Supporting a larger facility, an Inpatient Nurse Technician (IPNT) becomes akin to a circus ringmaster. The IPNT ensures all the functional areas are running well and concurrently for maximum effectiveness. Here's a little practice philosophy from our observations, beliefs, and experiences:

The Goal for the Inpatient Nurse Technician: To allow the treatment tables, surgery, and imaging capabilities to operate effectively and concurrently, for all healthcare delivery systems to go smoothly, and to increase the doctor's productivity. Concurrently, give the patient an advocate who will keep the animal's well-being, health, and safety foremost in mind.

The IPNT is responsible for knowing the status of every animal in the facility, maintaining the white board in treatment to reflect the current status of each animal, and to ensure all healthcare delivery is documented into the medical records, plus invoiced in an accurate manner.

The IPNT will ensure the rounds are conducted and prioritized by the appointed time to ensure the doctor has minimal "waiting time", and will ensure each patient is recovered and the steward kept informed on a real-time basis, according to hospital expectations and promises.

The IPNT will ensure scheduled drop-offs and surgeries are called the day before, and provide clients the delivery of healthcare information, as directed by the veterinarian. The skilled IPNT also provides whatever else the doctor or client may need, acting as a friend to the client and having genuine concern for the companion animal.

IPNTs always act, dress, and look like a member of a superior healthcare team. They must always remember that they are "on stage" and that their actions, appearance, and words are not missed by owners. They are impressive, simply because they are friendly and they "know their stuff".

The Benefits of the Inpatient Team

Dr. J.M. called us and needed help immediately. He had met with his accountant and committed to a gross income increase of $107,000 in the coming year. He wanted to know how to produce that much money in his two-doctor, eight hundred fifty transactions a month, storefront, companion animal practice.

As a consulting partner, we had established the four dental grades, with grade one (1+) being brown molars with white incisors, with no gingival detachment, a twenty-minute prophy for skilled inpatient staff. Dr. J.M. had never pursued grade 1+ dentals and had not deemed it important to start, even after the consultation had started.

With the above philosophy, we started a math problem: grade 1+ dental at $94 (door-to-door) times four per day, then multiply that by twenty-five days in a month, then multiply that by twelve months.

Dr. J.M. said, "$112,000"

Catanzaro said, "What you going to do with the extra $5000 dollars over budget?".

For the first time, Dr. J.M. realized what the consultation report and Catanzaro had been trying to tell him for six months: grade one dentals are an inpatient staff function, while he is on outpatient, so they are almost pure net income.

These factors even work in a one-doctor practice! It is obvious that an inpatient team doing risk levels 1 and 2 anesthesia for grade 1+ and 2+ dentals can produce major income, while the doctor is on outpatient duty.

It also applies to radiology. The films can be taken and hung, ready for the doctor, while the doctor is on outpatient duty. We know that morning t.i.d. and q.i.d. treatments, as well as one hundred percent patient TPR and review, should be done before the inpatient doctor even arrives for rounds.

We sincerely believe that adequately trained nurse/technicians are critical to effective healthcare delivery. The effectiveness of the staff is directly proportional to the level of trust for which they have been trained. If they have not been trained to be trusted, or if the doctor corrects them in front of clients or other staff members, the healthcare delivery team system will be non-functional.

Inpatient Rules of Thumb

The linear-thinking practice expects the doctor to come into the treatment room and tell everyone what they should be doing to support him/her. The zoned practice has an IPNT telling the arriving doctor what the case priorities are, based on complexity first for morning rounds, and RTG (ready-to-go) times for afternoon rounds.

The linear-thinking practice usually has a doctor running behind schedule, because everyone is following the doctor and asking questions, or waiting to be told what is expected next. The zoned practice has an IPN coordinating the inpatient team staff in patient-based healthcare delivery, regardless of the doctor's location, and is ready to gear up for surgery or doctor diagnostics, based on a pre-coordinated plan with the doctor.

The linear-thinking practice usually does not need, or effectively use, an inpatient white board or other prioritization system, since the doctor is "shooting from the hip", based on the crisis of the moment. The zoned practice has a plan, and works the plan. The IPNT adjusts the plan, based on caseload demands. No one is hovering or waiting for the doctor to speak, or lose his/her cool and yell.

In the linear-thinking practice, animal caretakers mow the lawn, when the animal census is down. Sometimes they change light bulbs and wash walls for diversity. In the zoned practice, the IPNT adjusts healthcare workload, based on patient census, and uses the animal caretakers as technical assistants, when the census is down. Some of these animal caretakers are the staff building blocks, via distance learning and in-service training, of the future and have a career progression in a ZONED practice, because the IPNT and OPNT want to develop additional staff for the busy rush times and practice growth support teams.