Where have all the nurses gone?

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I've been a veterinary technician, or nurse, for 20 years. I've always felt it was a calling. I also left this profession that I adored.

Like so many others, I love nursing but couldn't see myself staying in the profession long term. It's simply not a sustainable career as it stands today.

Mine is not a novel story.

It's been about three years since the National Association of Veterinary Technicians in America (NAVTA) published survey results that sparked the important conversation about the tremendous shortage of veterinary nurses in our country.1 What has changed since then, and what can we do to buck the trend of losing skilled nurses in veterinary medicine?

The real reason we leave the profession

There are many reasons why veterinary nurses leave the field,1,2 but I'm going to tell you the dirty little secret no one wants to talk about: More than anything else, it's money.

We are skilled workers, yet we aren't paid enough to do a job that is harder than most other available employment options. The dearth of benefits, advancement opportunities, recognition and utilization of our hard-earned skills plays a role, too, but if you want to know how to keep qualified nurses at your practice, know this: You have to start paying us a livable wage.1,2

The NAVTA survey results showed that veterinary nursing positions have twice the turnover rates of positions in similar fields.1 It's an incredibly difficult job emotionally; burnout and compassion fatigue are very real. But practice owners and hospital management seem disconnected from this fact. Upper management is often naïve to the stress and carnage these situations create. When a hospital is short-staffed, it's the employees-both doctors and nurses-and the patients who suffer.

Physical exertion also takes its toll

I know I said money is the No. 1 reason nurses leave the field, but physical limitations are also present. As we age, we become less able to restrain large, difficult animals. Therefore, opportunities for roles with less physical demand are urgently needed.

One medical director in the Atlanta area is trying to implement different levels of nursing staff in her hospital, in which experienced nurses would be paired with assistants who would restrain animals, thus allowing nursing staff to perform medical tasks and reduce the physical exertion required in their daily jobs.

What's different now?

That single-owner practices are becoming less common has potential for big changes for veterinary nurses. Large corporations, such as Mars, BluePearl, Banfield and VCA, are transforming the field by buying countless practices.

Corporations have deeper pockets and larger profit margins than smaller, privately owned hospitals. That means the potential for increased wages and better benefits. I've worked for a Mars company, and the benefits offered to me as a full-time employee were unmatched by any of my previous employers in veterinary medicine. However, the pay still wasn't what it needed to be, and management still wasn't focused on retaining credentialed and qualified staff members.

I recently sat down with the medical director of a large hospital owned by a Mars company. The management at this practice is desperate for skilled nursing staff, as are all hospitals in the Atlanta area where I live. They are “ready and willing to pay top dollar,” but when I broached the subject of what top dollar is for them, it wasn't a number that generated excitement or would make me switch practices. It was $18 to $20 per hour.

I've worked for almost every emergency and referral practice in greater Atlanta over my 20-year career. Practices in Atlanta offer higher wages than those in rural Georgia, which is understandable given the financial constraints of most clients in rural settings. We can't be indifferent to our clientele and their limitations. However, given my location, education and experience, it's frustrating to have to struggle to negotiate an hourly rate close to $20.

After interviewing for a relief position in Colorado recently, I was pleasantly surprised at the hourly rate being offered for licensed veterinary nurses: $25, with shift differentials up to $6, depending on the shift you picked up. The cost of living in Denver is slightly higher than in Atlanta, but the difference is not that significant. In my opinion, this is closer to the pay rate that experienced, credentialed nurses should draw. We are formally educated, must maintain a state license and are invaluable members of the veterinary team. Additionally, data from more than a decade ago showed that having a single credentialed, qualified nurse in a veterinary practice increases the average veterinarian's gross annual income by well over $90,000,3 yet the average hourly pay for nurses remains $15 to $20.1

Making progress

Let's talk about the title issue for a moment. I support the movement for veterinary technicians to be called nurses. That's not to say that the term “technician” isn't descriptive of what we do, but in most cases we are nurses. We are patient advocates, educated and trained in medicine, radiology, anesthesia, laboratory procedures and so much more. We are skilled medical professionals with the ability to raise the level of care in our practices. When a skilled nurse is on staff, veterinarians are free to write charts, see patients and generate additional revenue for the practice.

Unionization4 and pet insurance also have the potential to change the veterinary landscape. A union experiment is under way at two Mars-owned companies in Seattle and San Francisco, and many in our industry are in favor of unions. Nurses need to come together for collective bargaining power, and again, the introduction of large parent companies may offer hope to nurses who want to stay in the field. I wish these nurses the best, applaud them for being pioneers to advance the field and hope their efforts mark the beginning of a larger movement across the profession.

Pet owners who pay for their companion animals' care with the aid of pet insurance also help to ease the constraints of dipping into profit margins to pay staff members more. We need to encourage more pet owners to purchase pet insurance.

It's time for practices to act

Until big changes are made to ensure that veterinary nursing is a sustainable career with ample pay, I fear we will continue to lose competent, caring professionals to other occupations-much to the detriment of veterinarians and patients. It's time for practice owners and hospital managers not only to understand the deficiencies that exist but also to act. If your practice needs qualified help, come to the table prepared to pay for it, encourage your bright assistants to enroll in veterinary technology programs and become licensed, and place value on your current staff by listening their concerns.

References

NAVTA 2016 demographic survey results. NAVTA website. cdn.ymaws.com/www.navta.net/resource/resmgr/docs/2016_demographic_results.pdf. Published 2016. Accessed September 24, 2019.

Larkin M. Technician shortage may be a problem of turnover instead. American Veterinary Medical Association website. avma.org/News/JAVMANews/Pages/161015r.aspx. Published September 28, 2016. Accessed September 24, 2019.

Fanning J, Shepherd AJ. Contribution of veterinary technicians to veterinary business revenue, 2007. J Am Vet Med Assoc 2010;236(8):846.

Wogan L. Support staff unionize at two veterinary hospitals. VIN News Service website. https://news.vin.com/vinnews.aspx?articleId=49064. Published June 21, 2018. Accessed  September 24, 2019.

Dr. Bohn received her PhD and MS from Georgia State University and was a practicing veterinary nurse for nearly 20 years. She provides freelance medical writing services through her business, Bohn Communications.