Industry Q&A - Queensland health initiates nurse endoscopy program

---

Queensland Health has committed to establishing a nurse endoscopy workforce in line with recommendations of the Queensland Commission of Audit and the Blueprint for Better Healthcare.

---

The initiative is part of the Strengthening health services through optimising nursing strategy and action plan (2013-2016), and is aimed at improving access to timely diagnostic procedures and treatment for Queenslanders.
Australian Hospital and Healthcare Bulletin asked Dr Frances Hughes, Chief Nursing and Midwifery Officer for the Queensland Department of Health about how the program will improve services in Queensland and enhance the  nursing profession.

---

Dr Frances Hughes
Dr Frances Hughes commenced in the role of Chief Nursing and Midwifery Officer for the Queensland Department of Health in March 2012. Frances has extensive knowledge and networks in relation to health policy particularly in the field of nursing and mental health, research, and global health issues
Frances is an established scholar and has an extensive publication record, publishing her first book in 2007 Have your Say - how to influence public policy. Her scholarship and research interests are mental health, health policy and nursing
Dr Frances Hughes has a BA, MA and Doctorate in Nursing and was awarded the New Zealand Order of Merit in 2005 for her Services to Mental Health. In 2011, Frances received a Fulbright Senior Scholarship followed by a Distinguished Alumni Service Award from Massey University in New Zealand in 2013.
What are the main reasons for initiating a nurse endoscopy program in Queensland?
Queensland Health is committed to providing the best practice health outcomes for Queenslanders and is concerned about the number of people on public waiting lists including those requiring endoscopy services.
According to Queensland’s Cancer Registry, there are an estimated 1,650 deaths from upper gastrointestinal and colorectal cancers each year. 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.
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.
There are a number of reasons to consider when assessing the appropriate skill mix in hospitals and its impact on healthcare delivery. When considering the need for registered nurses to undertake endoscopy we need to assess and manage:

• increasing demand for diagnostic and therapeutic services;


• staff shortages in the medical workforce;


• available resources to ensure the appropriate use of skills to the required service (i.e.


• freeing up specialists time to perform more complex procedures, education, research


• and consultation); and


• It is within the scope of a registered nurse to undertake advanced and specialist tasks such as endoscopy, with appropriate education.

There are significant cost savings and improved health outcomes from earlier detection and treatment of pre-cancerous and cancerous tissue.
How successful has the program been in in other states and countries?
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. Nurses are performing these services safely and with high satisfaction rates overseas and in Australia.
Additionally, a number of international studies have indicated that endoscopy procedures performed by nurses are less expensive with comparable levels of quality and safety to those performed by doctors.
Endoscopy procedures including sigmoidoscopy, colonoscopy and/ or upper gastrointestinal are performed by nurses or technicians across various parts of the world including New Zealand, Canada, the United States of America, United Kingdom, Ireland, Netherlands and other European countries. In a number of these countries where nurses perform endoscopies within the model of service delivery, professional organisations including gastroenterology societies or associations, have embraced these initiatives. In the United Kingdom, registered nurses have been performing endoscopy since the mid–1990s.
Australia has recently piloted registered nurses undertaking endoscopies in Queensland (Logan Hospital) and Victoria (Austin Hospital).
Can you tell us about the pilot program for nurse endoscopy in Queensland? Who took part and where was it undertaken? What was the general feedback?
A pilot program occurred with nurses from Logan Hospital which used the HWA endoscopy standards to identify successful learning outcomes and clinical ability.
The pilot was valuable but there is a need for Queensland Health to move toward a more sustainable and Australian accredited program.
The final results will be written by the University  of Wollongong and published later this year.
What qualifications do nurses need to undertake the program?
Registered nurses will be educated, trained and gain clinical experience to undertake endoscopy procedures. The role requires post-graduate education (Masters Level) including theoretical and applied skills, accreditation and credentialing by the relevant professional organisation.
A post graduate level course will provide a flexible structure, the necessary theoretical content and a significant clinical component overseen by credentialed endoscopy specialists. The course curriculum will be established to ensure the nationally approved standards for endoscopy are achieved.
The university will develop the course in consultation with input and ongoing monitoring from academic and professional experts in the field of gastroenterology. National standards for endoscopy will be part of the requirements. In conjunction with a university, Queensland Health is currently working on processes to formally accredit the program at a national level and credential the graduates as registered nurses educated and trained in endoscopy.
Queensland Health has been assured that the university will integrate gastroenterology standards into the program. The university accreditation of the post graduate program provides assurance that it meets the highest levels of academic standards.
Registered nurses undertaking this procedure will be regulated within a rigorous safety and quality framework endorsed and monitored by the Nursing and Midwifery Board of Australia (NMBA). This regulatory framework ensures high standards relating to and referenced against the:

• National competency standards for the registered nurse


• Code of Professional Conduct for Nurses in Australia


• Code of Ethics for Nurses in Australia


• Nursing and Midwifery Professional Indemnity Insurance Arrangements Registration


• Standard Nursing and Midwifery Continuing Professional Development Registration Standard


• Nursing and Midwifery Recency of Practice Registration Standard


• National decision – making framework


• Nurse’s guide to professional boundaries

Where are nurses undergoing training for the Masters in Specialist Nursing Practice program and how is the program structured?
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.
Clinical oversight and assessment of registered nurses will form part of the clinical requirements of the Masters level degree program and, as such, willbe under the auspices of a university.
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.
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.

The course curriculum is being established to ensure the nationally approved standards for endoscopy are achieved. It is expected that two clinical experience units of learning will have outcomes that reflect established and recognised International and Australian endoscopy clinical standards.
On successful completion of their study, participating nurses will receive a recognised post graduate qualification at a Master’s level. This means the public and health service staff can be reassured that nurses have gone through a rigorous process to meet the practice standards required to be registered nurse endoscopists.
How many nurses are initially taking part and what are the plans for future numbers of nurses to be trained?
An initial cohort of up to 15 registered nurses will be selected by Hospital and Health Services across Queensland to undertake the Masters level education and training program.
What plans are in place for their continuing professional development?
The continuing professional development of educated and trained registered nurses in endoscopy will be in accordance with the Nursing and Midwifery Board (NMBA) Continuing Professional Registration Standard which sets out the minimum requirements for continuing professional development and has been approved by the Australian Health Workforce Ministerial Council.
Registered nurses are required to maintain their ongoing clinical competency and professional practice standards in order to renew their licences to practise. The role of the registered nurse has evolved and changed with advancing technology, newly defined client needs and changes in the way healthcare is delivered.
Who will nurse endoscopists work alongside in the  health system?
Nurses educated and trained in endoscopy are not sole practitioners working in isolation, or independently. 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 benefits of this approach allows the different professionals to work to their maximum scope of practice within a patient centric model that combines varying talents to maximise the efficiency and effectiveness of the healthcare team in its delivery of health services to support patients and families.
How will this affect waiting lists for patients waiting for endoscopies? Does Queensland Health have the equipment and facilities to ensure these waiting lists are reduced?
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.
Augmenting this service with registered nurses who undertake endoscopy will enable them to perform approximately 1,000 endoscopic procedures per year, enabling medical specialists to work where they are most needed. This initiative utilises the most appropriate use of skills within a clinician’s scope of practice for a particular task. The less complex procedures will be performed by nurses trained in endoscopy, freeing up specialists to work with more complex patients.
Hospital and Health Services from across Queensland, including those in the most populated areas, are currently embracing the nurse endoscopy training and education program and in many cases will be able to make far more efficient use of their available facilities and resources through training nurses in endoscopy and then fully implementing the program.