Nurse endoscopy lights new pathways

Australia adopts new specialist area to meet a growing need. 

The demand for bowel cancer screening has led to an emerging specialisation, as nurses in Victoria and Queensland have begun undertaking training to be nurse endoscopists.

Victoria statistics show a steady rise in the need for colonoscopies, and the annual total is expected to increase an additional 6798 procedures by 2020.

The move towards adding nurse endoscopists to address this demand follows a successful Health Workforce Australia (HWA) pilot that took place from 2012–14 at Logan Hospital in Queensland and Austin Hospital in Victoria.

Victorian Chief Nurse and Midwifery Officer Alison McMillan says the pilot program highlighted the need to upskill nurses to deal with patient demand.

“With the increase in bowel cancer screening, the demand for endoscopy services will continue to grow and the view is that we need to look at innovations we can use to create a greater workforce that can support this type of screening,” McMillan says. “As we see growth in the age of our population and the complexity of disease, we need to think about and explore new and different ways of caring for patients [through] a range of practitioners.”

There is a set of criteria for professionals wanting to become a nurse endoscopist. Candidates must be experienced in the field and undertake 12 months of advanced practice training.

Theoretical and practice modes of training are delivered under the direct supervision of gastroenterologists and colorectal surgeons. Like medical trainees, competent nurse endoscopists will have performed more than 200 endoscopic procedures.

“There is a clear training framework that is required and a whole range of competencies that need to be undertaken,” McMillan says. “We are developing the skill base of nurses who are already experienced and working in an endoscopy suite and are familiar with the equipment and working as part of a team with medical staff and gastroenterologists.

“The academic and learning requirements are quite considerable, and with those who have already been recruited we have been clear this is a significant undertaking with a lot of learning to be done. It’s demanding, and that’s something that we’re hearing – it’s not a walk in the park.”

Of course, the notion of nurses performing such procedures is not new. Nurse endoscopy has been carried out in the UK, US and Europe for decades.

“This has been around for about 15 years in the UK, so we are just catching up,” McMillan says.

Under the HWA project, six nurses in Victoria and Queensland have already trained to become nurse endoscopists.

Nationally, it’s expected that 90 nurses could be needed within the next 5–10 years. In Victoria, the government has established the State Endoscopy Training Centre to continue preparing nurses for the specialisation. In Queensland, the Department of Health is seeking a suitable provider to do the training. This process is expected to be finalised soon.

“There has been a huge interest,” Queensland Chief Nursing and Midwifery Officer Frances Hughes says, adding that the program has also provided new opportunities and career pathways.

“This is giving nurses the opportunity to step up and take leadership in areas where we have evidence that they can make a difference,” Hughes says. “And it’s great for nurses themselves because they feel valued and recognised. The whole reason we are doing this is to improve patient outcomes, and we have evidence of how nurses can make a difference in this area at an advanced practice level.

“[But] we haven’t just created a mechanism about getting more nurse endoscopists, we’ve created pathways for nurses to come into gastroenterology and impart new skills if they choose.”

McMillan says the feedback from nurses has been overwhelmingly positive.

“The program is exciting and the nurses involved are enjoying it,” she says. “It’s stepping into a new area and blurring the lines of what traditional roles of doctors and nurses have been. But it does take someone with maturity who can embrace and work through some of the new challenges that you face when you move out of one traditional role into a new role within the work team.”

So far, however, the traditional battlelines of doctors versus nurses have not been drawn.

“We should congratulate our medical colleagues for their willingness to be brave and courageous,” McMillan says. “This has been a true collaboration between doctors and nurses, with a commitment from the College of Gastroenterologists, the College of Surgeons and the anesthetists working with a range of nursing organisations to make this happen.

“A lot of the training is done by doctors, and they work side by side and it’s a team arrangement, which is fantastic to see.”

View from the vanguard

Austin Hospital nurse Jomon Joseph had already seen firsthand the role nurse endoscopists could play, having worked as part of a gastroenterology team in the UK. As a result, he was one of the first nurses to enrol in the program as part of the HWA’s pilot.

“I had previously worked with a nurse endoscopist in the UK for seven years and saw how they are helping people get off the waiting list and helping to give patients a better experience,” Joseph says. “If you needed a colonoscopy in the UK, you didn’t wait for more than three weeks. So I’d made a decision that was what I wanted to do. But when I came to Australia, I didn’t think it would be possible. And then by chance I was working at the Austin Hospital and I got into the program.

“Becoming a nurse endoscopist was a big learning curve for me. The role has given me a lot of responsibility. I undertake diagnostic procedures and have the opportunity to interview and review patients at the clinic, do the procedure and support the patients through it all.

“Initially it was challenging and there was a bit of negativity around it from some people, as people didn’t know what we could achieve so they were sceptical. But now those with a negative opinion of the program have changed their minds. Some of the doctors who were initially sceptical have seen that it’s also beneficial for them, as it frees up more time for them to do more advanced procedures. Some of the patients also have been a bit sceptical initially, and ask what sort of training I’d had. But once I explain the training and how many procedures I’ve done, they’re usually happy.

“There was a lot of study involved in becoming a nurse endoscopist, and it was hard work,” Joseph continues. “You need to achieve a certain competency to do the procedure and the assessment is hard. It’s not an easy journey but it’s a great opportunity. And it’s beneficial for all the people involved. For the nurses, it’s a great opportunity for a new career pathway. For the doctors, it allows them to do more advanced procedures. And for patients, the waiting lists will be reduced.”