26 Sept 2015
Helen Tottey
Job Title
The benefits of using nurses to communicate with clients, usually about preventive health care, have been widely discussed, but many practices still don’t offer this service to the proven benefit for their business.
As a profession, we are experiencing more competition, not only from other practices, but from the endless sources of advice clients have at their disposal, such as the internet, friends, groomers, pet shops, kennels and catteries.
People talk to others to gain a consensus of opinion and we are no different in our own consumer lives. We all know clients often feel uncomfortable questioning their vet and often ask the receptionist or nurse when they leave the consult room. This gives the nurse or receptionist the opportunity to ask the vet to explain things again, but what if the client doesn’t ask and just walks out?
Wouldn’t it be better if we enabled clients to speak to a nurse with their uncertainties or questions rather than one of the many other sources for advice? When thinking about utilising your nurses, it is important to first distinguish the differences between nurse clinics and nurse consulting (see Clinics v Consults panel).
How to start offering nurse consulting can take some planning. Firstly, selecting the right person is vital for success. A nurse only interested in theatre and the clinical aspects of the job will not enjoy the interaction consulting requires and this will be evident to the client.
The benefit of nurse consulting comes from the relaxed and open communication format that makes clients feel they can discuss and ask questions they may not feel comfortable asking the vet, or that would have resulted in an internet search or chat with friends or strangers for their opinions on the topics.
A nurse with enthusiasm for helping and educating clients is ideal for this position as this will bring the added benefits of building client trust. This means when the nurse promotes a product or service that will benefit the owner or pet, the client is more likely to make a purchase.
In an ideal world, as with vet/client relations, one lead consulting nurse is advisable to offer that consistency and also develop the service.
Clinics: Nurse clinics are generally topic-related, such as weight and dental clinics where clients, often after seeing the vet, are referred to the nurse for specific help. Clinics generally tend to be offered at a time convenient to the practice – when a room and a nurse is available – but often the convenient times for us are not convenient for clients and after putting a lot of effort in to his or her clinic preparation, the VN is left feeling demoralised when no one comes.
There are, of course, practical reasons why this may be the only option practices can offer due to lack of space and staff, and clinics run this way can still be very successful, but tend to take more effort and time to establish.
Consults: Nurse consulting ensures there is a VN with appointments available alongside, and often exceeding the vets consulting time.
This model incorporates not only the advice “clinic” type appointments, but also fee-charging appointments, such as nail clips, redress, anal glands as well as post-op checks and stitches out where the fee was incorporated into the surgery.
It’s important to remember that while the VN is seeing this type of work, it enables the vet to see a clinical and chargeable appointment and also benefits by helping reduce those “end of surgery appointments” as the vet is not fully booked with nail clips or taking stitches out.
If you have a nurse in mind, the next step is training. While the VN qualification adequately prepares nurses for their clinical role, this doesn’t mean it will come easily to switch to standing in a consulting room with a client. This was discussed at the SPVS/VPMA The Consulting Nurse day, and although there is more communication in the VN syllabus, it was not thought to be enough to lead straight into a consulting role, no matter how keen the nurse was.
Communication skills are one of the biggest elements to consulting – not necessarily clinical knowledge. I have worked alongside new graduates, and although they had all observed a lot of consultations, nothing prepared them to be alone in a room with a client, leading the consultation. While nurses have had a lot of experience interacting with clients over the reception desk, in kennels or over the telephone, this is very different to opening a door, inviting in a client and directing the consultation.
In the first instance of training for this new role the nurse should shadow the best consulting vet in the practice for a few weeks. This will not only help build confidence, but also develop an understanding of the elements of a consult, from preparation and greeting to saying goodbye.
When I first started consulting, I was told it would take me at least three years before I felt comfortable. This could be taken negatively, but I found it quite reassuring as it meant the expectation was this was a learning process and not something I was going to be fully confident and competent in from day one – a common fear among nurses.
Many companies offer training in this area. Onswitch has its seven steps consulting skills CPD day based on the Calgary Cambridge Principles and used as a benchmark by the Veterinary Defence Society. VetPhysch also provides The Colourful Consultation which formed the base for the SPVS/VPMA The Consulting Nurse day. While these are extremely beneficial, in-house training is a must, not only for the nurse to observe the vets’ consulting styles, but also for the rest of the team to realise this is an important role the practice is developing.
Practice product and service knowledge is a must. Nurse consultations benefit clients as they feel they can talk more on a level to nurses than they do with even the friendliest of vets. This will and should lead to them asking more about non-clinical aspects of pet health care, from puppy socialising, parasite control, dental care, behavioural questions and all the things they would normally search for online or ask a friend about.
Nurse training concentrates more on the clinical aspects so an update is needed in all the preventive health care areas. This is not too difficult to do as most companies will be more than happy to send a rep to advise on, for example, foods, parasite control, pheromones and insurance. It will be this knowledge that will lead to clients choosing to purchase products and or services that will benefit their pet.
What about sales training? While we don’t like to think we “sell”, when you listen to vets and nurses you can hear great product/service knowledge and promotion, but rarely hear that final part “what size bag would you like to try?” When the decision to offer nurse consulting was made at my previous practice, it was decided it would be a free service with the aim of bonding clients.
I was told if it didn’t work, I would effectively be out of a job as my position on the rota had been filled by a new clinical nurse. Added pressure or realistic business expectation? Being comfortable discussing products and services the practice offers is one thing, but actually asking if the client wants to take it is another vital skill.
Finally, in-house training allows the nurse and vets to establish an understanding and protocols around each other’s roles and boundaries. Just like VNs have to pass clinical concerns back to vets, the vet has to pass pet health care aspects to the VN. Initially, you may find, as I did, you are asking the vet’s opinion on everything and you need to feel able to do this. The vet needs to know your limits so either further training and support can be given or you can be reassured your opinion is right – “the wound is okay” or “it does need vet involvement as it is looking infected”. As the confidence of the nurse grows, so will the type of work that can be undertaken. With physiotherapy, wound and behaviour courses available, the consulting nurse can form an integral part of practice development.
So, what about the business element? If the nurse time is predominantly going to be free to the client, how does the practice know if nurse consulting is successful? Monitoring practice key performance indicators is important to demonstrate the impact a consulting nurse can have on your business. Repeat food sales, take up of health plans, pet insurance, continuing with yearly boosters and neutering are all services nurses have an impact on through being given the time to discuss with clients about the benefits to them and their pet.
This service was well received by clients and demonstrated by how after I had been consulting for a couple of years (developing confidence and adding to my skills), my appointments were often fully booked before the vets.
I suggest starting at the beginning – puppies and kittens. A first vaccination should be a dual appointment, the vet for the clinical and the nurse for the non-clinical – administer worming treatment, discuss house training, socialisation, and complete the free insurance at the same time as “playing” with the little puppy or kitten and establishing a relationship with the client. This leads to the second vaccination appointment being solely with the VN and for a minimum of 20 minutes to allow time for questions.
Following this will be regular weight checks, ongoing parasite control leading to a pre-neuter appointment and then postop checks – all developing that relationship and gaining the nurse’s confidence. Over time, more of the vets’ work that doesn’t involve clinical diagnosis and treatment can be transferred to the nurse – diabetic support, senior clinics, including blood pressure monitoring and, if further qualifications are gained, behaviour, physiotherapy and wound management are also possible. Add to these, for example, the traditional weight and dental clinics, nail clips, postop checks, stitches out and you can see how the nurse can become busier than the vets in bringing business to the practice.
To start and develop nurse consulting the practice needs to develop a clear practice protocol, not only for the VN consulting, but for the rest of the practice team, and the whole team has to want this to work. In-house training is required to ensure the VN follows practice consulting protocols and to help give confidence as well as external training from company representatives or attending courses.
And finally, clients have to know about it. This is a fantastic opportunity to demonstrate veterinary professionals can offer more than clinical support and treatment. In May, there was a contentious issue with a voucher being given to clients from a supermarket inviting them to visit a vet from a list of participating practices for a £10 health check. If your clients are already used to receiving all-round pet care from your whole team, they are less likely to take up such an offer.
So, if you do start nurse consulting, promote it and stop clients looking elsewhere for preventive health care and even clinical advice.
