Veterinary Nurse Initiative faces an uphill battle
October 31, 2018
Updated Nov. 7, 2018
Two years ago, the National Association of Veterinary Technicians in America formed the Veterinary Nurse Initiative coalition. Its purpose is to unite the profession under a single title—registered veterinary nurse—and push for uniform credentialing requirements and a uniform definition of scope of practice. Currently, a dozen states do not specify duties veterinary technicians can perform.
What's more, states may certify, register, or license veterinary technicians, or they may not recognize veterinary technicians at all. Eleven states privately credential via their state VMA or veterinary technician association, and in each of those states, credentialing is not mandatory. Utah is the only state that does not have any provisions for credentialing veterinary technicians. Of those states that do regulate veterinary technicians, most require successful completion of the Veterinary Technician National Exam; however, several states allow alternatives. Some states may also require a jurisprudence examination; others do not.
Such varying credential requirements have made it difficult for veterinary technicians to become credentialed in more than one state. In addition, there's no means of reporting a noncredentialed technician passing for a credentialed one in certain states, said Heather Prendergast, one of the leaders of the initiative. She presented at this year's Banfield Summit, held Sept. 10-11, in Portland, Oregon, which focused on the Veterinary Nurse Initiative for its theme.
"What we have in the industry is anyone is a vet tech. ... Sometimes there is no protection for using that term, so to the clients, of course, they think we are all on-the-job trained. We don't elevate those who are credentialed or give them more to do over assistants," Prendergast said. "Why do we do it? Because it's the way we practiced medicine decades ago. We still manage that way, and we still teach that way." (See story, "Prime issue for veterinary technicians: Underutilization.")
Through standardization and increased public awareness of the credentials of registered veterinary nurse, "the profession will make strides towards better recognition, mobility and elevated practice standards, leading to better patient care and consumer protection," according to the initiative's website.
The VNI's initial focus has been to introduce the name change to veterinary nurse—arguably the most contentious part of the effort. Doing so has resulted in strong pushback from nurses, while the veterinary profession takes a wait-and-see approach.
Early this year, the VNI pursued amendments to veterinary practice acts in Tennessee and Ohio that would establish the professional title of registered veterinary nurse. No other changes to the practice acts were needed because scope-of-practice definitions and credentialing requirements were already in place. The hope was that Tennessee and Ohio would be model states for the rest to follow.
In Tennessee, HB 2288/SB 2154 was introduced on Jan. 31, but it was never scheduled for a vote during the short legislative session. The initiative had the support of the Tennessee Veterinary Technicians Association, Lincoln Memorial University, and the University of Tennessee. The Tennessee VMA took a neutral position on the title change.
In Ohio, HB 501 was introduced on Feb. 13. The state House Agriculture and Rural Development Committee voted 14-1 in favor this spring, but the bill didn't advance before the legislature went on recess. The Ohio Association of Veterinary Technicians and Ohio VMA have come out in support of the initiative. Work will resume on pushing the bill forward later this year, said Ken Yagi, co-leader of the VNI. It will likely be reintroduced in 2019.
Both bills saw fierce opposition from the state nurses associations. Brian Burger, president of the Ohio Nurses Association, testified before the agriculture committee in late March that the title "nurse" has always been linked to the care of humans. Instead, he suggested, "Perhaps the title 'veterinary practitioner' would offer a solution to title confusion, without using another profession's well-established title." In the veterinary profession, however, the term "practitioner" means a veterinarian in practice.
What nurses say:
"We are not suggesting any pet owner will confuse a staff member in a veterinary clinic or hospital as a human health care practitioner. The issue at hand is the title 'nurse' and the connotations and respect that come with that title."
-Janet Haebler, senior associate director of policy and state government affairs for the American Nurses Association
What veterinary technicians say:
"To quote a section of the oath we all take once we as technicians graduate: 'I solemnly dedicate myself to aiding animals and society by providing excellent care and services for animals, by alleviating animal suffering, and promoting public health.' Human nurses are not the only profession that carries compassion, healing, holistic approach, and the desire to alleviate suffering."
-Ginny Nystrom, president of the Tennessee Veterinary Technicians Association
The Tennessee Nurses Association said it believes the Veterinary Nurse Initiative would undermine the title "nurse" and said it believes in "transparency of those who provide care for human beings and those who care for other forms of life."
Ginny Nystrom, president of the Tennessee Veterinary Technicians Association, wrote in a letter to members: "To quote a section of the oath we all take once we as technicians graduate: 'I solemnly dedicate myself to aiding animals and society by providing excellent care and services for animals, by alleviating animal suffering, and promoting public health.' Human nurses are not the only profession that carries compassion, healing, holistic approach, and the desire to alleviate suffering."
The VNI hopes to pursue the name change to veterinary nurse in a handful of states in 2019, including Ohio and Tennessee, though organizers will make a final decision after the November elections. Indiana is also a likely candidate. VNI leaders have contacted Indiana veterinary and veterinary technician organizations ahead of next year's legislative session, which begins in January.
The Indiana VMA board of directors discussed the initiative at its September meeting and sent a recommendation to its Legislative Working Group to investigate a road map to advance this concept in Indiana, said Lisa A. Perius, executive director of the IVMA. The association has not issued a position statement; nor has the Indiana Veterinary Technician Association.
To continue, the VNI will need more money. NAVTA started collecting money in 2017 for the initiative's legislative efforts, separate from the association's funds, and the VNI task force has raised additional funds, ensuring NAVTA membership dues were not used to fund the initiative.
"NAVTA has funded (the VNI) as far as it could; it only had so much in the treasury up to this point. We have had outside sponsors, but we cannot go any further. At best, we can still do one or two states. We should do five or six states ... but it's a question of funding," said Mark Cushing, legislative strategist for the VNI. "The initiative needs $250,000 per year, or about $50,000 to $70,000 per state."
Questions and concerns
Janet Haebler, senior associate director of policy and state government affairs for the American Nurses Association, confirmed to JAVMA News that NAVTA approached the ANA about the name change to veterinary nurse in 2015 after a referral from the National Council of State Boards of Nursing. NAVTA asked the ANA last year for an official statement endorsing the change, which the ANA declined to make.
The ANA has stated that while it encourages the efforts of veterinary technicians to standardize their education and licensure, it opposes the title change.
"We are not suggesting any pet owner will confuse a staff member in a veterinary clinic or hospital as a human health care practitioner. The issue at hand is the title 'nurse' and the connotations and respect that come with that title," Haebler said.
Australia and the U.K. already use the title "veterinary nurse," but Lizzie Lockett, executive director of the Royal College of Veterinary Surgeons, the veterinary licensing body for the U.K., cautions that switching to the title "veterinary nurse" may not be a panacea for all of the issues facing veterinary technicians, especially those related to recognition and value.
"We have had the title 'veterinary nurse' for many decades in the U.K. now, but we know that the level of professionalism our nursing team has—and the skills and knowledge they possess—remains undervalued by both the public and the veterinary profession," she said.
The RCVS is trying to address the issue with its VN Futures project to promote reward, recognition, and retention within the technician profession.
"This does not mean I am not supportive of the U.S. profession moving in whichever direction they feel most suits their ambitions, but just to stress that education around the role and value of the profession will need to continue," Lockett said.
Deborah B. Reeder, executive director of the American Association of Equine Veterinary Technicians and Assistants, says the direction for the VNI has veered off course as it has yet to address national credentialing requirements or better professional recognition—both of which her organization supports.
Reeder says the VNI should be a concrete package that veterinary technicians can get behind rather than focusing on changing the name to veterinary nurse, which she estimates could take at least a decade and an exorbitant amount of money. She points to the tens of thousands of dollars already spent on two states, with little to show for it.
"It's become extremely frustrating and extremely divisive now, which is very unfortunate. What this all started for was more recognition. We're putting the cart before the horse. We need to educate first," Reeder said.
She points to Canada, which uses the term "registered veterinary technician," as a country that does a good job promoting that segment of the profession by educating the public about its role.
"The governing bodies have stood behind this, and they are truly supporting the title and the profession and what those people do. That's something we should model. They don't do it just during Veterinary Technician Week, but all year long," Reeder said.
She also fears that having the ANA as an opponent, not an ally, in veterinary technicians' fight for better recognition and standards will not bode well. Reeder is speaking from experience. Twenty years ago, she worked on a project to change the name "veterinary technician" to "veterinary nurse" in Texas. She recalls bringing the dictionary to the state senate hearing to point out that the definition of nursing didn't say human medicine only. But ultimately the power of the nurses associations proved to be too much.
"You can't fight and win a battle against the ANA. (Veterinary technicians) don't have that structure or foundation," she said.
Wait and see
The VNI has so far gained 32 sponsors and supporters, including 17 position statements of support.
A few entities have switched to the title "veterinary nurse" in award names or adopted the new title, including Purdue University's veterinary technology program, which has now become its veterinary nursing program.
The NAVTA executive board itself has decided to not change the name of its organization until legislative changes have actually taken place. "We believe the VNI is a solution to several of the profession's issues, but we also realize that legislation moves very slowly and at its own pace. We do have plans to make changes as soon as it is practical," said Mary Berg, NAVTA immediate past president.
Indeed, the initiative has generated widespread discussion, but the majority of organizations have not yet formulated a position statement on the issue. That's according to a survey of its members the Veterinary Medical Association Executives conducted in early October. Of the 46 respondents—about 40 percent of the membership—40 represent state VMAs, three represent local VMAs, and three represent allied or national organizations. The responses were as follows:
The boards of directors at 32 organizations (70 percent of respondents) have had discussions about the Veterinary Nurse Initiative. Another three organizations (6 percent) have the topic slated on agendas for imminent discussion. The remaining 11 organizations (24 percent) have not discussed the VNI.
In regard to determining a position on the issue, 35 organizations (76 percent) have not determined a position, while 11 organizations (24 percent) have determined a position. The positions reported include support, neutral, and opposed—with many of the responses reflecting nuanced positions (eg, supporting a uniform basis for credentialing while not endorsing use of the term "veterinary nurse"). Of the 11 organizations that have determined a position, eight are in support (of some or all components of the VNI), two are neutral, and one is opposed.
The AVMA is one of the organizations that is backing the campaign to standardize the credentials, scope of practice, and title for U.S. veterinary technicians. But the AVMA Board of Directors voted a year ago to remain neutral on a campaign goal that the title should be "registered veterinary nurse."
At the Banfield Summit, Dr. Janet Donlin, AVMA CEO, highlighted the need for a professionwide dialogue about the value of credentialing veterinary technicians, particularly in light of concerns voiced by the Federal Trade Commission and some states about finding less-restrictive alternatives to occupational licensing requirements.
In August, the AVMA, American Association of Veterinary State Boards, Association of American Veterinary Medical Colleges, and NAVTA released a joint statement of support for licensing requirements as an essential component of protecting public health and safety. Together, these groups are working to standardize and improve licensure standards for veterinarians and veterinary technicians.
The Federal Trade Commission and several states are increasingly reviewing occupational licensure requirements in order to decrease barriers to entry into trades and professions, Dr. Donlin said. Strict requirements for licensure to join a trade or profession have been viewed by the FTC as a driver of higher costs for consumers without countervailing benefits. Against this backdrop, the AVMA and NAVTA agree that the public would be better served if all 50 states required credentialing for veterinary technicians, she said.
Prendergast acknowledges that the initiative seeks to do a lot, and pushing it all through won't come easy.
"We have people saying change isn't happening fast enough. There are going to be some states that will be easier than others, and then there's Utah, where vet techs aren't in the practice act. So it's going to be several years, absolutely. We have 50 states we have to work in; it's not going to happen overnight. That's OK. We'll have long-term success."