Communication – Difficult Clients!

Communication – Difficult Clients!

We’ve all met our fair share of challenging clients, haven’t we?

Theresa Time-Consumer: she overruns consults & pesters staff non-stop
Katy: Know-it-All who refers everything to ‘Dr Google’ or the breeder
Charlie: Cheapskate who wants it all but isn’t going to pay for it
Terry: Tyrant who has zero tolerance for everyone, everything and lets us know it
Susie: Sceptic who says she has tried it all before, but none of it works


Communication Skills

Why are communication skills so important?

Good communication skills are essential if you want to find out the information you need to help your patient and client and for you to give your fantastic advice in an understandable way.



Hottest Tips:

Listening: ‘Ear, ‘Ear… it’s not just about hearing the words. It is about understanding what your client is saying.

Speak clearly and confidently: ‘I say, I say’…but not loudly or in a dictatorial manner.

Looking: ‘eye, eye’ … look (not stare) at the person you are talking to and make occasional eye-contact. [You’d be surprised by the number of times I’ve caught myself talking to my computer screen…DOH].

Avoid using jargon: … That’s a Big 10/4 Rubber Duck…. Eh? Express yourself in a manner at the client’s level of comprehension, not yours. It’s all too easy to think that because you understand what you mean, the client must as well.

“Yes, he has a comminuted fracture of the left tibia”….

What’s that? Oh, a Broken leg – why didn’t you say so?

Chat:… a professional natter. Have a friendly conversation your client rather than read-off a script. They will feel far more at ease, less anxious and take on-board your advice more readily and you’ll probably learn more yourself as they relax, open-up and tell you more about their pet.

Ask probing questions:… dig deeper. Don’t just rely on what you are immediately told – you need to find out as much information as possible.

For example: Weight clinic. Bert the Labrador isn’t losing weight.

Initial Question:  “What do you feed Bert”
Answer:  “2 bowls of weighed-out dried food daily”.
Confirmation:  “That’s great! You’re feeding Bert the amounts we talked about last time we saw you”.
Probe further:  “Does Bert get any treats?”
Ask what?:  No wonder poor old Bert is not losing weight. The client hasn’t understood that ‘food’ includes ‘treats’ and so doesn’t mention this until you dig deeper.


How does your client live their life? Understanding their point of view and their life circumstances.

You say: You say: “Bert needs to have supervised walks on a lead 3 times daily for a minimum of 10 minutes
and a maximum of 30 minutes per session”.

*You’ve set an impossible task as, without knowing it, the client can’t (or won’t) do this. The only exercise Bert will get is toddling around free-range and unsupervised in his owners garden, once in the morning and once in the evening.*

How do you gain compliance?: You need to find out more about the client’s circumstances. What can they do? What can’t they do? What can you suggest to help them, to help Bert.

Clever tip: Ask what Bert enjoys doing for exercise?

Use this as an opening question over “what exercise do you give Bert?” and you will gain far more information to help you design an achievable exercise plan.

Joint Commitment: Ask what the client is able to regularly commit to, in time and involvement, to help Bert have fun on his weight-loss journey.

Design Bert’s new exercise routine together with the client. A jointly agreed enterprise works better than a dictated regimen.

Stuck? Clever tip: Suggest ‘outside help’ – you’d be surprised how many times this has been the magic-wand suggestion for me. Suddenly your client is excited that they CAN do this for Bert!

Temporary or permanent solutions; for example; a dog-walker or maybe enlisting help from a family-member or neighbour to pop around to supervise the redesigned garden jaunts.

Orating:… No speech-making or just reading words from a hand-out sheet or form.

There needs to be a conversation interaction between you and your client.

If your client needs to read a form, allow them time to do so and check their understanding; [especially if it is a consent form]. 

Observe & Listen: … Listen to the tone and check their facial expressions and body language – to check for comprehension and to modify your delivery as appropriate e.g. 

  • nodding (understands)
  • eyes darting or wrinkled brow (doesn’t understand)…
  • terse replies (get on with it!)
  • shuffling their feet or fidgeting (nervous or they want to get out of there – either way they aren’t engaged and not listening to you)
  • leaning towards you and smiling (either they fancy you or you’ve got the message across successfully!)

Not sure?: … Never guess, find out. You can’t make the right decision if you don’t have the right information.

SKILLS! They’re multiplying!!

Ask open-ended questions:

  • Tell me about…
  • Explain to me…
  • Describe…
  • Who, what, where, when, how

Use close-ended questions as reflective or qualifying statements


Giving Fred his Tablets:

Tell me about giving Fred his tablets. Listen. Then reflect on and qualify the information provided by the client e.g.

  • “I see. Does that mean it’s difficult to give Fred his tablets?”
  • Client answer: YES.

Explain / describe to me about giving Fred his tablets e.g.

  • “What else have you tried to do?”
  • “Please describe how you give the tablets to Fred
  • “When does Fred get his tablets?”
  • “Who gives Fred his tablets?

Ask a close-ended question: When a Yes or a No answer is needed e.g.

  • “Do you have any other questions about giving Fred his tablets?”
  • Client answer: YES. Resume probing/open-ended questions etc to find out more
  • Client answer: NO. Your Job’s Done!

Ending a consult: to ‘close’ the consultation, and very especially for those times when the client over-stays, (perish the thought!)

Close-down techniques

  • pack away your equipment
  • move towards the door and open it
  • discreet time-check: never look meaningfully at a clock or your watch – that’s rude – however a discreet glance at the clock or your watch can politely can prod the client into understanding you need them to go

Repeat over-stayers:… in advance of the consult, ask a colleague to pop in, after, say 10 minutes, to ask for your assistance in 5 minutes time. You can say…

“Ah good, we’ve still got 5 minutes left on your consultation before I am needed. Is there anything else we need to discuss before I go?”

Have any questions or thoughts on this blog? Send them over to Alison –



Personal Radiation Exposure Monitoring (PREM)

Okay, before you tune out to this necessary but, frankly, rather dull topic – please consider the following…

  • Do you know what your current annual ‘running-balance’ of exposure to radiation from X-ray sources is? No? You should do, you’re entitled to and it is definitely in your best Health & Safety interests!
  • Do you know what your responsibilities and rights are regarding PREM? No? Read on!



Are you aware that self-employed persons are responsible for making their own arrangements with an Approved Dosimetry Service for dose assessment and dose recording under Ionising Radiations Regulations 1999 (IRR99)?

Radiation doses-assessment and recording:

Exposure results:

Best practice is for all information to be passed from practice to practice when a nurse moves location. This is necessary because we should be monitoring our rolling twelve-month exposure for reasons of health, safety and action as required – RPS: Radiation Protection Supervisor (on-site supervisor)

Confessions of a slightly naughty nurse:

Also known as the episode where only half a ‘t’ got crossed & no ‘i’ was dotted!


Many locums are not aware of their responsibilities for dose assessment and recording under IRR99 and travel from practice to practice undertaking x-rays in happy ignorance of the law. Potentially jeopardizing their health and safety by remaining unaware of any accumulated, and potentially excessive, radiation exposure within the last twelve-months.

Using the practice’s own dosimeter badge – or other device – certainly appears to fulfil the criteria of a self-employed person ‘making their own arrangements with an ADS for dose assessment and dose recording under IRR99’. That is, so long as you are recording your rolling twelve-months’ exposure total.

Let’s think about this process. The badge is eventually sent off by the practice within their usual reporting time-frame, be that on a monthly or quarterly basis. It is read and a report is prepared for the exposure that this particular badge has recorded. Any issues identified are then passed to the practice to deal with…

What if there is a radiation exposure identified?

  • To whom does this exposure belong? It may be difficult to identify this as a ‘general-use’ or ‘spare’ badge has very likely to have been used by multiple people within the reporting period.
  • When did the exposure occur? Near impossible to tell to the exact day/date as the report is at best a monthly one and more generally a three-monthly one.

Why is this relevant to a locum?

  • You need to know what your rolling twelve-month exposure is.
  • Due to the peripatetic nature of locum-working, you are normally long-gone before the report appears. Does the practice get in contact with you after you have left?
  • The practice should get in contact with you to advise of the identified issue – even if they cannot be certain it was you that was exposed. It is sensible to show the exposure in your records, just in case.
  • You need to know what do you do with the information.
  • You need to know who is responsible to you for on-going information and assistance.

As a matter of routine, you should receive a copy of your dose assessment and recording report from every practice you work at – issues or no issues. If you do not already, then request these reports as you are entitled to them.

Permanent employee:

  • Similarly, for a permanent employee, who has changed employers within any one twelve-month period, it is sensible to obtain your own dose summary and termination records. You are fully entitled to do so under regulation 21 (6) IRR99. You can then pass the information onto your new RPS.
  • Some employers do pass the information on to the next practice or obtain it from the previous one(s); but check!

TIP: You can also request a copy of your full dose record from the ADS (record-keeping) within a reasonable period of any such request.


1. Practice-provided dosimeter badge. Is usually the ‘spare’ or ‘general use’, un-named, badge. No one person’s activities can be accurately identified.

2. The exposure report from the un-named badge is not specific; it could record activities of anyone at any time within the reporting period (one month’s or usually a three months’ period). The badge could be even be worn by a different person on the same day! The information is useless for individual monitoring purposes.

3. Unless you provide a report to each practice of your ‘running balance’ exposure total, and they provide you with theirs, your annualised total exposure undoubtedly cannot be assessed and therefore any issues cannot be addressed.

***This method clearly cannot accurately monitor an individual’s radiation exposure. You need to set up a different arrangement for yourself***.


Buy your own dosimeter badge!

Take charge of your own safety and obtain a dosimeter badge for yourself, with access to your very own RPS and RPA. It is, I believe, by far the easiest method and is also very reasonable on the purse (around £15 per annum).

The personal preference of my RVN Alison is to apply for an account with ‘JAK Marketing’ (other providers available)

From JAK Marketing:

You will receive a quarterly monitoring kit, consisting of:

  1. A location-badge to place in-situ, to monitor background radiation, whilst working at the practice,
  2. A body-badge to wear
  3. A return envelope.
  4. Send the two badges off every quarter and receive an official exposure report, to keep
  5. Make every practice aware you have your own badges.

This has been wholly accepted wherever Alison, my RVN, went. When she returned to permanent work she continued to use her own badge until the (paid for) year expired and then went onto the practice’s own system. She gave the practice copies of her exposure reports throughout.



Living with grey Squirrels – What’s the deal?

Living with Grey Squirrels – What’s the deal?

History: Grey squirrels are native to North America but were introduced to the UK in the late 1800’s. Since then they have spread throughout the country to the demise of the native red squirrel.

Grey squirrels are so detrimental to the red squirrels’ survival because they can out-compete for food and they are carriers of the squirrel pox, (to which they remain unaffected but if transmitted to a red squirrel it results in a painful death for the red squirrel).

Grey squirrels can also inflict devastating damage to the UK’s trees by ring-barking, (the tree dies), or by stripping bark, (leaving the tree prone to disease). It is also thought that they are playing a part in the decline of native bird species e.g. by egg stealing and the taking of nestlings.

Under the Wildlife & Countryside Act 1981 (as amended) it is illegal, except under licence, to release grey squirrels once caught.

What can (should) you do if you are brought a grey squirrel by a member of the public?







Sciurus Carolinensis Facts:

  • Colour: Various – grey, brindle, varying amounts of red in the coat and there are some genetic mutations of nearly all-white and all-black.
  • Distinguishing features: No ear tufts; the hair on the tail is all around tipped with white, (not on the all-black phenotype).
  • Adult weight: around 400 -700 grams.
  • Breeding: females can reproduce from around 15 months old.
  • Generally, producing a twice-yearly litter of 3-4 young, (kits). In favourable conditions can produce 3 litters in a year.
  • Gestational period: 44 days.
  • Life expectancy: around 8 years.
  • Habitat and food: active all year round and do not hibernate. The nest is called a ‘drey’ which is usually located in the fork of a branch, around 2/3rds of the way up the tree.
  • In a nut shell: They live in mixed broad-leaf woodlands, rural/suburban/urban parklands and farmland which have a wide and abundant food source. They are opportunistic feeders and will eat seeds, fruits, bird eggs and fledglings, fungi, buds and tree-bark. Will live in conifer forests if nothing else is available and exist on pine-cones, although this is not an ideal food source for winter survival.


Squirrels will bite! Handle with care.

Cover the squirrel with a thick towel and gently manipulate it into an up-turned sturdy plastic or metal container. [Never use a cardboard container as they will chew through it and escape]. Close the container (with air holes).

Leave the towel in the container for the squirrel to nestle/burrow/cling to.

Depending on the condition of the patient; some may need to be euthanised immediately on welfare grounds and some can be given emergency treatment before transport to a licenced rescue centre. For example, it may be necessary to warm and rehydrate them or give a baby squirrel (kit) a feed. Do not offer peanuts as they are poisonous for a squirrel.

Kits need to be fed two-hourly. Warmed goats milk is a good substitute (never cows milk).

If you are not going to euthanise the squirrel, consider that you are dealing with an animal that is a non-native species under the law and therefore you should think about the strict restrictions this places on what you can do with it… Can you fulfil the legal requirements?

…and the legal issue…

Remember that whatever your feelings about it, this patient cannot be released back into the wild unless it is done under licence; this means YOU cannot do it and neither can anyone else that isn’t officially licenced. [If considering taking the squirrel to a rescue centre you should check with them that they are licenced].

If this legal criterion cannot be met, very sadly the squirrel must be PTS; that is, unless it will be kept in captivity for the rest of its life. [Please think deeply about the pro’s and con’s of this latter option regarding the mental & physical welfare of a wild creature].

I can’t leave you with a feeling of sadness (I certainly feel a bit that way) so here’s a red squirrel to cheer you up, sporting some magnificent ear tufts and the bushiest of tails!


Are Essential Oils Poisonous to Cats?

Your client calls and may ask you for information about cats and essential oils.

  • Can they safely use tea tree oil to treat fleas?
  • What about using a diffuser to scent the house?
  • Are candles a danger?
  • What if the cat licks my body lotion?



Living on a budget — can you ever splurge?

When times get tough financially, frugality is where it’s at; however, if you are canny with your pennies you can shamelessly fritter a few pounds from time to time, when you want to.

There is definitely a lot to be said for identifying the difference between want and need and being sensible about it, (boo hiss!).

So, here’s a few tips to help you cut some corners. Then maybe you CAN afford that ‘gotta have it’ treat!

Here’s a great website. Check out the hints and tips on it!

  • Shop in the evenings at supermarketas they tend to discountperishable foods later in the day. Alison says she eats strangely sometimes but it’s all edible, some can be frozen and she usually gets change out of £15.00 for her ‘weekly’ shop.
  • Set friendly with someone who has one of those ‘bulk-buy’ cards. 50 loo rolls please…
  • Re-cycle fashion. Combine a day out road-trip to a lovely, upmarket, town, (i.e. where people have brass!), and a visit to their charity shops. My RVN, Alison, has been able to swank around in some really lovely clothes from such, ahem, specialist boutiques.
  • If, for any reason, driving is not your thing, go on-line e.g.
  • Shop in the evenings at supermarkets. The tend to discountperishable foods later in the day. Morrisons do a great 9p line! Alison says she eats strangely sometimes but it’s edible, some can be frozen and she usually gets change out of £15.00 for her ‘weekly’ shop.
  • Get friendly with someone who has one of those‘bulk-buy’ cards. 50 loo rolls please. . .
  • Pound shops (just make sure the product you are buying is not normally LESS than a quid elsewhere!).
  • Compare your staff discount for medications and preventatives against a written Prescription and ordering on-line. Same for food orders. Don’t assume that you’ll get the best value directly from your workplace. Sad but very true at some practices.
  • Car share.
  • Always, always shop around for insurance.
  • Chip in with mates to buy a voucher for something you can share out or
  • ”¢ Rattle your pockets!
    Loose change, say from 20p down, goes into a jar, (don’t be tempted to nick it). Write the start date on the jar. In 6-12 months time, empty it out and use the money to splash out on something special. Alison bought herself a session of spa treatments. Swanky!
  • Cut down on heating bills.
    Keep the heating off for as long as possible. Put extra blankets on the bed and wear jumpers and socks in the house instead. Save the heating for when it is really cold. I am also told this is healthier!
  • Cut down on your electricity bill.
    Don’t leave equipment plugged in or on standby.


Instead of going out, arrange nights in with your mates — that bottle of wine is much cheaper from the supermarket. Maybe you can treat yourselves by sharing the cost of ingredients and having your own cocktail making night? So Lush!

  • Ask your boss for a raise.

If you’re nervous about trying this and stumped for ideas how to do it effectively I am covering this subject soon. Keep ‘em peeled and watch out for it!

It’s not unfair to say that if you consistently live above your means, then it’s an odd way to keep your sanity intact. However, on a vet nurse wage, sometimes it is far from possible to permanently keep in ‘the black’ and the ‘very nice to haves’ are nearly always too far out of your reach. However, with some consistent penny saving activites you CAN go mad and enjoy the occasional spree!

A friend in need?
In case you’ve reached a difficult time; please speak to someone and ask for help.

Asking the boss for a raise

It’s not often I have had to prompt my boss for a raise in juicy beetles or ask her to appreciate my undoubted talents by upping the ‘Spikes Dinner’ rations in my evening dish but, yes, I admit it! There has been the odd occasion when she has slipped up and taken me too much for granted. A hedgehog cannot continue to happily live on meagre means, nor be inappropriately appreciated, thus matters need to be sorted! So, how did I go about successfully persuading her to agree to my demands?

It’s all in the planning. Who was it that said, “He who fails to plan is planning to fail”? (Answer below, if you’re interested!).

Ӣ Refer to Vet Suppliers!
Ӣ Ask a colleague who is a member of SPVS to access the latest
(2015) salary survey.
Ӣ Check out job-ads.
Ӣ WARNING: Be careful about asking your colleagues how much
they earn as some organisations frown heavily on this
practice. If you do, do it, be extremely discreet!
Ӣ Decide on a top figure you would be ecstatic to receive and a
bottom line figure as your absolute minimum.
”¢ Decide whether you will consider other ‘benefits’ in lieu of (or in addition to) a pay increase, and what they will be, such as additional paid holidays or CPD.

”¢ Choose a day and date when you know your boss isn’t rushed, is in a good mood and book the time out in the diary.
”¢ Don’t be afraid to cancel the meeting if the day runs away from either you or your boss. Re-book it for another day, rather than rush it through.
”¢ Some bosses like a ‘heads-up’ about the reason for the meeting. So tell them it is to discuss your salary; but don’t get drawn into a conversation about it before you are prepared to do so. On the spot challenges can be intimidating and result ina poor outcome!
Ӣ Otherwise, simply just ask for a meeting and be non-specific about the reason.

Ӣ There is no point in being over modest. Toot your trumpet!
Ӣ Perhaps ask a colleague to tell you what they think of your performance and Рgulp! Рactually believe them when they give you praise.
Ӣ Set out your specific reasons for requesting a pay raise. What have you done to exceed/excel?
Ӣ How have you supported the team?
Ӣ How have you improved the business?
Ӣ Write it all down in bulletpoints and take your notes into the meeting to refer to.

Ӣ Smile and be calm. Perhaps offer to make a cuppa for the pair of you.
”¢ DON’T say that you are not paid enough. That’s a direct challenge and is bound to aggravate.
Ӣ DO say that you have been considering all your responsibilities and how they could be represented in your pay.
Ӣ After you have spoken; ask your boss what they think, and then importantly: sit back, be silent, and allow your boss to speak.
”¢ Listen to what they have to say. Don’t interrupt.

The nitty gritty
”¢ If they ask you for your ideal salary amount — give them the ‘ecstatic’ one. Say, “I would be ecstatic with £x.”
”¢ DON’T give up the very second they draw their breath and say “no”. That’s part of the negotiating skill. Wait. Ask why they feel you cannot have a salary increase.
Ӣ Ask them what would consider a reasonable offer and, importantly, when it would take effect from.
Ӣ If this is within your hoped for salary range/benefits package, and you want to accept it, thank them politely and advise them that you will consider it.
Ӣ Accept it in writing, confirming the amount and start date.
Ӣ If not within your salary range / benefits package; ask whether a salary review is feasible in the future and if so when.
Ӣ Respond in writing to confirm this date. Diarise to set up a meeting for the date. Between now and then, prepare your case again.
”¢ If you do decide you need to leave because the gap betweenwhat you wish/need to earn and what is being offered, DON’T throw a tantrum and threaten to leave. Be professional. Be discreet. Resolve to make plans to find another job and, when you do, resign with your head held high.

Other ideas
Ӣ If you are working a lot of additional time, which has prompted your call for a raise, ask to reduce your hours and remain on your existing salary. At the very least it will give you more time to look for another job.
Ӣ Ask for paid overtime.
”¢ Ask your boss how they feel you can improve in the coming months, which might encourage a pay increase or bonus as a reward. Don’t forget to record this in writing (evidence of intent and timescales). You never know – if you switch your focus over to what they think is necessary – they may be more inclined to cough up!