The VBMA is the fastest-growing student veterinary organization with more than 3,000 members, and with chapters at all 28 U.S. veterinary schools and a number of international schools. Banfield Pet Hospital’s Chief Medical Officer, Jeffrey Klausner, DVM, MS, DACVIM, and I both participated again this year in the VBMA annual conference held in conjunction with the North American Veterinary Conference (NAVC) in Orlando, Fla., Jan. 14-18. We were able to meet with approximately 130 of the veterinary profession’s future leaders during their annual VBMA conference.

We took part in an evening speed-networking event, and presented lecture topics on the importance of preventive care and the value of lifelong professional development. Banfield Pet Hospital’s dedication to the future of the profession through Banfield student programs and our new graduate on-boarding programs were singled out as setting an example for the rest of the profession to follow.

Banfield looks forward to our continuing partnership with the VBMA and our joint efforts to develop leaders with the necessary communication skills, business acumen and leadership attributes necessary to meet the growing needs of our exciting profession.

Stevie was diagnosed with diabetes almost five months ago. He lives with Ms. W and her elderly daughter (who has health problems of her own), and they are treating him with daily insulin injections.

When Ms. W’s daughter was admitted into a hospital for several days, she instructed her mother to board Stevie at our clinic until she was able to return home and help care for their pet. When Ms. W dropped off Stevie, she told us he was not eating and felt he was having a hard time getting around. Over the next 24 hours, we administered his insulin and arthritis medication and fed him. He ate without hesitation, ran around the clinic and seemed to sleep comfortably with normal eliminations.

The next day, Ms. W was confused about why Stevie was at our clinic and came to pick him up. I informed her specifically when he had his insulin and when to give it again that evening. Within one hour of her leaving, she called back to ask if he had been given his insulin. When she called an hour later with the same question, we asked her to bring Stevie back and offered to board him at no cost until her daughter returned.

These incidents have brought up many concerns that I foresee we will need to address in the near future:

• When and how do I step in and express the concern that Ms. W may not be able to take care of Stevie the way he needs, especially if she is left alone with him?
• How do I discuss my apprehension with her family about allowing her to drive; should social services be contacted at some point?
• I know that the human-pet bond provides many real and measurable health benefits for people and would not want to limit her from this, but at the same time I have a responsibility to my patient. There is always the fear that she may forget to give insulin or give too much/too often, she may forget to feed him or give him an overdose of the arthritis medication.
• Is part of the reason we are having difficulty regulating the diabetes due to the effects of the Alzheimer’s and her ability to care for him?
• Is she legally able to make any medical decisions for her pet anymore?
• What if her family refuses to help care for Stevie?

More and more of us have family or friends who have been touched by Alzheimer’s and other health problems that cause very real concerns in terms of these pet owners’ ability to care for themselves and their pets properly. You want what is best for your patient, but do you tackle the invisible legal/ethical/moral boundaries to address those uncertainties and, if so, when and how?

The only answer I have is that every situation is unique, requiring the utmost compassion, communication and documentation.

For more information on Alzheimer’s:  http://www.alz.org/

Communication resources in veterinary medicine outline the caveats of good communication and Dr. Nan Boss makes some great points in her reference.

My 3 big take-aways  from her book are:

1)     Excellent communication in the veterinary practice is a team sport – from the receptionist to the DVM to paraprofessionals

2)     Keep it simple – use plain language to describe health issues not medical jargon

3)     Provide concise written information in support of your diagnoses and treatment recommendations

We know from the 2011 State of Pet Health Report that the most common pet diseases are those that are entirely preventable.  Strong communication is vital to client compliance to veterinary recommendations for preventive care.  The Bayer Brakke study found that 59% of dog owners and 56% of cat owners would bring their pets in more often if they could prevent problems and extensive treatments later on.

For our 2012 resolutions, let’s make enhanced client communications skills a priority so that we can help even more pets get the preventive care that they deserve!

Along with being a lumpy bumpy arthritic girl, she is considered a geriatric large-breed dog and is at risk for dental tartar, ear infections, and nuclear sclerosis according to 2010 Banfield data.  These were the top three diagnoses in 2010 for this age group, and as a practicing veterinarian, I find it fascinating because my experience with my own dog is similar to what I see in practice.   But how does this information help veterinarians and why should we care?

It is important to continue oral health care in our geriatric patients.  I’ve seen more than one case in my practice that the owner perceived the dog as “too old to undergo anesthesia”.  And then once the dental procedure was done, often with multiple extractions, the owner called me later and told me how much better their pet was doing -eating, playing, and acting like a young dog again.  Full oral examinations must accompany every physical exam.  We, as veterinarians, need to look for broken teeth, worn teeth, oral masses, tooth abscesses, and general periodontal diseases.

Ear infections are another common health issue that can affect geriatric patients.  Bailey has had many in her lifetime and they have been extremely painful for her.  More than once I’ve seen her scratch her ear and then cry out in pain.  You’d think as a vet, I’d catch them sooner.  But as a busy mom, I miss things too.  This is just one of many examples of the benefits of bi-annual thorough examinations.

In addition to periodontal disease and ear infections, lenticular sclerosis commonly affects dogs over 10 years of age.  When educating clients of geriatric pets, it’s important to include discussions on ocular health. Along with detecting it during routine physical examinations, conversations can ensue on how to help their older dogs cope with declining vision.  Although it may be out of reach for many owners, surgery can be discussed, but I also recommend non-surgical, practical interventions such as not rearranging furniture on a regular basis.  My own Bailey can’t see the tennis ball sometimes and has tripped over things the kids have left on the floor, so my family has had to make adjustments to accommodate our aging dog

I was taught that age is not a disease and as veterinarians we can help our older pets maintain healthy lives during their “golden” years.  We need to help our clients prevent diseases, such as periodontal disease, that are common among aging pets, and detect problems early.  There will come a time when I have to say goodbye to Bailey, but I know that she has had the best life possible!

~ Mathieu, 2007

When we have compassion fatigue as individuals, or it infiltrates the veterinary organization, many things happen. As mentioned above, the veterinary professionals become jaded about their work. Being dispirited, or no longer feeling that “calling” to help animals, can cause apathy which in turn can make the individual more susceptible to making clinical errors…they just don’t care as much. Certainly too many people on a team with compassion fatigue can contribute to a toxic work environment overall. Yet probably the biggest factor related to our practices’ success and the reputation of veterinary medicine overall is the tendency for team members with compassion fatigue to either discard acting respectful to clients, or be out-and-out DISrespectful to our clients. Besides the danger to the “big picture” of the practice’s success, this type of attitude or behavior can lead to an abrupt halt in employment at a practice, or ruin our professional career for good.

The danger is that it is very difficult for an individual to objectively gauge how well they are communicating with clients. Already in the shroud or fog of compassion fatigue, it becomes nearly impossible to look at ourselves in the mirror and gain an honest perspective on the person we put forward to those around us. Certainly if there are squabbles and run-ins among the team members, you can suspect that this type of behavior spills over into client communication. By the time a member of management calls out a veterinary professional for problems with client communication, it’s often been happening for a while, and negatively affected many clients before it came to the attention of management. This typically happens when a client finally launches a complaint, and the old adage is that for every one person who complains, there are ten others who would have liked to but didn’t. So it’s imperative that team members and management recognize when compassion fatigue is interfering with the level of client care provided by the practice. The personal symptoms of compassion fatigue give us a guide to determine if compassion fatigue is negatively affecting our client communication.

• Bottled up emotions: when a team member is holding in his or her emotions for too long, s/he finally explodes; this does not only happen in “the back” but can occur during interactions with clients. A team member may respond with anger, frustration, or even grief that is much stronger than the situation calls for. The reaction is blown out of proportion.

• Impulse to rescue anyone (or anyTHING) in need: at our very core, we want to help animals. This impulse is put to the test when a family cannot afford or chooses not to pursue treatment for their pet. In this situation, team members become tempted to ask to adopt these animals, rather than see them humanely euthanized. This becomes a problem at many levels. In regards to the client, this family who might have had extreme difficulty coming to this conclusion is now faced with the decision to keep their pet alive, but living with someone else. This may be a conversation that the practice wants to avoid altogether, in which case a policy should be constructed to protect both the family and the team member.

• Isolation from others: there are team members who tend to thrive on the fringe of the group, and they may have been like that from the beginning. Then there are those who may begin pulling away as compassion fatigue takes hold. This can be recognized by other team members, because it affects their relationships. This isolation can in turn make it more difficult for this team member to connect with clients. They will sense this separation, and may not have the level of trust in this team member.

• Sadness and apathy: it’s obviously difficult to communicate with others when sadness is a pervasive emotion. Yet apathy is even more dangerous. Clients can sense when someone doesn’t care, about them, their pet, or the outcome of the visit. These clients will be reluctant to agree to the care that is being recommended, and more likely to find fault with the services. At the bottom of most all complaints is the simple fact that the client didn’t feel compassion from the team member. Apathy and compassion do not often coexist.

• Feeling the need to voice excessive complaints about management and coworkers: while we may only think this affects the world “behind the scenes”, it can go way beyond this and creep up front. When team members feel pressed into a corner by a client, for example, they are more likely to blame the practice’s policies, the management itself, or even their coworkers. The motto “it’s not your fault, but it is your problem” is one that needs to be grasped by team members; even if they were not involved in the specific issue mentioned by the client, they are responsible for finding a way forward to an agreeable end. This acceptance of responsibility won’t happen with team members who are experiencing compassion fatigue.

• Lack of interest in self-care practices: we communicate by words of course, but this is only 10% of the message we send out. The majority of the message is body language. When team members cannot rouse themselves to take care of their personal needs such as hygiene and appearance, this sends a message to our clients. It demeans the professional atmosphere and can lead to mistrust. Everything in the practice affects the client experience, especially the people they come into contact with during a visit.

• Reoccurring nightmare, flashbacks: when a team member is experiencing these more severe symptoms of compassion fatigue, they will come to believe that if they do not connect, they may be able to avoid these “hauntings”. Again, apathy becomes the safest way to reduce the negative effects of forming relationships with clients. The connections become very superficial, if they indeed fit the definition of “relationship”.

• Persistent physical ailments: a team member must be physically present, in the best shape possible, in order to form healthy connections with clients. When a team member is not feeling their best, they can’t put their best foot forward with the client interaction that is part of their job. If the ailments result in absences, they aren’t there to serve your clients at all!

• Difficulties concentrating and mentally tired: a team member is responsible for taking information from the client, and relaying it to the rest of the team or assessing how it will affect the animal’s care. This requires concentration, and the ability to be mentally alert to absorb the details and process the impact of this information. This cannot take place with a team member who has “checked out” mentally.

• Prone to accidents: when a team member is involved in an accident with a patient, such as becoming bit or scratched, this information must be relayed to the client. In some states, it’s a legal requirement to report all bites, and the authorities follow up with the family. Otherwise for the sake of the team member’s health and recovery, often times the family needs to understand how their pet was involved. It’s not the fault of the animal if the accident occurred because the team member wasn’t concentrating on proper restraint, for example, yet the client becomes negatively affected. Injuries are bound to happen at times, but a rise in these types of accidents will have a trickle-down effect on the clientele of the practice.

Compassion Fatigue may begin as a “personal issue” affecting an individual team member, but as it takes root it affects the person’s behavior, attitude, and interaction with others. This includes our clients, the pet owners we are committed to helping with the animals they love. This ability to help requires a connection, both emotional and intellectual, in order to best serve the pet and the family. When compassion fatigue exists, these connections become difficult if not impossible to generate and maintain. This negatively affects the veterinary practice and its success, and also dooms the individual veterinary professional to a myriad of unfavorable outcomes.

The first step is to recognize the effect compassion fatigue is having on the individual, and sometimes this is initially made apparent by client complaints regarding communication with the veterinary team and a team member in particular. Take these complaints seriously; solve them to the client’s satisfaction, but then move beyond to examine the root of the issue and perhaps discover the individual on the team that needs to become aware of how to recognize and recover from compassion fatigue. In a very real sense, we’re all in this together!

Resources:

Healthy Caregiving by Patricia Smith

Despite the fact that I am already sleep deprived, I can tell that I am starting out this semester ahead of many other students.  We have a class called clinical competencies that focuses on small animal physical exams, restraint, blood draws, placing catheters, etc.  Because of my previous two years at Banfield, I have not only learned these techniques, but have become proficient in each of these.  Since my preparations have allowed me to excel in this class, it gave me the opportunity to pay it forward and help fellow classmates who have not been able to get previous experience with these techniques. 

In addition to being clinically prepared, I was also fortunate to scrub into many surgeries over the past two years.  This allowed me to not only become more familiarized with the process of scrubbing in, but also enabled me to become more confident with my surgery skills.  Since I will be starting surgeries within the next week, I feel much more prepared for the procedures to come.  While there is much preparation still required before each surgery, I at least feel confident that my acquired skills will aid me in my preparation.  Moreover, one of my surgery partners has not had experience with small animal surgery, so I am looking forward to being able to help her through our operative surgery course.  In return, I hope to learn how it differs from large animal surgical medicine. 

I am grateful for all of the experiences that I was able to get during my years at Banfield because it has made my semester slightly less stressful . . . slightly.  Amongst the numerous intense classes, Ophthalmology and Neurology, Metabolic and Endocrine Diseases, Theriogenology and Urinary Diseases, Hematology/Oncology/Dermatology Diseases, Digestive Diseases, Surgical Anatomy, and Applied Diagnostic Imaging, it is a very wonderful feeling at least to feel partially ahead in Operative Surgery and Clinical Competencies.  While the average person would look at that class list and would cringe, I feel very excited to getting my feet wet in areas that will be vital in every day practice. 

Good luck to those fellow students who are dangling between the wonderful world of clinics, and the dark hollows of the last semester.  With the right amount of coffee, it will be hello to clinics in January!

There is a great AAHA article about life stages that includes a table of their classification system.

Knowing that Sami is at the chronological equivalent of an 80-year-old human highlights all of the changes she’s experienced over her lifetime.  As a kitten, she learned so many things.  Sami learned to run, jump, and play, how to use the litterbox, and how to eat solid food.  She was also one of those kittens who climbed up your leg to sit on your shoulder the minute you came home.  During this life stage, kitten vaccines and deworming were at the top of the list.  Then it was time for her spay. I paced and paced until the procedure was done, then rushed in to hold her during recovery.  I tell my clients not to worry about being needy and nervous, that they don’t hold a candle to how I am when my own pets are on the surgery table!

Things were pretty status quo during the junior and prime years.  Routine wellness care, the occasional bout of hairballs, and fights with her sisters were her only trips to the vet school with me.  She moved to a few different houses and dealt with various dogs and cats that my roommates brought along.  Things continued to roll along during her mature years.  She began to be challenged by obesity so I put her on a diet.   Sami went back to being a normal sized kitty although her pooch remained.  She even handled a move across the country in her usual Sami style.  She hung out on my lap and shoulder for three days of driving.

In her senior years, Sami began to have problems.  The first was vomiting and diarrhea which began occurring on a fairly regular basis.  Bloodwork, radiographs, urinalysis and culture, ultrasound were all normal.  The diagnostic rule-outs that we think about in older kitties such as hyperthyroidism and renal failure didn’t appear to be a cause.  The oncologist was very worried it was early lymphoma; I hoped for everyday ordinary inflammatory bowel disease.  This went on for about 6 months, then spontaneously resolved.  I definitely gained a new appreciation for the frustration my clients went through when dealing with the ups and downs of life with a senior pet.

Next was the torn Achilles tendon from racing away from the dog.  It really hit me when the surgeon asked how old she was to determine her suitability as a surgical candidate.  The first thing I said was she’s young.  He asked how old.  I replied, 14.  Ok, that really hit me.  She wasn’t young.  My Sami was old.  My purring, climbing, scrawny kitten had turned into an old lady, seemingly overnight.

The Banfield Applied Research and Knowledge (BARK) team report confirmed my experience with Sami and the life stages of disease.  You can read the whole report at here.  As a practitioner, I always suspected that hyperthyroidism and renal disease were the top concerns, but these numbers prove it.  The proportion of these diseases in cats younger than 10 years was essentially negligible, where the proportion in cats over 10 years was 7% and 8% respectively.  Malaise and heart murmur were also overrepresented in older kitties.

Why is this important for Sami and our geriatric patients?  Early Intervention!  Diagnosing hyperthyroidism early can have tremendous benefits.  Treating these cats early can prevent some of the long term complications associated with the disease.  These younger cats are better candidates for I-131 therapy which can be a cure in lot of cases.  With renal disease it is a bit trickier.  This progressive disease isn’t curable, but diet can have a tremendous positive impact in longer term quality of life for these cats.

One important lesson I have learned from our research is that even with all of the trouble it takes to bring in cats to the office, it is well worth it.  These early detection tests are crucial to maintaining a long, high quality life which falls in line with my experience as a 10 year veteran of veterinary medicine.

This is the basis of evidence based veterinary medicine: augmenting experiences and observations with the use of hard evidence.  Banfield is unique in the world of evidence based medicine in that we have millions of records in which we can perform this kind of research.  The State of Pet Health Report referenced above contains a wealth of information in what we have found in these records.  Additionally, you can check out this website on evidence based veterinary medicine.

My parting thoughts are that we must embrace every life stage of our cats as we should do for ourselves.  With preventive care maybe someday for cats, 20 will be the new 15.

We have a reason to care. From 2006 through 2009, we saw a 57% increase in the number of new canine and feline patients seen at hospitals open for at least 5 years. Part of this increase, but not all, can be attributed to practice growth. Then something changed. In 2010, we saw a 21% decrease in new patients, and this downward trend is continuing. Although the decline could be blamed wholly on the economic crisis, other factors such as increased competition for services have also contributed.²

The implications of this decline for pet health are cause for concern. Fewer new visits means pets are not getting the care they need and deserve. Indeed, we have seen an increase in the prevalence of certain preventable diseases such as diabetes mellitus and roundworm in cats is increasing.³ In the current economic environment, the importance of routine preventive healthcare, something that pet owners already struggle to believe in, will surely take a perceptual hit, and the need to effectively communicate that importance is becoming direr.

But what about existing patients? Surely they are an important concern too.  Although Banfield data show an overall decrease in the total number of visits by new and existing patients from 2010 to the present, the number of visits by mature adult and geriatric cats and dogs seems to be increasing. Furthermore, the mean number of visits per month by all pets is also increasing by about 5%. This is indeed good news—it appears we’re getting better at keeping the patients we do have, and existing patients are getting more regular care.

So where should practices be placing their emphasis: on keeping existing patients or attracting new ones? I would argue that both are important in making a better world for pets. Repeat visits increase the opportunity for veterinary staff to develop trusting relationships with pets and their owners, which can be used to facilitate conversations about preventive health matters. I am much more likely to take my family doctor’s advice when I have a relationship with her than I am if I see a different physician each visit, particularly if she is familiar with my health history and my lifestyle. Initial visits open the door to ensuring all pets get consistent, compassionate life-long care. In the end, we all win.

1. Katie Burns. Reversing the decline in patient visits. JAVMA News. Sept 15, 2011. Available at: www.avma.org/onlnews/javma/sep11/110915o_pf.asp.
2. Bayer HealthCare LLC, Animal Health Division, Bayer Veterinary Care Usage Study. Available at: http://www.ncvei.org/articles/FINAL_BAYER_VETERINARY_CARE_USAGE_STUDY.pdf.
3. Banfield Pet Hospital. State of Pet Health 2011 Report, Vol. 1. Available at: http://www.banfield.com/Banfield/files/bd/bd826667-067d-41e4-994d-5ea0bd7db86d.pdf.

In a recent survey done by Banfield Pet Hospital and the National Association of Veterinary Technicians (NAVTA) in 2010, it was determined that recognition by their doctors and management team, along with maximum utilization of their skills, were just as important to veterinary technicians as their compensation and benefit packages and was one of the leading reasons why technicians left the practice.

Veterinary technicians are key to a successful and happy team.  If utilized correctly, client compliance, furry, feathered and scaly family members’ quality care and well being will sky rocket.  Team members overall will be happier in their positions, staying longer in the practice, and will also increase the bottom line in the practice/hospital.

Wouldn’t it be nice to surprise the veterinary technicians in your hospital and show them the recognition they need and deserve by celebrating with them?  Show them how much they are valued.  There are many ways others are doing this.  Some are taking them out for a special lunch, some introduce them to the clients as their credentialed technicians and let the client know that it is National Veterinary Technician Week, others post banners, posters (NAVTA’s has a poster you can request at no charge) or displays in their lobby/waiting area.  You can give them memberships to their state association and NAVTA or just give a simple thank you for the great things they do every day.

Happy Vet Tech week to all of you hard working techs out there!  This is your week!

For more ideas on what you can do to recognize your technicians, visit www.navta.net.

~ Betty Bender

The truth is, we spend much of our life at work, doing our job. The satisfaction we gain from that job determines in large part our level of satisfaction in life in general. Job satisfaction has many aspects, including the overall environment, the tasks we are required to perform, and the support of the team around us. Patricia Smith of the Compassion Fatigue Awareness Project has developed eight “laws” for creating a healthy workplace. Whether you are in management and can effect these changes directly, or are part of the floor staff that can help your team develop a healthy workplace together, these laws are important guiding lights for how we practice veterinary medicine. 

Eight Laws Governing A Healthy Workplace 

1. Provide a respite for the team.

Every team member needs to be given a break or “respite” from the work, both in small and large increments. This takes the form of a scheduled and actually taken lunch period and periodic short breaks, as well as a day off or extended vacation now and again. No matter the length, this respite needs to provide an actual detachment from the work. During short breaks, this does not mean sitting in the break room only to be called away by the intercom and back to work. Take lunch outside, or take a walk around the block after eating. Listen to music privately, or indulge in a good book. Actually escape from the workplace for at least a short time. For longer time away, release your worries and do not let thoughts of work interrupt or interfere with your escape. You will return much more refreshed!

2. Provide continuing education for team.

We usually focus on continuing education (CE) as a way to educate our team about information they need in able to perform their job, for the benefit of the practice. Yet an employee also gains personal satisfaction from the process of learning something new, and being able to implement positive changes in the practice. Ensure everyone on the team has a CE allotment, including the front office. If cost is an issue, work with the team to develop in-house talks performed by the employee who has an interest in a particular topic. Outside the workplace, be on the lookout for CE opportunities to pass along, both those recommended by management and those that the employee may be interested in personally attending. Especially if the practice offers financial support for CE, ensure that the employee is held accountable for bringing back information and sharing it with the rest of the team. 

3. Provide acceptable benefits to aid staff in practicing beneficial self care.

Typically this takes the shape of health insurance benefits, whether or not the practice pays a portion. Health insurance companies can also offer education regarding ergonomics, smoking cessation, and more. This law can also involve mental health services, including an employee assistance program (EAP). An EAP provides free counseling sessions to eligible employees who may self refer or be encouraged to seek help for a personal issue that is affecting job performance. There are other shapes this law can take, such as partnering with a nearby gym or fitness center for reduced rates or supplemented membership. Of course the old adage is true, you can lead a horse to water but you can’t make it drink. You can provide these resources, but it’s up to the employee to take advantage of them. But at least they have the option, and the practice shows their care and concern for employee well-being. 

4. Provide management and team with tools to accomplish their tasks.

This may sound like common sense, but it’s not uncommon to expect great results without providing the tools necessary. These tools may be equipment or supplies, which are obvious. Often more important and not as obvious is the allotment of time needed to do the task, or the authority with which the person needs to get it done. Perhaps training is the missing link standing in the way of success. “Tools” can be anything and indeed everything that an employee needs to get a job done, and this can take many shapes. The best plan is to ask the employee what they need to perform the task at hand. 

5. Provide direct management to monitor workloads.

Every person on the team is busy, and typically each one handles a large workload. Sometimes there is no one person in management that directly knows the workload of each person. This occurs when management gets more removed from the team, such as when the team size grows, the management tasks multiply, or the employees specialize in certain positions. This is where middle managers are so vital. These supervisors—lead techs, head receptionists, senior assistants, etc.—still maintain direct contact with the group of employees that perform a specific job, they understand the job itself, and they have a smaller number of people to monitor. Consistent and frequent review of each person’s workload is best. 

6. Provide positive, team-building activities to promote strong social relationships between colleagues.

Everyone groans when “team building activities” are mentioned at a staff meeting, but they can be fun, challenging, and insightful. When introduced as a “game”, many employees find themselves enjoying the activity despite themselves. Discover those exercises that would appeal most to your employees, and be sure to discuss the results and how they apply to the big picture of working together once the fun has ended. There are many resources online and in management books to offer suggestions as to appropriate team activities and how they should be introduced and performed. 

7. Encourage “open door” policies to promote good communication between team members.

“Open door” policies are all the rage right now, and for good reason. Management should not be hiding behind a closed door, but instead maintain an open and responsive presence in the practice. If employees fear going to management with an issue, the issue will only continue to grow and fester. However don’t always count on employees making the first move. Periodically check in with each employee, follow up any incidents that need further investigation, and provide a protocol for making suggestions in an open, or anonymous, manner. 

8. Have grief processes in place when traumatic events occur onsite.

This is perhaps the most vital piece that is missing in veterinary practice. In other care giving professions, for example human medicine, employees are debriefed after dealing with an emotional or traumatic scenario such as patient death. In truth, we are the only profession that must go from one room attending to the euthanasia of a dear family friend, to smiling at a new client in the exam room next door. This takes an emotional toll on us, particularly if there is no outlet for discussing how we feel about the situation. It is believed that it is important to debrief with someone who understands the job within the first 72 hours after the event. Waiting until the next staff meeting is not fast enough. Employees keeping it to quietf should not be encouraged. Instead we must learn to trust each other with our emotions and share the reality that is our job.

It’s easy enough to charge the practice owner and the management or leadership team with the responsibility for creating a healthy workplace. Indeed, some of these suggestions such as offering health insurance is a decision for the “higher” management. However the employees can suggest, initiate, and weigh in on all of these concepts. Express your ideas or feelings to management, and for those in management, take these suggestions seriously and do not shoot them down without further consideration. Only by working together can we truly create practices that are healthy for our patients, and also healthy for the employees inside!

Resources:

Compassion Fatigue Awareness Project at www.compassionfatigue.org, Patricia Smith