Board complaint against Texas veterinarian heightens debate about technician title
"Getting an email from the Texas veterinary medical board is never a good thing when you're a veterinarian, and that's exactly what happened to me this week," Dr. Tannetje Crocker said in a video she posted to TikTok in November.
The emergency room doctor with almost 100,000 followers on the social media platform explained that most medical board letters have to do with harm to a pet or poor communication with a pet owner. "Is that what happened in my case? Nope." The reason, she said, was politically motivated, and she invited viewers to guess what it was.
In a follow-up post, she revealed: "I got sent to the Texas veterinary medical board because I work at a hospital that calls some veterinary technicians 'veterinary nurses.' "
The complaint thrust Crocker into the midst of a yearslong conflict over an issue she appeared to know little about.
On one side of the dispute are the leadership of the National Association of Veterinary Technicians of America (NAVTA) and others in the veterinary profession who advocate calling technicians "veterinary nurses" to help the public better understand and appreciate the role of these chronically undervalued team members.
On the other side is the American Nurses Association (ANA), which maintains that the title "nurse" should remain legally designated for individuals engaging in human care only. The organization is aligned with a vocal cohort of technicians who believe the effort to adopt the title in the veterinary sphere was poorly executed and distracts from the more important work of establishing consistent knowledge, skills requirements and credentials for veterinary technicians.
In the 34 years since the American Veterinary Medical Association adopted the term "veterinary technician," states have made their own education and credentialing requirements, spawning four different titles — certified veterinary technician, licensed veterinary technician, licensed veterinary medical technician and registered veterinary technician — across the country for essentially the same job. Nine states do not license, register, establish minimum education criteria or define a scope of practice for technicians, which means anyone can call themselves a technician in those jurisdictions.
Until recently, the push-pull over the veterinary nurse title played out mostly in dueling public relations campaigns and in state capitols, where lobbying for and against title changes takes place.
Now there appears to be a new, higher-stakes strategy deployed by individuals in the anti-title-change camp: filing complaints with state regulators against individual veterinarians who use the term "veterinary nurse" in their day-to-day practice.
A fight from the start
In 2017, NAVTA launched the Veterinary Nurse Initiative. The campaign aimed to unite the profession under the title "registered veterinary nurse" in all 50 states. One argument for the title change is that the role of nurses is analogous to technicians but better understood and respected by the public. (Veterinary nurse is the preferred title in Australia, Ireland, New Zealand and the United Kingdom.)
The initiative also had the goals of standardizing credentialing and scope of practice across the country and "maximizing utilization," which means having veterinary technicians perform the full array of tasks they have been trained to do.
Of 2,790 technicians responding to a NAVTA survey in 2016, 54% said they preferred the title "veterinary nurse," 38% preferred "veterinary technician" and 9% were undecided.
The title change almost immediately met with opposition inside and outside veterinary medicine. The ANA expressed its objections to NAVTA and fought, with its affiliates, efforts to push the new title at the state level. According to the ANA, the title "nurse" is legally restricted in 39 states.
From inside the profession, one of the clearest expressions of dissent came in early 2020, when an online petition urging NAVTA to drop the title-change effort garnered more than 1,000 signatures.
Despite a lobbying push in at least five states, not a single state has adopted the title "veterinary nurse," and pushing legislation by the national organization has lost steam. In July 2021, NAVTA's then-president Ed Carlson told the VIN News Service that the national organization would no longer spearhead lobbying for the title.
However, the argument that veterinary nurse is a better moniker than veterinary technician has gained traction in some corners of the profession, including among some technicians. NAVTA's 2022 demographic survey, released Jan. 15, showed support for the new title increasing since 2016, albeit among one-third fewer respondents. Of 1,886 survey participants, 85% preferred a title with the word "nurse" in it.
The term is also getting more everyday use. In the winter of 2018, the publication Today's Veterinary Technician, published by the North American Veterinary Community, relaunched as Today's Veterinary Nurse. More than a dozen technician education programs are now known as veterinary nursing programs.
Dr. Michele Noreen is a veterinary nursing professor at Truckee Meadows Community College in Nevada, which became the veterinary nursing program about three years ago. "We changed the name of our program to be more supportive of the initiative," she told VIN News.
Veterinary Emergency Group (VEG), where Crocker works, uses both "veterinary nurse" and "veterinary technician" on its website and in its job listings. Kenichiro Yagi, a registered veterinary technician integral to the launch of the Veterinary Nurse Initiative, is VEG's chief veterinary nursing officer. The company reportedly touted the post in 2021 as a first in the profession.
Three months before VEG announced Yagi's role, the ANA complained about the proliferation of "veterinary nurse" terminology in a letter to the Federal Trade Commission. The association's chief general counsel Angelo Somaschini asked for an investigation into "deceptive practices" by schools and other organizations, name-checking Purdue University and Today's Veterinary Nurse, among others.
"A distinction must be made between those who provide care for human beings, and other forms of life; just as those providing medical care for animals are called veterinarians and not physicians," the attorney wrote.
VIN News could not determine whether the FTC had taken steps in response to the letter.
Liz Hughston, a registered veterinary technician and president of the National Veterinary Professionals Union, believes there has been a "concerted effort to normalize the use of the term [veterinary nurse] so that people just stop paying attention to it."
Trouble in Texas
But someone was definitely paying attention, as Crocker, the Texas veterinary emergency medicine doctor, attested on TikTok.
Who filed the complaint with the Texas Board of Veterinary Medical Examiners is not publicly available information. And how the TBVME may view the complaint is an open question. Board representatives did not respond to VIN News questions about the case.
The TBVME website says the public can file formal complaints "about veterinary services you received from a veterinarian licensed by the board." While it's conceivable a complaint about the use of the nurse title could be outside the board's jurisdiction, it will still receive a full vetting.
"Our statute requires us, unlike other [state] agencies, to fully investigate every single complaint that comes in," TBVME executive director Brittany Sharkey said during a December interview on the podcast Veterinary Vitals, produced by the Texas Veterinary Medical Association. While other Texas agencies have the latitude to dismiss a complaint on various grounds, the veterinary board can't.
One impact of the requirement is that it draws out complaint-resolution times. Sharkey estimated that a simple case could take at least four months to resolve.
Crocker posted six videos on TikTok about the complaint in mid-November. She has since moved on to other topics, and declined to talk to VIN News while the complaint is pending.
In her videos, Crocker repeatedly expressed incredulity over the complaint and feeling stressed and hurt by it. The vast majority of comments to her post are supportive. They include expressions of sympathy for her plight, annoyance over the complaint and support for the idea of calling technicians nurses. Many supporters in the comments thread identify themselves as human medicine nurses, veterinary technicians and veterinarians.
Crocker also expressed frustration that she's being held accountable for the fact that her employer uses the veterinary nurse title, even though "I personally did not make that decision."
Contacted by VIN News, her employer, VEG, said through a spokesperson that the company does not comment on board matters. It also declined to talk generally about its use of the veterinary nurse title.
In the TikTok series, Crocker said she discovered that a veterinary professional had filed the complaint, and that fact seemed to upset her the most. She wondered aloud why the complainant didn't talk to her directly rather than "targeting" her to "shut down people using the term ‘veterinary nurse' in veterinary medicine."
She lamented, "We're all out here working hard, and for you to cause this stress and anxiety on fellow vet professionals, I think, is pretty horrible."
Kathy Koar, the director of veterinary nursing at Harcum College in Pennsylvania, considers nurse-title complaints pointless, and she feels for Crocker.
"I have great sympathy for people who have frivolous complaints brought against their licenses, because it is your professional life that they are attacking, and you may not even be aware of it," she said.
In November 2019, Koar received a letter from a prosecuting attorney for the Commonwealth of Pennsylvania, on behalf of the Bureau of Professional and Occupational Affairs. He informed her his office had completed an inquiry into "allegations that [she] improperly [sought] to utilize the professional designation 'registered veterinary nurse,' " likely in her capacity as director of a veterinary nursing program. Koar provided a copy of the letter to VIN News.
She said she was unaware of the investigation until she received the letter, which said the office would not prosecute nor would it disclose any details of the investigation. She added that she is particularly bothered by the fact that complaints are made anonymously, saying, "The person making the complaint is attacking the professional integrity of someone else, without risking their own professional integrity."
Koar, who is also co-chair of NAVTA's Veterinary Nurse Initiative committee, doesn't understand why people are filing board complaints over title use. "Title protection within a practice act … is to protect the public from being misled, or confused, whatever term you want to use," she said. "It is just not reasonable to think that someone is going to walk into a veterinary practice, come up to someone who has the title ‘veterinary nurse' … and think that that person is there to provide human health care. So why are people spending so much time worrying about it?"
'The only way to get people to listen'
For their part, veterinary professionals critical of the growing use of the "veterinary nurse" title are concerned that it has no protected or credentialed role in veterinary practice acts. Complaints against veterinarians, some say, were an inevitable and maybe even necessary result of this trend.
Hughston of the National Veterinary Professionals Union believes the board complaints against veterinarians are the outcome of long-simmering discontent.
"The reason that [veterinarians] are being quote-unquote attacked from inside the profession," she said, "is because we've gone decades without proper legal title use, respect for our titles, utilization. The frustration is at a point now where when you're so blatant about it, people get fed up."
Hughston said she was not involved in the complaint against Crocker or other veterinarians.
"I am not saying anyone should lose their license for referring to people as nurses," she said. "But I do think that we need to start making sure that people are using correct legal titles across the profession, because the more we allow it to slide, the sloppier we get, the lazier we get, the lower our wages are, the less our voice is respected in the practice."
Stephen Cital, a registered veterinary technician in the San Francisco Bay area, concurs with Hughston.
"In my advocacy against people calling themselves ‘nurse' until it is legally adopted, I have certainly said the only way that people are going to listen is if people get turned in for this," he told VIN News.
However, Cital also said it wasn't he who filed the complaint, although he was aware of it and others. He corroborated a statement that Crocker made in a video that several other veterinarians in Texas were hit with similar complaints. Cital said he knows of cases in Colorado, as well.
A member of the NAVTA board in 2017, Cital voted to approve the Veterinary Nurse Initiative. "But it did not roll out as we were told it was going to roll out," he said. He said he doesn't understand why its advocates didn't do more to bring human medicine nurses over to the cause. He sees the title-change effort as misguided now, though he still supports the technician credentialing and scope of practice goals in the initiative.
Cital also criticizes NAVTA for not discouraging the use of the term "veterinary nurse" unless and until it is formalized. On the contrary, he points out that the organization has suggested parameters for how the title should be used. He points to several NAVTA statements, including a December 2021 press release that says, "NAVTA only supports the use of the job title ‘Veterinary Nurse' by credentialed Veterinary Technicians."
(NAVTA executive director Phil Russo did not respond to VIN News requests for an interview.)
"It pokes holes in the whole title protection issue because we're all trying to have credentialed people only call themselves veterinary technicians, [and] uncredentialed people call themselves veterinary assistants," Cital said. "We're trying to unite all under one name. But in reality, all this is going to do is introduce a fifth name, a fifth title, which is frustrating."
He regrets that Crocker didn't take the complaint as an opportunity to reflect on the issue. "What she's not doing is saying, ‘Hey, I've learned that this is a problem. I should not be doing this,' " he said.