Hello everybody. Today with me here I've got Amy Miller, who's an RVN who works out of hours as an emergency and critical care nurse. And the reason that VN Futures is doing these career case studies is really just to highlight the different roles that veterinary nurses perform in practice. And we thought it'd be really nice to do an actual interview with Amy here. So thank you for coming along today Amy, I really appreciate you giving us your time. Maybe if you'd like to just give me an introduction to yourself, who you are and what you do?
Hi, so I'm Amy. I'm a Registered Veterinary Nurse. I have been in the veterinary nursing industry for about 10 years now. I joined the industry when I was 16, so fresh out of school, went straight to college and I went down the apprenticeship route. And I joined Vets Now three years ago and have never looked back to be honest with you.
Sounds great. So you joined straight from school. Did you start your veterinary nurse training straight away?
How did you start out
Yes, so I originally applied to college for the full-time route, so I didn't have a job. It was just a case of studying and you'd go on placements a few days a week at practices where the college had organised. But then during my first placement they actually offered me a job, which was amazing. And then I switched over to the apprenticeship route and then continued my training whilst working, and it was amazing. The support I got from the practice and the college was brilliant. And I would say that's probably one of the best routes to go down because you get so much experience in practice but then the support from the college and the continuous learning from college as well is brilliant.
Yeah, so those two ways work together really well don't they—that practical aspect and then like you say the college support. So tell us a little bit more about the role that you perform on a day-to-day basis as a veterinary nurse.
What is your role
So with Vets Now I solely work nights. It was my choice really. Working nights worked well for my lifestyle, but obviously it is mainly out of hours, but you can do some weekend days and things like that. But my role is mainly a night role. We start our shift and we are in a host practice, so usually at the start of the shift we get a handover from the host practice as some patients have to stay overnight for overnight care. So they will hand over what we need to do in the night, what the plan is with the patients and things like that. And then I will go and TPR the patients, make a plan of when they need their meds, when they need to go out for walks and their TPRs and things like that. And if they need any further care such as physio or whether they might need more nutritional requirements than other patients and things like that. And once that's planned, that's the base.
And then because we are generally the only practice open overnight, I think within quite a fair radius—we cover about 58 clinics in the area—so we do get rather busy. But it's really good because we have quite good team support. We normally have two vets until midnight, and then there's normally another nurse with me until midnight as well. So once the other patients start coming in, sometimes they can be more minor emergencies such as like a cut pad or something like that, but sometimes you will see the more major emergencies like the GDV and things like that. So we usually, the nurses usually triage every patient that comes in and then we go with like a traffic light system as to which ones we feel the vet needs to see as a priority or potentially could wait a little bit longer.
Yeah, it's really interesting. Like you say, you'll get those patients that might only have a very minor issue but they still need to be seen don't they? And for anybody who's watching this who's maybe not in the profession, generally practices run a day service so they can provide consultations and care throughout the day, and then emergency appointments are usually—they are sometimes handled by the own practice aren't they—but Vets Now is a company that takes over that emergency care for pets outside of normal practice hours. So when Amy was saying about a host practice, they basically move into somebody else's practice for the night and take over that emergency care. Obviously that's a fully arranged situation. But yeah, it really shows Amy that you're doing the day-to-day nursing care that nurses who work during the day would do, so like those TPRs—the temperature, pulse, respiration—looking after those patients' nutritional needs and the emergency stuff as well. So you get the best of both worlds really, don't you?
Oh yeah, 100 percent. I've always been kept on my toes to be honest with you. There's never a moment where I think 'oh what should I do now'.
Yeah, yeah, which is good. That's always good. I mean that probably leads me on to my next question, which is:
How did you get into this area
How did you get into this area of vet nursing and why did you choose this area of veterinary nursing?
So I felt like I'd gained quite a lot of experience in day practice, and then from working as sole charge at weekends in day practice, I quite liked the buzz of the emergency side of things. So if you'd get a caesarean in or something like that or something a bit more that you need to intensively nurse, so I went down the route of applying to work at Vets Now and I was lucky enough to get the job. And it was amazing because within the first three months of working at Vets Now I had huge support. I didn't work on my own or anything like that. I worked with another nurse and she mentored me as to what I would expect overnight. And if something came in and I wasn't too sure of it, she would be there for all my questions and to give me any advice and things like that.
And I really felt going down the pathway of emergency and critical care really would expand my knowledge in nursing as well. And yeah, to be honest it's been absolutely amazing. The things I've learned, some of the things I've seen, it's just been incredible. And the opportunities it's also opened up for me has been amazing as well.
Yeah, that's really good to hear. It's really good to hear somebody who's chosen that career pathway and knows it's the right choice and is really enjoying it. It's fabulous.
What is the best part of your role
So we've had a rundown of a typical day and the variety of things that you do in that typical day or night. Tell me what you think is the best part of your role as an emergency nurse.
So I love seeing the case, say a patient come in really quite unwell—and obviously I don't love seeing that—but when they come in and they're quite unwell and you are able to really support and care for them through the night, whether that's through medical nursing or surgical nursing. And then by the morning they are actually able to walk out of the hospital a lot better, whether it's through caesarean or something like that. I find caesareans super rewarding because obviously you get all the lovely puppies and kittens at the end of it, so I find that a very rewarding surgery to do. But also a GDV or something like that, just seeing the patients come in so, so poorly...
Just give everybody a very brief overview of what a GDV is in case they don't know, because there might be people watching this who aren't veterinary nurses or veterinary surgeons.
So GDV, it's mainly seen in larger breed dogs, but we have actually seen it in smaller breed dogs and also some cats have potentially had a GDV as well. So it can be seen across a lot of species but mainly in those larger breed dogs. And it's unfortunately where the stomach gets quite dilated with either food or air, and then unfortunately the stomach is dilated and then it twists and causes an obstruction. So they are then not able to expel the air and their stomach dilates and dilates and dilates and there's no way of getting rid of any of the air...
And it really is a life-threatening condition isn't it?
Yeah, because there's a lot of other things that can go into it. It affects the circulatory system and things like that, so they can go into shock and things like that. So it really is, it's not a case of just going in, doing the surgery and they're better. It's actually a case of stabilising them, make sure that their vital signs are better before going into surgery and things like that.
And I'm guessing that as a veterinary nurse caring for a patient like that, you have a really big involvement in their care during that process.
Oh yeah, massively, massively. And I'm very lucky that the vets that I work with are very good. If I feel that the patient would benefit from a different medication or if under anaesthetic the ECG's changed or something like that, the vets really rely on the nurses telling them and asking them 'oh maybe if we've done this, the patient might benefit from...' So yeah, it's really good.
Yeah, I think it's really important that nurses are able, feel able to, and are listened to in having that clinical input to cases because we get really close to our patients don't we? We really know what's going on with them. We've talked a lot to their owners as well and that can have a big impact as well can't it?
Yeah, definitely, definitely.
What is the worst part of your role
So we looked at the best part, which is really looking after those patients, seeing them going from maybe a life-threatening or certainly very uncomfortable situation to walking out the door with their owners. What do you think is the worst part of your job? What are the things that you find the most challenging or upsetting?
Sometimes it is the other way with patients coming in being severely, severely poorly and not seeing those cases through because obviously we are just open overnight. And unfortunately some patients don't bounce back within that 15 hour period. So sometimes it's the not knowing of what's happened or how they've got on the following day or something like that.
But I would say another big thing is obviously the cost of treatments and things like that. Some people aren't always prepared for the out of hours costs and things. And unfortunately the costs are there because obviously we are there working overnight and we have a lot of outgoings and we have to rent the building that we're in and things like that. So obviously the treatment costs and the consultations are priced higher than in the day, but there's very valid reasons for that. But unfortunately some people just aren't aware that obviously the costs are higher.
Yeah, it's one of the really difficult things isn't it about veterinary medicine, that conflict sometimes between wanting to do the best for the patient and then what that's going to cost and whether that owner can afford that with their current budget. It can be really difficult can't it?
Yeah. Both us in the profession and obviously for the pet owners too.
Key piece of advice
So if somebody was watching this and they really wanted to become an emergency and critical care nurse, what would your key piece of advice be to them? How's the best way they can get into that role?
I would say definitely, obviously obtaining a lot of experience in daytime practice, because I think having a good understanding of how a daytime practice works is key to also working in out of hours. Vets Now do a really amazing program called the Nursing Edge as well, which is available to newly qualified nurses and I think less experienced nurses as well that are willing to go down that pathway. And it's actually an eight-week course and they are in practice for part of the course, but also they go to the Vets Now support office in Dunfermline in Scotland and they are taught by lectures. They're actually taught by the nurses that work in the Vets Now practices. I'm actually going up to lecture in a couple of weeks time on surgical nursing. So I think that as well is quite an amazing thing because they are being taught by nurses that are actually physically working in practice and also have undergone what they're all going to go through.
And yeah, I would say that's probably one of the best ways to get into it. But if you're able to and you're confident enough to go and apply for a job in out of hours, then I would always say give it a go, have an open mind and just take everything as it comes. Because you will have some shifts that you think 'why have I done this, why have I got into this work', but then you have other shifts and you just think 'this is amazing, I couldn't think of doing anything else'.
Yeah, yeah, that's really good advice. Thanks Amy.
Future plans
So what plans do you have for the future? Have you got anything coming up? I mean you're thinking about doing the lecturing on this course which is fantastic. That's a great career opportunity for you I guess as well isn't it. But do you have any other future plans?
I mean I would really like to do a certificate in emergency and critical care just to further my knowledge more and have the credentials against my name as well. And that would be something I would love to do to help me and the patients that I help look after as well, because obviously medicine changes so often. So it'll be good just to keep up to date with everything. And I would just love to continue mentoring nurses and lecturing just to share my experiences as well. Because I think some people look at me and think 'oh she's only 26 and she's done quite a lot'. And I just think that sometimes I've gone into other jobs and they've been like 'she's only 26, she can't know this much'. But then people get to know me and actually realise that I've worked really hard in my career and it really does pay off.
Yeah, yeah, and you're a really good example of that.
Thank you.
Oh well done Amy. Thank you for speaking to us today. It's really interesting to hear some of your experiences and I'm sure people watching that might be interested in this career option, because I know a lot of people that are really interested in it but maybe don't know quite what the job entails or what the challenges might be or how they could best get into that. So I'm sure you've helped them out a lot with that. And we have other career case studies on the VN Futures website, so please do take a look and have a look at those—all sorts of different roles within the veterinary profession. But for now, thank you very much Amy and I'll speak to you soon.
Thank you.
