beating. So I don't see why virtual nurse clinics can't. Become the norm, actually, and we can embrace them beyond COVID.

So we just thought, really, the best thing to do was to put you, you know, put together a handy sort of guide of maybe little hints and tips, ways that you can adapt what you're doing and think about what you're doing beforehand to make them as successful as possible, because I don't think that virtual clinics are going to go away, even if this virus, ends up going away. So there's a few things to, to think about. First of all, not everyone has got, technology on their side.

Not everyone understands technology, but we're in the best position that we've ever been. In terms of getting people to embrace it. I've lost count of the number of people who have been having family quizzes every week and they've been having get-togethers and they've taught their 80s, you know, 80 year old granny to, to use Zoom, you know, really, the world has been dragged kicking and screaming into the need for technology.

And I think it's, that's gone well. So we should really, like hone in on this, this new ability. I've taught my mom, who's 76, to use FaceTime, which I'm sometimes regretting because she really, really enjoys, FaceTiming me constantly.

But, you know, you can, you can teach your dogs new tricks is what I'm saying, I suppose. And I think there's lots of benefits to being able to do things virtually that were real issues for us before. So there's a few things before you get started.

And this is regardless of whether you've already been doing them as a stopgap. I would say, really think about it if you want to take them forward into the future, to decide on your protocol. I have to mention pricing.

I'm an advocate for, for pricing properly, but you have to decide whether or not that you want to do that. And if you are Going to do that, you must get agreement on costs and also on how you're going to take payment, because, of course, in the virtual world, that client isn't there in front of you. And so how, how are you going to make sure that you're going to be paid for your services?

And I suspect that's something that all practises are working out, you know, how to get these things done at the moment. Consider your format, consider the content that you're going to provide and, and really to, to help you work in this different way. It's very difficult when you're speaking to a group of people, whether it's a, a, a group for, for, for a client evening, for example, or whether it's 1 to 1 where you perhaps wouldn't get the normal, the normal body language cues that you might, that you might get in a, in a face to face consultation.

And so perhaps have some guidelines to follow to, to, to, to know what you're going to be doing and how you're going to do it. You also need to think about who's going to do them. And this really is exactly the same as with physical face to face consultations.

If, if somebody in my opinion, anyway, if somebody doesn't want to do nurse consultations, they absolutely should not be forced to do that because they don't get a good experience of their working day. And their clients don't get a good experience and, and ultimately, the patients don't get a good experience. So it's only people who feel that they want to be running clinics that should, should do that.

And you might find that people who wanted to run physical clinics don't want to run physical clinics, or don't want to run virtual clinics and that people that were a bit nervous about doing the face to face clinics feel a little bit more comfortable with technology. So don't assume it's just because it's the people that have always done them, they will carry on doing them. Think about how you're going to, which ones you're going to do and which ones you might not be able to do.

Now, this limitations have been mentioned both by, by Steph and by Brian. There's certain things you can't do and you can never replace a full, clinical examination. By virtually, of course, you can't.

But there are things that you can do to help people, even though you can't do anything hands on and I'll, I'll, I'll I'll come across that as we go forward. But a really good example of this is, of course, you can't clip claws, but what you can do is make a little video of, of you clipping, you know, somebody else's dog's claws, your, your colleague's dog's claws to show where the quick is, to show the best practise of doing it, to show which clippers are the ideal ones. And you could be really, really useful in that way and just lots, you know, lots of little half a minute videos of, of information to post on to your social media pages.

And I, I think that would be a really useful way of helping your clients when there's something that they can't do now. And don't forget one of the limitations for, for clinics in the past has been lack of room and waiting for the vet to clear the room, waiting for the, the right time of day. Now, actually, the world's your oyster because so long as you've got somewhere to go, it doesn't have to be a consulting room anymore.

I think it's opened up a whole, world of, of, choice for you. So when you've decided what you're going to do and who you're gonna, you know, who's going to come, how you're going to run them, who's going to run them, make sure you include everyone. Obviously, the vets have to be part of this clinic protocol, because you can't just make, you know, business decision changes without any sort of consultation with the people that, that you're working alongside and, and also the people that pay your wages.

But also include reception staff. And I would say this is something that really gets overlooked quite often that, you know, this, this, the nurses have a great idea to run these clinics. The vets are on board with it, everyone's fine and the reception staff haven't got a clue who does what.

So when to offer it, when not to offer it. So you need to set that out very clearly, which person's in charge of which clinic, which person, you know, what's the, what are the timings, when could they offer a virtual consultation with the, with the nurse rather than get them to, to, to see the vet and, and, and, and let them feel clear and included in this, and then you'll get much more, much more uptake actually. So once you've decided what you're going to do, you need to advertise it widely.

So I think at the moment, how I've seen it is that it's been a, a knee jerk reaction that we, we're carrying on doing some of the clinics. We've let it go by the sideways, you know, some, some wait clinics, people are staying in touch with a, with a phone call, but they're not doing. Anything with, with the patients.

And so everything's sort of been put on hold. And I suspect some people have absolutely embraced it, which is great. But whatever you decide to do, make sure that people know about it.

So on your social media page, your website, you know, send out an email. This is what we're going to be doing now to all of your clients if, if you, if you want to do that, you know, and if you want to boost your post, you know, always paying a little bit to, to boost them to anyone who's liked your page is always a good eye, is a good way of spreading the word a bit more. And one thing I've always enjoyed about nurse clinics is that it's a point of difference, usually, that if you're running nurse clinics in your practise, it's often that the practise up the road, you know, your, your direct competition isn't running nurse clinics.

Well, now you have an extra point of interest and an extra point of difference in that maybe other people up the road are offering nurse clinics, but you could For virtual nurse clinics as well. And it just takes you, you know, along with the modern world. You know, the, the, the world is changing, whether we like it or not, and technology is really being embraced by, by everybody, and everyone has got less time and they want things to be at the, at the, you know, on their phone, all the information they can have.

So, let people know that you're willing to embrace this. And also includes, you know, photos of, of how it's worked, demonstrations and case studies, ask permission before you do this, but, but post those onto your website, let people know, you know, there's a really successful outcome, even though we didn't ever meet in person. So really, you can make it what you want it to be, I suppose.

I, I hate this phrase, this new normal is it's what we hear everyone saying all the time. But I would say, Whatever we do, this is, this is going to be happen. You know, we've all, this is going to happen.

We've all had this steep learning curve, and you can make a lot of prep here, a lot of step by step information for your clients to show them how this is going to be in the future. And I'm not Saying that this should replace, face to face clinics. It absolutely shouldn't, of course, but it's something that you can really embrace, to go alongside those clinics.

And I do hope people do that. It's almost made me want to go back to practise and actually see, see how well I could do it, because I think I would really enjoy it. So create a step by step guide, let your clients know what they're going to expect.

Let them know how it's going to work. And I'm going to come through some of the idea, the ideas that we have for preparing them for it, because there's some very practical tips, which, which, which people may not, might not have thought about, including myself, until I actually sat down to try to consider what I would need to think about. So make that step by step guide so that people know how you're going to do it.

And what to expect. And as I said, as you get more successful, gather the client testimonials and let people know that this is not a scary thing, and that, you know, in all honesty, I, I try and grab some of the older generation, they call them silver surface, don't they get, get those people who had some successful, interactions with you virtually because it, it shows, it shows other people their age that, that it shouldn't, there's nothing to be afraid of. And then just communicate regularly, any changes, any, any additions that you can add to, to the work that you're doing.

If you're gonna not be meeting people face to face very much, or when you meet them, you're going to be covered with a face mask and they're never really going to get to know you, then you need to start bringing people to life and showing, showing more, about yourselves, more about your colleagues. You obviously need to get permission before you start plastering their lives all over, all over your web web page. But, but bear in mind that you can really make yourself seem like a real.

Very easily by talking about your own pets and your own experiences and anything you've published, anything that you've achieved, any certificates that you've got, you know, anything that makes you stand out an extra special, really, that's what, that's what makes people, Warm to you, I suppose, when they, when they see that you, you're somebody that they can trust, even if they can't really see your, your face all the time. I'm, I'm hoping that someone somewhere will will bring out some really great see-through face masks so that all the animals that are seeing everyone masked up aren't, aren't terrified all the time for not seeing faces properly and that we can show that we're smiling when we see people, even if we're making a mask. So bring people to life, on your Facebook, pages and whatnot.

And then also choose the right software for your practise. Now there's loads to choose from and I'm no expert in it at all. So there's obviously Zoom, which is a I must, must be absolutely loving this COVID because everyone suddenly knows what Zoom is when perhaps they didn't know that before.

There's things like FaceTime and WhatsApp on your phone, there's teams, there's various other mediums and there's lots of demos that are available if you look on YouTube, look online and see how they work. And there's also companies will be falling over themselves to show you their software, and allow you to try it and find out what's best for you. Do be aware, I would say, of a couple of things.

First of all, if you use your personal phone for these consultations, which is something that you, you may do automatically, then if you're using WhatsApp and whatnot, they'll they'll have your phone number. So you really, I, I guess you don't want to be giving that phone number to people willy-nilly, and you also don't want it to be a number that people call at 3 in the morning when their, when their dog's injured and it's, it's your private phone. So it may be that if this is something going forward, you need to consider whether or not the practise should have a set of phones that specifically used for this, so the numbers are not active during, during, non-consultation times.

The other thing as well is this, be careful of, of knowing how to use your, use your phone. So these are two just made me laugh really. There at the priest in Italy that was giving a sermon and accidentally had his philtres on.

So he, his face was changing and beards and, and horns and helmets and things. And this was, an Indian press conference on the right where they had a cat philtre. We had a cat philtre on.

And You know, it's really funny. I think it's, I think it's really funny, but it's not going to give the right impression to your practise, of your practise if, if you're, you know, talking to somebody about their elderly animal that may be reaching its end of days and you've got whiskers and ears on, of course. So there's a few things that are really practical, I would say to do before each clinic.

So regardless of whatever the topic is, and they some of them are very obvious, but some of them aren't necessarily so. And one is checking your Wi Fi, and particularly if this concurrent clinics running and the prep the vets are doing virtual consultations too, and there's somebody watching something in the staff room. So just be, just be aware that the Wi Fi needs to be strong enough.

And if you can have a wide connection, Then all the better because it's much, it's much better to have the confidence that you're not going to be dropping out of information. To information and also check that your mic and your, your video is enabled, and that seems really obvious, but it's been making me chuckle, I suppose, every, Every official, briefing that we've been having, there's always one person that has to say, you're on mute, you know, and somebody has to stop and there's people that are really supposed to be the people either leading this country or really high, highbrow journalists, and they, they can't seem to get this right. And it's just, you know, it's, it's a bit tedious really to have to keep asking people to, to unmute when they need to.

So make sure sure that the settings internally on your laptop or your PC are, are enabled. And keep a cuddly toy to hand. Ideally one that is roughly, you know, anatomically properly shaped, as opposed to sort of care bear or whatever, but something that, an animal where you can demonstrate holding, where you can show a specific area.

And, you know, via a video link, you can point to what, what underneath actually is because we know the owners that word for underneath, and you know, we look underneath their tummies and underneath means that the anus or their backside, you know, people don't like to use proper terminology. We also know that the, the four legs aren't necessarily four legs to the owners, and sometimes they're the arms. So we just need to be able to demonstrate where we want to look.

So, You can really help people know how to do things. And of course, Brian's shown you all these different ways of holding, but you can't be there to show them, but you can demonstrate with a, with a colleague or with a little, video if you need to. And we would recommend that you use something that's got the largest screen possible.

So although you may need to do some of the, the calls via your phone, using a laptop or a PC will give you the very best ability to see clearly what you may be looking at. And don't forget you may be asking them to lift up a lip so you can do some sort of dental check. You need to be able to see as clearly as you can, put your glasses on if you need to as well, which is advice I should take for myself.

And then the preparation for the clients, and this can all go into your step by step guide for them, is that they should have their animals to hand. So if you've booked your appointment for 12 o'clock, and you don't want your 1st 5 minutes of the consultation for them to be trying to pull the cat out from under the bed. To attend the clinic or for them to be going outside down the garden and getting the rabbit out of the hutch and bringing it back up again.

So they, they need to know that the animal has to be contained in the room that they're planning to be in as if it was being taken to the vets and that you're ready and on hand and on time to see them. Hopefully, you know, it's going to be great for, for cat clinics, really, where, where the stress of actually getting in the basket and going to the vets is something that perhaps sometimes skews the almost skews the results of some of the things you're trying to do with a cat. So this is a really nice way of being able to deal with cats, in the comfort of their own home.

Dogs, we believe should be on a lead and you know, restrained, ready to, to, to be able to, to, to turn them around or stand them up or do whatever you need to. Dogs are very compliant, usually on leads, then they, they, you know, that they, they're, they're aware that somebody else is in charge, And there's always the animals that have never been lead trained and what can we do about that? But most dogs have been trained to, to know that when somebody's caught them on the end of the lead, that then that the human is in charge and it's not a case of running around the house.

So just get the plants prepared because otherwise, you're just going to waste a lot of time. And from the client's point of view, we feel that the client should be using the smartphone or a tablet. And the reason for this is if you want to look at an area more closely, if you want to look and see whether the, you know, the dew claws along, you know, they, they, you've shown them how to clip nails and they forget that there's a dew claw there.

So you want to check whether that's too long or you want to have a look at in. Mouth or you want to have a look at the back and see if there's any flea that's in there. You need to be able to to have them put the phone video right close to the area you want to look at and then you'll be looking on your laptop or PC ideally to see a very big picture.

It gives you just the best, to, to, to way of information there. And I mentioned this at the beginning, if there is going to be a cost to these clinics, I think it's really important that the owners are aware of it beforehand. My opinion is your time is valuable regardless of what you do, whether you're speaking on the phone, whether you're having a video call or whether it's in person, because the, the knowledge that you're imparting and the time that you're investing is the same regardless of how you do that.

But the owner shouldn't be surprised by the, by the fact there's a fee in any area of, of veterinary world, whether it's from nursing or, or . All the vet consultations, of course. So make sure the client knows that this isn't a free service you're, you're adding in, unless it is a free service you're adding in, in which case, that's up to you.

Something else that's really important. I said for the owners to have their, their animals to hand. It's also really important that you have everything to hand.

So, so Brian mentioned already, make sure that you've read the records, you know, the medical history that you can empathise with them very quickly. You can make a, make an obvious understanding. I see that this is what you've been worried about.

You know, I see that we were, we've been treating your, your pet for this over the last couple of months, or, or whatever, how you're getting on, you know, and use all those methods that this Brian's talked about, but have the information there. I feel sometimes I've seen with nurse clinics that the proper, you know, no one's spent a whole time reading very much history, and just the last couple of entries and then because you're in this consulting room and they'll mention something, you kind of nip back to the computer and have a little scroll through and, and then have a look. And, and that's not a good thing to do when you're doing any sort of video, video call.

So make sure you've got the full medical history. As well, and any questionnaires that you can send them via email beforehand to give them time to fill out all that information, makes things very easy for you. Don't forget clinics, nurse clinics are not normally an emergency.

So they are, people have time to think about what they want to say. I've always been a very big advocate of sending out, particularly for senior pets and we clinics, sending out questionnaires with structured questions on that give me an indication of one, how I'm going to follow this clinic through to the end, to making sure that whoever does the clinic, they, they, they're not missing any of the questions. They're not missing any of the areas that we want to discuss and that everyone is getting the same.

You know, great service, because, you know, sometimes, sometimes people are a bit, bit more slapdash than others or or people are a bit more nervous than others or they're, they're a bit more, inexperienced than others. And that means that perhaps the client won't get the same level of, level of service each time. So have the questionnaires, let them run through as, as your, as part of your protocol and, and have them sent back prior to the clinic so you can have read them and see what we've gone through and then go through point by point.

Just a little tip with, with questionnaires. I like to, to word things in such a way that if, if, you know, if the word yes comes up, it flags up an issue. So I don't want to say, you know, perhaps refer to vet.

I don't want to say, is your pet overweight? Yes or no, because I, I don't want to then refer to the vet for the, for the weight consultation because that's a nurse's, nurse's area. So obviously registration forms if they're new images too.

And what I would suggest here is, is part of your guide that you would put together for them is what sort of images you're after. So if you say to somebody, I want to see a picture of their mouth, you know, that isn't a picture of them, you know, just looking at you and their mouths there. It's a picture with you lifting the, the lip up and looking at the gums.

It's not just the end of the teeth, you know. How you want to hold them, how to, how to measure food on, on scales, you know, get them to, to, to, to show you, to show you what they're doing. Where, you know, as I said earlier, where to click claws, where the quick line is on a claw, how do you work that out in a black claw.

So, so have photos available to show them, but also ask for photos, but you need to, you know, direct people of how they're going to give you this information because they generally, I, I, I don't think people are very good. At, giving you the information that you need in the same way as, as Brian said, they're not very good at holding their pets even. They're not really very good at, at, at, at following instructions unless you make it very simple for them.

So some examples are You know, how to check your claws, how to apply and where to apply treatments, where to look, you know, where's the most common place to find flea dirt, where's, where's the most common place where you might see signs of, you know, excoriations from, from over scratching for flea, for flea treatments and that sort of stuff. There are lots of different things that you can think of depending on what actual clinics that you're planning to run. And I know that, Steph said this right at the beginning of the day.

Make sure you record everything. And I would say, I would say in virtual consultations, it is more important to be as accurate as you can and really write down everything that you have discussed. And even more importantly, is to state the limitations of a virtual consultation every time and record this.

Now, I know that the, the best way to do this so that you've got evidence that you've said this, is to have a button on your computer. You know, so where you're, where you're putting in the, what, what they've paid for, there's the services they've had, you can have a button that doesn't have a fee attached to it, but does say, you know, stated this doesn't replace a consult, you know, a clinical examination, whatever it is you want to, however you want to word it. In the same way as I know, it's often recommended that we would say offered insurance and owner declined and then have a, a, a button on the computer that says the same, you know, zero fee for that.

But for your own records to say that you have stated this because people will want to do things that are easy for them and it's much easier to sit at home. Have a consultation, then it is necessarily to bring the animal in. But you just need to make sure that you've, you've, you've prepared for that.

I think it's really important just to cover yourselves and put as much of that history on, on, on the records as possible, as word for word, if, if possible. Another thing I think is really, would be really useful is to make your appointments longer than they would have been normally. And that's because certainly at the moment, some people may not have seen anybody for months.

Those people that have seen people won't have seen very many people. You know, we have, none of us have been going to parties and, and big gatherings. And also, this is a situation that's affected lots of people, for, in lots of different ways.

And People like to talk. If you're going to be building rapport with somebody when it's virtually, then you have to have that conversation. And to give you an example really of how this hasn't worked for, for, for me, is that my, my dog was, was at a vet last week and we had virtual consultation, and it was awful.

It was really bad experience for me because it was very abrupt, and they didn't have their mask off while they were on the phone. And I, I couldn't read any, any expressions and, and I wasn't offered the opportunity to ask very many questions. And I also, I also didn't feel I could ask any questions because it was very abrupt and the, the, so the bedside manner of the person that I was dealing with was, in my opinion, was quite poor, and it's left me with quite a horrible, taste in my mouth, really.

I didn't feel that, that I got the service I should have got at all. And I'm pretty like I'm pretty laid back about things like this. So I, I am.

Yeah, I, I didn't enjoy that. And I think it, it was a real lesson for me to say you've really got to give people the time and actually, people don't always know that they want to ask a question. So you have to invite those questions.

You have to, clarify understanding and show that you understand that they might be worried about something and almost give them opportunity, you know, give an example. Things they might not realise that they were worrying about, but let them have the time because it'll be less stressful if you know that you've got half an hour as opposed to 15 minutes. And if you want, you know, if you want to run, well then that that's great.

But let, let people be human and let them show you their side as well as you see their side. So that's something important. You still need to be professional as well.

I would suggest that you use a quiet room that's private and it doesn't have to be a consulting room. It just can be an area that's nice that you've taken down all the joy pictures in the corner of the staff room or it can be, an area of, of, that's, that's a quiet part of the, the corridor, but that's, that's tidy and that's smart and that people aren't going to barge in because you always have a door shut when you're in a consulting room with a, with a, with a face to face consult. And people may want to feel like they have something, private to say, who knows whether they will or not, but what they don't want to do is see lots of people walking back and forth behind them and feel that they can't say anything.

It's private because they know it's not private because they can see that. So it's really important to do that. You can see that you can also make, if you can't find a neat and tidy place, you can actually just make it neat and tidy with lots of different backgrounds that you can add on to, so they could be branding for your practise.

It could be, just a nice plain, you know, consulting room background. I think you can get those as well. You can put your own photos on, but you, you, you, you can make things seem very, very professional.

Even though it's on a video link, you should also use a bright room with ideally natural light if you can and face towards the window. What they, what they don't want a very difficult way to build for is to have your face in deep shadow and look like some spectre that's looking at them through the screen. So it's much nicer for them to see your face if you're doing a video call, and, and to not have the light behind you.

And pop your phone on silent because no one wants to feel that they are being rushed because they can hear ting ting ting of, you know, your, your notifications coming in. And finally, I would say wear a uniform because, you know, you're, you're still at work, even if you're not in the normal way of things, and it doesn't mean you have to wear a uniform on your bottom half, but make sure you've got your credentials laid out. You've got your name on your name badge on your uniform, you've got the practise logo, and you've got people to remember that you are giving them a professional service.

And the way to do that is to remain professional and to look like the, the person that you are. So really very similar to normal, normal, normal, face to face clinic. And the last thing I wanted to say in this section really is that when you're doing something visually, it's really difficult to, to, to have the same interaction.

When you're doing it virtually. Now, I chose to have my camera off today because I was aware that I needed to, remind myself what I wanted to speak of and that I may feel that I want to look meaningfully at you, but I, if I look into my camera, I can't see what I'm wanting to talk about. And one of the things to remember is if you're doing a face to face consultation.

With your client, you might feel like you're looking into their eyes and nodding when they're talking, but actually just remember what they can see is you looking at your screen and nodding. So you can't maintain eye contact because you also need to see what their facial expression is doing. Brian went through the steps, are they giving you a blank or an obvious agreement.

You need to see that in their face, but you also need to look up to your camera where you're not looking at their face so that you can give that eye contact. So look often. And making sure that you are making the eye contact, but you, but look at their face at the same time.

I think it's a, it, it must be a real art actually to, you know, to, to be in the media where you're looking to a camera to answer questions when really you want to answer the person that's speaking to you. So I find it quite interesting to see how hard it is and how unnatural it is to look into a camera unless it's something you've been trained to do. Remember, you've been, you know, you can be seen and keep your body posture open.

What, what, what people don't want to see is somebody slumps over in front of the camera, you know, with a, with a chin in their hand, just, you know, going through the motions of this clinic. Just remember to keep your body posture as open and friendly as it would have been if you were there in person. And obviously, if you're finding things hard, which a lot of people are at this time, then perhaps it's not the time to run the clinics for you to maintain that friendly demeanour.

And just remember that everyone can see what you're doing. And you, you, just because they're not there in person and they can see, they can see everything. It's really easy to forget that.

you know, I'm sure no one's going to get themselves into sticky situations with that because you are choosing when you're going to speak to people. But I suppose the bottom line is to treat it like a normal face to face consultation, just a bit more modern. And I think if you can plan properly and make protocols for every type of clinic, you can really do a good job with this and really make it something that's really successful, and a, and a really sort of exciting venture, new chapter in nursing clinics.

So that's really the end of this, this part for me. This afternoon, I'm going to be very specific and talk about how you can take your weight clinics into a virtual realm and continue them just as successfully as before. But for now, I think we've got a few poll questions, just for a bit of a light relief really.

So I'll pass over to Sophie. Hi, Claire, thank you for that. Hi.

OK, it's just a there's a fun questions for you. So which country is leading the way with virtual consultations? Is it UK, USA, Australia, or France?

Nice easy one to get you. To get you started. Absolutely.

We are rocking it, and we're gonna be rocking it with the virtual nurse consults too. So, excellent. So what's the next question?

So what should you ensure you do at the end of each virtual consultation? Wash your hands, write up all the notes, take a photo of the client, or breathe a sigh of relief. This is not really exam grade questions from me here.

Absolutely right up, you know, it's to really make, take care to write them properly. Make sure that, you're not missing anything that's really important. I think the final one.

How much should you charge for a virtual consultation? So half the normal consultation charge, this should be free. It's up to you in your practise, but this should be agreed beforehand or more after all, it's stressful with all this technology.

I may actually take them for myself. Here you go. Brilliant.

Everyone was listening. That's really fantastic. So I think that's the end of my, my session now, as polls took a bit, they went a bit quicker than I expected.

But, We're moving on to whatever's next, Sophie. Yeah, I don't think we've had, has anyone got any questions for Claire, then just pop them in the question and answers. We have got a little bit of time before we go on to our next speaker, .

But I don't think any have come through. Everyone's today or you're just so informative that you've answered everything already, so I hope so. You certainly made me think about sitting up straight and and looking at the camera correctly.

Yeah, we've been watching you slumping down there very beautiful sitting there. I'll just all the foliage, makes it look better. Yeah.

I have that in the consult rooms though. I'm sorry. So we've not had any questions come through, so we will, move on to our next and next speaker and our first guest speaker of the day, which is Samantha Payne from PET Doctors in Southampton.

So Samantha's career started in London with Middlesex University. She works in charity practise for 5 years before moving to Oxford and into head nurse management, including practise management and clinical coaching. Last year, Samantha moved down to Southampton and into her current role as a full-time consulting nurse, including senior management in the team.

So I'll hand over to you, Samantha, there we go. She's already. There we go.

Oh, Kyle. Thank you for, just a quick thank you to Steph for inviting me today, and just to give you an idea of where, sort of who I am, where I sort of come from, and sort of how I've got to where I am at the moment, in my current role. And just have a quick look, at some of the sort of the consultations I do regularly, some of the less regular ones, and just a quick overview, of how I set up sort of some of the, the more So the more difficult ones that we sort of do, do regularly, I was asked to get going once I got into the role.

So I'll get going now. So, obviously, hopefully, the outcomes from today, as I sort of have a, did, go through quickly, is, who I am, where I've come from, and obviously, yeah, we'll, we'll get on to, sort of hopefully looking at some telephone triage problems, and also some of the concerns that I had when I started, out my role. We'll get towards that, towards the end of the talk.

So hopefully, We all have our own concerns, and I want to just make sure I get across my initial concerns when I took over, and so obviously that's kind of all we're here for today. So who I am, like I say, yeah, my name's Samantha Payne. I'm a registered veteran nurse, qualified in 2009, worked in a charity hospital with Blue Cross after qualifying.

And then have completed my certificate in emergency and critical care. Current BVNA council member and also on the Committee for British Veterinary LGBT. My future plans, also looking at doing, colourful CPD, their certificates, and we'll be getting that done in the next year or so, and also looking at the ISFM, medicine certificates as well, just to further my knowledge, so I can actually help, those clients that I do see regularly that a little bit more with a little bit more knowledge, just to make sure we're doing the right things, for our pets during every consultation.

So, how did I get here? So, like I said, qualified, in 2009, and initially worked in charity hospitals. During that period of time, I was a, staff nurse of clinics.

So, during that point, this was early in my career still, and I was always, already finding a love for managing clinics, setting up clinics, doing consults, throughout the day, managed dispensaries as well, which is also another side of my job now. Which I really enjoy learning about new drugs, making sure you're using the right things, teaching other people on what the best things might be. We do have new products coming out all the time, so I think a certain amount of, sort of the consulting side of things is making sure you're up to date, with, The best new things on the market, that can help make our patients and our care that a little bit better.

After that, I moved up to Oxford, took on a head nurse role, slightly different role to what I was sort of used to, but I felt like I needed the experience and wanted the experience. Certainly, that role gave me a lot of experience with dealing with clients, which obviously is a lot of what consulting is. It's dealing with clients, how to speak to clients, how to come across in the right way, and making sure you're getting the best out, and getting the right information from them at all times.

Even still, I had a keen focus on consulting. At that point, unfortunately, we weren't as busy a practise as I would have liked. So I didn't get to do as much as I would have, hoped for.

The vets were still keen to do a lot of the stuff I'm doing now. But obviously, as things do change, practises get busier, then certainly more nurses will be doing them. I tried, but certainly it was one of those things, but certainly I wasn't not doing any at all.

I was still doing a lot. And keen to make sure the nurses I was working with, whether that's students or RVNs, were getting good training at the same time, which is obviously key. After a period of unrest during that, during that sort of employment, I was then approached, to take on an exciting new role down in Southampton, at the time.

I jumped for it, it was sort of a, a bit of thinking, but I think at the time I knew I needed a change. This was a role that I was really excited about, and certainly I just jumped for it and got down here, and haven't looked back since, which is fantastic. So I'll just have a quick look at the sort of the more regulatory, sort of, consults I do.

A lot of these you'll be doing already, some nail clips, anal glands, as long as you've seen a vaccine them once a year, post-op checks, second or third vaccinations, obviously make sure, in the notes, there is, something from the vet saying. An RVN can do the 2nd and 3rd vaccines and an idea of what you're actually giving. If there isn't, then I normally do just double check with one of the vets beforehand to make sure I'm given the right things.

I don't want to go against whatever sort of protocols we have in practise. We probably know them quite well, but we also want to make sure, we're doing what the previous vet has said or what the vet you're working with today is the best course of action to do. Also 6-month health checks.

So we have a care plan, at work, so within that, you get a health check 6 months after the vaccine. So, pretty much we want our nurses to be doing all of those. There will be the occasional one that will be in med check at the same time, so, obviously they need to be with one of the vets, but certainly otherwise, I do pretty much 80% of those, throughout the branches, which I love.

You learn to start, building a bond, with clients, which is fantastic. You get more out of clients, when you've got that little bit of a bond. You're more likely to get people coming back to see you, which again, strengthens that bond, which is great.

I certainly love them. Like I say, a lot of my time is doing those, and I find them really rewarding. They're all pretty much very different, because every animal is different.

Everyone. Need something different from you, which is good. Next one is dental grading, I will be talking about those, shortly, about how we got those sorted a bit more, we practise, and also just follow ups, follow-ups with those, really.

Also, moving on to puppy and kitten checks. So we also have, those ones that They're coming in for the vaccine, and then obviously, we have to see them a little bit later on. So, I try and give them back every single month.

You're gonna get the occasional client that doesn't want to come back every single month, but we do encourage them to come back every single month. Certainly, and moving on, we're looking at telephone triage. Gonna have a little look at that, later on as well.

It's certainly a key thing at the moment. We are doing more and more of it, which obviously we need to be. We are still in sort of very much a, a situation of, unrest, going forward.

So the more we can do over the phone at times to make sure we're seeing the clients that need to be seen, that day, rather than booking things, that we might not need to. in practise triage, again, we are gonna have times where, someone else might speak to someone on the phone and go, I'm not 100% sure. Let's bring you down, get one of the nurses, to see you in practise, which is really, really good.

Dressing changes. I love dressing changes, I love monitoring the wounds, progress throughout. As you can see, I have got a picture just there.

That was one that sort of came to me not healing very well, over quite a long period of time, post to the lump removal. Going through lots of things, to make sure we're using the right, course of actions. Certainly within two weeks, it was fully healed, and I was very happy, which was fantastic.

It'd been going on for sort of almost a month, if not longer, it just wasn't healing very well. Wounds, rips, nails. Again, these are all things that we can look at.

We can clip wounds up, we can give them a good clean. We can get the vet to have a quick look at, and say, you know, yes, let's go ahead with antibiotics, but it looks really good, and do a wound check in sort of a few days or the next day or a week. Again, with ripped nails, there's no reason why we can't be looking at.

Flipping these off, if we're not sure we want to put it off, then obviously we can get one of the vets to have a little look, see if they, what they think is the, the best thing. But it's all that triage, in practise to make sure we're helping the vets as best as we can do. We're getting job satisfaction as well at the same time.

Blood pressures. I very much include these in our senior, wellness screens. I'll go into those, a little bit shortly as well.

Weight consults and follow-ups, we've all done them, but what we need to be doing is doing more of them. We know weight, issues, is a massive, sort of issue across the profession. We see it all the time.

Are we doing enough? That's very much for you to sort of decide and practise at times, but we should be doing those, we should be referring every single sort of overweight, animal to one of the nurses to make sure we're doing the right things. And of course microchipping if we're told we can do it.

All on the lines of sort of less sort of more regular ones. I know Brian did say, things like immunotherapy, cartrain, and second OCN is if we're obviously told we can do those and it's all in the notes as well. Less regular consults I do see, is senior wellness clinics, can be slow to progress, but certainly we are getting there for ourselves, behaviour consults outside of puppies and kittens.

But with that, I would always say it's within my area of scope of knowledge. If I hear some sort of notes and I don't feel I can help, then obviously I will, pass those and advise them to speak to, sort of a, a fully trained behaviourist. I'm only gonna be doing stuff that I actually have any kind of knowledge with.

So it's certainly, it's always remembering what you can remember, and what your skills and knowledge base is. Diabetic consults and checkups, that's one that's a sort of a slow burner for myself. But in my previous practises, I used to do a lot of the initial setup and initial training with staff and with clients, which I really enjoyed.

Again, it's that kind of building up that report, the filming. Familiar face for them to see trying to do all this, starting a diabetic patient is stressful, having a diabetic patient at home is even more stressful. So having one person you can speak to all the time.

Makes them feel a lot better, but certainly we don't have a huge amount of patients that need, diabetic treatment. So it's certainly difficult. It's always that one on the back burner.

Other diet discussions, whether that's allergies, renal diets, all those sorts of things, again, we need to be on hand. We need to know what diets, we can be using, the benefits, to using all of these as well. And last but not least, physio, more often not, it's post.

Post orthopaedic physio that I deal with, little Lucy there, she'd had a cruciate, but obviously we just wanted to get physio physio started relatively quickly. She recovered really quickly and she was walking within a couple of days and she was fantastic, which is good. So we'll just have a quick look, at the senior wellness appointments.

I know a lot of practises have tried to do these, and it hasn't been very successful. For myself, it comes from fits and spurts sometimes. It very much depends on the vets that are kind of referring, patients for them.

If you've got vets that are very much behind the process, and are keen for them, then it can work really, really well. So it's always getting, other staff on board. We need to look at what sort of 3 questions that we want to get from these, what do we want from these appointments, what are we going to be offering, and should we charge for them?

Sorry. What do we want from a senior consult? We want better education for our clients on our senior pets.

I think a lot of us, we've all been aware of, clients that come in and, They don't quite understand how things change, as, as their pets grow older, things start to slow down, our mobility, sort of gets worse. So, it's just giving them an idea of where those changes can start occurring, and how young sometimes they can start, as well. I think people forget, or don't realise or are shocked when we say, you know, anything over sort of 7 years of age, for most animals is sort of senior, and They kind of start worrying and they're not doing the right thing, to be honest.

Increased long-term care for our senior patients, again, by doing these things, by doing, what we can do during a senior senior consult, we're hoping to catch, any issues that Might hide for a little bit longer, but a little bit easier, so we can actually prolong, our long life care and prolong our sort of health at home, which is good. Increased client satisfaction, two pronged thing. Some people might think, well, you know, we're gonna be trying to spend more money, so it's all about the money, but.

If you give them a reason, then obviously, we're doing this for the patient. We're catching things early, we're doing better care. So actually, they suddenly start realising, the benefits of actually doing it.

Again, increased client bonding for practise. You start picking up issues, they're gonna realise, actually, you are here for my, my pet rather than, other than anything else. What are we gonna offer?

We can keep it short and sweet, we don't have to do loads of stuff. My senior, sort of consults, I book at least half an hour. Minimum, really, because there can be a lot to go through sometimes.

We're gonna do a blood sample, that's sort of a good one. We're definitely gonna include T4 with that. We want to check, especially for our cats.

We want to be checking our, thyroid levels, as we go over 7. Obviously, we all know, things can happen quite quickly. Blood pressure, we want to be picking up any sort of inks inaccuracies with the blood pressure, and putting that with our urine at the same time.

Dipstick SG is a basic, or we're gonna do microscopy. If we're happy doing it, and we've got concerned to do it, and I certainly would do, it's always good for us. We all need to be doing it as well, so certainly I would be offering it as well.

A full health check, we want to be checking everything we can do, we want to be going head to tail, listening to our chest, making sure we're picking up any heart murmurs, any arrhythmias. And looking back through previous history to see, have we had issues before, have we got concerns going forward? Has a heart murmur changed?

Is it worse? Is it louder? All these little things we want to pick up, and by doing them as regularly as we can do, we're gonna pick up those, changes that bit more regularly.

Mobility questionnaires, there's lots out there. There's some that are really long, others that are quite short. It's finding one that works for you.

Certainly, yeah, I've got a few that I use. I don't always give them to the clients, especially ones I've seen before. I try and discuss it, sort of at the time while the animal's sort of walking around, so we can actually look together.

Age questionnaires. Again, there's some sort of regarding dementia and those sorts of things. They're fantastic to use.

I think when a client is at home with a pet, they don't necessarily notice deterioration in a lot of ways. So by using some of these age questionnaires, again, try and keep them from previous ones. So we've got those on record, so you can look back, and see what they were 6 months ago, a year ago, 2 years ago.

And we can work out where our changes are coming from. Again, we can talk these changes through with the clients at the same time. And again diet discussions, similar as before, are we looking to put them on renal food if they're sort of having.

Slight issues with the kidneys or we're looking at other foods just to make sure we're providing the right thing, whether that's urinary or something else. Should be charged. I think so.

I do. Certainly a lot of what we're gonna be doing, in that sort of consultation is gonna be charge services anyway, things like the blood pressure, the blood sample, the urinary workup. That's all gonna be chargeable, but we should also be charging for our time.

A lot of what we're gonna be discussing takes a lot of knowledge and a lot of skills, and a lot of understanding. So yes, we should be charging. We'd be charging if it was a vet, then, yeah.

So yeah, there's no reason why, we shouldn't, that wouldn't charge, so why shouldn't we? Our time is valuable. We've all trained, long and hard to be where we are.

We've all done more than likely extra CBD every single year. So, yes. Definitely, in terms of how much should be charged, practise policy, really.

Certainly, it's a good thing. Before you sort of start advertising the, the actual consultations, you work at a price, and do it as a bulk. So rather than doing it sit, sort of, things separately, actually put it all together.

Bring it all into one sort of, fee, so that when you do price it up, it's that that fee, and they know they're getting, the value of what they can see, but also your time at the same time. So again, in terms of that, yeah, discuss with your management and work out the best price, and go from there really, but don't undersell yourself. Moving on from those, we're gonna have a quick look at dental consultations, and grading.

So when I joined, the practise, we were looking to increase our dental wellness and our dental care for our patients, . We've got good, equipment, but we were wanting better equipment, and obviously make sure we're doing the best thing for them. So, I was approached, to sort of feel for my ideas.

A group of us got together, to discuss the best way of doing things. How can we make the process easier for everyone, and how can we educate, and use these gradings to educate our clients better, for long-term care, really. So, we looked at, well, I went away, with sort of a brief, and we looked and made an actual dental grading charts that we can give our clients.

So, we didn't do a 0. We did a 1234. I'll go the next side we'll have 3 and 4 on it.

. It's the brief kind of idea, . To make sure we're educate some of our clients. So it's a brief, sort of description of where we are at the moment, sort of what our concerns are with the teeth, a great picture.

I certainly learned very visually. I know a lot of our clients, that I've spoken to also learn very well with visuals. So a good picture on the front, of what our teeth look like at the moment.

Not all patients want their Lips lifted up, I certainly ask clients to do it before and they really struggle, because we might come along and it's absolutely fine. So, having that picture, nice and bold at the fronts, really gives an idea of how they look. Certainly level one.

It's not sort of too shocking, but sort of 23 and 4, especially for having that picture almost as gross as possible, so they've got an idea of what their animals pet teeth really look like, and just ask them. Would you want your teeth to look like this? And more likely the answer would be, absolutely not.

Obviously, that's why we want to move on. On that, I've also put a date, a rough estimate as well, and the prescribing vets, or the sort of, referring vet. I did ask the vet or nurse there, but they won't be a vet, which is fine.

They, especially if they can sort of. The idea is these, we're gonna go home, being put on their fridge, with a nice little date on there, give them an idea of, OK, 2 months ago, they were this bad. OK, they might be now worse.

So you better get on that, and get that sorted. Obviously, we've also got on their phase to treat this result, in progress to level 2, which is good. Just a quick look at 3 and 4, like I say, the pictures do get worse as you get along, which I think is good.

That's what we need to see, and we need to be sort of showing that. How bad they can be. We've all seen those 4s that, you know, we almost want to wretch at, but the clients don't necessarily realise that.

Also, the bottom, I did sort of get to say, we've got sort of rough timings for how quickly we want these to get sorted. It's sort of 6 months to grade 2. I think it was 3 or 4 months, for grades, 22 months for grade 3, and then within 2 weeks, for grade 4.

We discussed having these sort of a lot shorter, but I think at the time, what we didn't want to do was start feeling like we were pressuring our clients to do treatment too quickly. Ideally, grade 4s, we're gonna get a lot done a lot sooner than, sort of 2 weeks, and more often a lot. They do get booked in a lot quicker than that.

But it's giving clients a bit of leeway and a bit more of an understanding that, OK, ideally, we get it done, but this is sort of, yeah, your biggest, bigger time frame to get sorted for. And finally on the back, every card, has the same four pitches on the back, just a little bit smaller, again with the same descriptions, . It's so that, you know, obviously on the front, it does say, without treatment it will progress to level 2.

So obviously, having that on the back, gives them an idea of, OK, if I don't get it done within the sessment. Next 6 months, we will be at grade 2, and we're gonna be looking like that. Oh, if I need it even longer, I'm gonna be suddenly at grade 3.

And we suddenly get 6 months down the line, and, you know, we're, we're a grade 4 all of a sudden, it's, it's not gonna be good. So, just given, again, it's that education, it's that visual, view of, oh, no, that it's gonna get worse. I've certainly had clients that book came pretty much straight away after sort of being given one of these cards, which is, the idea of what we don't want to do.

So where we want to go, we're gonna create a grade every cat and dog, every health check, whether that's vaccination or the six month health check. We could do them in between time, but what we didn't want to be doing is grading it every single time a patient comes in cause, You start sort of watering, getting too much, you end up having lots of it on there and you know, in reality. Every few months is fine, if they're only coming in every 6 months, then that's a good sort of leeway to make sure we're catching any real changes.

The grade is recorded by the practise management system, we did add a, sort of, A thing we can price up. So when we do see them, we then price up, grades, grade 2 or grade 3, which we can then actually run reports, however long afterwards. So we can start catching and following up, on those grades.

If we know we saw a grade, for two months ago and they still haven't booked in, then we can just do a cursionary follow up, to sort of just discuss how we're doing. And we can go from there. It's trying to catch those ones that we really want to do sort of sooner rather than later, really.

Like I say, estimates are given at time of consultation. I think we've given the grade and an estimate at the same time, I find a lot of clients do actually book in. I've had multiple people that have asked me to just book it in straight away.

And I've had a lot of also just gone straight out to the waiting room and said, can we just get it booked in now? They've got an idea of how much it's gonna cost already, and. If they can budget it straight away, then hopefully we can just get it done.

And by giving them awareness of how much it could end up being, if it gets worse, then they're gonna get it on quicker. So, yeah. Always good to, to look to the future and give an idea of quite how bad it can be.

Get those dental books, dentals booked, and then once we've had those dentals booked, we can then do our post-op checks, and we can start discussing at home care, whether that's brushing. If they really can't brush, then at least if we can smear something on, . Then just giving them realistic expectations as well, to clients, and that's what I try and do.

I don't go rushing for brushing because a lot of clients are gonna struggle with it. Stars are slow, and the amount of clients that I've said, have had come back to me and said, He's taking out a lot better, can I now look to start brushing, and I'm like, yeah, that's fine. He's got used to having something shoved in his mouth, where that was just a nice soft finger.

Now he can go with a bigger, harder brush, and we can go from there. Quick look at telephone triage. So, obviously over the last few months, I've certainly been working the whole of it, and telephone triage has become a much more common and bigger thing than it has been for a very long time.

We all kind of do it subconsciously more often not when we answer the phone. We all listen to what the concerns are, in in our sort of, brain, we go, OK, does it need to be seen by a vet right now, or can it wait, . But what we want to do, we want to go a little bit deeper, we all almost want to be doing, A consultation, but not quite a consultation, just to get as much information as we can do before we make a decision.

Are you confident with telephone triage? Do you feel it's something you could be doing? Is it something you're doing already?

And what would make it easier for you, is always a good question. I know that to a lot of people that just don't really want to do it. More often, it's not a case that they don't want to do it.

They just don't know what it should involve. And is it any much different to any other consultation that you might do in ways, not really, in other ways, definitely. So telephone trios obviously we want to start, we've taken a full history.

We also want to make sure we've read the previous history as well, just to make sure we're not, it's not something we've had before, and we can work out where where we're going. Once we've got a full history, so that we can get all our presentations. Photos are fantastic.

If I have a telephone triage or someone asks me to do one, I will normally say, yep, that's fine. But depending on what it is, can you get me some photos sent to me via email, or send a video if it's sort of lame, or we're worried about mobility. Or breathing, again, get a video sent over.

Wounds, eyes, all those sorts of things, get some photos sent over. If you've got something visual in front of your face, you can't do a video call. And those sorts of things are really gonna help bring in that bit of information that's missing, between, you know, where you are at the moment, where you are normally, which is essentially seeing an actual physical animal in front of you.

Vital signs. Some clients might find it really easy, taking a heart rate, taking a rest rate, all those sorts of things, looking for reflexes. But there are really good links on YouTube.

We sent a few routes, over the last few months to clients, and you then speak to them over the phone, and they go, oh, that, that video was really, really helpful. For. So find a video that works for you, which one that you like, you feel clients are gonna find easy, and send that out to them.

Just pop it in an email. You can do it in a text message as well with a lot of practise management systems. Again, it's really helpful, or you can talk them through sort of actually where to search, if they were quick enough to do it, sort of, at home while you're on the phone.

Get descriptions if you can't get photos, get measurements, shape, size, colour, flow of blood, all those sorts of things, as much as you can do to paint a picture inside your head as to what you're, as to what they're looking at, that you're not looking at physically. Again, triage sheets can be helpful. There's lots of ones out there.

I think BVA, did one, I'm sure BSABA did one as well during, sort of COVID. You'll find a lot of places may have had one anyway, certainly corporates, will have their own one. Again, certainly I worked for CBS and we had our own one sent out, sort of during.

During lockdown, and it was good, and it certainly helps, and having one of those in front of you so you know you're not gonna miss something really will make your life easier. Also, know your limits. I know that's with everything, really, know your limits.

If you don't think you're gonna handle it all, as soon as they start talking, it doesn't sound quite right, then just get them down, you know, in the end, if it comes down, it's not as bad as it was. It's not the end of the world, in the end, a patient still had the care it needs, . And you can learn something from it.

We're all here to learn every single day, so certainly, know your limits. I know my limits. If I don't think I can help, then I'll just get someone to come straight down.

Barriers to telephone, any telephone triage or any kind of consultation, there's always gonna be barriers to all of this, and there's gonna be a few barriers that will be there. It's gonna be staff around you, then certainly when you're trying to set up a clinic, you want all the staff that are around you to be on your side. You're not gonna get people coming in for these things if the receptionists, the other nurses, the vets aren't referring you, referring them to you.

If they're not booking you in, booking you up for all these things, then it's not gonna work. So by discussing the benefits of all these consultations to all your staff, we'll have staff meetings, do a little presentation and say, here's what I'd like to do. And then work from there, give them the benefits and go, OK, you know, it's gonna save the vet's time, they can do other stuff while I can do these things, we're gonna get better bonds, and go from there.

Again, practise directors, owners, they can be sort of a barrier, unfortunately, they might find that. They're not gonna make money from some of these things. But there's no reason why you can't make money.

There's no reason why you shouldn't be making money from them. Our time is valuable. If they feel they're not going to make or they shouldn't charge for your time, then I would be really having sort of very frank discussions with them and making sure, that they see you as a valuable member of the team.

Yourself? There's always gonna be a big barrier. There's a confidence issue there, always, you know, or am I gonna be good enough?

I'll go through some of my initial concerns I had, when I started. But yeah, it's, it can always be yourself. If you, if you don't want it to be successful, or you're worried it's not gonna be successful, and you're gonna, you're gonna get in your own way, then, yeah, certainly, it, it's gonna get in your way.

So, get yourself on side, know what you can do, start off slow, do a few consultations first, and then, and then build there and bring in some of the more sort of, complicated ones. And again, quite uptake. Again, that's kind of going back to the staff around you.

Clients, some clients might not want to, they might not see the value of nurses, but for ourselves here, what we actually did, we didn't give them a choice. I know it sounds really harsh, but by saying, no, you're gonna be seeing one of the nurses, mostly myself. And then once they start seeing, they can't come in, they see the value, and the experience they have, they start to realise, actually, yeah, nurses do know what they're talking about, and I'll carry on coming to see the nurses, so.

It's always good, but yeah, just get in there, and get sorted. A little bit of my sort of experiences, and my enjoyment. I think when I came to doing it, yes, I was already enjoying consulting.

I used to love it. But I used to do a few a day. But I was then gonna be going to a full day of consulting.

I was gonna be doing it for 8 hours every day, nonstop, apart from lunch, so. My concerns were, you know, was I gonna be able to do it? Was I gonna be able to sort of, keep going for that long, was I still gonna enjoy it, was I gonna be able to have the enough knowledge.

Is there gonna be any skills gaps? You know, chest auscultation is always one that we kind of knock ourselves down for. Am I gonna be picking up issues, good enough?

But what I started to do before I went, I watched the YouTube videos of heart murmurs to make sure I'm a bit more clued up. I listen to as many chests as I can do, even when I'm not doing it. I'll listen to chests.

Anything that's anaesthetized, I'll come along and have a quick listen, just so I'm picking up any issues. Was I gonna have the confidence to get on, of the other staff, again, that's also that sort of side of things, you know, I was a new member of staff here. I've never worked with any of these people.

I was expected to come in, and they were just expected to trust me. Thankfully they did, which is great. Is my communication skills gonna be good enough?

Am I gonna be able to talk to clients? Am I gonna have some that didn't like me? But certainly I haven't had any issues so far, but if you do, all you can do is sort of keep talking to them, and work out any issues.

If it really doesn't work, then we can obviously look at other ways of dealing with that. My enjoyment of that sort of consulting. I love it.

The client and animal bond development is fantastic. It's a big side of why I enjoy doing it. Everyone's different, every animal is different.

And that's where it comes, you know, no two days is, ever the same, really. Helping other nurses develop their own con confidence in consulting is a big thing, for myself anyway. Certainly I try and get other people doing it.

I try not to . Still them all, but there's always gonna be a moment when actually, you know, this one needs to get done quickly, and you go, educating clients on appropriate care long term as well, it's a big part of why I enjoy it as well. And lastly, thank you for listening.

Thank you for joining me today. I'll see if there's any questions. OK, Samantha, I'm gonna jump in actually, because, I, I, I know in theory it's Sophie who's supposed to be thanking you, but I actually want to thank you so much because that was fabulous.

You were wonderful, and that was really, really good and really inspiring. And honestly, you've touched on so many of the things that actually I'm gonna touch on again this afternoon, so. Yeah, that's fine, that's fine.

But, because I'm gonna touch on them and I'm gonna think about it from almost I suppose from the, the veterinary practise owner's point of view a bit later. I have loads of things I want to ask you, however, I am aware it's 1 o'clock and we promised people that we would finish for lunch at 1 o'clock, and I imagine people are wanting to go away. But you're coming back again, aren't you this afternoon?

Perfect. So there's lots of stuff that I would like to discuss with. This afternoon.

So if you're happy to come back, I will save all of my questions until then, if that's all right with you. Yeah, that's fine. Yeah, excellent, excellent.

Sophie, have we had any other questions come through at all? No, no other questions just yet. So, but like you said, we can always do them later on at the end of the day.

OK. But yeah, that was, that was absolutely brilliant. I hope you all enjoyed that.

That was just a great presentation from, you know, to hear all about a nurse who's obviously really, very engaged with the consulting, which was just wonderful, wonderful. Thank you. Yeah I think you