• BARK: We still have a section dedicated to the Banfield Applied Research & Knowledge (BARK) team. This section includes the quarterly white papers, Critically Appraised Topics (CATs) and updates on event participation.
• Case Studies: We keep an archive of case studies from Banfield veterinarians so other veterinary professionals can test their knowledge and gain insight.
• Contribute: We are welcoming submissions from all veterinary professionals to discuss trends, key findings and insights into pet care.
• Publications: Visit this section to view the Banfield Journal archive, BARK white paper archive and to read the newest edition of our Anesthesia Book.

For any feedback, please comment on this post.

Personal compassion fatigue is a result of how much a team member is personally affected by the emotional work of care giving. Organizational compassion fatigue is not only how the practice culture is affected by employing personnel that are influenced by compassion fatigue, but also how the organization creates and maintains an atmosphere where acts of compassion are expressly expected, modeled by leadership in the practice, and rewarded by management.

The question is: does your practice create a culture of compassion? We are expected to treat our patients with compassion, but do our team members demonstrate compassion through their actions, and receive reprimand when they fail to act with compassion toward a patient? We are expected to treat our clients with compassion, but do our acts of compassionate client service get rewarded? We strive for our team to treat each other with compassion, but do we recognize that they need time to make connections with each other?

Compassionate Patient Care

A manager suspected compassion fatigue in her team. The reason she knew that her team’s compassionate care of patients was falling short was when she noticed, much to her credit, that her medical staff was no longer talking to the patients. One of the methods she used to enhance this relationship between person and patient was to purchase combs and brushes for the team to spend time grooming and loving on the patients. Now some people in a leadership position may look at a technician brushing a patient for a few minutes as a waste of time, but instead this should be recognized as a display of compassion, and it should be rewarded as a contribution to compassionate culture.

Compassionate Client Care

When we are faced with clients in difficult situations, whether it be an illness or injury of a beloved pet or even the fear and confusion of being a new pet owner, that person needs our time and attention for assurance that they can be good pet owners, or our time to pause and let them reflect on their relationship with their pet when that relationship may be coming to an end through death or euthanasia. Yet there are those in a leadership position that may chastise a team member for spending too much time with a client, when they should assumedly be in the back being productive. Compassionate care takes time, and this is often what our clients need most from us.

Compassionate Colleague Care

One of the ways to minimize personal compassion fatigue is to have a support system in place. Talking to someone who understands the emotional roller coaster that is veterinary medicine can help to reduce the personal symptoms of someone experiencing compassion fatigue. Often times, the best support system is staring us right in the face: the faces of those team members we work beside every day. Building connections and sharing stories and emotions is one way for the team to help itself, yet often the management team will observe team members talking with each other as “riding the clock” rather than being productive. Even chatting about what they did over the weekend helps to build the bonds that may be utilized to help one of them overcome a particularly emotional euthanasia or difficult situation with a client. Rather than discourage team members from making these connections, we should encourage a supportive atmosphere where the team feels comfortable turning to each other for help.

In order to reward acts of compassion, it is necessary that we recognize compassion when we see it, in ourselves and others. How do you know someone is being compassionate? If we are able to watch our team members as they interact with patients, clients, and each other, we can recognize compassion by their tone of voice, choice of words, and overall body language that is being expressed. Compassion is actively engaging and listening to the other person, or being perceptive to an animal’s nonverbal communication. Yet we also have to realize that often acts of compassion happen around us when we cannot necessarily observe the team member, such as when they spend extra time with a client in an exam room or on the phone, or take a break with another team member to talk about their day. We often want to jump to negative conclusions, rather than give our team members the benefit of the doubt. They may be trying to contribute to a compassionate culture, if only we can recognize and reward this behavior.

We also have to look for demonstrations of team members not being compassionate. This could be the technician that is hollering at the patient who is constantly verbalizing in the cage, the veterinarian who hesitates to offer sedation for radiograph positioning of an uncomfortable or agitated patient, or the receptionist who is more involved with the fax machine then the client who just approached the counter. We have to be aware that sometimes even our own company policies and expectations foster a culture that is not compassionate. If we focus more on the quantity of work produced rather than the quality of work produced, we are looking for something that can be measured rather than something that can be sensed or felt. We must step back to feel the culture of our practice. Our clients will experience certain emotions, or leave with a certain feeling, at the end of an interaction with our practice. By ensuring a compassion culture, we are creating a place where are clients want to return, a place where our team member feel supported, and a place where our patients can be assured of receiving the most compassionate care.

The following eight laws introduce strategies that we can use both within our workplaces and beyond to create a healthy change in our life.

Eight Laws Governing Healthy Change (~Patricia Smith, 2008)

1. Take frequent breaks from what you are doing: most employers offer break time, yet we choose to work through breaks quite frequently. You are entitled to take this break, and it becomes even more important as you become more engrossed in your work. Your dedication is admirable, but it’s vital for you to step away from your work on occasion. At home or in your personal life, you also need to create space for your own thoughts, hobbies, and interests.
2. Learn the word “no”; use it whenever necessary: this doesn’t mean you can suddenly refuse to do what your boss says, but it does mean that you need to be reasonable in the expectations put upon you, even by yourself. You may be tempted to keep saying yes to new requests of special projects or a heavier workload, but you have to realize when you’ve reached your limit. If needed, let your boss help you prioritize your “to do” list based on the practice’s needs. At home, let your family help you say yes to those things that are important, and no to those things that don’t require your energy at this time. You may find that you’re better at the things left on your list when you’ve shortened the length.
3. Share the load with others: although the space you find yourself in at times may feel lonely, you are not alone. You are surrounded by people who share the same passion as you during the workday, and you are all struggling in the same way. Help each other to even out the load. The same is true at home; you share the same goal as others in your lives, to spend less time “working” and more quality time together. If the load is spread out, there will be more time to appreciate each other.
4. There is humor in every situation: find it and laugh. Laughter IS the best medicine, and it certainly has its place in veterinary medicine as well. In fact, most of our practices have developed many “inside jokes”, and at times a rather “dark” sense of humor that can help lift the mood after an intense situation with the team. It’s ok, there is a place for humor in our workplaces. Be sure your home life supplies some laughs too, whether it’s funny pets, happy children, or just laughing at, or with, your spouse from time to time.
5. Recognize when you need help; ASK for it: we are not good about this is our profession. In fact, what we ARE good at is taking on the load by ourselves, and then complaining about the fact that no one stepped up to help us. It has to occur to us to ask for help, and not expect our colleagues to be mind-readers all the time. Certainly there are times when it’s obvious you need help and someone should offer, but we also have a responsibility to make our needs known. Kids, spouses, and friends are also not mind readers, so pipe up during your personal time as well when you need a hand.
6. Give yourself credit when credit is due: it’s perfectly natural to want to feel appreciated by our bosses and colleagues, but sometimes we don’t give ourselves enough credit. Pat yourself on the back for a job well done, and if you’ve accomplished something that others might not see as obvious, go ahead and mention the project you completed, the cleaning you finished, the difficult client you were able to soothe. You do deserve the credit, both at work and at home.
7. Give others credit when credit is due: if you’re not handing out praise from time to time, then you aren’t looking hard enough at the success of others. Gratitude is one of those things that is contagious; if you give it out, it’s liable to come back to you two-fold. Show you colleagues that you appreciate their hard work, and then take that attitude home with you to show your family that you are proud.
8. Breathe deeply as often as possible: this may seem natural, but often during stressful times we do not breathe as deeply as our body needs. A few moments of deep, concentrated breathing can make a world of difference to how our minds, and bodies, cope with stress. High levels of stress sometimes require intense coping methods such as meditation, breathing exercises, or others.

As we make these changes to create a more balanced and satisfying life, the more we will come to understand how caring for ourselves supplies the energy and motivation to help others. Next month, in Part III of my three-part compassion fatigue series, I will discuss the basics of self-care and how they can protect us from compassion fatigue now and in the future.

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

A client calls a half hour before closing stating their Pet has been vomiting for three days and they need to come in now. Without question, they need to bring the Pet in right away, but I can’t help wishing the client had called three days ago. So how do I approach this stressful situation?

I begin by tackling the task before the client even gets to the hospital. I take a deep breath and force a positive attitude. I know from experience that when I walk into a situation with a sour mood it makes all tasks daunting and creates frustration. And nothing spreads faster within a team then a bad attitude! It’s important that I (as well as my team) begin the appointment on the correct footing – the last thing we want is to have the client think we are rushed or that their precious Pet’s health and well being are not important to us.

Next, I create some organization. Once the veterinarian and I gain compliance with an owner on a treatment plan, we need to communicate the most efficient path to completion. Team work is always the key to success. By delegating the tasks necessary, I relieve stress on the responsible team members and increase the turn-around time on diagnostics. This is a tip that is not only essential in late arrivals but also on a day to day basis. When a team member expresses that they are overwhelmed, delegating even the smallest tasks – such as differentials, fecals, ear swabs and cleanings – is a much needed relief to the team member as these tasks are often the final piece to completion.

Finally, by maintaining a constant and evolving conversation of the progress of the Pet with the veterinarian and support staff, I greatly decrease the chance for mistakes. I do this by utilizing the treatment board and maintaining patient SOAP notes throughout the entire process. Outlining the specific tasks that need to be completed on the treatment board keeps all surrounding team members up to date on the case. It also promotes team members with down time to quickly offer assistance in areas of need. And by maintaining SOAP notes as we progress, the veterinarian and I are able to accurately and thoroughly document all stages of the patient’s care in the official records.

Bottom line, when I complete difficult tasks utilizing a positive attitude, ever-flowing dialogue and team work, I enable my team to provide top quality care to each and every Pet – even on the busiest and most stressful of days. This ultimately leads to healthier, happier Pets, and more clients committed to our practice. To me, that’s a strategy for “surviving the trenches” that spells success!

As a veterinary professional, you may seek advice from your local veterinary association through their FaceBook page to connect with colleagues in your area and discuss medical issues. Or if you would like to connect to colleagues on a more personal level, you could try Google Groups or LinkedIn Group, where you can find groups on almost anything from medical specialties, support groups, or philosophical discussions on the state of veterinary medicine. Plus, if there’s something missing, you could create your own group!

As for the content you may want to create online, keep what you write on the Internet positive if you’re thinking about starting a blog, Facebook page or Twitter profile. Whatever you think is private really isn’t when you publish it online, whether it’s on FaceBook, Twitter or a blog.

For instance, discussing a general problem about communicating the importance of a healthy diet in a Pet is different than picking at the personal qualities of a client who’s in denial about his dog’s obesity. Another example includes talking about preferences of breeds or species, because one of your clients or potential clients is bound to take offense. Writing in a way that criticizes specific people can always be misinterpreted in the worst way possible. Remember that frustrations and annoyances are temporary, but what’s written on the Internet is not.

Writing in a positive tone can also assuage some of the anxiety you may have about making yourself open to online criticism. Note that even if you decide not to communicate online, someone else will do it on your behalf and you may not like what is written about you. By taking on the online space first and writing positively, you set the tone on how you communicate with your clients and colleagues.

However they both surface during our professional lives. Robert G. Roop, Ph.D., performed a survey of the veterinary profession (Humane Society of the U.S., 2003-2004). It was called the Compassion Satisfaction and Fatigue Survey, and they surveyed veterinarians, technicians and assistants, and office staff and managers to identify the top stressors and satisfiers. The researchers realized that while there are things about our jobs that cause stress, there are also things about the job that create in us satisfaction, and the desire to stay in this difficult profession. It is supposed to be a balanced equation.

Here are the top three satisfiers and stressors for the three categories of veterinary professionals:

Top Stressors for Veterinarians

1. Difficult or noncompliant clients
2. Not enough time
3. Discussing/disputing fees

Top Satisfiers for Veterinarians

1. Helping/healing animals
2. Thankful clients
3. Working as a team

Top Stressors for Veterinary Technicians and Assistants

1. Difficult or noncompliant clients
2. Problems with co-workers
3. Not enough time

Top Satisfiers for Veterinary Technicians and Assistants

1. Helping/healing animals
2. Working as a team
3. Thankful clients

Top Stressors for Front Office and Practice Management

1. Difficult or noncompliant clients
2. Time demands
3. Disputes over fees/billing

Top Satisfiers for Front Office and Practice Management

1. Thankful clients
2. Daily contact with animals
3. Helping/healing animals

Understanding these stressors and satisfiers can help us focus on those things that create satisfaction in us at work, and reduce those that cause stress. This is a great way to minimize or prevent compassion fatigue as much as possible. In November, in Part II of my three-part compassion fatigue series, I’ll discuss how we can approach making changes in our lives if we discover that we have some degree of compassion fatigue. 

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

We all can relate to this, particularly when the work load overwhelms our ability to do it all…and maintain a good attitude at the same time! The good news is that burnout is a process, not an event, and is marked by physical, emotional, and behavioral indicators that can be easily recognized. If we remain aware of our response to the increased workload, we can keep burnout in check by utilizing these coping methods:

• Accept that the situation itself is stressful
• Share your feelings with a trusted friend or colleague
• Enhance your communication skills to lessen feeling of being unheard
• Initiate positive action to change your environment
• Suggest solutions to proper management
• Care for your personal needs (i.e., good nutrition, hygiene, exercise)
• Take time away from your stressful situation, and allow others to help

So then what is this new term, compassion fatigue? As a perfect example, burnout and compassion fatigue were contrasted by member of the “human” medical profession: Burnout results from stresses that arise from the clinician’s interaction with the work environment…while compassion fatigue evolves specifically from the relationship between the clinician and the patient.  ~Kearney et. al., 2009

When the workload is heavy, the hours long, the coworkers grumpy, the equipment shabby, those are all examples of the work environment causing stress, i.e., burnout. But compassion fatigue is different; it’s about personal relationships with your clients and patients. It would stand to reason then that you have some measure of control over burnout. You can use some of those coping methods listed above, and make appropriate changes to your work environment. In fact, you can change your work environment altogether by quitting and getting a new job. Burnout is more about WHERE you work.

But compassion fatigue is more about the work you DO, and as long as you remain in a care giving role, you will need to be able to recognize and minimize compassion fatigue. First, how do you diagnose compassion fatigue? Here are the some of the symptoms:

• Bottled up emotions
• Impulse to rescue anyone (or anyTHING) in need
• Isolation from others
• Sadness and apathy
• Feeling the need to voice excessive complaints about management and coworkers
• Lack of interest in self-care practices
• Reoccurring nightmare, flashbacks
• Persistent physical ailments
• Difficulties concentrating and mentally tired
• Prone to accidents

As you may imagine, these personal effects also spill over to affect the organization as a whole. So how do we change to a healthier emotional status? It’s mainly about sustainable self-care. We must turn our care giving inward to provide for ourselves, so we have the energy to sustain our care giving role in the profession. Here are Eight Laws Governing Healthy Caregiving, from Patricia Smith, founder of the Compassion Fatigue Awareness Project:

• Sustain your compassion
• Retain healthy skepticism
• Learn to let go
• Remain optimistic
• Be the solution
• Embrace discernment
• Practice sustainable self care
• Acknowledge your successes

Resources:

• Compassion Fatigue workshops and webinars at http://www.katherinedobbs.com/
• Compassion Fatigue discussion forum at http://www.compassionfatigue.org/
• Compassion Fatigue in the Animal Care Community, a book from the Humane Society
• To Weep For a Stranger: Compassion Fatigue in Caregiving, a book by Patricia Smith

No other Iams foods are affected, and this recall is limited to Iams canned cat food in North America. The Procter & Gamble Company is recalling these specific lots because the product may contain insufficient levels of thiamine (Vitamin B1), an essential nutrient for cats.   Thiamine deficiency in cats can manifest with clinical symptoms including loss of appetite, salivation, generalized weakness, vomiting, weight loss, ventroflexion of the neck, ataxia, tremors, falling, circling and seizures. 

Diagnosis is made by history, physical examination, and response to thiamine supplementation.  Thiamine concentrations can be measured in whole blood (the sample must be frozen and protected from light during collection, storage, and shipment), or in food.   

Treatment requires thiamine, given either by injection or by mouth.  Recommended doses are 100 to 250 mg SC q 12 hrs or 2-4 mg/kg PO q 24 hrs.  Note that injections may sting, and rapid intravenous administration has been associated with anaphylaxis.     

Concerned pet owners who have purchased Iams ProActive Health canned cat and kitten foods with these codes should discard the product – please make sure the contents of the can are destroyed in such a way that no other pets can inadvertently eat the food. For further information veterinarians should call P&G at 800-535-8387.  Clients/Pet owners can call P&G at 877-340-8826.

I personally feel very passionate about the career of veterinary technician – and I know that with the right training and development opportunities, veterinary technicians will be empowered to invest in themselves and the career they’ve chosen.  At NAVTA Annual Conference there will be courses aimed to help vet techs at any stage of their career to develop professional and leadership skills, and to expand their career options.  (Note: This does not replace traditional lab CE at local and national conferences.)

Here’s just a few of the exciting new features that I’m looking forward to at this year’s NAVTA conference: 

• Speakers Skip Lineberg & Emily Bennington will be teaming up to teach one session on making the right first impressions– and attendees will receive a copy of their new book “Effective Immediately: How to Fit In, Stand Out, and Move Up at Your First Real Job”
• Aundray Collins, professional image consultant, will be on-hand to answer questions, and one lucky attendee will win a consultation & “attire makeover” valued at $250
• Stan Krejci will guide participants, via a multifaceted and personal approach, through positioning yourself on a board of your peers, focusing on effectively working toward common goals

Whether you plan to spend your career in a veterinary clinic, move into sales, education or various leadership roles within the field of veterinary medicine (i.e. serve on a local board, found a specialty group, support a non-profit, etc.), it’s important to you, the profession, and the Pets in your care to stay fresh on your skills. Looking forward to meeting you at this year’s conference!

The 2010 NAVTA conference is November 12-14, 2010.  For more details or to register, visit http://www.navta.net/index.php?pr=Annual_Conference.

Here are 5 ideas for creating a healthy working environment.

1. Reduce Stress.  Stress in the work place can lead to illness and accidents.  It is the nature of our profession that there will always be some level of stress.  What can you do to decrease stress in your hospital?   Having supportive co-workers is an important method to effectively minimize stress.  Sharing the load of the stress with colleagues will help remove the load on the individual’s shoulders.  It is important that we understand as veterinarians we must keep our stress in control.  Observe your words and actions and do not take out your stress on the support staff.
2. Encourage breaks.  Do you work right through the day?  Your body and mind will thank you for taking time to leave the treatment area for a break.  Make it easy and simple.  A 5 minute walk outside or quiet meditation in an exam room can really make a difference.
3. Encourage healthy eating.  It is important to take time to invest in our bodies by providing a balanced diet.  Low blood sugar can make you feel anxious and irritable. Keep some dried fruit & nuts, string cheese, jerky and whole wheat crackers on-hand for those busy days when you or a co-worker needs an energy boost.
4. Value employees and set clear job expectations. Basic respect goes a long way. Employees need to understand what is expected of them.  Set clear guidelines and offer positive reinforcement often. Job descriptions and regular reviews give the support staff the chance for growth and development. 
5. Encourage all staff to contribute ideas.  Feedback from everyone on the team is important for developing a healthy work environment as well as it is good for the practice.  Most employees have thoughts about how they can improve where they work.  Opening up the lines of communication is a healthy way to seek new insights from another perspective.