Veterinary nurses want growth. Doctors want relief. Patients want better care. The thing that provides all of the above is better utilization, which can also lead to a more efficient team and sustainable business. Appropriate utilization directly impacts patient care, team morale, and practice revenue. In fact, research shows being utilized and contributing meaningfully significantly improves burnout scores among veterinary nurses.1,2 Veterinary nurses conducting an abdominal ultrasound exam. Photo courtesy Kenichiro Yagi As your veterinary nurses become more skilled, they will want career growth, so utilizing them at the “top of their license” is required to become literal. Are your veterinary nurses performing pericardiocentesis, thoracocentesis, unblocking cats, closing lacerations, performing endoscopy, performing locoregional blocks, or conducting ultrasound exams? Being at the “top of their license” means moving beyond basic tasks and exploring advanced procedures that push the boundaries of what’s “normal” in your practice while staying within the scope of practice laws. What tasks considered a “doctor thing” at your practice that can be done legally by veterinary nurses? The deepest core of non-utilization If utilizing veterinary nurses at the “top of their license” is so beneficial, why aren’t more practices doing it? What’s preventing better utilization? When examining the root causes, the barriers typically fall into a few categories: unclear role boundaries, inconsistent training expectations, and reflexively defaulting to “doctor-centered” workflows because “this is how we’ve always done it.” However, at the deepest core of non-utilization is fear. More specifically, fear from the perception of clinical risk and legal anxiety. Many doctors hesitate to delegate because of a low tolerance for errors, uncertainty around the scope of practice, and the ultimate fear: “My license is on the line.” To address this fear, it is crucial to draw a distinct line between negligence and responsible utilization. Veterinary medical boards exist to protect the public, and they will take disciplinary action against a license when they determine a practitioner has acted out of true negligence, such as failing to maintain exact medical records or operating recklessly outside established protocols. However, these boards do not typically take punitive action against unfortunate patient complications that occur despite rigorous application of appropriate safeguards. When you employ responsible utilization by equipping your team with the right training, clear clinical standards, and appropriate supervision, you are actively mitigating risk. Complications are an inherent reality of veterinary care, but when they happen within a structured, well-documented, and legally sound framework, it is recognized as responsible practice, not negligence The responsible utilization formula The answer lies in “responsible utilization,” a structured framework that enables veterinary practices to maximize their nursing team’s skills while actively mitigating clinical and legal risks. Rather than simply handing off complex tasks and letting what happens happen, it is a deliberate system and formula designed to protect doctors, empower veterinary nurses, and ensure patient safety. At its core, responsible utilization means establishing a safeguarded environment in which advanced delegation is guided by concrete criteria. It is defined by rigorously answering five critical questions, which I now refer to as the “5 rights of responsible utilization.” The 5 rights of responsible utilization The right procedure (Is it legal?): Research relevant state regulations on the scope of practice. Determine whether your hospital leadership supports veterinary nurses performing these specific advanced skills. Before delegating an advanced skill, you have to answer the baseline question: Is it legal? This requires a clear, accurate understanding of a state’s practice acts and the legal scope of practice for credentialed veterinary technicians. To find this, go directly to the American Association of Veterinary State Boards (AAVSB) website, which provides links to every state’s veterinary medical board. There, you can access the most current, publicly posted statutes and rules governing the scope of practice. While state advocacy organizations often create useful, easy-to-read resources, the ultimate jurisdictional authority always lies with the state veterinary medical boards. However, legality is only the first layer. You must also ask: Does your hospital leadership want to allow nurses to do these things? Look for procedures that offer a high return on investment for both the team and the patient. Ideal target skills are frequently used, improve patient care, relieve doctor bottlenecks, and are highly fulfilling for nurses to learn and perform. The right way (Are the expectations clear?): Define standards of care through concrete clinical guidelines, and additionally, provide visual, step-by-step algorithms to guide patient care. Ambiguity leads to anxiety and risk. You cannot expect a nurse to perform at an advanced level without establishing the “right way” to execute the procedure. Fundamentally, this means there must be absolute agreement from everyone involved (doctors, nurses, and assistants) on exactly how the procedure should be done. In an ideal situation, there is a clear, evidence-based guideline that can be easily adopted as hospital protocol. Building on this, creating visual clinical algorithms to guide decision-making gives nurses true autonomy. These algorithms act as hospital-approved, pre-established written instructions on how to treat patients that meet specific conditions. The RECOVER CPR Guidelines and algorithm are a great practical example of this in action, demonstrating how standardized, evidence-based protocols empower the entire team to act decisively and safely. However, creating comprehensive guidelines and algorithms takes a tremendous amount of effort, time, and clinical expertise. When external resources are unavailable or internal bandwidth is simply tapped out, you still need a baseline. The absolute minimum requirement is that doctors and nurses talk to each other. They must have a direct conversation about exactly how the procedure is expected to be performed so that there are absolutely no surprises on either side. When expectations are clearly communicated, you remove the guesswork and set the stage for consistent, high-quality patient outcomes. The right person (Is the person qualified?): Assess a veterinary nurse’s experience, clinical competency, and professional judgment to ensure they are the right person who is ready to learn the task and put them through standardized and thorough training. Not every nurse is ready for every advanced procedure, and that is absolutely okay. You must objectively assess who is the right person to trust by establishing strict selection criteria that evaluate clinical competency, professional qualities, good judgment, and trustworthy behavior. This rigorous selection process serves a critical, dual protective purpose. First, it guides highly enthusiastic and ambitious team members to build the necessary foundational experience before taking on advanced tasks, ensuring patient safety is never compromised by a well-intentioned reach beyond their current proficiency. Second, it protects nurses who aren't quite ready from being pressured into performing high-stakes tasks prematurely. Forcing a nurse into an advanced procedure before they have the requisite experience can result in emotional damage and anxiety, which ultimately deteriorates their long-term confidence, job satisfaction, and career longevity. Escalation awareness and knowing exactly when to ask for help are just as important as the clinical skill itself. Once you have identified the right candidates, they should undergo high-quality, standardized training. A successful training program relies on a structured progression: starting off the floor with foundational clinical knowledge, followed by practice on models or simulation, before moving to the clinical floor to observe, perform, and eventually teach the procedure. Crucially, this training must provide them with the comprehensive ability to critically think through the entire management of the case. A great nurses does not simply learn the technical “what” and “how” of a procedure, but they understand the “why.” By mastering the underlying reasoning, nurses are empowered to anticipate subtle changes in patient needs, make informed decisions, and foresee potential complications before they ever happen. The right patient (Is this the right patient?): Every delegated task requires considering patient selection criteria, inherent risks, and potential complications. The golden rule remains: Always stabilize the patient first. Then match each patient with a veterinary nurse who has the appropriate experience level. Even with the right procedure, clear guidelines, and a thoroughly trained nurse, not every patient is a candidate for delegated advanced care. Performing a proper risk assessment is an essential step in the formula. Each patient and condition can be evaluated and categorized along a spectrum from low to high risk. From there, case assignment becomes a strategic matching exercise. Nurses with less experience in the newly acquired skill should be matched strictly with low-risk, straightforward cases, while the most experienced nurses can be trusted with higher-risk, more complex patients. Plus, as always, the fundamental rule applies: you must stabilize the patient first before proceeding with any advanced procedure. Because we are strictly matching risk to experience, there will inevitably be times when a safe match simply is not available on the floor. Therefore, open communication about boundaries is non-negotiable. Doctors must be prepared to say no to delegating a specific case, and nurses must be prepared to hear no without taking it personally or feeling the need to push past safe boundaries just to prove their readiness. This is not a reflection of a nurse’s overall competence; it is an objective clinical judgment about the specific situational risk. These conversations do not have to be discouraging shut-downs. A “no” might simply sound like, “Not this patient, their comorbidities make this too complex,” or “Not right now, the floor is too chaotic for me to provide the right support.” Alternatively, it can be a collaborative pivot: “Let's work on this patient together.” This approach ensures patient safety remains the ultimate priority while still fostering a culture of learning, trust, and mentorship. The right help (Is there appropriate support?): Ensure access to necessary equipment, supplies, and legal support. Crucially, this involves having an experienced team member on the floor who acts as a practical coach, a rescuer when needed, and a culture of learning champion. If things do not go as planned and a complication occurs, the team must support each other, take care of the patient, and treat people like human beings. A nurse performing advanced procedures will require a safety net. There must be experienced team members on the floor who are ready to coach and mentor. When a hospital first introduces an advanced procedure, it is common that no nurse in the building is experienced enough to lead the training. This is the perfect opportunity for doctors to step in and do the coaching themselves. Having doctors directly teach nurses has a significant positive impact on the hospital’s culture. As the doctor watches the nurse progress and master the skill, they build first-hand trust in that nurse’s capabilities. The doctor becomes personally invested in seeing their trainee succeed, which bridges the traditional doctor-nurse divide and fosters genuine psychological safety on the floor. The right help is also defined by how the team responds when the inevitable happens. In veterinary medicine, complications arise, and things will not always go according to plan. When an adverse event occurs, a psychologically safe culture dictates that the team’s immediate focus is taking care of the patient, followed closely by supporting each other. It means treating people like human beings in the aftermath of a stressful event rather than pointing fingers. Furthermore, a supported nurse knows that if they operated within the established guidelines, they have the full backing of the practice’s legal and insurance teams, supported in the exact same way a doctor would be. The benefits of high-level utilization When you move past the fear and fully commit to implementing structured, advanced training, the results reveal huge benefits across patient care, doctor bandwidth, practice revenue, and overall team culture. Elevated patient care and safety: The ultimate goal of any clinical initiative is better patient outcomes, and advanced utilization delivers on this front. When veterinary nurses are specifically trained and empowered to use critical thinking to apply clinical guidelines or algorithms, patients receive timelier, effective interventions. For example, wait times decrease, pain management protocols are initiated faster, and the overall quality and consistency of patient care drastically improve. Creating time for doctors: Veterinarians are chronically stretched thin. Successfully delegating advanced procedures saves countless doctor hours across a hospital’s caseload. By shifting these responsibilities to capable, trained veterinary nurses, you give doctors the vital relief they need to focus their cognitive bandwidth on complex diagnostics, surgical procedures, and case management that require a doctor’s direct attention. Sustainable revenue generation: Empowering veterinary nurses to perform advanced skills is not just good medicine; it is sustainable business. By capturing the value of these advanced, veterinary nurse-led interventions, a practice can unlock significant financial growth. It optimizes the workflow so that billable services can be performed simultaneously by more team members. Carlin Johnson, CVT, unblocking a cat with veterinarian supervision.Photo courtesy Kenichiro Yagi Second-order effects: The culture shift While the benefits in terms of time, money, and patient safety are compelling, equally (if not more) important are the behavioral shifts that emerge once the system is in place. Implementing an advanced nursing training program signals a massive mindset shift across the entire hospital, extending far beyond mere skill acquisition. When nurses are trusted, trained, and supported to perform at the top of their license, the hospital ecosystem evolves in several powerful ways: From task-doers to case managers: Instead of waiting for a checklist of tasks to be handed down, advanced-trained nurses begin to assume end-to-end ownership of patient outcomes. They begin viewing the case holistically, managing the patient’s trajectory from triage through discharge. This level of autonomy fosters a deeper sense of professional pride and purpose. Self-regulating workflow efficiency: When the hospital gets slammed, the floor dynamics fundamentally change. Teams naturally default to these advanced-trained nurses based on their proven capabilities, bypassing traditional bottlenecks. Doctors do not have to micromanage the floor because the team knows exactly who is qualified to handle the procedures, creating a highly efficient, self-regulating workflow. The confidence ripple effect: Conquering a highly complex, historically “doctor-only” skill fundamentally changes a veterinary nurse’s self-perception. Veterinary nurses trained and utilized in these advanced procedures demonstrate significantly increased confidence when initiating other clinical skills on the floor. Because they have mastered a high-stakes procedure, the rest of their clinical duties suddenly feel less intimidating, leading to a more proactive and assertive nursing team. Growth and retention: The existence of an achievable, highly respected advanced training program fights stagnation and turnover. It motivates the rest of the team to push themselves. Less experienced veterinary nurses become actively engaged in internal training programs, and veterinary assistants push harder in their credentialing efforts because they now see a tangible, rewarding goal they want to reach. A reciprocal culture of learning: Getting nurses to perform advanced procedures normally thought of as “doctor things” creates a continuous, reciprocal cycle of education. Doctors invest time in teaching veterinary nurses, but as those veterinary nurses achieve mastery, they turn around and teach their peers, and often, they end up teaching newer doctors. This bridges the traditional doctor-nurse divide, building a culture grounded in mutual respect and shared expertise. Steven Kirkpatrick, LVT, VTS(ECC), performing pericardiocentesis with veterinarian supervision. Photo courtesy Steven Kirkpatrick Note on professional titles: The term “veterinary nurse” is used in this article to refer to credentialed veterinary technicians. In alignment with the National Association of Veterinary Technicians in America (NAVTA) policy, the author recognizes this title as reserved for professionals with CVT, LVT, LVMT, or RVT credentials. For more information, visit navta.net/policies. Steven Kirkpatrick, LVT, VTS(ECC), performing ultrasound-guided thoracocentesis with veterinarian supervision. Photo courtesy Steven Kirkpatrick Taking the next steps To make this a reality, don't try to overhaul your entire practice at once. Apply this formula to one skill in your hospital that is considered a “doctor thing” that doesn’t have to be. Look for a procedure with a high occurrence rate, that improves patient care, generates revenue, and is fulfilling for veterinary nurses to learn. Ask yourself: Is it legal where you practice? What expectations need to be written down? Who is the first nurse you would trust to start, and who else possesses similar qualities? By answering these questions, you build a foundation of trust and capability that transforms your practice. Kenichiro Yagi, MS, RVT, VTS (ECC, SAIM), is chief veterinary nursing officer at VEG ER for Pets and program director for RECOVER. A recognized leader in ECC and transfusion medicine, Yagi publishes, speaks globally, and advocates for veterinary nursing, inspiring others to challenge norms and push the profession to new heights. References Kogan, L. R., Wallace, J. E., Schoenfeld-Tacher, R., Hellyer, P. W., & Richards, M. (2020). Veterinary technicians and occupational burnout. Frontiers in Veterinary Science, 7, Article 328. https://doi.org/10.3389/fvets.2020.00328 Hayes, G. M., LaLonde-Paul, D. F., Perret, J. L., Steele, A., McConkey, M., Lane, W. G., Kopp, R. J., Stone, H. K., Miller, M., & Jones-Bitton, A. (2020). Investigation of burnout syndrome and job-related risk factors in veterinary technicians in specialty teaching hospitals: A multicenter cross-sectional study. Journal of Veterinary Emergency and Critical Care, 30(1), 18–27. https://doi.org/10.1111/vec.12916
