Explaining the role of Approved Veterinary Assistants

BigStock/eamesBot “Approved veterinary assistant;” what does this title mean? The veterinary field is full of abbreviations and acronyms setting apart the variety of skill sets necessary to care for the animal patients of the world. This relatively new designation was established in 2011 to highlight the benefits of North American Veterinary Technician Association (NAVTA)-level assistant training in veterinary facilities nationwide.1 There are currently 58 NAVTA-approved Veterinary Assistant Programs available in the United States that reach students from all walks of life. This can include high school co-op type programs, community college programs, as well as online programs.1 Due to the novelty of these programs, there tends to be confusion surrounding the differences between roles in a clinical setting—particularly around the responsibilities of an approved veterinary assistant versus the responsibilities of a credentialed veterinary technician. The confusion is exacerbated by a lack of public knowledge of veterinary team roles outside of receptionists and veterinarians. Approved veterinary assistant (AVA) vs. credentialed veterinary technician (CVT) (Note: this article uses CVT as the example, but it also applies to the other titles that vary, depending on the state of licensure.) The goal of NAVTA in creating this designation was to provide aid to credentialed vet techs and DVMs, while not encroaching on the medical knowledge and skills that those titles hold. The Center for Veterinary Technician Education (CVTEA) and NAVTA have outlined the specific tasks of each of these designations. There will be overlap of many of these responsibilities, but what sets the technician skills apart is the addition of response to medical emergencies and critical thinking sections. The chart above is a very generalized look into the areas of focus for both clinical roles. Additionally, there are several areas of overlap. The non-medical duties are quite similar from one role to the next. If these skills were the focus for an AVA, the CVT could focus on the medical procedures including: Collecting lab samples Monitoring patient anesthesia Patient physical exams Phlebotomy Placing IV catheters Recovering post-op patients Taking radiographs Treatments Triage Wound care CVTs have earned a medical license to practice; removing the nonitalicized skills from their day-to-day responsibilities provides them the freedom to do just that. There has been recent movement within the American Veterinary Medical Association (AVMA) for the proper utilization of CVTS, and they released the following quote to summarize it perfectly: ‘‘When we (DVMs) fully leverage or technician’s skills, we free up the veterinarians to spend more time using their advanced veterinary medical and specialty education to treat patients. The result? Technicians feel more challenged, satisfied, and valued at work. So do veterinarians, who are able to focus on the work that only they can do. And the practice operates more efficiently.”2 Utilizing each member of the veterinary healthcare team to their fullest potential creates a snowball effect that benefits everyone involved. CVTs are free to do what they do best, which, in turn, allows the doctors to do what they do best. They can actually sit down and complete medical records, have time to work up more intensive cases, and even return their clients’ phone calls without working excessively long hours and burning out. Each role is set in place for a smooth flow that will increase staff morale and satisfaction, as well as provide gold standard treatment and care for all patients that walk through the door. This is not to say that the skills perpetuated by an AVA are easy or mundane. The help these team members offer to a clinic are invaluable, particularly an AVA who has been through an accredited program and comes with a wealth of knowledge surrounding the day-to-day runnings of a functioning practice. Assistant students are made aware of the fact an AVA is not necessary at this point to work in a clinic. However, emphasis is placed on the importance of education and learning the “whys” behind everything they could find themselves responsible for. Students are also introduced to their responsibilities early on so there is no misconception about an AVA program being a veterinary technician program. Students who are successful in an AVA program truly have a passion to be a part of the veterinary medical team, but may not feel prepared or have any desire to gain credentialing as a technician. There are a percentage of students who utilize an AVA program as a stepping stone into a technician program, and many veterinary technician programs incorporate an AVA designation as an initial part of their program. These students will matriculate into a veterinary technician program with a base knowledge, setting them apart from other applicants. Non-traditional students looking for a career change and unsure what to do next are also a percentage of these AVA prospects. An AVA program is a relatively inexpensive way to discover if the veterinary medical field is a good fit for any individual who has aspirations of joining the veterinary medical profession in any capacity. Veterinary assistant programs In order to become an approved veterinary assistant, a student must graduate from one of the NAVTA-approved programs previously mentioned and sit for a 100-question certification examination. These programs are generally accelerated; average program length is one year or less. During a student’s time within an AVA program, they will learn the basics of medical terminology and anatomy before diving into an AVA’s role and contributions within the veterinary medical team. Each student must complete at least 100 hours of clinical externship at the end of their chosen program and are given a set list of both required and optional clinical skills that must be successfully supervised by a CVT or DVM. After completing didactic coursework and externship hours, students may sit for the AVA exam, which is a 100-question multiple-choice test, proctored by a CVT or a DVM to be completed within 150 minutes. Success is quantified by 75 questions answered correctly, or 75 percent. Once the examination is passed and the AVA designation achieved, the student is then responsible for continuing education (CE) credits to uphold and renew the designation each year. CE credits are determined at the state level. VetMedTeam,³ an online resource for technicians and assistants alike, has partnered with NAVTA to track this designation, as well as the CE hours that must be accrued for renewal. This is also a resource that can be used to search all active AVA designees. The details of successful AVA program completion are going to vary depending on the program itself. NAVTA does not provide step-by-step instructions for how an AVA program is to be run, instead they are responsible for monitoring the caliber of the curriculum being provided to the students. As the AVA designation becomes more recognizable within the field, the program requirements may change in favor of stricter rules, expectations, and student learning outcomes similar to an approved credentialed veterinary technician program. Even now, the essential skills list is being consistently reviewed and changed to better accommodate the needs of a thorough veterinary team. These AVA programs do tend to be diploma-type in nature, never culminating into a college degree. Once earned, the AVA designation is recognized by all states and requires a set number of continuing education hours to remain active. According to VetMedTeam, the designation is “currently for the U.S. and is nationwide.”3 AVA vs. CVT programs In comparison to the AVA examination previously discussed, the Veterinary Technician National Exam (VTNE) is a more rigorous and focuses heavily on medical treatment and care of patients. The bones of a veterinary technology curriculum follow the same path as the AVA, however, the students are taught in much greater detail and depth. VT students complete a longer program; generally two to four years, and complete the program with either an associate’s or bachelor’s degree. These students will complete a minimum of 240 clinical hours and their essential/optional skills list is more extensive. The focus of these clinical hours are going to vary as well; a prospective VT will focus on phlebotomy, medical care, anesthetic monitoring, all while learning the ins and outs of veterinary practice. A prospective assistant will focus more on the administrative and equipment maintenance and care, with a focus on patient restraint and basic clinical procedures such as ear cleanings and nail trims. This curriculum and program flow will be governed more closely by the accrediting body, and must follow more stringent requirements. The accrediting body for technician programs is the AVMA Center for Veterinary Education Accreditation (AVMA-CVTEA). The VTNE consists of 170 multiple choice questions, and candidates are provided three hours to complete the examination. The ultimate scoring of this exam is based on an algorithm set by the AVMA: The gross score is converted into a number between 200 and 800, with 425 being the minimum score necessary to pass. The questions focus on the information gained during the student’s time in a veterinary technology program, but also on critical thinking skills, applying the medical knowledge to medical cases and decision-making within the legal bounds of a CVT. The AVA is much less focused on the medical aspects of the veterinary field, focusing more on equipment identification, including nail trimmers, examination equipment, surgical instruments, and anesthetic monitoring equipment. Also included is basic care and maintenance of said equipment and the process of animal restraint, both compliant and non-compliant. There is no algorithm associated with this exam; the percentage is determined based on a score out of 100 available points. Both the VTNE and the AVA exam lend proof the individuals who successfully complete them are more than able to function within a veterinary healthcare team with the necessary depth of knowledge for their position. They now contain the knowledge and hands-on experience to become an integral part of the team and the knowledge also provides a basis for continuing growth and development in the field. The veterinary medical field grows and progresses fairly quickly, these students are able to accommodate and adapt to the changes. Roles comparison According to PennWest California, the role of a CVT is to assist the veterinarian in a wide array of tasks- equating the role to a registered nurse in the human medical field.4 These tasks include medical/imaging procedures, anesthetic monitoring, and overall patient care. The role of an AVA is to assist the technician with these tasks—setting up supplies, running laboratory tests, assisting in physical exams, maintaining surgical and medical equipment. This could easily be equated to the role of a certified nurse assistant (CNA) in the human medical field. A CVT leaves their schooling with a wealth of knowledge concerning the medical health of their patients, but their knowledge is often underutilized because they are filling roles that an AVA can easily accommodate. In the summarized skills below, it becomes apparent there are tasks an AVA is able to complete, freeing up a credentialed veterinary technician to focus on more in-depth patient care. Employing AVAs will improve clinic efficiency when each role is able to function to their full potential. How is efficiency increased? The biggest benefit of proper utilization of all veterinary team members based on their education is employee retention. Happy, fulfilled employees are going to have the desire to stay within the practice. Currently, the turnover rate in a general practice veterinary clinic is 23 percent for the care team as a whole.5 A fully staffed clinic gives the team reasonable working hours, a work-life balance, and the ability to use earned vacation time without the inherent guilt of leaving co-workers in a bind. Retaining good employees will also foster time management, as onboarding training will not need to continually occur. Time and effort can be invested into current employees to encourage further growth and team work. As veterinary professionals, we know it is hard to wake up and go into work each day when feeling underappreciated and overworked. A constant revolving door of employees is not going to prove at all helpful, and the hiring reputation of a clinic will suffer. Word of mouth reputation can make or break a clinic. The goal should be for the turnover rate to fall below the 23 percent reported by the American Animal Hospital Association (AAHA). Employee retention and maintaining the non-DVM staff members will ultimately lead to an increase in the number of appointments and surgical procedures that can be completed each day. This will also affect the amount of time the DVM can spend with each of their clients and patients. According to the National Library of Medicine, there is a correlation to the number of non-DVM staff employed per DVM in regards to maintaining appropriate efficiency levels within the facility. The information in the study utilized does not break down the roles, but the point still remains.⁶ As responsibilities are allocated in a logical manner based on the knowledge and education of the staff, practices are able to accommodate more patients through “increased booking, better use of time, and increased efficiency.”⁶ Larger numbers of staff can also mean more management, but if the oversight is there, the practice will benefit. The study found a ratio of about four non-DVM staff per DVM will greatly increase efficiency for large, busy practices.⁶(This study focused on receptionists, veterinary assistants, and credentialed technicians, but it does require a strong team to make each interaction a success.) Increasing the number of staff does require revenue that is able to sustain the staff salaries, bonuses, raises, and more. We all know customer satisfaction and loyalty drives the day-to-day practices of a functioning veterinary clinic. Overall, this is what will raise that revenue, but how do we ensure clients have the best experience, keep coming back for more, and recommending the clinics to their family members and friends? The answer is smooth, efficient appointments and interactions.⁷ If the care team presents itself as calm, cool, and collected, all while addressing the client’s concerns and offering the best possible care, this will foster that loyalty. These interactions will occur more frequently when the veterinary healthcare team is happy and fulfilled. Example scenario You may be wondering, “What does this look like?” or, “What is the flow of a day in the life of a veterinary clinic?” From the moment a patient steps into the lobby or waiting area of a clinic, veterinary assistants and veterinary technicians will work together to make the patient’s visit as smooth as possible. Here is a case study, of sorts: A seven-month-old great Pyrenees puppy comes in for an ovariohysterectomy procedure. She has been seen previously by the DVM and has been cleared for the surgery. The owners had originally declined pre-op bloodwork, but changed their minds this morning. The veterinary assistant can gather the patient and her owners from the lobby, place them into an examination room and begin to record vital signs; body weight, heart rate, respiratory rate, and body temperature. Once this is complete, the veterinary technician can grab the necessary blood sample for pre-op blood work and begin to talk to the client more about the surgical procedure, and address any questions and concerns the owners may have about the anesthesia process and/or the procedure itself. The assistant can take the blood samples and start them running on the in-house lab machines. The patient may be examined by the doctor at this point as well, if necessary. During the pre-op exam, the assistant can begin to setup for anesthesia and surgery (IV catheter supplies, intubation supplies, warming devices, clippers, scrub, surgery packs, sterile gloves, sterile gowns, anything that may be necessary for this procedure to occur). The doctor will calculate or approve anesthetic drug doses. These may be completed by a technician, and the technician and assistant will once again work together, the assistant adequately restraining the animal, and the technician administering the medications. Restraint will then become a large responsibility for the assistant; they will know how to safely restrain the patient for her IV catheter, intubation, and surgical prep and shave. Working together, these roles will move the patient into surgery and secure her to the table, connecting any monitoring devices. Once the patient is secured and the DVM can begin the procedure, the technician’s focus will switch to closely monitoring the surgical patient and the assistant can step back out to reset the preparation area for the next surgery. This flow will allow for a level of efficiency in surgery that would be difficult to achieve otherwise. A surgical patient should come off of the table, and another prepped patient should be ready to take their place once the surgery suite is reset. Veterinary assistants are taught to properly monitor a recovery patient once the ET tube has been removed. This will allow for the technician to prepare for their next surgery patient, or to prepare for their exam rooms. Any variation of this type of flow will ensure each animal care team member is performing their role to their level of knowledge and skill, as well as ensuring patients remain the top priority throughout their stay in the clinic. The dynamics may vary depending on the case that is presenting to a clinic, but the overall concept and flow of efficiency should run somewhat similarly to this. This would apply to vaccine appointments, injury and wound appointments, illness and contagious disease appointments. As mentioned above, the AVA designation has only been recently introduced into the veterinary healthcare team, but as programs become approved and more graduates successfully complete the certification exam, the demand for these graduates will increase. According to the U.S. Bureau of Labor Statistics, “Employment of veterinary assistants and laboratory animal caretakers is projected to grow 19 percent from 2021 to 2031, much faster than the average for all occupations.”8 Conclusion The growth of the AVA role on a veterinary healthcare team is going to be somewhat dependent on the DVMs and hiring managers in the field. Recognizing what these competent, educated AVAs add to the team, and utilizing all team members to their fullest potential, will prove to be a wonderful advertisement, not only for a practice, but also for these approved assistant programs. Bethany Gabrie, LVMTg, MBA, is a credentialed veterinary technician with 10 years of veterinary clinical experience and seven years of technical education experience in veterinary, technician, and assisting school programs. She graduated with associates and bachelors degrees from Morehead State University in 2012 and 2014; she also earned her master’s degree in business administration from Lincoln Memorial University in 2018. She is currently the program director for a veterinary assisting program in southern Indiana. References Approved Veterinary Assistant Committee. North American Veterinary Technician Association. https://navta.net/volunteer-opportunities/approved-veterinary-assistant-committee/ How empowering veterinary technicians supports practice success. American Veterinary Medical Association. https://www.avma.org/resources-tools/how-empowering-veterinary-technicians-supports-practice-success What is the approved veterinary assistant designation?. Vet Med Team. https://www.vetmedteam.com/library/va-ava/ava-master-folder/ava-website-docs/what-is-the-ava-may2019.pdf What does a vet tech do?. PennWest California. https://www.calu.edu/academics/undergraduate/associate/veterinary-technology/what-does-a-vet-tech-do.aspx Rose, Rebecca. Does your practice have a turnover problem?. American Animal Hospital Association. https://www.aaha.org/publications/newstat/articles/2021-04/does-your-practice-have-a-turnover-problem/ Osborne, Darren & Richardson, Frank. Non-DVM staff: Doing more with more. National Library of Medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1624915/#b1-cvj47pg1125 Gautier, Kate; Tiffani, Bova; Chen, Kexin; Munasinghe, Lalith. Research: How employee experience impacts your bottom line. Harvard Business Review. https://hbr.org/2022/03/research-how-employee-experience-impacts-your-bottom-line Veterinary Assistants and Laboratory Animal Caretakers. Occupational Outlook Handbook. https://www.bls.gov/ooh/healthcare/veterinary-assistants-and-laboratory-animal-caretakers.htm#tab-6

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Explaining the role of Approved Veterinary Assistants

Learn more about the tasks behind the title and how they can help your clinic

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