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Saturday, January 10, 2009

Controversy Week: Nurse Clients

Ready for me to get myself into really hot water? I'm about to tell you the type of client that veterinarians dread most. Nurses. Human nurses.

Once again, keep in mind that I'm generalizing. I have had some nurses that are great clients. I have nurses in my family. And one of my receptionists is currently in school to become a nurse. Unfortunately, the good ones are the minority.

Nurses are just about the worst kind of client vets see, and you can ask any vet about that. I have had more problems and arguments with nurses than with any other type of client. They seem to think that because they know a lot about human medicine that they know as much or more about animal medicine. They question a vet's judgment and diagnosis, argue on the necessity of basic tests, make their own decisions about which medications to use, and generally make life difficult. There is a certain arrogance in they way the talk to you and expect to know as much or more than the vet. I know I'm not the only one with this opinion, as I have yet to find a vet or veterinary staff in 11 years that doesn't agree.

Remember my receptionist who is a nursing student? I asked her about it yesterday, and she shares the opinion. She said that this is even a problem in human hospitals, and they put notes on the medical directors that the client's relative is a nurse. In the hospitals nurses will argue with the doctors and even change their orders. I was recently speaking to another vet who's brother is a nurse, and she agreed. She said that he was a horrible veterinary client, making his own diagnoses and choosing his own treatment, even if his sister the vet disagreed.

I wish I could tell you why this happens. Nurses are highly skilled, intelligent, and necessary people. Doctors would be in trouble without them, and they serve a crucial need in the human health field. They are very important to our health and well-being, and have chosen a very difficult profession that requires a lot of patience of compassion and is often thankless. Perhaps knowing that we need them and knowing that they are great with medicine creates a degree of arrogance. Maybe such strong will and opinion is necessary as a defense mechanism for dealing with their own difficult clients and patients.

To any nurses reading this, please realize that neither I nor my colleagues hate you as people. We just wish you would realize that vets are not second-class doctors. We have gone into this profession by choice, and not because we couldn't get into a human medical school. We also wish you would realize that animals are not people, and do not have the same anatomies or physiologies. You can't take the same knowledge about human medicine and make direct correlations to animals. Please realize that your knowledge in your profession doesn't extend to your pets. Vets really are trying to do the best thing for your dogs and cats, and really do know more about their health than you do.

And honestly, please chill out and take the chip off your shoulder!


  1. OUCH!! I am one of those dreaded nurse-clients. I have been an ER nurse for more than 25 years, and for the last 3 years, I have also been a volunteer surgical nurse/treatment tech/veterinary assistant at a severely understaffed and under-funded shelter. I assist with spays and neuters as well as the emergency surgeries we do, including amputations, eye enucleations, wound debridements, and whatever else comes through the door (or hits the fan, as it were). I prep and recover the animals, give vaccines and antibiotics, dress wounds, apply splints, administer fluids, monitor anesthesia, draw bloods for testing, start IV's when necessary, and generally do whatever is needed (all under direct vet supervision, of course). I also foster animals at my home that need ongoing care and treatments until they are ready to be placed up for adoption.

    With my own animals (2 dogs, 4 cats), I try not to be too much of a pain in the @$$, but I do try to ask informed questions and (hopefully) intelligently discuss options. I have never considered my knowledge to be superior to that of my (very trusted) vet, but as the person who knows my animals best, I am their "voice". I feel it is my duty to share what information I can to do whatever is in their best interest, in partnership with my vet. I have never considered vets to be second-class doctors; rather the opposite, as their patients cannot tell them directly what ails them.

    After this post, I will probably always hesitate before I volunteer any information, so as not to be thought to be one of those overbearing, nightmare nurse-clients.

  2. You're definitely not the kind of nurse client I'm talking about. In fact, I wish I had more with your experience and attitude! But you have a different perspective, having actually worked in the veterinary field.

    I am fully supportive of all of my clients asking questions about their pets' care. I've always felt that if I can't give a good rationale for my recommendations, I shouldn't be making them. But there's a difference between honest and respectful questions, and ones where the client has already made up their mind before asking.

    I also realize that my comments don't extend to all nurses. Just yesterday I had a nurse client who was great, and followed my recommendations. I also like some of my human medical clients, as I can talk to them on a different level than the average layperson.

    If you're respectful of your vets and listen to their recommendations you won't be thought of as overbearing. We do treat everyone individually, and have difficult clients of every profession. However, it seems that of our problem clients, nurses are overrepresented. I was also surprised when my receptionist bluntly said that the arrogant attitude extended to hospitals. As a nursing student who also has worked in veterinary medicine for almost 3 years, she completely agreed with me.

    Ask the vets and veterinary staff you work with about this, and you'll likely find my comments agreed with. I've seen this hold true among all vets and staff I've known in 11 years and 5 states.

    See...."Controversy Week"

  3. My brother is like this, and he's a nurse. Maybe nursing just draws people like this? Like how a lot of human doctors are insufferably arrogant?

  4. I'm a critical care nurse. I am with my patients for 12 hours. The doctor may see them for 5 minutes, if that long. Without the input of nurses in the hospital, many patients would be in sad shape. We have to tell the doctors what is going on with their patients and keep them advised of any changes in their status. If an order is "changed" it's because we are fixing a major fooba and it is usually appreciated. Of course, these change orders are verified beforehand with the doctor at 3am ;). We have to look up medications, know and understand what we are giving, watch for adverse effects, and verify the correct dosage. Our license is at stake just as much as the doctors. We can get sued, too. I, like others in health care didn't get into the business to hurt anyone.
    I have turned down cortisones for my dog as I do not like putting my animal on long term steriods when I could treat skin inflammation topically with aloe/oatmeal baths and maybe a little benadryl for severe itching. Does it make me bad that I don't want my dog to have steroids if I can avoid it? My vet had no problem with it. And my dog got past his itchy spell and doesn't require anything except his (yay!) new oral flea control. I would have gone back to the vet and got the steroids had the baths and other not worked.
    I also had a dog with CHF that was managed with lasix and enalapril. My vet kept him going another 3 years after he was diagnosed.
    I'm totally awed by my vet. He has to figure out whats going on from without the animals telling him "it hurts here when I do this". I most certainly don't believe vets are not second class doctors. I'll bet if you could do a secret poll, you would find those "pushy, opinionated" nurses don't think so either. Many elderly patients will talk to the nurse and not say a word to the doctor. We have to pass this information on. Many nurses are used to having to nudge doctors to get their needed orders. I think you just been nudged. Don't take offense; none was intended.


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