Table 3 Roles for, barriers to and facilitators of veterinary technician and assistant involvement in antimicrobial stewardship

Potential stewardship roles for veterinary technicians

Having discussions with veterinarians (n = 25)

“Having a conversation with the veterinarian and asking them why they’re choosing this versus something else […] because sometimes they will talk to like an internal medicine specialist or a criticalist, and they will come to that conclusion themselves, but we just need to know that that has happened and they’re not just doing this because that’s what usually happens.”

“Advocating for our patient […] if we really don’t think they need or really do think they need something. Really just trying to communicate with the doctors to be, ‘hey I think they really need this antibiotic’ or ‘is this actually doing anything, nothing has changed in their status, why are we still continuing’?”

Client education (n = 25)

“I think that [educating clients] is something we could do more, I don’t hear a lot of like explanations about why we need these recheck, certain things were just like ‘oh and come back’. And then […] since that importance isn’t passed along as well as it could be, then we get a lot of […] no shows, and like ‘oops we missed that appointment we’ll do it in another two weeks’ and i’m like ‘well, now it’s been four weeks’ and…I feel like that could be impressed upon owners better.”

Barriers to involvement in antimicrobial stewardship

Hierarchy in the workplace (n = 16): veterinarian-technician

“The concern there is that […] a lot of veterinarians, at least in my experience in surgery, aren’t interested in hearing what their nurses have to say. […] So there’s some some standoffishness there I guess.”

“It would be very difficult, because we are not, you know, diagnosticians and we are not primarily responsible for diagnosis and treatment of patients. We’re here to carry out orders and recommendations by the veterinarians that are in charge of the patient.”

“At this point in my career and [with] the doctors that i’m working with at this time, I would not probably ever feel comfortable [with me speaking up about antibiotic overuse]. In my past I’ve had doctors that I definitely would have felt comfortable saying ‘hey, you ever worry, you know, in a way, like do you ever worry that like maybe this is, it could lead to overuse or you know something’ and there’s people that would have received it well, but I don’t think it would be received well now.”

Hierarchy in the workplace (n = 16): client-technician

“You know, how the client perceives you. And I […] was in derm six years, I knew a lot of information, but they still wanted to talk to the doctor and the doctor could literally say exactly what I said, word for word. But they wanted to hear it from that person, so I guess the perception of a nurse versus doctor is a hard barrier to break.”

Time constraints (n = 13)

“Everything is so fast paced, you want to try to get people in and out, jumping to antibiotics is very easy. And so I think, having them kind of stop, slow down, think if that’s what they really want to use or do, or talk to the doctor about, I think that would be hard for people to change.”

Lack of interest (n = 8)

“My truthful answer is I don’t think [technicians] really care, to be honest with you, you know as much as it probably hurts you guys. I think there’s certain things in our field that people will think it’s just like “roll with it”, like it’s written on the thing, I get the drug and I administer it. It’s not something that they’re like ‘hey, you know, wait a minute, maybe we should like change this or stop it’, or you know, like I don’t I think it’s just become such a routine like just a treadmill type thing they just keep going and like nobody really stops to think about it.”

Lack of knowledge about antimicrobial stewardship (n = 7)

“I don’t think [technicians] enough know about [antimicrobial overuse], to know that they should be concerned. A lot of places have the same protocol it’s been the same protocol for a long time, as far as they know it works, so why change it. […] So I think if more knew about the importance of it, they would definitely be more interested… But if they don’t know that they should be advocating they don’t know that they should know, then that’s hard.”

Lack of confidence in their abilities - by themselves or the veterinarian (n = 10)

“I think that unfortunately GP just doesn’t elevate the certified techs…I do think that the specialties take more into account that they have a CVT and they try to elevate them and have us work to the top of our license, where kind of at GP you just get thrown in and you’re doing the same job that an assistant is doing…we go to school and we learn a lot in those two years, but yeah, just elevating them and actually using them for, you know, what they can help a doctor with”

“I know a lot of new nurses, sometimes are still trying to learn the ropes so they’re focusing on like the hands-on stuff first”

Ways to promote technicians’ engagement in antimicrobial stewardship

Regular discussions within the practice (n = 18)

“I think an open discussion is really critical to have. I hate the us-and-them, like with vets and vet nurses. It’s a team, we’re nothing without each other, so I definitely think it’s it should be an open conversation if [an antimicrobial] is being prescribed. As long as the nurse is approaching the question appropriately, I think the veterinarian should be open to that discussion. And then be able to explain that and have a conversation about it, because the nurse is interested.”

Presentation of educational material on stewardship (n = 9)

“I think, at least for me from a training standpoint, […] I think finding a way to make it interactive so finding you know either utilizing you know zoom features and breakout rooms and having dialogue and discussion. Because it’s one thing to present material, which I think is important to get everybody at a level setting place, but then have that discussion and dialogue and and even at that point, finding out what additional things vet nurses are looking for or need support with.”

Empowering technicians with responsibilities (n = 6)

“I think it depends on how a technician is used, I do know that there are practices where technicians are used more as assistants so they’re like restraining and that sort of thing, and then I do know there are places where technicians do have a lot of power. […] I think those ones will probably be interested [in promoting stewardship]”.

Frame stewardship as patient care (n = 4)

“I think if [stewardship] was something that was better presented in a way that like ‘this really does make a difference and we can make things go poorly when we don’t pay attention to this’. I think presented in that light, I think a lot more nurses would be more willing to learn about it.”