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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
The comprehensive guide to the role of the consulting veterinary nurse
The Consulting Veterinary Nurse is an invaluable guide for veterinary nurses running clinics and providing consultation. It covers the basics of setting up and marketing a clinic alongside the essential knowledge of the assessments, conditions, and issues required by a consulting veterinary nurse. Topics include nutrition, chronic illnesses, behavioral issues, lifestage clinics, and medical clinics for a full range of conditions from mobility and dental problems to epilepsy and cancer.
This second edition provides coverage of a wealth of new advances in veterinary medicine since the prior edition, exploring the normalization of telemedicine, novel diets, chemical castration and updates to the code of professional conduct. A notable addition is a new chapter on surgical clinics that discusses wound management, post-operative appointments, neutering, and other services delegated to the veterinary nurse.
The Consulting Veterinary Nurse readers will find:
- The role of the nurse in the veterinary practice, covering ethics, consultations, diagnostic clinics, marketing, and named nurse and protocol writing
- Feeding behaviors, dietary transitions, methods of increasing water consumption, and dietary supplements
- Considerations for arthritis, cancer, cardiac disorders, cognitive dysfunction, dental problems, diabetes, epilepsy, obesity, and urinary tract disorders
- Novel diets such as raw feeding and vegan pet foods as well as specific diets for puppies and kittens
The Consulting Veterinary Nurse is an essential read for veterinary nurses looking to develop their consulting role and expand their confidence in consulting with animal owners. The book is also valuable reading for veterinary nurses in general practice and students in the field.
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Seitenzahl: 444
Veröffentlichungsjahr: 2026
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
Foreword
Abbreviations
Introduction
Acknowledgements
Section 1: Fundamentals of Nurse Consulting
1 Ethical Aspects of Consulting
Suitably qualified persons
Welfare cases
2 Theoretical Aspects of Nurse Consulting
What is narrative medicine?
Consultation models
Difficult conversations
Breaking bad news
Motivational interviewing
Discussing nutrition without an argument
Nurse clinics: How to broach the nutrition subject?
Starting the nutrition discussion
What is the best diet?
References
3 Gaining Confidence in Consulting
Where does confidence come from?
What can I do to improve my confidence?
Reflective practice
4 Chronic Condition Clinics
Why run nurse clinics?
Charging for clinics
Compliance and concordance
Clinic protocols, guidelines and care bundles
Setting up nurse clinics
Marketing your clinics
References
5 Consulting Room and Resources
Educational resources
Equipment
Section 2: Nutrition
6 How to Conduct a Nutritional Assessment
Monitoring nutritional interventions
Calculating ideal body weight
7 Nutrition
Labelling of diets
Proximal analysis of food
Types of proprietary diets
Home‐made diets
Palatability
Energy calculations
Methods to increase water consumption in animals
References
Suggested reading
Section 3: Diagnostics
8 Diagnostic Clinics
Clinical examination
Sample collection
Blood sampling
Blood pressure monitoring
Urinalysis
Examination of urine
Schirmer tear testing
Skin scrapings
Electrocardiography
Pain scoring
Reference
Section 4: Well Pet Clinics
9 Preventative Medicine Clinics or Wellness Clinics
RVNs role in preventative medicine
Vaccination clinics
Life‐stage consultations
Puppy and kitten parties
Deciding on a format for puppy parties
Marketing
Running the puppy party
Advice to give to owners when things go astray
What to do if things go wrong during a puppy party
Quiet puppies
Training and behaviour
Play biting
House training
Training groups
Adult life stage (six monthly healthcare examinations)
Neutering consultations
Informed consent
Physical maturity
Social maturity
Protocol for neutering
Conclusion
References
10 Feeding Behaviours
Finicky feeding behaviour
Food addictions
Food aversions
Feeding methods
11 Alternative Forms of Nutrition
What do the terms mean?
Preservatives
Gastric pH
Evolution of the digestive system
Vegan feline diets
Animal Welfare Act
References
Section 5: Clinics
12 Cancer Clinics
Clinical nutrition
Cancer cachexia
Feeding a cancer diet
Key points
References
13 Cardiac Clinics
Nurse clinics
References
14 Cognitive Dysfunction
Nurse clinics
Monitoring
Nutrition and nutraceuticals
Behaviour, welfare, environment
References
15 Dental Clinics
Nurse clinics
Monitoring
Interventions
Water additives
Clinical nutrition
References
16 Dermatological Clinics
Diagnostics and monitoring
Nutrition
Clinical nutrition
Food intolerances and allergies
Conclusion
References
17 Diabetic Clinics
Diabetes treatments
Clinical nutrition
Key points
References
18 Epilepsy Clinics
Nurse clinics
Pharmaceuticals
Clinical nutrition
Monitoring
FAQ
19 Gastrointestinal Clinics
Nurse clinic
Diagnostic monitoring
Pharmaceuticals
Clinical nutrition
Gastrointestinal Biome
References
20 Hepatic Clinics
Nurse clinics
Clinical nutrition
21 Mobility Clinics
Nurse clinics
Monitoring of arthritic patients
Nutraceuticals
Key points
References
22 Obesity Clinics
Nurse clinics
Clinical nutrition
Nutrigenomics
Behaviour and its role in obesity
Tips for obesity clinics
Tips for weight loss
Key take‐home messages
Client conversations
References
23 Renal Clinics
Introduction
Nurse clinic
Vitamins and minerals
Key points
References
24 Urinary Clinics
Canine urolithiasis
Nurse clinics
Diagnostics
Clinical nutrition
Feline lower urinary tract disease
Nurse clinics
Reducing stress in cats
References
25 Noise Phobias and Fireworks
General advice about the firework period
Phobia treatment
Pheromone use
Reference
26 Surgical Clinics
Wounds
Types of wounds
Wound dressings
Bandages and dressings
Complications
Clinical audit of wounds
Appendix 1: Diet History Sheet
Animal’s information
Dietary information
Owner and environmental information
Appendix 2: Chronic Condition Clinics Examples
Appendix 3: 6 Month Health Check – Health Report
Appendix 4: Checklist for Obesity Clinics
Glossary
Index
End User License Agreement
List of Tables
Chapter 4
Table 4.1 Calendar of events. The light blue blocks represent the p...
Chapter 5
Table 5.1 Equipment required for consulting rooms
Chapter 6
Table 6.1 Percentage over/underweight using body condition scoring...
Chapter 7
Table 7.1 Comparison between dry and moist diets when calculated on...
Chapter 8
Table 8.1 Examples of chemical preservatives for urinalysis
Table 8.2 Electrode placements
Chapter 9
Table 9.1 Difference between male and female cats, and the conseque...
Table 9.2 Average maintenance energy requirements for dogs at diffe...
Table 9.3 The four areas of reward
Table 9.4 Use of the six‐point chronic condition clinics framework ...
Table 9.5 Age of neutering recommendation in 35 different breeds...
Chapter 13
Table 13.1 Cardiovascular adaptations that occur during the transi...
Table 13.2 Functional classification of heart failure and correspo...
Table 13.3 Comparison of feeding‐restricted sodium diets and comme...
Table 13.4 Daily sodium intake for a dog and cat eating various fo...
Chapter 16
Table 16.1 Deficiencies and their effects on the dogs skin
Chapter 17
Table 17.1 Difference between a traditionally used high‐fibre diet...
Chapter 19
Table 19.1 Classification and pathophysiology of diarrhoea (Batter...
Table 19.2 Differences between small and large intestinal diarrhoe...
Chapter 20
Table 20.1 Causes of liver disease
Table 20.2 Factors precipitating hepatic encephalopathy
Chapter 22
Table 22.1 Calorific value of nutrients
Chapter 23
Table 23.1 IRIS staging of chronic renal disease in cats and dogs ...
Table 23.2 List of possible target organ damage due to hypertensio...
Table 23.3 Treatment recommendations from IRIS dependent on the st...
Table 23.4 IRIS recommendation of renal staging based on plasma cr...
Table 23.5 Urine protein/creatinine (UP/C) ratio
Table 23.6 Sub‐staging renal failure with blood pressure monitorin...
Chapter 24
Table 24.1 Urolith formations and treatments, with urinary pH pref...
Table 24.2 Recommended levels of minerals in commercial cat foods ...
Table 24.3 Risk factors associated with increases in FLUTD cases
Table 24.4 Recommended levels of minerals in commercial cat foods ...
Chapter 25
Table 25.1 Pharmaceuticals commonly used in the treatment of noise...
Table 25.2 Important points in the design of a bolthole
List of Illustrations
Chapter 2
Figure 2.1 Calgary‐Cambridge consultation model.
Figure 2.2 Veterinary Nurse–Client Communication Matrix graphic....
Chapter 4
Figure 4.1 Elements to be involved in chronic conditions clinics....
Figure 4.2 Client survey question: I find it acceptable to pay a f...
Chapter 5
Figure 5.1 VNs are often called on to discuss or confirm advice in...
Figure 5.2 Nurses’ consulting room needs to be fit for purpose, eq...
Figure 5.3 Equipment ideal for a consulting room.
Chapter 6
Figure 6.1 Body condition score nine‐point scale.
Figure 6.2 World Small Animal Veterinary Association (WSAVA) muscl...
Chapter 7
Figure 7.1 Example of a pet food label, demonstrating the legally ...
Figure 7.2 Proximate analysis of foods.
Figure 7.3 Methods of prehension in the cat.
Chapter 8
Figure 8.1 Doppler blood pressure monitoring equipment ‐ headphone...
Figure 8.2 Cat friendly handling should be instigated.
Figure 8.3 Example of non‐absorbent litter.
Figure 8.4 Urinalysis can be an exceptionally useful screening too...
Figure 8.5 Urine specific gravity should be read with a refractome...
Figure 8.6 Digital pH meter.
Figure 8.7 Schirmer Tear Test (STT) strips.
Chapter 9
Figure 9.1 Examples of replacement milk.
Figure 9.2 New owners and breeders might need guidance on parasite...
Figure 9.3 Puppy socialisation programmes are a vital part of the ...
Figure 9.4 Pastes (cheese/meat) can be very useful as a reward. Ve...
Figure 9.5 Puppy socialization must be closely monitored.
Figure 9.6 Example of a toy box.
Figure 9.7 Waltham puppy growth charts.
Figure 9.8 How a dog can react to stress or threat.
Figure 9.9 Proposed steps for discussing neutering to include medi...
Figure 9.10 Diagrammatic representation to gain consent for surgi...
Chapter 12
Figure 12.1 Diagram demonstrating the effects that contribute tow...
Chapter 15
Figure 15.1 Pushing the gel/paste into the brush’s bristles will ...
Figure 15.2 Gel onto the finger and being wiped into the mouth is...
Figure 15.3 Small headed brush into the cheek pouch would be the next step....
Figure 15.4 moving to the front teeth last, as these are the most sensitive....
Figure 15.5 Diagram demonstrating how fibre alignment within the ...
Chapter 16
Figure 16.1 Pruritus scale can be completed by owners to monitor interventio...
Figure 16.2 Flow diagram demonstrating different causes of advers...
Figure 16.3 Inhibition of inflammatory pathways by supplementatio...
Figure 16.4 The difference between adverse food reactions.
Figure 16.5 Flow diagram of protocol of elimination diets.
Chapter 18
Figure 18.1 Examples of epilepsy/seizure diaries.
Chapter 22
Figure 22.1 Obese cat with BCS 9/9.
Figure 22.2 Demonstration of the excessive weight gain can be use...
Figure 22.3 Image showing that clients need education/help to cor...
Chapter 24
Figure 24.1 Flow diagram illustrating how inflammation and crysta...
Figure 24.2 Systematic diagram of urolith and crystal formation w...
Chapter 25
Figure 25.1 Bot‐holes are important in noise phobias.
Figure 25.2 Examples of pheromone products for cats and dogs.
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
Foreword
Abbreviations
Introduction
Acknowledgements
Begin Reading
Appendix 1: Diet History Sheet
Appendix 2: Chronic Condition Clinics Examples
Appendix 3: 6 Month Health Check – Health Report
Appendix 4: Checklist for Obesity Clinics
Glossary
Index
Wiley End User License Agreement
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The Consulting Veterinary Nurse
Second Edition
Nicola Lakeman
This edition first published 2026© 2026 John Wiley & Sons Ltd
Edition HistoryJohn Wiley & Sons Ltd 1e (2012)
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Library of Congress Cataloging‐in‐Publication DataNames: Lakeman, Nicola, author.Title: The consulting veterinary nurse / Nicola Lakeman.Description: Second edition. | Hoboken, NJ, USA : Wiley, 2026. | Includes index.Identifiers: LCCN 2025043330 (print) | LCCN 2025043331 (ebook) | ISBN 9781394192502 (paperback) | ISBN 9781394192519 (adobe pdf) | ISBN 9781394192526 (epub)Subjects: LCSH: Veterinary nursing. | Pet medicine.Classification: LCC SF774.5 .A25 2026 (print) | LCC SF774.5 (ebook)LC record available at https://lccn.loc.gov/2025043330LC ebook record available at https://lccn.loc.gov/2025043331
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Foreword
Everyone in veterinary practice has to do some form of consulting at some point. This is irrespective of the role, everyone has to talk to the pet owner/caregiver. This is consulting. The skills we need for consulting are vital in ensuring good clinical outcomes, improving patient welfare and preventing any negatives; these rely heavily on communication skills.
The book is a wealth of underpinning knowledge for everyone that is communicating to owners and caregivers about the health of their pet. Consulting and nurse clinics are now a staple in the majority of veterinary practices, worldwide. Owners understand that veterinary nurses provide a different aspect of care than veterinary surgeons do and that both sets of knowledge are needed to create holistic care plans for the pet.
Consulting frameworks and models alongside narrative medicine and contextualised care are discussed for a range of chronic conditions, lifestages and surgical care.
Abbreviations
ACE
angiotensin‐converting enzyme
AFR
adverse food reaction
BER
basal energy requirements
BCS
body condition score
BUN
blood urea nitrogen
CHF
chronic heart failure
DCM
dilated cardiomyopathy
DER
daily energy requirements
DHA
docosahexaenoic acid
ECG
electrocardiogram
EFA
essential fatty acid
EPA
eicosapentaenoic acid
EPI
exocrine pancreatic insufficiency
FLUTD
feline lower urinary tract disorder/disease
IBD
inflammatory bowel disease
IBS
irritable bowel syndrome
IRIS
International Renal Interest Society
MCS
muscle condition score
MCT
medium‐chain triglyceride
OA
osteoarthritis
PEG
percutaneous endoscopic gastrostomy
PPS
portal systemic shunt
QOL
quality of Life
RCVS
Royal College of Veterinary Surgeons
RER
resting energy requirements
RVN
Registered Veterinary Nurse (UK)
SCFA
short‐chain fatty acid
SDMA
symmetric dimethylarginine
SGLT2
sodium‐glucose cotransporter‐2
SQP
suitable qualified person
SVN
student veterinary nurse
VFA
volatile fatty acid
VN
veterinary nurse
WSAVA
World Small Animal Veterinary Association
Introduction
The role of the veterinary nurse (VN) has evolved greatly from being merely a kennel maid to a fee‐earning regulated professional in the United Kingdom and is leading the way as a template for others. Registered Veterinary Nurses (RVNs) have a vital role in the veterinary practice, in the offering of advice and educating clients, performing work under delegation from the veterinary surgeon in order for them to make a diagnosis and in preventative healthcare.
For a nurse with a keen interest in consulting, this is an ideal opportunity in which they can pursue the specialism that interests them, whilst still being of use to the veterinary practice in both improving clinical outcomes for the patient and fee earning. Veterinary practices are businesses, and RVNs who consult need to perform sufficient work not only to cover their costs and overheads but also to make a profit. This isn’t necessarily through the charging for nurse clinics, but through products sold, increasing the footfall through the practice and helping with client loyalty and most importantly compliance and concordance.
Simplistically nurse consultations improve clinical outcomes, are a better welfare choice and add to the commercial aspect of the business.
VNs who fully utilise skills learnt during training are more likely to remain with the profession, and do feel a more valued member of the practice. VNs are not ‘mini‐vets’ and do perform a different aspect of veterinary medicine compared to veterinary surgeons, though veterinary surgeons do undertake many roles that can be completed by RVNs, e.g. blood sampling, post‐operative examinations.
The purpose of this text is to act as a source of information for those VNs who undertake consultations, clinics and other initiatives such as puppy parties.
Acknowledgements
The role of veterinary nursing is changing almost daily. Being viewed (in some countries) as their own regulated profession – there is still a long way to go. I acknowledge all of the veterinary nurses (and our allies) who have made it possible for veterinary nursing to become a recognised (hopefully soon protected and autonomous) profession in its own right. Without this there would be no consulting veterinary nurses.
I acknowledge all of the support from my family (Ellena and Gavin especially), friends and colleagues who have acted as cheerleaders, encouraging me to write this second edition of the book.
I also thank the team at Wiley for encouraging and helping me every step of the way with this second edition.
Section 1Fundamentals of Nurse Consulting
1Ethical Aspects of Consulting
The role of the VN has evolved into a regulated profession. VNs in the United Kingdom are now regulated, and therefore an understanding of the Veterinary Surgeons Act and the Code of Professional Conduct is essential. A solid understanding is required to ensure that ones actions are within the law and the guidance provided by the Royal College of Veterinary Surgeons (RCVS). Though the title of veterinary nurse is not protected, the title of Registered Veterinary Nurse can only be held by someone on the RCVS register.
As a consulting nurse or a nurse who consults, it is important to know your own limits, both to be within the law and your own personal limitations – competency and confidence are also criteria to be aware of. Under the Veterinary Surgeon's Act (VSA) 1966, only veterinary surgeons are permitted to make a diagnosis, and care should be taken when examining an animal or answering an owner's questions that fall into the area of a diagnosis. It is permitted for the VN to inform the owner of the clinical symptoms that the animal is displaying, e.g. weight loss, increased thirst, tachypnoea or anaemia. RVNs can discuss conditions that show these symptoms, and give guidance on what steps the owner then needs to take, e.g. consultation with a veterinary surgeon. If it is likely that the animal will require further investigations, e.g. blood tests, the owner should be primed that this may occur in the veterinary consult so they can prepare the animal if required, e.g. pre‐starve it, rather than having to come back for an additional appointment. The veterinary surgeon responsible for the case doesn't need to have examined the animal before they can delegate tasks to the RVN.
Suitably qualified persons
It can be useful for nurses to have the suitably qualified person (SQP) qualification to prescribe appropriate medicines for animals, though the number of medications that fall into the SQP classification for small animals is exceptionally low. Anthelmintics that are of Prescription Only Medication ‐ Veterinary Surgeon, Pharmacist, SQP (POM‐VPS) or Non‐Food Animal ‐ Veterinary Surgeon, Pharmacist, SQP (NFA‐VPS) category can be prescribed by the VN with the appropriate SQP qualification. Some veterinary nursing qualifications will teach the two qualifications alongside each other, so on completion, the student will become both an RVN and a Companion Animal ‐ Suitable Qualified Person (C‐SQP).
One of the roles of the VN is to ensure compliance and concordance with recommendations given by the veterinary surgeon (Box 1.1). In some cases, this can refer to medications, and it should be confirmed with the owner whether they are able to administer the medications that their pet has been prescribed. A different format of medication, liquid instead of tablets, can be used to ease the administration, but a separate prescription should be written by the veterinary surgeon to accommodate this change.
Box 1.1 Definitions
Compliance: Undertaking a task that you have been told to do.
Concordance: Undertaking a task that you and another have jointly agreed to do.
As a regulated VN, it is vital to have personal indemnity insurance. RVNs are responsible for their own actions, and this includes any work undertaken within a consultation/clinic. Indemnity insurance for RVNs can be included under the veterinary practices insurance policy for all staff, or, if self‐employed, as a personal policy. Self‐employed locum nurses must ensure that they are adequately insured.
It is clear that the person conducting the consultation is responsible for the health and safety of all the persons in the room; this also includes the client. This means that if the client is hurt, even if it is by their own pet, the practice is responsible for this. Any injury, cat bite, scratches, etc. should be entered into the practice's Accident Log Book. It is, therefore, prudent to ask a colleague to restrain any animals that are not being overly cooperative. If children are behaving unruly, you are within you rights to ask the parent/guardian to ask their children to moderate their behaviour. If consultations are time‐consuming, then activities for children to undertake can prove to be a useful distraction. Pictures to colour in, or a pretend ‘vet kit’ with a stuffed toy, can be a great hit with younger children (see the below image). Any pictures that are produced can be put on the wall or notice board.
Welfare cases
If, at any point, you are concerned about the welfare of the animal, or the owner, you do need to relay this information to the veterinary surgeon in charge of the case. Any clinical recommendations concerning the animal should be written in the clinical history. Client confidentiality and welfare (pet and/or owner) are factors, but guidance from the regulatory body and employers can advise you, as each situation is unique.
2Theoretical Aspects of Nurse Consulting
Veterinary nurses/technicians have quite a unique and important role as veterinary professionals. Whilst working under the direction of the veterinary surgeon, VN/Ts also have elements of autonomy and are responsible professionals. Occasionally, VN/Ts must convey a vast amount of very technical clinical information to pet owners in a non‐patronising, yet informative format, whilst in a potentially highly emotionally stressed setting. Communication skills are the most important of all the ‘soft’ skills that veterinary professionals need to master (Box 2.1).
The way in which we communicate is very important, not just the content but also how this is conducted. Narrative medicine is making large inroads into veterinary practice; it is something that isn't new, but has always been undertaken, though not widely recognised in its importance. Research has been conducted looking predominantly at veterinary surgeons, rather than nurses/technicians. The veterinarians predominantly relied on asking questions, giving information and persuasive talking, suggesting a paternalistic communication style, when attempting to motivate a client (Enlund et al. 2021). The veterinarians dominated the conversations and made minimal attempts to involve the dog owner, resulting in a power imbalance between the veterinarian and the client (Enlund et al. 2021). The research concluded that veterinary communication and, thereby, client adherence to medical recommendations may improve if client‐centred communication styles such as motivational interviewing (MI) and narrative medicine are introduced and implemented in veterinary practice (Enlund et al. 2021).
Box 2.1 The difference between soft and hard skills
Soft skills: Non‐technical skills that relate to how you work. They include how you interact with colleagues, how you solve problems and how you manage your work. They include interpersonal (people) skills, communication skills, listening skills, time management, problem‐solving, leadership and empathy.
Hard skills: Technical skills that can be taught (e.g. intravenous (IV) cannula placement and blood sampling).
What is narrative medicine?
Narrative medicine considers all aspects, not just the medicines but also the diagnostic tests that are required. The owners and pet's narrative (their back story) needs to be understood to work together towards a treatment plan. Each owner and pet will have a unique narrative (story) that needs to be understood (Fine 2020).
VNs are excellent at acting as advocates for their patients and owners. Ultimately, the best care that can be provided for the patient is reflective of the owner's/pet's narrative. What might provide the best care plan for one patient will not be the best care plan for the next. Their narrative might be different. Balance is vital to achieve the best clinical outcomes for the patient. The term ‘gold standard treatment’ is no longer used as it can mean different things to different cases; it will depend on their narrative and to different veterinary professionals depending on their knowledge and experience. Understanding the narrative will help with concordance and compliance with the treatment care plan. This means that veterinary professionals are providing treatment plans that are achievable. This all goes back requiring good communication skills. It doesn't matter what form of communication is being utilised (in person or telemedicine); if the owner/pet narrative is not considered, there is a potential that clinical goals and therefore outcomes won't be achieved.
Discussions have been made on the influence that narrative medicine has on the well‐being of veterinary professionals. Narrative medicine has been shown to help reduce burnout and fatigue within practitioners (Fine 2020), by providing tools and strategies to help reduce burnout and compassion fatigue, minimise guilt and manage distress. Every veterinary professional should be equipped with skills that can be readily utilised in practice to help both the clinical outcomes for the patient and patient welfare, support the owner's narrative and their own well‐being and aid in teamwork within the practice.
Consultation models
Consultation and communication models are widely referred to as veterinary nursing, but these tend to be adapted from the human medical field or from veterinary surgeons (Calgary‐Cambridge consultation model) (Figure 2.1) (Kurtz and Silverman 1996). The Veterinary Nurse–Client Communication Matrix (VNCCM) (Figure 2.2) has been suggested as a model that incorporates the Veterinary Surgeons Act and the RVN Code of Professional Conduct (from the United Kingdom) as more appropriate communication consulting model for the RVN profession (Macdonald et al. 2021). Sharing information is not just with the owner but also with the larger veterinary professional team. In some clinical cases, confirmation with the veterinary surgeon may be required. The matrix isn't bound by time, as reflection and planning can occur after the face‐to‐face elements of the consultation (Macdonald et al. 2021).
Figure 2.1 Calgary‐Cambridge consultation model.
Figure 2.2 Veterinary Nurse–Client Communication Matrix graphic.
Source: Kurtz and Silverman (1996) / with permission of John Wiley & Sons.
Difficult conversations
Difficult conversations aren't just about bad news for the pet but can also be about a client who is unhappy about a situation or when having to explain that something has gone wrong. Before you put yourself in this situation as the deliverer of this information, plan. Whether this is written down or not but ensure that you are mentally prepared. It is vital that you distinguish feelings and emotions from facts and you need to remain calm in these situations. Check any assumptions, and gather evidence (whether it is hospitalisation sheets, times of phone calls to the client, etc.).
Key step
Description
Prepare
Set your goals clear, anticipate questions from them, get all the facts from clinical histories and other parties and choose a setting.
Plan
Prepare an outline of your discussion, practice, follow a logical approach and think about timing.
Ask or enquire
Be empathic, use open‐ended questions and don't assume.
Acknowledgement
Showing that you have heard and listened – acknowledgement is not the same as agreement; using pauses, summarising and writing key points down show you are listening.
Approach
Rather than having assumptions, try to approach from a neutral perspective.
Problem‐solving – make a plan
Build solutions – this is not an ‘I want to win’ situation. We need to build a plan together to move forward.
Breaking bad news
Tone of voice
In these very highly emotive situations, people really do remember some of the strangest details about a conversation. Keep brief, keep to the facts. It is sometimes better to deliver the news and stop. Follow‐up discussions about the details can occur later, but inform the person that this is available to them. People will have questions, but in a highly emotive state, they might not be able to formulate what they want to know at that time.
Motivational interviewing
MI is a client‐centred, evidence‐based counselling method aiming to strengthen a person's motivation and commitment to behaviour changes (Enlund et al. 2021). MI is a technique that requires the VN/Ts to discuss and ask questions to the owner to discover their ‘motivation’/understanding/reasoning behind a certain task. Why do they believe their pet is not overweight, for example? Or what is their reasoning for feeding a certain diet? By fully understanding the owner and their understanding of the situation, you can help succeed in building a plan together for the mutual benefit of them, their pet and the practice (Miller and Brown 1994). There is an overlap with Narrative Medicine, in that you want to be able to understand the owner's motivation (Miller and Moyers 2017). Another term that is also used is Brief Interventions. Mainly used in human medicine, this term relates to a technique used to initiate change for unhealthy or risky behaviours such as smoking, the lack of exercise, obesity or an inadequate diet (Miller and Rollnick 2017).
Six key aspects of brief interventions have been identified – they are denoted by the acronym FRAMES. FRAMES can be utilised in the veterinary profession and can help in the understanding of behaviours of owners as caregivers to their pets.
Feedback on personal risk or impairment
Responsibility for change
Advice to change
Menu of alternative change options
Empathy on behalf of the practitioner
Self‐efficacy or optimism in clients facilitated by practitioners.
Discussing nutrition without an argument
Owners have many beliefs when it comes to nutrition, and the word ‘belief’ is key. It isn't an opinion or something they have been taught, but a key belief that the reason they are doing something is right. Questioning someone's belief reasoning is difficult. For example, if you know an owner who truly believes that the food they feed their dog is the best, it will be very difficult to dispel that belief. There is some psychological evidence that shows that the communication methods required to dispel some nutritional myths that are truly believed will be unsuccessful unless the person understands the correct information on at least three different occasions – and some will never change their minds.
Nurse clinics: How to broach the nutrition subject?
All animals that are seen in a consultation (whether seeing an RVN or a veterinary surgeon) should undergo a nutritional assessment as part of the five vital assessments (Freeman et al. 2011). A nutritional assessment should include weighing the animal and a body condition score (BCS). Clients need to be made aware whether their pet is over, under or at an ideal body weight. Many clients are not aware of this, and it is important that the subject is discussed with clients. People's perception of what is an ideal body weight and shape has been skewed greatly. Studies have shown that pet owners are not able to correctly determine whether their pet is at its ideal body weight or not (Eastland‐Jones et al. 2014; Courcier et al. 2011). There is a fear that just starting the discussion of nutrition can open a whole can of worms regarding which diet is best, but there are ways to give recommendations that are in the best interest of the animal and the owner. Ninety per cent of pet owners have reported that they want a nutritional recommendation from their veterinarian but when being seen in practice, only 15% of clients actually perceived receiving one (Pet Nutrition Alliance 2011). Don't be afraid to talk about nutrition.
Once you have got into the habit of weighing your pet every time and palpating for the BCS, it really doesn't take any extra time. Remember to record your findings. If you are happy, the owner is happy, the pet is at its ideal BCS and there are no risks present (e.g. neutering is occurring next week), then the nutritional assessment is complete. If risk factors are present, then an extended nutritional assessment can be performed. This doesn't have to be done at the same time. This can be scheduled at a different time, with owners being asked to go away and start a food diary or answer a food questionnaire.
When broaching the nutrition question, it is important to think about how we conduct our nurse clinics. Hollins (2017) described the term ‘Learning Pyramid’, which is also referred to as Cone of Experience. None have been proven to be correct, but there is a huge degree of sensibility that we learn from more active means than passive ones. The numbers are designed to be rough guidelines but do highlight this point.
90% of what they learn when they teach someone else/use immediately.
75% of what they learn when they practice what they learned.
50% of what they learn when engaged in a group discussion.
30% of what they learn when they see a demonstration.
20% of what they learn from audio‐visual materials.
10% of what they learn when they've learned from reading.
5% of what they learn when they've learned from lectures.
Telling someone that the food they are feeding their pet is appropriate or telling them that their pet isn't at the correct BCS is going to fall into the 5% being lectured at category. Having a discussion with them about nutrition or engaging with them will hit the 50% category (10 times as much information). Showing them how to conduct a BCS will hit the 75% category. Getting them to go home and show family members how to conduct the BCS will reach 90% retention of the information. Think about visual aids, and what handouts and diagrams can we use; it's a digital age – websites and YouTube videos hold a vast amount of easily accessible information.
Starting the nutrition discussion
Why not just open with, ‘Are you happy with the diet that you feed?’ It is a closed question; it's either going to give you a yes or no answer. The way in which they answer will also give you a lot of information. How did they answer that question? As you know, it's not just what you say but also how you say it. What was their body language saying? Some clients get very defensive when you start discussing nutrition. This may be because they have been reprimanded in the past about what they feed. It is vital that clients are educated about nutrition, but not made to feel guilty or to be bad owners.
If their pet is outside the ideal BCS, this needs to be highlighted to the owner. If you have demonstrated the BCS, then they will already know this. It might be that the diet they are feeding is a really good quality diet, they are just feeding too much or too little, or too many treats, or no enough exercise.
Many clients won't be able to tell you what diet they feed, whether it is a complete diet, or life stage, the feeding volumes in grams; some will be able to tell you down to the number of kibbles. Don't be judgemental. Communication is important. What is important to you as an RVN is not the same to that pet owner.
What is the best diet?
There is no real answer to this other than ‘the best diet for that pet is the one that it does the best on’. There are studies looking at individual nutrients and their benefits in set populations of animals. Recommending a diet can be difficult but should be primarily aimed at ensuring that the diet is balanced and complete for the life stage it is intended for, and that it is batch tested (for contaminants and nutrient content – this is valid for dry, tinned or raw diets). The quality of the ingredients will not necessarily be reflected by anything that is displayed on the packaging. There are also no definitive minimum or maximum levels for carbohydrates in cat and dog foods, so we just don't know what is the most ideal. This highlights why having that nutritional conversation with the owner and performing the nutritional assessment is so important. It needs to be performed regularly and recorded in the clinical history.
References
Courcier E, Mellor D, Thomson RM, et al. A cross sectional study of the prevalence and risk factors for owner misperception of canine body shape in first opinion practice in Glasgow.
Prev Vet Med
2011; 102: 66–74.
Eastland‐Jones RC, German AJ, Holden SL, et al. Owner misperception of canine body condition persists despite use of a body condition score chart.
Journal of Nutrition Science
2014; 3: e45.
Enlund KB, Jennolf E, Pettersson A. Small animal veterinarians' communication with dog owners from a motivational interviewing perspective.
Front Vet Sci
2021 Sec. Veterinary Humanities and Social Sciences.
Fine KR.
Narrative Medicine in Veterinary Practice: Improving Client Communication, Patient Care, and Veterinary Well‐Being
. CRC Press: Taylor Francis Group, 2020.
Freeman L, Becvarova I, Cave N, et al. Nutritional Assessment Guidelines.
Journal of Small Animal Practice
2011; 52(7): 385–396.
Hollins P.
The Science of Accelerated Learning: Advanced Strategies for Quicker Comprehension, Greater Retention and Systematic Expertise
. Createspace Independent Publishing Platform, 2017.
Kurtz SM, Silverman JD. The calgary‐cambridge referenced observation guides: an aid to defining the curriculum and organizing teaching in communication training programmes.
Med Educ
1996; 30(2): 83.
Macdonald J, Gray C, Robbé I. The development of a veterinary nurse‐client communication matrix.
MedEdPublish
2021; 10(1): 144.
Miller WR, Brown JM.
What I Want from Treatment (2.0)
. 1994. Retrieved from
https://casaa.unm.edu/inst/What%20l%20Want%20From%20Treatment.pdf
.
Miller WR, Moyers TB. Motivational interviewing and the clinical science of carl rogers.
J Consult Clin Psychol
2017; 85(8): 757–766.
Miller WR, Rollnick S.
Motivational Interviewing: Helping People to Change
, 3rd edition. Guilford Press, 2017.
Pet Nutrition Alliance.
Tips for implementing nutrition as a vital assessment in your practice
. 2011.
http://www.wsava.org/sites/default/files/PNA_TipsGuide_WSAVAproof2.pdf
(accessed 26/06/2025).
3Gaining Confidence in Consulting
Undertaking nurse clinics and consults is an important aspect of veterinary nursing, whether you are the designated clinic nurse or not. Admit and discharge appointments are a form of nurse consulting, and the same skills are required. Good communication skills are needed to help improve client compliance and client education which in turn help improve animal welfare. Confidence is not something that can be learned like a set of rules but it is a state of mind. Positive thinking, practice, training, knowledge and talking to other people are all useful ways to help improve or boost your confidence levels.
Where does confidence come from?
Confidence comes from feelings of well‐being, acceptance of your body and mind (self‐esteem) and belief in your ability, skills and experience. Low confidence can be a result of many factors, including fear of the unknown, criticism, being unhappy with personal appearance (self‐esteem), feeling unprepared, poor time management, lack of knowledge and previous failures. Confidence is not a static measure as our confidence to perform roles and tasks can increase and decrease; some days we may feel more confident than others.
What can I do to improve my confidence?
There is no set way to improve your confidence levels when it comes to undertaking a task, there is no magic button you can press, but there are several steps that can help. You need an open or growth mindset to accept these concepts or situations to reflect and grow. These steps can include, but are not limited to:
Increasing your underpinning knowledge
: Having a robust understanding of the disease process or the surgical procedure that was undertaken really helps with better explaining to a third person. If you can fully explain something in complete layman's terms, it shows that you have an excellent understanding of the process and will find it easier to relay. Having this excellent underpinning knowledge for some people does help with their confidence. The fear of not knowing the answer to an owner's question can be removed by really understanding the subject, but don't worry about saying you don't know or are unsure. Go and seek clarification from a colleague. Veterinary surgeons are often seen running to find the exotics manual or medicines formulary. If you don't know the answer, say that you will find out. This doesn't have to be immediate; it can be later that day or the following day. Answers can be conveyed via email, text or phone.
Practise and experience
: Doing something repetitively will help you build your confidence in a set task; whether it is drawing a blood sample, placing an intravenous catheter or performing a nurse clinic. You might not like doing them to start, but by performing more consultations your confidence may increase. Your liking to doing the task might stay the same, but your confidence will improve.
Observation of other
nurses and veterinary surgeons performing consultations can help. You can ‘cherry‐pick’ ideas from observing others and build them into your own style of consulting. It is important to remember that everyone has their own style of consulting; there is no right or wrong way. Different clients will prefer different styles – this is why you have some clients who prefer to see certain nurses and vets. If you are in a situation where you have no one else to observe, then use the internet. There are lots of uploaded videos of example consultations of several platforms. Some are good and others are bad, but it will show you what to avoid. There are also many nurses/technicians who are consulting, that would be more than happy to have someone spend a day with them. Be the work‐experience kid for the day.
Have someone evaluate your work
: This can be another work colleague, a friend, a Continued Professional Development (CPD) provider, clients or a video yourself. Feedback can be gained through direct observation, a questionnaire or workshops. Some people will find this process quite difficult, but once you have done it a couple of times, it can be very enlightening. As student VNs, you have to be under direct and continuous supervision (including time in consults/admits/discharges) and this is an ideal opportunity to start building on confidence levels and having someone (your supervisor) give feedback and encouragement.
Interacting with peers
is an excellent way to talk to other VN/Ts who are in the same situation that you are potentially in. In many cases, it is the affirmation of something that you are already doing that gives a boost to your confidence. There are many forums and Facebook groups where consulting nurses ‘chat’ about their experiences and difficulties but also their successes. Remember not to discuss specific cases/clients without permission.
Research and reading
: Some people are very theoretically based and will need to do their background reading on the consultation process, consultation models and case studies of what other nurses have done in their practice.
Having set protocols in
practice aids to give guidance and structure. This can help what to include in a weight clinic or what to do if you find an abnormality on a clinical exam. Having the answers already decided, with clear guidance on what to do, can help remove some of the unknowns. These protocols need to be written and agreed on by the whole practice.
Preparing and planning your nurse consults and clinics touches on a few of the steps mentioned above. Reviewing the appointments that you have for the day, 24–48 hours before can allow you to prepare both physically (leaflets, handouts, ordering in a specific diet, etc.) and mentally (reviewing history, finding out any details that you need to know, etc.).
Having confidence in performing a task can occur naturally in seconds or take months. It depends on the situation and you as a person. There is no magic answer to this. There is a lot of CPD out there on consulting skills for VNs, so it is important to find a CPD type that suits you. Most people hate doing workshops but pushing yourself out of your comfort zone can help boost your confidence. Things won't change unless you change them.
Look at who is giving the CPD. Do you like the style of the teaching they provide? Different lecturers will ‘teach’ differently – they will have their own styles. Find one that fits your style of learning and the situation that you are in. Is the lecturer a veterinary surgeon or a VN – their styles might be different, as the consultations they undertake are very different.
Reflective practice
Reflective practice is something that we are familiar with in terms of nursing care plans and evidence‐based nursing but is also something that we should be doing to ourselves. Reflect on your last few clinics: what were the positives and negatives? Celebrate the positives – it is an important aspect of increasing confidence levels – look at what you have already achieved. It could be something like keeping on time, using the animal's name in the consultation where you keep forgetting to do it before. Make a list of the things that you view as negatives, and formulate a plan on how they can be resolved. CPD on time management, assertiveness or leadership skills can really help, and these don't need to be provided by the veterinary CPD provider. These types of skills can be covered by local colleges or business groups.
Vocalising the problem, and talking to someone, can really help. From your aspect, of getting the issues externalised but also that person might be able to give your perspective on the problem, give you guidance – act as a mentor. Everyone needs a mentor at some point in their life, whether they know it or not. You might have acted as someone's mentor and not realised it at the time.
Some people will find talking in front of others a very easy skill, but others will find it more difficult. Time and experience alongside a helpful feedback system will really help. In many veterinary practices, nurses do have to undertake all tasks. Sometimes, playing to people's strengths can be beneficial, but don't avoid situations because you don't like them, it won't make it better.
4Chronic Condition Clinics
Traditionally RVNs are taught how to conduct a ‘renal’ clinic or a ‘diabetes’ clinic and, on occasion, there is a set list of things that need to be covered in this clinic, as set out by a protocol written by the practice. Protocols and guidelines (care bundles as a whole and frameworks) can be exceptionally useful in giving guidance and structure to the consultation, but at the forefront need personalisation of the care/treatment plan for that animal and owner. Adapting that specific consultation to the unique narrative of that pet and its owner, it is highly likely that animals will have more than one comorbidity and adaptation of clinics is required. With the prevalence of mobility issues in senior cats being 80–95% for example, many cats with renal disease will also need guidance regarding mobility.
