Nurse Endoscopist Model of Care Pilot Project

SA Health has introduced an advanced practice Nurse Endoscopist Model of Care Pilot Project into a public hospital setting. Three nurses are being trained to perform low-risk, non-complex colonoscopy as part of a multidisciplinary team.

In this age of changing health care needs there is a global need to find innovative, cost-effective ways of delivering care.Increasingly around the world, experienced nurses are trained to practice at an advanced level, providing clinical expertise in a variety of settings. The scope of advanced practice means greater and increasing complexity, an increase in clinical skills, reasoning, critical thinking, knowledge, expertise and experience.

Health professionals advance their practice through continuing education, experience, and ongoing development. Nurses practising at an advanced level incorporate leadership, education and research into their practice. Research evidence shows that advanced practice nursing roles are safe, effective and well received by clients. A variety of titles are used throughout the world to denote advanced practice nursing roles, one of which is the role of Nurse Endoscopist.

What is a Nurse Endoscopist?

An advanced practice, specialised registered nurse, trained under the supervision of medical specialists to perform endoscopic examinations, such as that of the lower intestinal tract (colonoscopy).

Why is advanced practice in endoscopy nursing necessary?

Bowel cancer is the second most commonly diagnosed cancer, affecting one in 12 of the population by the age of 85, with the majority of cases diagnosed in patients aged over 50 years. However, it can be treated effectively in 90 per cent of cases if detected early. In 2012 it was projected that 431 South Australians would die from bowel cancer and 1,264 new cases would be diagnosed in 2015. Estimates indicate that every week, 22 South Australians are diagnosed with bowel cancer and eight die from the disease. Colonoscopy plays a crucial role in the diagnosis, treatment and ongoing surveillance of bowel cancer.

The growing demand for colonoscopy screening services in South Australia is driven by:

  • Increased public expectations and awareness in relation to health and health services including the value of screening programs such as the National Bowel Cancer Screening Program.
  • The predicted rise in demand for colonoscopies as a result of the National Bowel Cancer Screening Program, which will be fully implemented by 2020.
  • South Australia’s ageing population.
  • An increase in certain lifestyle conditions, such as obesity, which are associated with the presence of diseases or disorders of the stomach and/or intestine.

What are the benefits of advanced practice nurse endoscopy?

Advanced practice nurse endoscopy means real benefits to patients and public health services. Access to timely endoscopy services is necessary to support the delivery of high-quality health care to South Australians. Nurse Endoscopists can contribute to improving access to services for patients requiring follow up screening and review services. They will build workforce capacity in the form of extra, dedicated nurse endoscopy lists in addition to current medical endoscopy lists.

The introduction of advanced practice nurse endoscopy enables medical staff to better manage and treat patients by delegating appropriate cases to highly qualified advanced practice nurses. This in turn allows better access to medical specialists for complex and advanced endoscopic cases.

Nurse Endoscopists not only perform colonoscopy, they also work in collaboration with medical and allied health staff to enhance the patient journey from pre-admission to post procedure follow up.

Is advanced practice nurse endoscopy new in Australia?

Since 2010, both Victoria and Queensland have successfully implemented Nurse Endoscopist Models of Care and other jurisdictions are developing similar models. South Australia has previous experience of Nurse Endoscopists working in public settings (Repatriation General Hospital and Flinders Medical Centre) and was viewed as a pioneer in nurse endoscopy practice.

What other countries use Nurse Endoscopists? Is it successful?

The introduction of the SA Health Nurse Endoscopist Model of Care Pilot Project is built on extensive international and national experience from the United States of America, United Kingdom, Netherlands, Canada, China, New Zealand, Victoria and Queensland. International experience in nurse endoscopy in the United States of America, United Kingdom and Europe demonstrate that health workforce reforms can be implemented without compromising patient safety. An abundance of evidence clearly articulates that Nurse Endoscopists, under proper supervision, can perform at the same level of procedural competency as doctors.

What training are advanced practice Nurse Endoscopists undertaking?

Under the Nurse Endoscopist Model of Care Pilot Project, three highly qualified and experienced nurses within the endoscopy field are undertaking a minimum of 12 months advanced skills training leading to a Certificate of Endoscopy. The training pathway involves a collaborative partnership between SA Health and Austin Health, Victoria through their state of the art State Endoscopy Training Center (SETC).

Training involves three concurrent learning modules;

  • Clinical Knowledge - Online learning and assessment via e-Bridge provided by the University of Hull, United Kingdom.
  • Skills Development Training - Trainees will attend three, three day residential training workshops at the SETC. The workshops include interactive theory sessions, clinical observation, practical simulation training and hands-on supervised training.
  • Supervised Clinical Practice – Trainees perform colonoscopies under the direct supervision of medical specialists at The Queen Elizabeth Hospital as part of a multidisciplinary team, meeting all formal Directly Observed Procedural Skills (DOPS) assessments.

By the end of the 12 month training period, it is anticipated that trainees will achieve the following proficiency requirements;

  • Perform a minimum of 100 unassisted, unsupervised, complete colonoscopy procedures.
  • Complete 200 colonoscopy procedures in total.
  • Perform successful snare polypectomies on at least 30 patients.
  • Achieve at least 90 per cent caecal intubation rate.

The pilot project and training commenced in June 2017.