To close out 2019, the VIN News Service caught up on several stories that have been brewing for the past year or longer. Read on for a roundup of what's become of the Veterinary Nurse Initiative; national legislation on veterinary prescriptions; a dangerous mystery stomach bug that struck dogs in Norway; an effort to establish an alumni branch of the student-run Veterinary Business Management Association; and standards on handling hazardous drugs in the clinic.

Veterinary nurse title fights for toehold

It’s been more than two years since the National Association of Veterinary Technicians of America announced an ambitious plan to unite the profession under the single title "Registered Veterinary Nurse" (RVN) and to standardize credentialing requirements and scope of practice across the country, with the aim of reversing dissatisfaction and high turnover among veterinary technicians.

The Veterinary Nurse Initiative (VNI) aims to raise awareness of veterinary technicians' role and their professional challenges. In a clinical setting, veterinary technicians work under the supervision of a veterinarian. They compile patient case histories, collect specimens, perform laboratory procedures, provide nursing care, assist in medical procedures, administer anesthetics, take radiographs, advise and educate animal owners, supervise and train personnel and more. In general, they have two to four years of post-high school education and an associate's or bachelor's degree in veterinary technology. 

Four veterinary technology programs — at Purdue University, Harcum College, Colby Community College and College of Southern Nevada — are now known as veterinary nursing programs and offer accredited degrees in veterinary nursing.

However, a national RVN title, which requires revising statutes on a state-by-state basis, has yet to gain legislative traction. That could change in 2020.

In Ohio, a veterinary-nurse title bill passed the House and is now in the Senate Agriculture and Natural Resources Committee. Mark Cushing, a lawyer and consultant who is managing the VNI's legislative process, said he anticipates lawmakers there will approve the title change in early 2020.

"This is a key year," he said. "Getting one state, and a major state like Ohio, in the winning column is a big step" toward building momentum elsewhere.

In Indiana, a title-change bill made it to the Senate floor last February, where it fell short by four votes. Days later, lawmakers in Georgia introduced in a similar bill in their state's Senate but it failed to get a vote.

Cushing said the campaign will continue working in Indiana and plans soon to turn to Oklahoma, where a periodic review of the state's veterinary practice act is coming up. Veterinary medical associations in both states have endorsed the VNI.

When the campaign began in 2017, Cushing predicted the title change would take five to 10 years to achieve nationwide. He recently acknowledged that progress is sluggish. "We have not been able to raise enough money from the [veterinary] industry to sustain [lobbying] three, four, five states at a time," he said. That, coupled with opposition from nurses, he said, "makes it very slow."

Recent legislative developments relating to veterinary technicians in other states hint at some of the attitudes that challenge efforts to elevate their status. The Big Sky Veterinary Technician Association promoted a bill that would require licensing veterinary technicians in Montana. That effort stalled in the Senate Agriculture, Livestock and Irrigation Committee in March.

The committee chair, Sen. Brian Hoven, said licensing was unnecessary for veterinary technicians, whom he equated with car mechanics, according to a post on the state association’s Facebook page.

One proponent of licensure commented on the post: "A veterinary technician only gets one chance to get it right. There is not 'whoops ordered the wrong part' in the veterinary field."



The VNI and NAVTA also lobbied, successfully, to pull veterinary technicians from the list of occupations in "apprenticeship bills" under consideration in North Carolina and Maine. These bills would have established a credentialing track for anyone with a minimum eighth-grade education and a certain amount of work experience.

Kenichiro Yagi, a registered veterinary technician and VNI co-chair, considers bills like this a step in the wrong direction. "Lowering that bar by removing formal education significantly undermines the hard work the veterinary field has made to set standards for those that practice veterinary technology/nursing to ensure appropriate quality of patient care and public safety," he said.

Prescription-writing bill goes nowhere fast

For more than eight years, a bill called the Fairness to Pet Owners Act has been kicking around Congress, causing periodic flares of concern in the veterinary community, which generally doesn't support it.

The bill would require veterinarians, when prescribing medication, to provide their clients with a written prescription for free and without having to be asked. Advocates say it would promote competition, enabling clients to shop around for medication rather than feel obligated to buy it from the veterinarian.

Upon introduction of the legislation in 2011, the American Veterinary Medical Association called the proposal onerous and unnecessary, and rallied its members to voice opposition.

The bill was deemed dead by an AVMA lobbyist in 2012, only to be reintroduced in 2014. That version didn't make it out committee, either.

The bill did prompt the Federal Trade Commission in 2012 to host a public workshop on pet medication distribution. The agency's exploration of the topic culminated in a report, released in 2015, that concluded that, while the market for pet medications had become more competitive in the previous decade, it could be even more so. The authors said consumers could benefit from broader access to portable prescriptions, a greater choice of generic drugs and wider access by non-veterinary retailers to drug supplies.

The Fairness to Pet Owners Act has been continually revived in successive legislative sessions. Its latest iteration, as H.R. 1607, is in the House Committee on Energy and Commerce.

But not much is happening with it. "You hear about an occasional member [of Congress] who supports it, but no great passion," said Cushing, the veterinary industry consultant and sometime lobbyist, who has tracked the bill closely over the years.

" ... It's a classic solution in search of a problem," he said. "There's virtually no active lobbying going on. None of us [who oppose it] are active, because there's nothing to be active about."

Source of intestinal disease outbreak in dogs still a puzzle

Norwegian authorities this month declared an intestinal disease outbreak that killed dozens of dogs in the Scandinavian country to be over, but the cause remains a mystery.

More than 40 dogs perished after suffering from signs of severe enteritis, including bloody and watery diarrhea, according to the Norwegian Veterinary Institute. The unusually severe and fast-acting illness made international headlines.

One particular type of bacterium, Providencia alcalifaciens, remains a prime suspect because it was found in a large number of sick dogs, and genetic analysis indicates it may have originated from a common source.

Some disease experts have doubts, however, because P. alcalifaciens commonly is found in healthy animals, and its presence can spike in individuals suffering from another cause. Possible other causes, including algae poisoning, rat poisoning, tick-borne pathogens, parvovirus, circovirus, Salmonella, yeast and mold have been ruled out.

"It will take time to determine whether Providencia alcalifaciens alone can cause such severe bowel disease in dogs, but this will remain a priority research task for us and our research partners in the months to come," the Veterinary Institute's chief security officer, Jorun Jarp, said in a statement Dec. 16.

In an interview in September, one Norwegian veterinarian speculated that the cases might be linked to especially humid weather conditions, which can promote the spread of some pathogens.

Other than finding a lot of P. alcalifaciens, authorities have not identified commonalities in sick dogs regarding forms of activities, walking areas or feeding to explain a common source of infection.

"Therefore, it is still uncertain whether a point introduction of this bacterium is the origin of the outbreak," Jarup said. "We are prepared that it may never be possible to confirm this."

VBMA Alumni: Focusing on a sustainable future for the profession

For the past year or so, the student-run Veterinary Business Management Association has been searching for former members in a quest to start an alumni branch.

To date, they have made contact with 444 alumni and set up a committee to oversee the new branch and serve as liaison with the student board. Committee members are Drs. Stacy Bartholomew, Kate Boatright, Kristen Britton, Hailey Gentile and Ilyssa Meren. Drs. Meghan Wood and William Hodges will join the committee in 2020.

Founded as a student club at the University of Pennsylvania in 2001, the VBMA today has chapters at every veterinary school in the United States and Caribbean. Its purpose is to teach business and personal finance skills to veterinary students.

The consensus of founding members of the alumni group is to focus on helping to solve problems in the profession, along with providing networking opportunities and supporting students. At a meeting in August, attendees indicated wanting "to be able to have a forum to discuss issues in the profession and how ... we in the alumni group [can] contribute to solutions," said Boatright, an inaugural committee member who served as a student on the national VBMA board in 2011.

Big issues of the day, she said, are student debt, mental health and wellness and a "sustainable profession."

Asked to elaborate on the last issue, Boatright said a sustainable profession is "about helping veterinarians find enjoyment in the profession to keep them from leaving it." That might mean, for some, taking an alternative career path — deviating from the conventional private-practice route to work in, for example, industry, research, government, public health and so on, she said.

The group also is "talking about utilizing veterinary technicians and the veterinary team in the best way," Boatright added.

VBMA Alumni will hold an annual meeting next month in Orlando, Florida, timed to coincide with the national VBMA annual meeting and officer training at the VMX veterinary conference. The VBMA Alumni gathering will take place place off-site and as a separate event from VMX. Boatright said about 20 spots remain for participants in a discussion on "Creating a Sustainable Profession," which will be followed by a networking event. Contact alumnicommittee@vbma.biz for more information and to obtain a password to register.

Former VBMA members wishing to learn more about the alumni group may provide their contact information by filling out an online form. While no one knows exactly how many alumni are out there, the number is estimated to be in the thousands.

Rules on handling hazardous drugs delayed

Veterinarians worrying about whether their hazardous-drug handling practices are up to snuff have a breathing period to get into the swing of things.

As of Dec. 1, Chapter 800 of the United States Pharmacopeial Convention, also known as USP 800, sets a national standard for working with hazardous drugs in health-care settings.

However, because final publication of two intertwined USP chapters — 795 and 797, having to do with pharmaceutical compounding — have been postponed indefinitely due to appeals, USP 800 is considered "informational and not compendially applicable" for the time being.

Translated into plain English: The publication of USP 800 is final but is not considered enforceable for the foreseeable future. (USP doesn't itself have enforcement powers but states that adopt its standards do.)