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Safeguarding and improving the mental health of the veterinary team

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Ratification Date: 10 Dec 2021

Policy

Safeguarding and promoting the mental health and well-being of the veterinary team requires a multifaceted systems approach which is both balanced and sustainable. This involves taking action to moderate work demands linked to occupational stress, while implementing interventions and resources to improve well-being targeted at the level of individuals, groups, leadership and organisations.

Factors to be taken into consideration include key stakeholder interests to achieve:

  • productive and profitable business enterprises;
  • long term career success and satisfaction for veterinary professionals and veterinary staff;
  • client satisfaction; and
  • improved animal health and welfare.

Background

According to the World Health Organisation, “mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community”. 

Mental health is not simply the absence of mental ill-health.

Safeguarding and improving the mental health of employees makes business sense. It is also morally the right thing to do and assists employers to meet their obligation to the physical and psychological health and safety of their employees under Australian occupational health and safety laws.

A bi-directional positive relationship exists between work and mental health. Employment is beneficial for mental health2 and happiness or well-being is associated with and predicts successful outcomes at work.3 Krekel and de Neve (2019)4 in a recent review of the evidence, concluded that there is a strong business case for promoting worker well-being due to the associated beneficial impacts on productivity, business performance and customer satisfaction.  In short, mentally healthy workers are good for business.

The positive impact of veterinary worker well-being has been recognized by the Royal College of Veterinary Surgeons (RCVS) and the American Veterinary Medical Association (AVMA) in their statement on mental health and well-being – “Improving veterinary mental health and well-being has a positive impact on individuals, the profession at large, and ultimately animal health and welfare.”5

Whilst work is generally positive for mental health, it also contains recognised challenges and stressors which have the potential to harm well-being and performance and contribute to and/or create mental ill-health. Stressful work conditions may lead to job dissatisfaction, burnout, absenteeism, presenteeism, staff turnover, anxiety, depression, and suicidal thoughts6,7,8,4 all of which come at a significant cost to the individual, the quality of care and the business.9 All members of the veterinary team can be affected including veterinarians, allied animal health care professionals and veterinary students.10,11,12 Australian veterinarians are reported to experience higher levels of distress, anxiety, depression and burnout than the general public.13,14

The Job Demands - Resources (JD-R) model provides the theoretical basis for explaining how the workplace can impact on both job performance and employee well-being.15,16,17,8 Job demands are aspects of the job which require a physical, emotional and/or cognitive investment by the worker. Excessive demands deplete resources and create a health impairment process leading to occupational stress, exhaustion, empathy fatigue and burnout. Hindrance demands, which are perceived as being unproductive and creating an unnecessary barrier to quality work are particularly damaging.11 Job and personal resources, on the other hand, induce a motivational response and engagement, allowing people to grow and develop whilst meeting workplace demands and goals. The balance between job demands and resources is critical. When job demands are high and resources are limited, productivity declines and the likelihood of experiencing stress and burnout is increased. 

Aspects of veterinary work that are considered to be demanding include such things as work overload (long and irregular hours, high intensity/fast pace of work and negative interactions between work and home); dysfunctional or unsupportive workplace cultures; the emotional burden of exposure to suffering in both animals and humans; unexpected and poor outcomes; and challenging interactions such as those that occur around finances, client expectations and ethical dilemmas.18,19,20,21,22,23,24,25,8,10  Key stressors such as these need to be moderated to enhance resilience and well-being.25

Job resources linked to improved outcomes such as well-being, satisfaction, motivation and retention in the veterinary industry, include positive team cultures and daily work experiences, social support (both within and outside the workplace), effective leadership, meaningful work, constructive performance feedback and autonomy support. Reasonable salaries and work flexibility allowing holidays and leisure time are also important.26,27,28,29,8,10,17,21,24  

Personal resources important to employability (day one competency and career satisfaction and success) in veterinarians were identified by the VetSet2Go project (2018).30 Eighteen capabilities in five overlapping domains were highlighted; Self-awareness (including knowledge of self, reflective self-evaluation, confidence and self-efficacy), Psychological Resources (such as emotional competence, adaptability, resilience and motivation), Effective Relationships (trustworthiness, collaboration, empathy and relationship-centred care), Veterinary Capabilities (effective communication, application of expertise, problem-solving and managing workflow) and Professional Commitment (sustainable engagement, diligence and continual learning). Development of mindful self-compassion and other effective coping strategies such as the willingness to seek help, is also considered important. 8,21,25

Authors such as Rohlf (2018)31 have drawn attention to the dearth of evidence-based literature investigating potential therapeutic intervention to improve well-being in the animal care profession. What we can do at this point is to moderate the demands which have been shown to be stressful to people in the veterinary industry, whilst providing and fostering the development of resources in organisations and individuals which have been shown to be beneficial. In addition, we can borrow from research conducted in other fields and especially human healthcare, contextualising it for the veterinary industry and the unique context of each workplace. As evidence emerges, recommendations will be updated.

In human healthcare, interventions designed to improve employee well-being and performance are more effective and likely to have a synergistic impact when targeted at a number of levels i.e. individual, leader and organisation.32,33,34,35 Similar recommendation has also been made in the veterinary literature.21,25,28 Professional bodies also have a responsibility to promote veterinary well-being and performance.36,25,28

Recommendations

A summary of generic and veterinary industry specific recommendations based on established and emerging evidence, including consultation with veterinary industry stakeholders, is outlined below.

Individual

Support, encourage and access life-long and holistic personal and professional development for all members of the veterinary team; through the provision of accessible information along with reflective practice, training, coaching, mentoring and role-modelling for the development of the personal resources that enhance resilience and well-being.

Leader

Develop leadership capabilities. Leaders play a pivotal role in creating the systems which enable individuals and teams to flourish, in supporting their teams and creating a workplace culture which is psychologically safe ie people feel safe expressing and being themselves.

Workplace/Organisation

Develop job resources through the promotion of positive team relationships, connection and peer support amongst colleagues, along with collegiality within the profession. Normalise checking in with each other and open discussion around well-being. Provide support, training and opportunities for both formal and informal conversations to express, explore and manage the emotional demands and challenging interactions inherent to veterinary work.  

Improve workplace conditions to balance the needs of the veterinary team with the needs of the patients, clients and business. Minimum employment conditions are covered under the Animal Care and Veterinary Services Award 2010 and the Fair Work Act. These should be considered a safety net rather than a guide to conditions that promote positive mental health.

Specific areas of focus include;

  • Creation of a workplace mental health and well-being strategy which includes the normalisation and promotion of early help seeking and intervention, and facilitates access to appropriately trained coaching and counselling services.
  • Management of workload. Matching workload (both working hours and intensity of work) to the available staff, allowing team members to create a balance between their personal and professional lives.
    • Monitor working hours (including on call) for each staff member and make reasonable efforts to keep actual full-time working hours below 40 hours per week on average or provide time off in lieu. Working additional hours in busy periods is sometimes necessary but should not be the norm.
    • Institute expectations around answering phones and emails outside work hours.
    • Allow flexibility in rostering and scheduling, within business requirements, to balance the needs of all stakeholders.
    • Create reasonable time allowances for tasks to support the provision of quality care for patients and clients
    • Allow regular breaks for periods of recovery, unexpected emergency presentations and administrative work.
    • Maintain suitable nurse:receptionist:veterinarian ratios37.
  • Collaborative development of job resources such as templates, checklists, standard operating procedures, policies and protocols.
  • Provide protected time for teams to meet to share their successes and debrief their challenges
  • Provide regular constructive performance feedback. Where appropriate, endorse and enable learning, growth and utilisation of skills in individual areas of interest. 
  • Facilitation of intrinsic motivation and meaning. Recognise and celebrate the rewards of veterinary work such as a making a difference to animals and people and belonging to the veterinary profession.

These suggestions also hold true for educational institutions. Universities, TAFEs etc can be considered workplaces where the work is learning.

Professional Bodies

Professional bodies, such as the Australian Veterinary Boards Council (AVBC), state Registration Boards, Australian Veterinary Association (AVA) and the Veterinary Nurses Council of Australia (VNCA) have a role to play in advocating for and formulating, the overarching industry frameworks and guidelines which safeguard the wellbeing of veterinary practitioners.

Some specific areas of focus include;

  • Facilitating collaboration between professional bodies to develop an industry-wide approach to safeguarding and improving mental health.
  • Strategic work at the level of registration boards and the AVBC in veterinary accreditation standards, complaints handling, holistic continuing professional development, and veterinary nurse regulation.
  • Representing members in negotiations to ensure that the award is robust and represents the needs of both employees and employers.
  • Supporting business through developing industry level mentoring programs, and providing conferences and training programs which promote the growth of personal and job resources.
  • Educating animal owners about the role of the veterinary team and the costs of service
  • Increase understanding of mental ill-health, its impact on fitness to practice and how best to support people currently experiencing mental ill-health.
  • Encouraging destigmatisation of mental ill-health so that people experiencing mental ill-health can be open with registration boards and their employers.
  • Development of policy statements such as these.

Together, these recommendations aim to foster mentally healthy and sustainable veterinary professionals and workplaces that enhance the welfare of animals.

Purpose

This policy is intended for member guidance.

References

  1. https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response
  2. Van der Noordt et al (2014) Health effects of employment: a systematic review of prospective studies. Occup Environ Med.71(10):730-6.
  3. Lyubomirsky et al (2005) The benefits of positive affect: does happiness lead to success. Psych Bulletin 131(6);803-855
  4. Krekel, Ward and de Neve (2019) Employee Well-being, Productivity, and Firm Performance: Evidence and Case Studies in Global Happiness and Well-being Report 2019
  5. https://www.rcvs.org.uk/news-and-views/news/rcvs-and-avma-join-forces-to-tackle-veterinary-mental-health/#statement
  6. Bartram et al (2009) Psychosocial working conditions and work-related stressors among UK veterinary surgeons. Occup Med 59(5):334-41.
  7. Powell et al (2014) Staff satisfaction and organisational performance: evidence from a longitudinal secondary analysis of the NHS staff survey and outcome data. Health Services and Delivery Research, 2(50)
  8. Wallace (2017) Burnout, coping and suicidal ideation: An application and extension of the job demand-control-support model, Journal of Workplace Behavioral Health,32:2, 99-118, DOI: 10.1080/15555240.2017.1329628
  9. Panagioti et al (2018) Association Between Physician Burnout and Patient Safety, Professionalism, and Patient Satisfaction: A Systematic Review and Meta-analysis. JAMA Intern Med. 2018; 178(10):1317-1331. doi: 10.1001/jamainternmed.2018.3713
  10. Moore IC, Coe JB, Adams CL, Conlon PD, Sargeant JM. The role of veterinary team effectiveness in job satisfaction and burnout in companion animal veterinary clinics. Journal of the American Veterinary Medical Association. 2014 Sep 1;245(5):513-24.
  11. Deacon and Brough (2017) Veterinary nurse psychological well-being: the impact of patient suffering and death. A. J Psych 69;77-85
  12. Yang et al (2019). DVM students report higher psychological distress than the Australian public, medical students, junior medical officers and practicing veterinarians. Australian Veterinary Journal. 97. 10.1111/avj.12845.
  13. Fritschi et al (2009) Psychological well‐being of Australian veterinarians. Aust. Vet. J 87(3);76-81
  14. Hatch et al (2011) Workplace stress, mental health, and burnout of veterinarians in Australia. Aust Vet J. 89(11):460-8. doi: 10.1111/j.1751-0813.2011.00833.x
  15. Bakker et al (2014) Burnout and Work Engagement: the JD-R Approach; Annu.Rev.Organ.Psychol.Organ.Behav. 1:389-411
  16. Mastenbroek et al (2013) Measuring potential predictors of burnout and engagement among vet professionals, construction of a customized questionnaire (the Vet-DRQ). Vet Rec 174(7); 168-
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  18. Shaw and Lagoni (2007) End of life communication in the veterinary medicine. Vet Clin North Am Small Anim Pract. 37(1):95-108; abstract viii-ix
  19. Batchelor and McKeegan (2012) Survey of the frequency and perceived stressfulness of ethical dilemmas encountered in UK veterinary practice. Vet Rec. 170(1):19. doi: 10.1136/vr.100262. Epub 2011 Nov 14.
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  21. Page et al (2017) Ch 11 – Workplace mental health in the veterinary sector. In Research Handbook on Work and Well-Being edited by Ronald J. Burke, Kathryn M. Page
  22. Kipperman, Morris and Rollin (2018) Ethical dilemmas encountered by small animal veterinarians: characterisation, responses, consequences and beliefs regarding euthanasia. Veterinary Record doi: 10.1136/vr.104619
  23. Dow et al (2019) Impact of dealing with bereaved clients on the psychological wellbeing of veterinarians Aust Vet J 97:382–389 doi: 10.1111/avj.12842
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  33. Panagioti et al (2017) Controlled Interventions to Reduce Burnout in Physicians: A Systematic Review and Meta-analysis. JAMA Intern Med. 2017;177(2):195-205. doi:10.1001/jamainternmed.2016.7674
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  35. Shanafelt TD, Noseworthy JH. Executive leadership and physician well-being: nine organizational strategies to promote engagement and reduce burnout. Mayo Clinic Proceedings 92, 129–46, 2017
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  37. Acer Consulting (2019) https://www.canadianveterinarians.net/documents/exploring-the-value-that-registered-veterinary-technicians-bring-to-ontario-companion-animal-practices