Quantitative and thematic analysis of complaints by clients against clinical veterinary practitioners in New Zealand.

AIMS: To provide a descriptive analysis of all notifications and complaints received by the Veterinary Council of New Zealand (VCNZ) during 1992-2016 and to use a thematic analysis of complaints made by clients to the VCNZ during 2013-2015 to determine the underlying reasons for their complaints. METHODS: A mixed methods approach was used. Notifications and complaints against veterinarians between 1992-2016 (n=1218) were summarised based on complaint categories and by gender of the veterinarian respondents, the number of years registered with the VCNZ and the animal species to which the complaint related. In-depth thematic analysis was made of the content of clients' complaints between 2013-2015 (n=141) to identify details of the key themes and subthemes underlying the complaints. RESULTS: The VCNZ categorised 595/959 (62.0%) of the complaints made between 1992-2016 as related to technical competency, and 308/959 (32%) to professional behaviour. Of the 1,218 complaints, 818 (67.2%) were not investigated or were dismissed, and 18 (1.5%) cases were upheld due to technical competency concerns. Of the complaints in which animal species was identified, 623/738 (84.4%) involved companion animals and 104/738 (14.1%) involved large animals. Male veterinarians were the subject of 855/1,218 (70.2%) complaints. Of the complaints that recorded the number of years the respondent had been registered, 488/1,121 (43.5%) involved veterinarians who had been registered ≥21 years. Thematic analysis identified client expectations as the one overarching theme, within which were four subthemes; a veterinarian would be trustworthy and honest, provide good quality care, communicate in a way that the client finds acceptable, and charge fairly. CONCLUSIONS AND CLINICAL RELEVANCE: Notifications and complaints against male practitioners outnumbered those against female practitioners, and companion animal practitioners were over-represented. Many complaints that were ostensibly related to technical failures, were shown by thematic analysis to also represent underlying failures of professional behaviour. Key issues included lack of trustworthiness, honesty, good quality care and acceptable communication with the client. These data should not be interpreted as an accurate indicator of the prevalence of misconduct in practice, as the proportion of dissatisfied clients who did not raise a notification or complaint is unknown. Accurate classification of complaints will enable veterinary regulators and educators to identify competencies that could be developed or improved through training and experience.

Workplace bullying and relationships with health and performance among a sample of New Zealand veterinarians.

AIM: To examine the relationships between workplace bullying, destructive leadership and team conflict, and physical health, strain, self-reported performance and intentions to quit among veterinarians in New Zealand, and how these relationships could be moderated by psychological capital and perceived organisational support. METHODS: Data were collected by means of an online survey, distributed to members of the New Zealand Veterinary Association. Participation was voluntary and all responses were anonymous and confidential. Scores for the variables measured were based on responses to questions or statements with responses categorised on a linear scale. A series of regression analyses were used to assess mediation or moderation by intermediate variables on the relationships between predictor variables and dependent variables. RESULTS: Completed surveys were provided by 197 veterinarians, of which 32 (16.2%) had been bullied at work, i.e. they had experienced two or more negative acts at least weekly over the previous 6 months, and nine (4.6%) had experienced cyber-bullying. Mean scores for workplace bullying were higher for female than male respondents, and for non-managers than managers (p<0.01). Scores for workplace bullying were positively associated with scores for destructive leadership and team conflict, physical health, strain, and intentions to quit (p<0.001). Workplace bullying and team conflict mediated the relationship between destructive leadership and strain, physical health and intentions to quit. Perceived organisational support moderated the effects of workplace bullying on strain and self-reported job performance (p<0.05). CONCLUSIONS: Relatively high rates of negative behaviour were reported by veterinarians in this study, with 16% of participants meeting an established criterion for having been bullied. The negative effects of destructive leadership on strain, physical health and intentions to quit were mediated by team conflict and workplace bullying. It should be noted that the findings of this study were based on a survey of self-selected participants and the findings may not represent the wider population of New Zealand veterinarians.

Relationships between workplace well-being, job demands and resources in a sample of veterinary nurses in New Zealand.

AIM: To use a job demands-resources model to examine the associations among perceived job demands, job resources, family-to-work enrichment, positive team relationships, work engagement, emotional exhaustion, cynicism and intention to leave, in a sample of New Zealand veterinary nurses. METHODS: Data were collected by means of a self-reported online survey, with the help of eight New Zealand tertiary education providers and the New Zealand Veterinary Nurses' Association. Nine measures or variables were assessed using questions or statements with responses categorised on a linear scale. Measurement models for each of the variables in the study were assessed to establish whether the variables represented the respective item-level data. Structural equation modelling was then used to test the hypothesised interrelationships among study variables. RESULTS: There were 253 respondents; 17.1% of individuals who classified themselves as veterinary nurses in the 2013 New Zealand census. In the final structural model job demands were associated with emotional exhaustion (standardised regression coefficient ß=0.57), which was related to cynicism (ß=0.52) and intention to leave (ß=0.56). Job resources were negatively related to emotional exhaustion (ß=-0.32). Higher work engagement was associated with lower emotional exhaustion (ß=-0.29) and lower intention to leave (ß=-0.30). Job resources were associated with work-to-family enrichment (ß=0.69), which was related to work engagement (ß=0.57); and job resources were associated with positive team relationships (ß=0.79). CONCLUSION: It is important that job resources are available to help deal with demanding work. Without resources, demanding work is associated with exhaustion, cynicism and increased intention to leave, while positive spill over between work and family life are related to higher work engagement.

Apoptotic cell-derived ICAM-3 promotes both macrophage chemoattraction to and tethering of apoptotic cells.

A wide range of molecules acting as apoptotic cell-associated ligands, phagocyte-associated receptors or soluble bridging molecules have been implicated within the complex sequential processes that result in phagocytosis and degradation of apoptotic cells. Intercellular adhesion molecule 3 (ICAM-3, also known as CD50), a human leukocyte-restricted immunoglobulin super-family (IgSF) member, has previously been implicated in apoptotic cell clearance, although its precise role in the clearance process is ill defined. The main objective of this work is to further characterise the function of ICAM-3 in the removal of apoptotic cells. Using a range of novel anti-ICAM-3 monoclonal antibodies (mAbs), including one (MA4) that blocks apoptotic cell clearance by macrophages, alongside apoptotic human leukocytes that are normal or deficient for ICAM-3, we demonstrate that ICAM-3 promotes a domain 1-2-dependent tethering interaction with phagocytes. Furthermore, we demonstrate an apoptosis-associated reduction in ICAM-3 that results from release of ICAM-3 within microparticles that potently attract macrophages to apoptotic cells. Taken together, these data suggest that apoptotic cell-derived microparticles bearing ICAM-3 promote macrophage chemoattraction to sites of leukocyte cell death and that ICAM-3 mediates subsequent cell corpse tethering to macrophages. The defined function of ICAM-3 in these processes and profound defect in chemotaxis noted to ICAM-3-deficient microparticles suggest that ICAM-3 may be an important adhesion molecule involved in chemotaxis to apoptotic human leukocytes.

Work-related stress in the veterinary profession in New Zealand.

AIM: To investigate sources of work-related stress in the veterinary profession in New Zealand, perceptions of levels of stress being experienced, and the social support that veterinarians are using to manage work-related stress. METHODS: A postal survey was distributed to 1,907 veterinarians registered with the Veterinary Council of New Zealand (VCNZ). The survey collected information on respondents' age, gender, type and number of people in the workplace, stress levels, depression, suicidal thoughts and attempts, causes of stress and sources of support. RESULTS: Nine hundred and twenty-seven (48.6%) veterinarians returned useable responses. Veterinarians who were retired, working overseas or did not provide information about their type of work were excluded from the analysis, leaving data from 849 (44.5%) veterinarians. Women experienced more work-related stress and depression than men, veterinarians in small animal/mixed practice reported more stress and depression than those in other types of work, and younger veterinarians experienced higher levels of stress than older veterinarians. The main sources of stress were hours worked, client expectations, and unexpected outcomes. Respondents were also stressed by the need to keep up their knowledge and technical skills, and by personal relationships, finances and their expectations of themselves. Most respondents reported that they had good networks of family and friends to help them deal with stress. In general, respondents tended to rely on informal networks such as family and friends, other veterinarians and workmates to provide support. The small proportion of respondents who reported clinical depression or suicidal thoughts or attempts were more likely than respondents in general to have used health professionals, counselling, pastoral/spiritual support and the Vets in Stress phone line, but less likely to have sought support from employers and workmates. CONCLUSIONS: There is a need for a wide range of strategies to manage work-related stress among veterinarians. Sources of stress in the workplace must be identified and strategies developed to control those which present a significant hazard. Strategies may include attention to workloads and working hours, design of work processes, and increasing social support. Training in work-related skills such as communication, conflict management and stress management may be helpful where lack of these skills is contributing to stress. Support services such as help lines and mentor schemes are also available and information about these needs to be more accessible.