Dr. Yvonne and Dr. Lucy are two emergency vets that have created FlexiVet, a veterinary CPR training service. Dr. Yvonne is Dutch and she worked in both the UK and Australia in general practice and now for many years in emergency. She has her ECC Memberships and she working part-time in emergency and now teaching.

Dr. Lucy is English, graduated in the UK, and worked in the UK and Australia. She started working emergency in 2013 where she met Dr. Yvonne. She also has her ECC Memberships and both Dr. Yvonne and Dr. Lucy have performed the RECOVER Initiative, and they have now created FlexiVet to help veterinary teams across Australia to not only save the lives of their patients, but even more importantly be confident when an arrest occurs and be able to act in a way that leaves the staff and team feeling they did everything they could have, instead of any feels of guilt, helplessness, or despair that often follows the death of a patient.

Both Dr. Yvonne and Dr. Lucy work clinically part time, and this is a discussion Dr. Ann has had with them before. “Definitely the only way forward for me was part-time” Dr. Yvonne says, in regards to working shift work and overnights. After a few years the body can’t really handle it anymore. For Dr. Yvonne two 12hr shifts that end at 3am are the limit in terms of her physical and mental health. Dr. Yvonne shares that she sees the same pattern in the young emergency vets that come through, and “it affects you more than you realize.” She stresses the importance of having a good work-life balance, and trying to create a schedule that is both finically feasible but also attainable long term.

Dr. Lucy did full-time nights for 3 years, so is no stranger to working the hard shifts either. She loves the night-time job and the work, and initially she slept very well. Over time however her sleep quality dropped, and by the end of the week she was “bitter and twisted” and “not that nice of a person.”

Dr. Lucy expresses that in emergency, especially referral centres, the cases are all difficult, stressful and emotionally charged. The clients are stressed and emotionally draining, and on-top of this you are working shifts, nights and undesirable hours. Therefore, every hour of work is more mentally draining than a typical hour in day-shift general practice, where you still have the difficult cases, but you also have some less stressful vaccine appointments to break up the tension.

This leads to a situation where full-time hours in GP may be much more sustainable than full-time hours, especially night shifts, in emergency and referral hospitals.

This added stress, seen in both GP and emergency centres, especially when vets are working more than full-time either from staying late or picking up extra shifts due to the high demand for vets right now, leads to significant burn-out and vets leaving the profession. Dr. Yvonne feels it's a huge shame that so many vets, because we have issues saying no and setting limits, work until they are completely burned out and leave the profession. Instead, try early to create a sustainable work situation!

Dr. Yvonne, Dr. Lucy and Dr. Ann have all taken large (multi-month) breaks in their careers to travel or do different things, to get a break and ‘reset’.

Financially, working part-time is just not feasible for some. Dr. Yvonne shares some strategies such as living outside the city and commuting in to have lower cost of living, or having something else on side whether that is part-time GP along with part-time emergency, working for boards or government, vaccine clinics, etc. Or, another possibility is to start your own side business as Dr. Lucy and Dr. Yvonne have done with FlexiVet!

“We had to figure it all out because neither of us knew anything about business.” Dr. Lucy and Dr. Yvonne both had no information, no knowledge, no background and no training in starting a business. So, they started with a good accountant who helped direct them and provided advice. They then had to address issues such as getting a logo, a business name, licences, etc.

When these budding founders of FlexiVet first met with the account, she initially informed them that most businesses that fail are partnerships, and that friendships can often fall apart. The accountant then had them go and sleep on it for a bit, to determine if they felt their friendship could handle a business partnership.

There are many different ways that a business partnership can be ‘set up’, and FlexiVet opted for a ‘Limited Company’ and they had a “Partnership Agreement” created. This basically is an agreement outlining what happens to the business if the relationship dissolves, if a partner dies, one goes “off their trolly”, etc. The choice of a Limited Company was such that it allowed the business to be a separate entity from either Dr. Lucy or Dr. Yvonne as individuals.

These legal aspects are time consuming, expensive, and complicated, but are necessary to make sure all parties involved are legally covered. These costs wouldn’t necessarily be present if you were starting up a business on your own.

In terms of set-up costs, Dr. Lucy and Dr. Yvonne both put in $3000 to get the business up and running. This was the costs for the accountant, the legal set-up, domain names, website, logos, etc. Given that their business didn’t involve having inventory, or an office, these set-up costs were low. The other big cost was a $4000 CPR Dummy Dog. Other miscellaneous costs include ongoing website costs, a printer, projector, etc. Dr. Lucy and Dr. Yvonne did try to keep costs as low as possible, using the basic template websites, and taking advantage of their partners’ skills to help with some IT and equipment tasks.

PAYING THEMSELVES:

One of the next steps for Dr. Lucy and Dr. Yvonne was to figure out how to pay themselves. Given that the work-load wouldn’t always be 50:50, they opted to invoice the company as independent contractors with their own ABN numbers. They decided on a wage/hour, on top of milage for travel. This allowed for more simple accounting software which saved money, and removed any fairness if one person performed more training sessions than the other. These little aspects, that ensure fairness and prevent resentment towards eachother, are some of the important points that need to be considered when going into business. They may seem trivial, but they ensure the proper function and ongoing good working relationship, which is important to any business or company!

MARKETING:

“That is still our weak point.” Dr. Lucy and Dr. Yvonne share how it's hard to get the message out and have clinics see the value of the training BEFORE it’s done. After they have completed training the clinics find immense value, but prior to that it can be difficult to convince clinics. Also, in-clinic training is a newer and clinics aren’t used to it, so there is a barrier to entrance.

Dr. Lucy discusses as well that a lot of general practice clinics feel that CPR is only important if you work in an emergency clinic, and don't feel it’s important for GP. However, the opposite is true. Dr. Lucy shares that the 6 month old bitch is going to have the best chance of survival and recovery, and those cases, the ones in general practice, are the ones that you should be doing the “best CPR of your life” on. In emergency clinics most of the patients that arrest are critically ill and unlikely to have a good long term survival even if you get them back. Things like blocked cats, GDVs, and ‘routine’ anaesthetics, are the animals you are most likely to get back, and these are the cases that GPs will see!

WHY IS CPR TRAINING IMPORTANT FOR ALL CLINICS?

“CPR training is very good team bonding and very good mental health, for the nurses in particular”. “Outcome for the animal is almost irrelevant,” as feeling comfortable and confident after an arrest in a clinic is incredibly important for the mental health of your staff. Also, getting comfortable with the process, vets will become more comfortable talking about CPR with clients, preparing them for possible outcomes, and obtaining CPR or DNR orders.

FlexiVet discusses that the empowerment and permission that the training gives to all staff, including reception, animal attendants, students, anyone, that “It’s always right to start chest compressions,” will not only save lives, but will be massively important to mental health, so that everyone knows what they can do, and can feel comfort in knowing that they acted! So many times when cases go wrong, and people feel powerless and upset, these are the reasons that vets/nurses leave the profession. The stress and guilt is over-powering…. BUT, “if they feel they did everything they could”.. their mental health is massively improved. It also massively helps with client communication.

DO YOU TALK ABOUT CLIENT COMMUNICATION IN YOUR TRAINING?

Yes. “Once everything is in motion” and the roles are delegated, drugs are sorted, etc. Once the CPR is in the ‘swing of things’ and you are in your rounds, you have someone step out and call the owner. Discussing an arrest with an owner, and confidently giving owners prognosis and advice, is part of the benefits of being confident with the process. This is important not only for the vets comfort, but also important for clients who need a strong and confident professional to rely on for advice in this stressful situation.

The training also discusses the different roles in the team and how that fits into a CPR code. Working in emergency referral centres you often have lots of staff, and enough nurses to run the code. However, in general practice clinics this won’t always be the case. You often will have less staff, and may need to have a receptionist or assistant be part of the process. The training teaches EVERYONE, and shows how everyone can be involved, and how you can run a successful CPR even with limited numbers of bodies!

HOW OFTEN DO YOU RECOMMEND OFFICIAL TRAINING?:

Surprise drills can happen at anytime, and clinics should aim for once a month. On a quiet day anyone, any member of the team, can initiate a surprise drill. Just rush a rolled towel in the treatment room and simulate an arrest.

Official training is recommended every 6 months to a year. This is great team building, and also helps remove any kinks or bad habits. Also, “staff love it, particularly the nurses.” Kennel hands, students, receptionists, etc, can all be part of the training!

HOW CAN ASSOCIATES/EMPLOYEES CONVINCE OWNERS TO APPROVE TRAINING:

FlexiVet makes training easy by coming to your clinic, and also has great value for money in terms of CPD points. Vets get 4 AVA points, and nurses get 3 VNCA points each. So in Australia this is good value for money for clinics for continued education.

Everywhere however, if you can even save 1 animal, it is worth it. Not just for the mental health of the clinic, but the PR disaster that can follow.

Also, “it takes away a huge amount of stress and anxiety” for your team, and it's a massive team building experience.

Simple life support, chest compressions and ventilation, make the biggest difference! So even if your clinic doesn’t have a de-fib, doesn't have an ETCO2, doesn’t have an ECG, that’s OK! All clinics have the tools to do effective CPR, and reiterating this to owners/business managers that might think the training is only useful if you have these tools, can be helpful.

The cases that are most likely to do very well, anesthetic deaths, blocked cats, GDVs, etc. are those that are seen in general practice! General practices perform many more surgeries and anesthesias than speciality and referral and emergency centres, therefore the risk/incidence of true anaesthetic reactions are going to occur more commonly in general practice. Also, these are the cases that will do the best, therefore GPs should be well versed in CPR.

“What if it was your dog? Wouldn’t you want people that know what they are doing?”- for Dr. Yvonne this is an important point. So often to function as medical professionals we have to be emotionally detached. But sometimes it's important to remember these are still people’s pets, and making sure we are in the best possible situation to help their animals is important.

- Be confident & trust yourself. “You’re better than you think” shares Dr. Yvonne!
- If you have an idea, surround yourself with people that know what they are doing. Get a good accountant, people that have set up businesses before, a good support network. You don't have to do it all yourself.
- Failure isn’t always a bad thing. Yes you might fail, but it just means you will learn from it and do better next time. And, what if you succeed?? What have you got to lose? Taking some risks in life is needed, and it might all work out!
- “Give yourself a break”. Dr. Lucy shares that people are really hard on themselves. Especially now, the industry is really hard. The vet world is changing so much, has become more litigious, the debt-load is higher, and the job is becoming harder and harder as client expectations climb without their willingness to pay for services. Forgive yourself for not being “everything” and give yourself a break! You are doing great!
- There are so many facets of the vet world, find what works for you, and if you don’t like something try something else! You don’t know where you will end up. “You can’t expect to know what your life will be the day you graduate”, Dr. Lucy shares. So just go out, try things, and be OK to try and find different path if you aren't happy. The veterinary profession is amazing that there are so many doors, there is so much diversity, opportunity to travel, etc. So if you aren't happy, take a step back and re-assess and try something else!
- If your job sucks, and your boss is an a$ just leave and find a new job! You aren’t doing yourself any favours by staying in a bad job!

SIDE RANT:

Dr. Lucy, Dr. Yvonne and Dr. Ann all HATE the expression “I’m JUST a GP vet”. We all have the experience of GP vets being impressed or intimidated by us working in emergency, and we know how limited our knowledge is in the GP world, and we all have a huge amount of respect and admiration for how difficult a GP job is. “Being a good GP is just as hard as being a specialists”, and being a “GP is a very hard job”. So no matter what type of vet you are, GP, specialist, emergency, research… don't belittle yourself, don’t be hard on yourself, be proud of who and what you are!

Thank you Dr. Lucy and Dr. Yvonne for your time, and if you are a nurse, vet, manager, receptionist, anyone… and are interested in having CPR training in your clinic, consider either FlexiVet training or another in-clinic CPR training company! The benefits to the mental health and work-environment are huge, as are the benefits to that patient you will save in the future with your new knowledge!!

You can contact FlexiVet Training either through their website @ www.FlexiVettraining.com.au or through FlexiVet Training on Facebook.