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How to be a better E-Vet Assistant

Discussion in 'Pre-Veterinary' started by kittyterran, 05.11.12.

  1. kittyterran

    kittyterran

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    Hello, I started working at a pretty busy animal clinic on emergency hours. Things were going great in the beginning. I was learning a lot (though it was quite overwhelming how much information that I needed to know). Now that I'm off training and actually working shifts, I feel that my progress in waning and the tech and Dr. I'm working for may be a little less impressed by me. I have come here for some advice. Here are some challenges I am having:

    1. Being proactive: The tech that I work with is extremely fast and he expects me to hear a treatment plan and go get all the materials. This is my first vet job, so I don't know anything about treatments or related materials, just basics...like "go get IV catheter supplies", but I don't know to do that if the receptionist comes in saying, "Dog with bloat." How should I be more proactive with treatments? Should I research cases in my free time?
    2. Patient Histories: How long am I supposed to take good patient history for emergency cases? I'm really confused because one doctor told me I need to get all signalments and take my time getting pt history. I still miss a lot of information like when the doctor does her assessment and asks me if I asked something, and I didn't. She gets frustrated. Once, I was trying to be really thorough and taking signalments for a dog with a laceration and the client got pissed at me for asking "irrelevant" questions....The doctor got pissed at me for taking too long and making the client angry...but I thought signalments were "essential"( according to the other doctor). How do I take appropriate patient history, especially with animals that have more pressing medical emergencies and clients that are really nervous and angry?
    3. Retaining details. How do you remember details as you work, because I can not remember an animal's details (what kind of collar it had, TPR results, age, etc) off the top of my head, especially when the animals are basically coming in one after the other all night on a 12 hour shift. Do you have any tips on how to keep on top of everything?

    The desire to do better is definitely there, but I am having trouble proving it. I don't want to get fired. I'm just discouraged by the vast amount of skills that I have not obtained and yet are expected to know. A lot of the people that work there have had years of experience on-the-job and seem to basically read eachother's minds. Feel free to give me some advice, tough love, sympathy, suggestions for how-to guides, w/e. Anything is appreciated!
    Last edited: 05.11.12
  2. missdvm

    missdvm WesternU c/o 2016

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    I hope you'll get less stressed over time - working emergency is always difficult since there's a fine line between being helpful and getting in the way in life or death situations, especially if you haven't had formal vet or tech training.

    What really helped me was a little notebook that I could put in my pocket, and jot down information as I worked with each patient. Patient stickers, TPR, history, etc. For histories, it also helps to ask the same questions in the same order each time (or relatively same). If you always ask the same questions in the same order, then you'll know you're not missing anything out. Writing in the notebook would also help you, for example, if you couldn't remember exact details, you'd still know where to find that information later.

    For treatments and getting materials, it's honestly something you'll pick up as you work there longer. Don't let mistakes get to you and don't be stressed by them. Instead, just remember what you did wrong or inefficiently and make sure you don't do it again or that you'll know what to do the next time something happens. Good luck! :)
  3. Trilt

    Trilt NCSU c/o 2016 Gold Donor

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    Ooh I definitely just went through this! My time ended on a bit more of a sombre note, though, as after about a month of working I ended up sitting down with the doctor and we decided that I just wasn't going to be ready to be as effective with technical skills and such as they needed for the summer rush of patients. I'm still working very, very part time with them, but let me help you have that not happen. ;p

    First of all, I would suggest sitting down and talking with the tech you usually work with and stating these concerns. It's really hard to learn in emergency because everything you do is super critical and crazy, so just say you're really excited to be working and wanted to ask about a couple concerns so you can grow more quickly in the position. Try it either after a shift or during downtime. My clinic personally had a checklist of things I should know, so I just referenced that; you could just make a sheet with things you want to know and go down it as you have time.

    I have lots more to say, but have to head home. I'll be back with more in a couple hours; I know we have some emergency techs on this forum who will probably answer a bunch of the questions from their view, too.
  4. JoAnna423

    JoAnna423 NCSU c/o 2017!!!!

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    Im not so sure if this is advice...or just something to make you feel better. But if they hired you knowing that you did not know everything you were suppose too, then I can almost bet that they are understanding of "the learning process". I hope that someone would not hire someone expecting them to just magically know the same as people, who like you had said "have years of experience". That would be an error on their part. It might be all in your head that you are not doing well, and that is only going to make things worse. I would talk to the Dr., and I am sure he will give you a boost of confidence and then feeling better you will perform better (or the exact same if you never were really doing anything wrong in the first place!) :D
  5. Bracco Pointer

    Bracco Pointer UF CVM 2017!

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    I think Missdvm hit the nail on the head. Write everything down in a little notebook. I keep my rounds book for patient histories, etc but also in the back of it I keep notes of all the things I had trouble with. It's a place for me to keep my "notes to self." It's good to have little reminders, checklists, step-by-step instructions for yourself... that usually by the time you write them down once, you'll remember for the future.

    As aforementioned, learning different scenarios and treatments comes with practice. When it's slow (or when you're cleaning, putting stuff away) walk around and quiz yourself: what is this? how is it used? when will I need it? what will I need with it? what comes next?

    The vet I work for said it best: think it through, *think* through the entire process and you're less likely to miss stuff.

    Depending on the nature of the emergency, the questions you ask for a history will be different. I always start with signalment: Name, Age, Sex, Breed/Species, and primary complaint. Then history: what's happened within the last 2 hours? the last 24? Depending on the emergency, it may not be necessary to ask about a week ago, but sometimes it is. Always check about other conditions, medications, allergies/med reactions, are they vaccinated? It will take practice to know what questions to follow up on.

    I think everybody goes through a crisis phase of feeling totally overwhelmed, but you'll get through it! :) Good luck!
  6. Angelo84

    Angelo84 Tufts Class of 2011

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    Good for you congrats on working in ER its fun! As an ER vet things I like my assistants/techs to do:

    Always have a crash station pre set up--IV cath supplies, fluids that way if something comes in you already have those things ready. They likely also have a crash cart (ET tubes, laryngoscope, tube ties, ambu bag, drugs. Find it, make yourself familiar with it so you can get things quickly and accurately. There should be a list of things that come straight to the back--possibly blocked cats, bloat, seizures, anything down, etc know this list and think about what you might need for that creature. If in doubt bring the animal back.

    Histories: Start with signalment always-- age, breed, gender intact or not. Presenting complaint (why did they come in--laceration, vomiting, down dog etc), duration of signs/when was creature last healthy per owner, are they eating/drinking currently, any coughing, sneezing, vomiting, diarrhea, increased thirst/urination, weight loss, any current medications (including over the counter meds, aspirin, etc). Past major medical/surgical issues. Any known toxins, foreign body ingestions. Vaccine history (esp puppies, and bite wounds ask when were his last vaccines NOT is he up to date!) Often times the answers you get and the answers the vet gets will be different--this is not your fault it often takes asking the same question multiple ways/multiple times to get the owners to give you information. I had a case recently where the answer to past major medical/surgical issues was "none" the next day turned out the dog had a history of seizures apparently to the owner that didn't count as a past major medical issue!

    Keeping details in your head: Write down the history/put it in the computer. You are only responsible for having that info in your head until you present the info to the Dr and have it written down. Do keep in your head what is going on with each creature in your care--ie you currently have the hemoabdomen golden, the vomiting cat, and the young laceration dog.

    Hope that helps--also talk directly to the techs/Drs and see if they have specific advice.
  7. Dsmoody23

    Dsmoody23

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    It's pretty much inevitable that you're going to take a beating at your first job, especially if it's something with a small margin for error like emergency.

    The real key to getting good at your job is two-part:

    1. There is absolutely no way that you're going to learn everything in a week, a month or even a year. Make a point of trying to learn something new every day, and take every opportunity to practice the things you do know. My favorite phrases at work are: "can you walk me through, step by step, what you're doing?" and "Watch me do this, and tell me how I can do it better."

    2. Don't get frustrated. Especially when people get super frustrated with you. You're probably going to get hollered at. You're going to make many, many mistakes. Probably serious ones. As long as you can take criticism, incorporate it into your work, and then come back the next day ready to try again, you'll be fine.

    Just roll with it, learn from your mistakes, and try not to make the same ones twice.
  8. PppermintTwist

    PppermintTwist

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    Dont get discouraged! Its hard and it takes time to adjust. Do your best!

    1)Have a notebook and pen on you to write things down. Extra step but will safe going back to vet/tech to ask again. You will get better at remembering long lists that get spit out at you.

    2)Manage your time well. If a dog has a laceration. Ask if the dog has been otherwise healthy, any other known medical conditions, vaccine status, current meds. If a dog is sick/ADR (aint doing right) you probably need to ask more questions.

    There really isnt a magic time limit. It really depends on the patient and severity of illness.

    3)Ask your veterinary practices protocol for triage. Tech only? Then let the tech get the bloat, and go get an IVC and radiograph ready for it.

    Typically at our emergency for things like bloat, or active seizure we immediately ask owner if we have their permission to place an IVC and take the dog out back. Having IVC supplies ready is key!

    4)If it is quiet....be nosy. Look in cabinets, figure out where things are. Know where the crash cart is. E-tubes, laryngealscope, IVC supplies. Know how to change the anesthesia machine to and from flow by. Ask questions, and write down answers in your little notebook.

    Your vet hospital may also have handbook on protocols...

    Stay positive! Smile a lot. Offer to help. Try to take criticism well. Use it to do a better job next time, but dont let it get you down! Staying positive is important. Its a stressful job, but rewarding :)

    Well...I have to be at work my e-clinic at 4am so better get to bed!
  9. Chilli

    Chilli

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    I've worked as a veterinary assistant at an emergency hospital for the past 4 years and I have to say time and experience really are the great teachers here. The more cases you see the more you will be able to predict the flow of the coming action.

    For instance if you know a bloat is coming in you can think through the scenario like this:
    Bloats happen in bigger dogs, they are incredibly painful so the dog might not be willing/able to walk, I should get a stretcher out just in case.
    You can't go wrong readying an IVC for a bloat, either it will be used in treatment or it will make euthanasia easier, so get one ready in case. You can set fluids and a line out also but don't break the packaging so that if it's not needed it can be used another time.
    Your Dr. will probably want to get blood work so set out the collection tubes with the catheter supplies.
    Your Dr. will probably also want to take an x-ray, so set that up if you can.
    Bloats will probably need to go to surgery, so if you know how, get that set up also. Bloat surgeries can be long and extensive, your patient will probably be sore and need heat support during recovery, set up a clean cage with lots of padding (and some kind of drip pad if you have it) and a heat pad.

    The key to being a good emergency assistant is to plan ahead, whatever you can do to make the process smoother will benefit the patient in the long run and as I said a lot of this comes from getting experience with a variety of cases. Also it's pretty much crucial to know where everything is so do exactly as Peppermint Twist said and be nosy, get into every drawer and cabinet you can think of.

    Patient histories can be tricky depending on the vet, for instance at my clinic one of the emergency Dr.'s wants very thorough histories taken, however; the other one likes to ask the questions himself and so only wants very basic histories: age, sex, weight, vitals etc. You'll get to know your Dr. and what they like. However one pointer is to customize your history to the situation, obviously if the dog is bleeding out you probably don't want to waste time asking the owner what kind of diet it is on.

    As far as keeping things in your head you will get used to it, it does take a little while to get your brain to hold all that information at once when it is coming so rapidly, just do the best you can and in the meantime WRITE EVERYTHING DOWN! At my clinic every patient gets printed out an admittance sheet and the back side of it is usually blank paper so I fold that up and use it to jot down notes, I feel like it looks more impressive to the client if I'm actually writing in the chart rather than scribbling on a notebook, also then the information wont get lost in your notebook.

    Finally don't be afraid to admit when you don't know how to do something, you can do much more harm trying to guess your way through a treatment then if you just asked for help in the first place. No one should get angry at you for asking questions, they should understand that you are still learning and need help. Keep a level head and don't let anxiety to perform persuade you to do something you are not comfortable with.

    Wow I'm sorry for the long post but I hope it helped a little, I love my job, emergency medicine is my passion and it's one of the coolest experiences you will ever have so stick with it and good luck! :luck:
  10. Jamr0ckin

    Jamr0ckin UTK c/o 2016

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    Get yourself a "nerd book". Organize it alphabetically - A for atropine dose, B for bloat, C for cat bite abscess, etc. Once you learn/observe something, write it down as standard procedure. Under H you can put your history and the list of ?s you need to ask and in what order - pretty soon you won't need to consult it anymore for certain things.

    You may have the book for 6 months before you can add snake bite, but eventually you can put it in there.

    Have you heard of VSPN? It is the VIN for staff members and they have a notebook you can order/print out. It is an EXCELLENT resource for those learning vet med. It is free to join the site. :)

    Good luck!
  11. kakurubird

    kakurubird

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    Ask the doctors their preference if you don't know/aren't clear, not only on how much of a history they want you to ask about vs. how much they want to get the first time themselves (since many will ask the important questions again as a lot of owners will take a prompting or two to remember things). But then also ask the other techs who have been there longer what the doctors prefer. I'm sure there's something a doctor may not say they want done, but they really would like if you do it.
  12. kittyterran

    kittyterran

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    Thanks for all the responses! I hope that one day, I will be as competent and sharp in the clinic as you all seem to be.;) I actually brought a sticky note pad with me last night and found a lot of use for it (yay!). I didn't get much criticism as I usually do about patient histories (lol). I'm hoping the clinic will be patient with me as I straighten out my confusion.

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