20 Jan
The role of the REVN varies between practices, with the skills used daily depending on the caseload and the type of the clinic (hospital or ambulatory).
Sports horse work plays a large part in the caseload of many practices, from amateur competition riders to world-class professionals, we are presented with performance-related concerns on a daily basis.
It has recently been considered that dedicated equine practices would be unlikely to survive without the continuation of sporting disciplines involving the use of horses (Webb, 2024).
When considering the role of the equine nurse, many immediately think of in-patient care, theatre work, neonatal nursing and general clinic work. However, the role of the nurse in the sports horse workup is just as important.
With discussions around social licence and the use of horses in sport, the use of REVNs can aid to further improve and provide the optimum care and support to the equine athlete, bringing a different perspective on the role.
When horses are initially presented, a member of the team will be required to trot up and lunge the horse for assessment. While this is an important part of the process, it is not the only way to get involved. Instead, this role can be carried out by veterinary technicians and grooms, meaning nurses can use their skills more effectively, making the process run smoother.
Throughout this article, references will be made to Schedule 3 procedures that are within the remit of the REVN. Clarification of these procedures has recently been outlined by BEVA, which has further recognised the skills nurses should be using in practice (BEVA, 2024).
To enable us to use the privilege of Schedule 3, nurses must remain within the remit of their role, working under the direction of the veterinary surgeon and not making a diagnosis.
During the initial phase of the workup, nurses can be used by assisting the veterinary surgeon with key aspects.
Firstly, RVNs can acquire a detailed history on admit, making notes of key findings and giving feedback to the treating vet.
They can also carry out an initial clinical exam and take any required samples. RVNs can fit and set up the gait analysis equipment, and provide a helping hand with ensuring the correct data is obtained.
During the lameness workup process, RVNs under Schedule 3 guidance can perform nerve blocks under the direction of the veterinary surgeon – a skill that not all clinics will require their nurses to use, but the option is there for those that want to explore it.
Once an area of interest has been localised, RVNs can carry out the required x-rays, leaving the treating vet to start on another case or catch up on paperwork.
Ultrasonography is a tool that veterinary surgeons like to often do in real time; however, it is a skill an RVN can develop as long as they are not making a diagnosis.
In many practices, RVNs are fundamental in the acquisition of MRI and CT advanced imaging, which again is an important role of the nurse and adds a further challenge and advancement of skills (Hall, 2022).
Performance cases may not always be orthopaedic based. Nurses should be competent to set up and use the mobile ECG machines, enabling the vet to simply watch and observe the findings.
Gastroscopy is a common cause of poor performance (Franklin, 2010) and again under Schedule 3 guidelines this is a role that nurses can carry out, if they are not making a diagnosis. This procedure, again, is something many veterinary surgeons like to see in real time.
However, the nursing team should be confident to pass and drive the gastroscope when required.
Airway endoscopy is another common procedure carried out when looking at performance-related respiratory issues. This can vary from respiratory noise, cough, epistaxis, and head shaking (Massie, 2023).
Nurses should be confident to pass and drive the scope when required, and prepare the patient and equipment for sample collections such as tracheal washes and bronchoalveolar lavage.
Carrying out the associated laboratory work following sample collection is an avenue that can also be opened to nurses wanting to develop their laboratory skills. In turn, this enables quicker results for our patients.
Overground endoscopy may also form part of the poor performance workup, with nurses able to fit and set up the equipment for the veterinary surgeon.
Dentistry plays a crucial role in any horse, pony or donkey, but animals that are asked to work on a contact or are stabled more may present more often with dental related conditions (Carmalt, 2006).
Nurses can be involved in dental workups and dental-related procedures, but with regards to any rasping of teeth, they should follow the BEVA guidelines as to which category they fall into (BEVA, 2024a; BEVA, 2024b).
This will depend on additional training they may have undertaken and extra qualifications. This, however, can be considered as a role for the equine nurse should they wish to carry out equine dentistry by obtaining further qualifications in equine dentistry through the British Association of Equine Dental Technicians.
Nurses play a vital role in the treatment and management of performance-related conditions and can be involved throughout the process, from diagnosis and treatment to home care.
It is not appropriate for nurses to perform joint injections as this is considered as entering a body cavity, but they still should be involved in the procedure. Aseptic preparation of the area is a key element in infection prevention and control (Mitchell, 2017). This is something that nurses are well equipped to carry out.
During an ultrasound guided procedure, the RVN can also be involved by positioning the probe and obtaining an image for the veterinary surgeon administering the injection. Following joint injections, bandage application is a skill that RVNs can use for infection control and patient comfort.
With training, nurses can carry out shockwave therapy under the direction of the veterinary surgeon.
Knowledge of anatomy and technique should be established prior to the nurse undertaking this alone.
Many options exist for regenerative biological therapies that we can use for the treatment of various orthopaedic conditions, such as platelet-rich plasma, interleukin-1 receptor antagonist protein and alpha-2 macroglobulin.
Preparation of these for use requires laboratory skills and asepsis – all that RVNs can carry out. Often, training can be provided from the supplying company, which enables the nurse to obtain the techniques in the preparation of the biological agent.
Following the guidance of Schedule 3, RVNs can prepare the patient and obtain any samples needed to start the process. This will often involve the insertion of an IV catheter and phlebotomy when directed to do so by the case vet.
Nurses are essential to the smooth running of the theatre. During orthopaedic surgery, nurses should be involved in preparation of the patient, managing the theatre during the surgery or acting as a scrub nurse. Encouraging nurses to scrub into surgeries enables further skill development.
At the end of surgery, under Schedule 3 guidelines nurses can close the incisions when required. Nurses can also be involved in or, under specific circumstances, carry out equine anaesthesia, which are again skills that are day one skills for nurses, but should be further developed in practice.
For standing procedures such as impinging dorsal spinous process surgeries or dental extractions, nurses can set up and monitor a standing continuous regional infusion of sedation and ensure patient comfort and tolerance throughout.
Any medication administered will have been prescribed by the case veterinary surgeon.
Postoperative care of the orthopaedic surgical patient involves clinical assessments, pain scoring and bandage changes as a minimum. Nurses can include some light physiotherapy and with further knowledge and training, develop rehabilitation plans for both surgical and non-surgical cases in consultation with the case vet and a physiotherapist.
RVNs with an interest in physiotherapy could consider additional training and qualifications around this area.
RVNs can be used in administering regular injections such as pentosan, which can be carried out at the clinic or at home incorporating the role of the ambulatory nurse (Woods, 2022).
An additional role that can be carried out by REVNs is the use of a class IV laser, which can be used under the direction of the veterinary surgeon to aid in the treatment of certain orthopaedic conditions.
Not all performance related issues stem from orthopaedic conditions.
Medicine conditions such as those concerning gastroenterology and respiratory systems can also be responsible, opening up more avenues for the role of the equine nurse – particularly those that also have a medicine interest.
A variety of conditions may need to be treated regarding the respiratory tract, ranging from surgery to medication administration and management changes.
RVNs, as previously mentioned, play a key role in any surgery – both during an operation and postoperatively.
A common condition for nurses to be involved in is the management of equine asthma. This can involve the use of medication administration and equipment demonstration. This is a good example of how the RVN can get involved in home care during ambulatory visits.
The demonstration and use of inhalers and nebulisers during a nurse visit also allows opportunity to study the home environment, and help with the improvement of its management. (Woods, 2022). For example, assessing ventilation, pollens and other environmental factors.
For the horse with gastric ulceration, nurses should firstly be involved with education around the diet and management with the owner. This can be a formulated plan, including a weight check and a feeding regime depending on the requirement and needs of the horse.
Owners are usually capable of self-administration of omeprazole via syringe, but when the injectable form is required, this can be another role of the nurse in an ambulatory form.
Throughout all the above the nurse can also play a key role in communication and support for the client during the process.
Overall, the use of equine nurses during poor performance investigations gives another opportunity for more involvement and job satisfaction for the REVN.
This should be considered not just in hospital settings, but also for those in ambulatory practices where the employment of an RVN working alongside a performance horse vet could be greatly beneficial to all parties involved.
Opportunities for nurses to support veterinary surgeons at sporting events should also be considered, where they can provide assistance and support as well as improving job satisfaction and variation in the role.
