Frequently asked questions
About nurse endoscopy
Each year there are an estimated 1,646 deaths from upper gastrointestinal and colorectal cancers. Many of these deaths could have been prevented with earlier detection and intervention. Additionally, delays to diagnosis and treatment lead to poorer patient outcomes, high service costs and out of pocket expenses to patients and their families.
The Commonwealth’s National Bowel Cancer Screening Program, which is introducing biennial FOBT screenings for Australians aged 50 and older, will significantly increase demand for endoscopy services.
Providing additional capacity within the health system to undertake early diagnostic procedures will significantly improve outcomes and help address existing waiting lists. Nurses are performing these services safely and with high satisfaction rates overseas and in Australia. Queensland Health believes that introduction of registered nurses undertaking endoscopy is an important part of improving health outcomes for Queenslanders.
No. Nurses trained in endoscopy are not sole practitioners working in isolation. They work within multidisciplinary teams. Where nurses currently undertake endoscopies around the world, they are highly valued team members contributing to practising with the concept of nursing values in mind.
The Medical Board of Australia’s Good Medical Practice: A Code Of Conduct For Doctors In Australia (section 4.3) identifies the functions and responsibilities relating to the delegation, referral and handover of care. This guidance provides the framework for the safe and effective management of all patient care including that provided by nurse endoscopists.
Who will be responsible for developing the model of service delivery?
Individual health services (HHS) are responsible for developing models of service delivery for endoscopy just like they are for other services. Queensland Health can assist by providing overarching guidance to support the education of registered nurses.
Nurses working in public hospital and health services acting within their scope of practice (of which nurse endoscopy is a part) are protected from civil liability by legislative provisions. This combined with the Queensland Government Indemnity Guideline provides comprehensive indemnity protection for state employees.
Why do we need nurses to undertake endoscopies? How will nurses undertaking endoscopy assist in solving the current wait list in endoscopies?
Currently, there is insufficient capacity within the public health sector to meet the demand for endoscopy services. Estimates based upon current training levels indicate that within the next five years the gastroenterology medical specialist workforce will only slightly increase.
Delays in accessing diagnostic endoscopy procedures that would enable earlier interventions increase the risk of more complex conditions requiring intensive treatments and also resulting in higher mortality rates.
Registered nurses with the required experience and qualifications will be able to perform approximately 1,000 endoscopic procedures per year, enabling medical specialists to work where they are most needed. The less complex procedures will be performed by nurses trained in endoscopy, freeing up specialists to work with more complex patients
Why not train more doctors to perform endoscopy?
There is significant demand for endoscopy services in Queensland, and a program for registered nurses to undertake endoscopies is just one of a suite of strategies being implemented to improve access to quality, safe healthcare in Queensland.
This initiative is not in competition with the need to train more doctors to perform endoscopy. There is also a clear need to increase the number of medical practitioners to meet the demand for gastroenterology services.
No. Endoscopy procedures are performed by nurses or technicians across the world including New Zealand, Canada, the United States of America, United Kingdom, Netherlands and other European countries. In the United Kingdom, registered nurses have been performing endoscopy since the mid–1990s.
There is significant and growing evidence internationally and in Australia that demonstrates appropriately educated nurses can perform endoscopy safely with no increase in patient risk.
The nursing education model for registered nurses to undertake endoscopies in Queensland has been through a rigorous development process including consultation with high level departmental staff and hospital, health service clinicians, national professional bodies, and tertiary education providers.
Queensland Health is having ongoing discussions with, public and private health services representatives, including gastroenterologists, Chief Executives and senior nursing staff.
For health practitioners
Nurses with appropriate education can undertake the following gastrointestinal procedures :
- flexible sigmoidoscopy
- upper gastrointestinal endoscopy.
The program will use the HWA endoscopy standards to identify successful learning outcomes and clinical ability.
HWA is not an accredited education or training provider and during the pilot at Logan Hospital, education and training for nurse endoscopists was provided by the University of Hull, United Kingdom. Following the pilot, Queensland Health is moving to a more sustainable and Australian accredited program.
Education and implementation
What is required to educate nurses to undertake endoscopies?
Registered nurses will be educated, trained and gain clinical experience to undertake endoscopy procedures. The role requires masters level post-graduate education including theoretical and applied skills, accreditation and credentialing by the relevant professional organisation.
Queensland University of Technology will deliver nurse endoscopy education as part of its Master of Nursing program.
Will only nurse practitioners be able to undertake nurse endoscopy studies?
No. Queensland Health considers that while there may be a role for endoscopy to be performed by nurse practitioners within their scope of gastroenterology, enrolment into the Master’s program will be open to all registered nurses who meet the entry requirements. However, individual health services (HHS) will determine the role requirements within their departments.
The new masters level course is based on the national standards for gastroenterology meaning that nurses will need to reach the same level of competency as doctors in order to become qualified.
Individuals with extensive experience and credentials in performing endoscopy procedures will act as clinical mentors, supporting and assessing clinical skills and abilities of the nurse endoscopy course participants.
Registered nurses undertaking education in endoscopy procedures will undertake their clinical experience in health services across the state where there has been an identified need and capacity for support from nursing, medical and management staff. Their education and clinical experience will be guided by specialists within the health service in which the participant is employed.
To ensure ongoing quality and safety, health services providing registered nurses with clinical experience will have:
- an established endoscopy-gastroenterology service;
- compliance with Gastroenterological Society of Australia (GESA) Standards for Endoscopic procedures; and
- established facilities – minimum standard, or equivalent.
Given the absolute importance of patient safety, the program’s focus is on achieving competencies not the length of study.
To complete the endoscopy program, nurses must demonstrate their ability to apply their knowledge and clinical skills to meet the nationally agreed and recognised endoscopy clinical standards.
This means that some individuals may require a longer time frame to achieve the required standard while others may do so sooner.The program will use the HWA endoscopy standards to identify successful learning outcomes and clinical ability.