Have you considered taking your Veterinary Nursing career in the route of referral practice? With many disciplines, it can be hard to find the right place for you.
Today we have a really interesting discussion about finding your ‘niche’ with Oncology Vet Nurse Inge Breatnach and how finding her passion has not only excelled her Veterinary Nursing career but has also helped with longevity and happiness within the industry.
Referral Veterinary Nursing Routes: Oncology Nursing
Can you tell us a little about your Veterinary Nursing career so far?
Most people don’t know this, but I actually worked with horses before I became an RVN. I realised, however, that my interest lay in the medical care of animals rather than grooming and mucking out, although I still miss working with them!
I graduated from University College Dublin in 2007 with a diploma in veterinary nursing, after three years on job training. At that time there was no degree route in Ireland, but actually, the practical nature of the training really worked for me, I’m not sure 4 years in a classroom would have suited me at all.
I trained in a lovely small practice in Dublin, some of our clients didn’t have a lot of money, but would always do their best to look after their pets. I then spent some time working in a busy small animal hospital with a heavy surgical caseload, where I learned some really valuable skills regarding patient care and time management.
In 2009 I decided to go to Australia and worked there for 10 months on a working holiday visa. I absolutely adored the work there and met some amazing vets and nurses.
I also loved the quality of life, but sadly RVNs weren’t on the skills shortage list at that point, so staying there full time wasn’t an option. I moved back to Dublin, and did an array of RVN work, including setting up a new clinic as a head RVN, working part-time on an urban farm, and lots of locuming.
I was always looking out for my niche, however. I noticed that we commonly saw patients with cancer, but often treatment either wasn’t an option, or people couldn’t afford it due to pet insurance not covering as much treatment there. Two golden retrievers stand out in my memory, both under five years old, both with grade 4 lymphoma, who were put to sleep on diagnosis, even though they were clinically still well. I knew there must be more we could do for them.
When I saw Noel Fitzpatrick speaking at a conference in Ireland in 2014, he mentioned his new oncology hospital, and my interest was piqued. I went online for a look at the website, and immediately sent my CV to them, not thinking that they would be interested in an RVN with general practice experience!
However, they emailed me offering an interview and I ended up moving to Surrey in 2015 as one of their RVNs. I worked with some amazing people there and worked my way up from RVN to Senior nurse clinician (doing a stint as clinical nurse manager along the way!).
I really love surgical oncology as well as medical, and some of the procedures and interventions I saw there just blew my mind, as well as the excellent nursing care that was provided. I also completed my DipAVN there via Harper Adams University, which was the start of my journey into further qualifications!
In 2020 I moved to The Ralph Veterinary Referrals to help them set up their new oncology service. We started with one oncologist and one RVN (me!) and now have a second RVN and are recruiting a third.
We’ve also been joined by another amazing oncologist, and the service has gone from strength to strength. Just before I moved to this role, I also decided I wanted to help other oncology nurses, so set up The Oncology RVN on social media, as I struggled to find online oncology information that was accessible and accurate.
It helped me hugely when working on my PGCert AVN (oncology) and I really enjoy connecting with oncology professionals across the world, as well as teaching colleagues.
Why did you decide you wanted to take the route you are on now?
I always hoped we could offer more to our cancer patients, so when I had the opportunity to work exclusively with them, I jumped at the chance!
People imagine oncology as depressing and sad, but actually, I choose to see the flip side of that. Often our patients come in with sad carers who expect bad news, but actually, we can make a huge difference to our patient’s quality of life.
By truly nursing these patients as individuals, rather than as a diagnosis, we tailor their care and can keep them doing really well for extended periods of time.
When the time does come to say goodbye to them, their carers often comment on how well they stayed, despite their initial concerns or expectations. And that time with a beloved pet is so precious!
Did you need to undertake any further training or qualifications to get into the role of an Oncology Nurse?
Although additional qualifications can be useful, to start working as an oncology nurse I think you just need a passion for the subject!
You need to be interested in what we do, and open to trying new treatments, as oncology treatments and knowledge are constantly evolving!
There is lots of good CPD out there, so attending talks and speaking to oncology professionals is hugely helpful, as well as researching conditions and looking at research papers.
People skills are a must, we spend a lot of time talking to clients and explaining what’s going on, as well as good communication. And you need stacks of empathy!
Some of the best oncology nurses I know may not be super academic, but actually have a huge amount of skill and knowledge, as well as being amazing calm, and gentle when handling patients.
I’m just finishing my post-graduate certificate in advanced veterinary nursing (oncology) at the moment, and aim to start my VTS in oncology after that, I don’t think they’ll be essential for my job, but I do think they will add to my day to day skills and knowledge.
What does an average day as an Oncology Nurse look like for you?
At the moment we have just moved to a two-vet service, so we are incredibly busy. Thankfully I like the challenge, so I enjoy it hugely!
This also means we vary how we run our days, depending on who is in. As the senior oncology nurse, I tend to spend the first period of the morning checking if I have nothing urgent on my radar, between inpatients who might have been admitted to our ECC department overnight, emails in the oncology inbox, or memos on our practice management system.
At 9.30 we then have rounds, where we discuss all the patients we will be seeing that day, as well as their plans, and any concerns, or nursing aspects we need to remember. We then see our first patient at 10 am. This may be a recheck or chemotherapy patient, an admit for restaging or an initial referral patient we have never seen before.
For initial patients, myself or my colleague Enya will have checked through the history, noted anything important, and written synopsis on the file. This makes it easier for other services to see what’s going on with the patient, without reading what can be a long clinical history. We also contact referring vets in advance to get any missing information and submit a procedure request, as these patients often need diagnostic imaging or sampling.
Whether they are initial patients, rechecks, or chemotherapy patients, the oncology nurses play an active part in looking after our patients. We place IV catheters, restrain, draw up and administer chemotherapy, as well as assist with sampling, lymph node measurement, and body maps.
Often our most important task is to reassure the patients, we are very focused on gentle handling and usually try to give the patients some time to settle before we perform any procedures. Our techniques reap rewards, often our patients will pull us into the building on recheck, as they’re so keen to see us again.
Communication is also vital for our role, between team members, with the wider team such as wards or imaging, and with the pet carers, who are often worried and need reassurance and further information.
We block off an hour for lunch between 1 and 2 pm and do our best to ensure all staff members get a full lunch break, so we will stagger these as needed too. After lunch, we may be assisting with procedures or seeing more rechecks or chemotherapy treatments. I also spend a lot of time on admin tasks, whether that’s checking and ordering stock, or contacting patients who are due repeat CT scans. Clinical work takes priority, so whatever I don’t get time to do, will get done at the end of the day.
The days are often varied and can change very quickly too, especially if ICU has a patient that we may need to slot in for an oncology consultation urgently. I enjoy problem-solving though, so this tends to keep my brain working to find solutions in those situations! We also fit in a tea break if possible a little later in the afternoon, which gives us a moment to catch our breath, especially on those hectic days! We need to look after ourselves to ensure we are doing our jobs safely, especially where chemotherapy is involved.
We tend to finish at 7 pm, as we work a 4-day week, so the end of the day is about cleaning and ensuring everything is ready to go for the next day. I might stay a little while and catch up with a colleague, but usually, my day ends with a dog walk on our little green outside work, as I’m lucky enough to be able to bring my dog to work with me.
What do you enjoy most about your job now? And are there any downsides?
I love the dynamic nature of oncology, our days are always interesting and there’s always something new to learn. With the advent of new procedures, tests, and treatments for our cancer patients, it feels like we are advancing and improving every day.
My favourite part is probably seeing our pet carers and patients develop a bond with the team. They learn to trust us and we form a little team against cancer with them, it really feels so special. They know how much we grow to care for their pets, and often I’ll be sent a photo of a dog with lymphoma running through the mud, or a cat with sarcoma curled up and happy in a sun puddle, which makes me so happy. The goal is to provide quality of life, and those photos really prove that we are achieving that!
The downsides, of course, are when we seem to hit a brick wall with some diseases. Treatments don’t work, patients aren’t happy and the whole team feels like we’ve failed. It’s so difficult, and we do tend to take it personally, even though we have tried our best.
Thankfully, there are few patients whom we can’t help in some small way, but those few really break my heart.
Has moving into this role opened any further doors for you?
I’ve been really lucky to connect with a lot of oncology professionals, especially on social media. This led to the European Society of Veterinary Oncology (ESVONC) contacting me last year, asking me to speak at their recent congress in Siracusa, Sicily. I lectured twice on their nursing stream and also lectured on the nursing aspects of Stelfonta patients for Virbac there too.
I also have some nursing CPD talks lined up, as well as an online oncology nursing course lined up via Innovet, which I will hopefully launch in the next few months. I really enjoy sharing my passion with other veterinary professionals, so I hope to continue being able to do so in the future.
What would you say the major differences are from working in general practice to Referral?
I am so glad I have worked in both general practice and referrals, GP gave me a great base to work on, and an understanding of the challenges GP nurses may struggle with.
We are quite lucky in referrals, we have time, equipment, and opportunities that other nurses may not always have. I think it’s important not to think we are better than those working in GP, we often just have more resources at our disposal.
When I moved to referrals, I actually found it a huge culture shock and doubted my ability hugely for the first few months. The sheer amount of new information and knowledge can be overwhelming, and I had to remind myself to take things day by day.
However, I don’t think I could ever go back to GP, it’s so important to me to work within my area of passion.
What advice would you give to any RVNs looking to move their career in the direction of specialising in a certain discipline?
I think you will never fail if you strive to learn more in whatever discipline you are interested in. Seek out CPD, articles, and find someone who will mentor you or teach you more.
Having someone there to discuss cases is a huge help, you learn to question why we do things and to think of other methods and ways to nurse these patients better. Try to move to work with people who support you, in an environment that encourages growth and education.
And finally, work with a team that has the same values as you and who will look after you. It’s a hard job, we all need to be working within a team that cares for each other.
Finally, as a Registered Veterinary Nurse, what are your current future career goals or aspirations?
I have so many aspirations, I don’t think I will ever stop! I hope to continue to teach and lecture, improve my lecturing skills ( as I tend to get quite nervous still!), to share my passion for what I do, both online and in person.
The next year will be all about my VTS and hopefully giving that a good try, as it’s very difficult to achieve. I also miss surgical oncology, so would love to do a little more of that again, to provide holistic nursing for all patients, whether they are surgically or medically managed, or both!
I’ve met some amazing oncologists and nurses in the past year too, so would love to collaborate with some of them in the future, whatever way that might be achieved. I tend to be very stubborn, so will do my best to achieve my goals, but as long as I’m looking after my patients and their carers too, I can live very happily!
You can find and follow Inge’s incredible work at:
Instagram: @oncologyRVN
Facebook: The Oncology RVN
Twitter: @OncologyRVN
