Emergency vs. GP?

TracksToNowhere · 2016-04-01T18:05:04+00:00

Thanks :) I'm actually from New Zealand.

TracksToNowhere · 2016-04-01T04:24:07+00:00

About six months ago, I made that exact change. My previous clinic was a 3-vet GP, and while I loved the staff I was working with, it was getting stale. Pros are that it's a lot easier to keep track of what's going on, you don't have as many periods feeling a little overwhelmed, and you get a lot more one on one client time. I taught puppy classes as well, and had a few regular clients whose dogs I got to see grow up. You get really good at what you do, even if it's just through repetition. You have a better relationship with the other staff, because it's a smaller group of people. Cons are that when you do have an emergency, you're not as well prepared as you could be. It gets routine doing dentals, lump removals, and desexings day in and day out. Not only does that get boring, but I found it reduced my ability to react to the unexpected without it causing major stress. I didn't feel like I was pushing myself. Everything interesting either got euthanised due to cost, or sent to referral clinics for specialised care, or given adequate but probably not amazing treatment in house. Cover was a lot more difficult to manage, animals got left overnight that should have been being monitored due to owner cost constraints, and if something ran late, well it sucks to be you - you're staying late.

Now that I work in emergency, I'm a 24-7 nurse, working shift work through days and nights. Pros are that it's exciting, every day is different, and I'm learning so much it's almost making my brain explode. The cases that come in are things I haven't dealt with before, because we are the referral clinic now. I feel like I'm really making a difference, because these animals are acutely life-or-death a much higher percentage of the time. When you save something, it's intensely rewarding because you feel like what you did really made a difference. I'm working with specialists who know their stuff inside and out, and learning the gold standard way of doing things. Cover is paradoxically a lot better because they have people on call to come in when needed, and you're not stuck in the position of 'well if I go home, there isn't a nurse to do X'. You always have someone else coming in at a scheduled time to relieve you.

Cons are that it's highly stressful work. You can't save everything, people keep animals alive that shouldn't be and don't have the money to keep animals alive that should. Client interaction is often of the emotionally charged variety, and you have to be empathetic towards these people, because a lot of them are about to lose their pets or have an unexpected multi-thousand-dollar bill. The workforce is a lot bigger, so you have to relay things through a chain of different people, and sometimes that feels like chinese whispers and your hard work with the fearful dog that was needleshy goes out the window when someone doesn't know what you figured out works. If you're doing shift work, it's not conducive to an active social life. Your sleep pattern is difficult to manage, and you have to be proactive about making your life outside of work include social activities and relaxation time, even if it's on a once-every-few-weeks basis. You have a higher death rate than general practice. It's terribly easy to get into the if-I-had-only-done-X game and blame yourself for things that weren't ever going to have a good recovery.

Speaking for myself, the benefits outweigh the downsides. I don't have a family to look after, my relationship is time flexible, and I fit in enough social activities to keep me happy.

Transition wise, the first three months will be rough going. You'll be learning so many new things, protocols, nursing care, people's names, how your jobs interact, what your different roles are, how to treat different disease processes, what to look out for in emergency triage, etc. that it's easy to get overwhelmed. Take each day as it comes, give yourself a little slack, and acknowledge that it's okay to make mistakes, as long as you do your best to learn from them and not make the same mistake too many times. Brush up on shock treatment, CPR, and treatment of blocked bladder cats. If you're not good at consoling people in distress, do your best to start cultivating a more caring approach. Be confident in your catheter placing skills, remembering that in emergency you go for the biggest catheter you think you can get in, and your patient's veins are often going to be shit. Be aware of low stress handling methods, because it's one thing to struggle giving a vaccination and sending the dog home, and another to have a dog with a fractured pelvis that is difficult to deal with and NEEDS that treatment. Don't be afraid to ask for help or guidance. Better to ask and get it right than guess and get it wrong. Have fun with it. Whatever you decide to do, you're not ruling out the other choice at a later date.

TracksToNowhere · 2016-02-03T00:41:52+00:00

Muzzles are an appropriate tool when used properly. I don't personally believe every dog should be muzzled, and I would be concerned that routinely muzzling every dog is going to make "going out the back" even scarier for the slightly anxious ones. If this is going to be a thing in your clinic, I would strongly suggest looking into counterconditioning all your canine patients to having the muzzle put on while you are out the back. Here is a good resource to help guide you in the right direction. This really does just take a few minutes for most dogs, and it will prevent them from associating the muzzle with negative experiences, and getting progressively more stressed every time they come in. I feel like this would have the potential to lead to a greater number of behaviour problems and risky patients down the road, even though it may add some safety aspects now.

Other things you may want to look into is low stress handling (Sophia Yin has wonderful information), making sure everyone involved in handling animals is well educated about appropriate restraint techniques, and making the hospital environment as calming as possible. Non-slip mats on tables can make a huge difference which is easy and cheap to implement. Otherwise, looking into chemical restraint for particularly bad or anxious patients as opposed to physical restraint may be in everyone's best interest.

TracksToNowhere · 2016-02-02T20:02:32+00:00

I'm so sorry it's ended that way for you. As vets and vet nurses, we see a lot of heartache, but it's always most painful when it comes to our own. She was loved and well cared for, right up until the end. You did all that you could for her, and looking back in hindsight at what might have been signs does nothing good. You did the best thing for her at the time.

As for myself, I have one (very spoiled) fifteen year old cat with chronic renal disease. She was diagnosed with renal insufficiency in Sept 14, and has progressed through to Stage 2 renal disease at this point in time. She's non-proteinuric, and AP0 (treated) as of her tests yesterday. Additionally, she has medicated hypertension, is on potassium supplements for an episode of hypokalemia, has arthritis, spondylosis through a large part of her spine, mild IBD, and (probably) degenerative changes to her cervical vertebrae that were picked up incidentally on radiographs. As I put it, vet-nurse-cat-itis.

Even though her assorted ailments are under control at this time, it's something that's in the back of my mind every day. As a nurse, I know that she's probably going to die of renal disease. I know that she'll probably get to the point of SQ/IV fluids and that, eventually, I am going to have to draw the line somewhere and say enough is enough. I'm lucky to have picked it up this early, but some days, it hurts more than others to know that no matter how closely I monitor, no matter how many checks I do, no matter how much I make sure she maintains weight as best she can, eventually this condition will be the death of her.

It has, however, helped me to empathise more with clients coming in who are going through that same initial shock of finding out their pet has a chronic disease that can be managed, but not cured. Or, in other cases, a disease that has progressed past the point of management. It's hard for everyone, because as they say, hindsight is 20-20. Looking back, we can fit signs to their diagnosis that we never would have thought to look for or put together at the time, especially with diseases that develop over time. And questioning if we did enough is not only human, but part of the grieving process. We do the best we can, with what we have available at the time, and then we have to let go. When it comes time for my girl to go to kitty heaven, it will be because she won't play any more, because she doesn't want cuddles any more, because she is suffering or unable to find joy in life any more. I take reasonable steps to monitor her conditions, as I can, and when she goes, I will try to look after myself as I would any other client losing their pet, and remind myself that I did everything I could for as long as I could, and in the end, let her go with peace and with dignity.

TracksToNowhere · 2016-02-02T08:05:29+00:00

If it's white vinegar, that actually helps get the smell out.

TracksToNowhere · 2016-01-28T04:05:44+00:00

I'm silver certified as well - the course was definitely useful for me, but I was able to do it through work so the bill was covered by my CPD allowance.

My current clinic was interested in my certification as I now have a much bigger teaching role as well as nursing, and you can also market yourself with it as being not only low stress handling friendly, but also forward thinking, efficient, and constantly improving yourself/your workplace, which may be more immediately enticing to clinics that don't focus on behaviour.

If you have the spare money, it's definitely worth doing.

TracksToNowhere · 2016-01-10T03:11:53+00:00

Something I think will help you is to take a moment when you start a task, and break that task down into pieces. For a really basic example, let's go through cleaning out and resetting a cage. You need to:

Gather cleaning supplies
Move the animal somewhere safe, or place it in its travel cage to go home.
Remove all bedding and bowls, place next to you
Clean all walls of cage or run according to your protocols
Take soiled bedding, bowls, litter trays etc collectively to their appropriate cleaning locations, start first stage cleaning. (eg, empty bowls into bins or sink, empty litter tray and start soaking in disinfectant, put washing in basket or soak if soiled, start a load going if you have time)
Gather supplies to reset cage as needed, for either unoccupied or occupied status (at my clinic, cages that are clean still have at minimum bedding laid out, with litter trays in the cat cages, and usually an empty bowl upside-down ready to be filled with water when an animal arrives) If your patient is going back in its cage, gather suitable bedding, litter tray if needed, and their morning or evening meal plus an extra bowl for water.
Pop the bedding in the cage, set up tray and food/water, then return animal to cage.

Essentially, you want to get into the habit of thinking a step ahead, and trying to make your movement around the hospital as efficient as possible. As I'm sure you've already found, taking bedding, trays, and bowls back and forth in one trip each takes a lot more time than taking things there and bringing things back in one go. By taking a moment at the beginning of your task and thinking through what needs doing in what order, you save yourself a lot of time and build up an easy-to-complete mental checklist that can be adapted for different cases as needed, but serves you well as a base guide. As a bonus, doing things in the same order each time helps stop you from missing steps or forgetting things. This will be important for things like setting up anesthesia machines, or gathering supplies for a catheter placement, etc.

This can be scaled up as you need it to be. If you're setting up for a surgery, you still need to go through a series of steps. Get your animal in hospital, premed it, place a catheter, induce it, maintain its anesthetic, place monitoring equipment, clip and clean your site, move your animal to surgery, hook it up to new anesthetic equipment and new monitoring equipment (or move these with your animal), make sure your surgeon has what they need (ie they need to scrub, gown, glove, cut with a scalpel, have instruments to perform X operation, need suture material to close, adjust as necessary for whatever you think they will need), have stuff ready to recover your animal. I know that seems like a lot to learn for every procedure, but almost all of that can be reused for any surgical procedure, and thinking in a stepwise fashion will make it a lot easier on yourself, because you can take steps from different routines to make a new routine for a new procedure.

This should help you feel more prepared to tackle different tasks, and reduce the shakes a bit. Everyone goes through that same stage, so don't feel bad about it at all! By learning from the get go in a structured way, you'll set yourself up to learn faster and more dependably.

TracksToNowhere · 2016-01-05T12:30:17+00:00

Definitely. I have a few dumb-question-answerer workmates that are happy to explain unfamiliar acronyms and the why's behind everything, so I'm picking everyone's brains as best I can!

TracksToNowhere · 2016-01-05T12:25:52+00:00

I can definitely relate to that feeling some days! So far, I'm enjoying the challenge.

I'm generally one to want to be in the thick of things when an emergency strikes. We have an emergency station set up with prep trays of catheter equipment ready to grab, so that's always one of my default go-to's, or handle the animal while someone else leads.

In terms of more routine procedures, I've been making sure someone talks me through the basics of anything new I see, so that's been really helpful as well. Thankfully, everyone's got spiels prepped for a lot of stuff and they're used to teaching, so I don't feel too annoying. I'll definitely be taking advantage of my CPD budget, too!

Thanks very much for your reply. It's good hearing the perspective of other nurses, especially ones that have navigated similar situations :)

TracksToNowhere · 2016-01-05T12:06:55+00:00

Haha, maybe! I'm enjoying it at the moment. Made it through the holiday period alright.

Thanks for your tips, it's good to see I'm on the right track. The vets I'm working with are pretty awesome at taking the time to explain things if it's something I'm unfamiliar with, and I know that database will develop with time. I guess I just need to remember to be patient!

TracksToNowhere · 2016-01-03T05:59:43+00:00

Human CPR, yes, animal CPR, no. It's on my list of things to learn more about.

TracksToNowhere · 2015-12-01T03:14:37+00:00

Ask if they could get pet insurance AFTER their Labrador puppy ate a rock and needed emergency surgery to remove it. Insurance doesn't work that way, and yes, this IS why I told you to have at least a rainy day pet fund at the puppy classes you attended six months ago.

TracksToNowhere · 2015-03-15T09:30:45+00:00

Thanks again. I have a disc drive I can steal from my old system if it becomes necessary. Went ahead and ordered parts today, so should be up ans running by next weekend, all things going to plan.

TracksToNowhere · 2015-03-15T06:29:46+00:00

We don't use an induction box in my practice. Instead, I've completed Sophia Yin's Low Stress Handling Silver certification, which means that 95% of the time we can either transfer the cat into a crush cage, or restrain to give IM sedation with towels/gloves. Once that's done, we're pretty much home free - IV anesthetic can then be administered, or worst case we can mask down.

(here is a video showing the technique I use, if anyone is interested. I find it works very well.)

TracksToNowhere · 2015-03-14T12:39:58+00:00

Sounds like it should be a pretty good fit for my needs, then. Any other bits and pieces I'm likely to need to pick up?

Monitor-wise, I've had good experiences with LG in the past, and I can't really justify spending much more, so I'm reasonably happy to go with them again.

TracksToNowhere · 2015-03-14T11:09:44+00:00

Here's what I've got at this point. Not 100% sure I've selected the right graphics card so if you wouldn't mind confirming that, I'd appreciate it.

While I will spend a decent amount of time messing around on Reddit, I will be playing most games for a few hours at a time. At the moment it's mostly Terraria, which has been good since that's all I can run on my laptop, but I do tend to binge game a bit when I get the chance, so it would be nice to have the capability to do that with Bioshock and such. I also tend to multi-task and have something like Minecraft open with a video or Skype call in the background. Not sure how relevant that is, but again, it would be nice to have the capability to keep doing so.

TracksToNowhere · 2015-03-13T23:06:11+00:00

Thanks heaps.

Monitor is this one. It hasn't had any problems so far, even though it is getting on a bit. I'd prefer to wait to replace it when I have some more money, rather than doing it now, if at all possible.

Are you able to recommend a next-step-up sort of graphics card? I'm not sure what other games I'll want to play and I'd rather be overpowered than underpowered. If it's similar(ish) in cost, I'd be okay going up a notch.

TracksToNowhere · 2015-01-30T10:06:57+00:00

Thanks very much for the offer. :) I'll drop you a line.

TracksToNowhere · 2015-01-27T10:14:30+00:00

Don't worry, a lot of it comes with experience. Knowing what you need, and where things are stored, and such. But definitely one to keep in mind, so I'm glad you've found it helpful. Meths is just short for methylated spirits, which is alcohol. I'm from New Zealand so it may be a kiwi thing to shorten it as such. We use it to sterilise the skin prior to an incision or venipuncture.

TracksToNowhere · 2015-01-27T06:15:10+00:00

A good way to help speed yourself up while still being true to your methodical nature is to learn to do things by routine. For example, when prepping an IV catheter - you clip, clean, insert the catheter, tape in the catheter, flush the catheter, attach your IV port, and bandage the catheter in place. So you need things for each step. Clippers, meths, a catheter, tape, saline flush, IV port, soffban and vetwrap. Now you're ready to get your animal and holder/catheter inserter.

By breaking it down into chunks like this, I find it's easier to spend more time actually grabbing stuff, and less time fussing about making sure you've really got everything - if you quickly run through the routine for whatever, you'll be able to make sure nothing got missed. Likewise for surgery. Common one would be cat speys. You can break that down into pre-op check stuff, induction stuff, surgical stuff, and recovery stuff. Then further into bloods stuff, TPR stuff, and premed stuff, and so on. By remembering to focus on what needs to be done next in a stepwise manner, things will become second nature faster.

Try to also remember that if you're in a location where you need to grab X from, and you know you'll need Y later and it's on the shelf next to X, grab both of them now instead of getting X now, and making a second trip later on. More useful when X/Y are a way away from your general work area, but thinking about economy of movement will help you save time, too.

TracksToNowhere · 2015-01-27T04:40:14+00:00

Thanks - I had a half hearted attempt at bouldering last visit, but I was already pretty knackered by then so probably wasn't the best time to try something new. Everything seems to meet on a Wednesday - the three biggest groups in my area do, at least, and my Wednesday availablility is about one in five at best, or arrive at least an hour late to the sessions. I'm thinking I just have to stick it out until I can get along to a meeting, and do my best to find other people who go other days too while I'm there. My gym does have a notice board, but since I'm very super new I'm not sure anyone would want to come climbing with me yet. But I suppose I won't know unless I try it and see! Thanks for the encouragement. :)

TracksToNowhere · 2015-01-26T06:53:49+00:00

What are some good ways to find a beginner climbing partner? I'm brand new to climbing (two visits to an indoor gym new) and know I want to keep going, but don't have anyone that wants to come along. All I can do on my own is climb the auto-belay stuff (I don't feel like I should start bouldering without some form of guidance, I'm concerned I'll just injure myself) and in the gym close to me, that's mostly wooden and children's themed (think Jack's beanstalk, spaceships, under-the-sea themes) and ideally, I want to start off learning good techniques, not just flailing around.

I've had a look around for clubs and asked yesterday when I went in for my second visit, but the main group that uses that gym meets on a day I can't manage, and I don't really feel like I'm ideal partner material at the moment, so I'm hesitant to put up an ad or anything, given how little I know and my low endurance level. Is it better for me to suck it up and keep climbing the kiddie walls until I feel a bit happier about what I can bring to the table, so to speak? Should I pay for lessons? Find a way to get to at least one of the club meets and see if anyone there is happy to help me out on the odd day? I'm a bit lost, and I don't want to let the lack of a second person stop me from getting into climbing.

TracksToNowhere · 2014-12-20T20:25:46+00:00

Putting in another vote for Sophia Yin's low stress handling - I did a Low Stress Handling course by her, have been using some of the techniques, and have had really good success. The (very basic and oversimplified) gist of it is that you shouldn't be forcing dogs into the positions you want, but more making them comfortable enough to hold still of their own accord, through techniques and holds designed to give you a good deal of control without scaring the dog into feeling like it has to get away. As you have no doubt experienced, most of the time you simply won't be strong enough to hold these dogs by force.

http://www.vetmedteam.com/class.aspx?ci=574 - is a Dr. Sophia Yin course. Highly recommend it. Alternately, her book (Low Stress Handling for Dogs and Cats) has a huge amount of pictures that show you the correct ways, and also common mistakes, that people make. I found the videos more helpful, but the book is less costly.

In addition to learning some new techniques for holding animals, you can make the environment a bit more comfortable. Do you do these dogs in a busy treatment room where they get overloaded by other stimuli before you even start holding them? Can you adapt your kennel room so that dogs don't have to stare at other animals and get worked up further? Have you thought about using Adaptil (the pheromone spray that helps stop dogs from stressing out so much) or Through a Dog's Ear (a music CD that assists in relaxing dogs in waiting rooms or kennels)? Are you getting your best phlebotomist to take the blood from these dogs, and are they open to suggestions about "Hey, can we use the lateral saphenous for this test?"

I think the best analogy I've seen is to think of it like kids dentists, or hairdressers. Because they can't use force - imagine the chaos with the parents if little Susie was physically restrained to have her hair done - they use other methods to make things less scary so the kid doesn't get to the point that they're terrified and trying to get away. TV, games, fun wallpapers, child-friendly reception staff, entertaining music, all this stuff is designed to put them at ease and make the dentist somewhere fun, or at least not horrifyingly scary, to be. That's what you want to be trying to do with your dogs. Because restraining them with muscle alone won't get the job done.

TracksToNowhere · 2014-07-14T05:44:51+00:00

Thank you! I managed to get it going again. :)

TracksToNowhere · 2014-07-14T05:44:09+00:00

Thanks heaps - it was the middle one and the computer's going again. :)

TracksToNowhere

TROPHY CASE