Stalled nurse endoscopy training to make fresh start

18 August 2015

A second attempt to get nurse endoscopy training underway – to help boost the colonoscopy workforce prior to introducing  national bowel cancer screening – is set to start in 2016. An attempt at fast tracking nurse endoscopist training was announced in mid-2014 by then Health Minister Tony Ryall. Training was due to start early 2015 but was stalled and recently a second start date was set for 2016.

It is understood that one of the reasons for the delayed start to training is the need to gain the backing of anaesthetists for nurses to carry out conscious sedation.  The academic requirements are set but negotiations are ongoing with district health boards and anaesthetists to get the go-ahead for the hands-on clinical endoscopy training for nurses.

Frustration was expressed after the government's Budget in May that the successful Waitemata District Health Board bowel screening pilot was extended rather than funding announced for a national rollout of screening for bowel cancer, which is New Zealand's second biggest cancer killer. Health Minister Jonathan Coleman in his Budget announcement said that the largest constraint on rolling out screening nationwide was the lack of workforce to meet the increased demand for diagnostic colonoscopies.

Professor Jenny Carryer, a former nurse representative on Health Workforce New Zealand's (HWNZ) nurse endoscopy advisory group, argued at the time that the money spent on extending the Waitemata pilot would be better invested in training the expanded colonoscopist workforce.

In late June HWNZ uploaded on the Ministry of Health website the first framework for the "Nurses performing endoscopies" project and said training would be available from 2016 involving two specialist papers and a practicum.

The training is to be subject to identical standards and under the same governance as the training currently provided for gastroenterology and general surgery registrars working in endoscopy.

Nursing Review was declined an interview by HWNZ staff over the delayed start to nurse training but in answer to written questions HWNZ group manager Ruth Anderson said development of the nurse endoscopy training programme was "on track".

She said some nurses had completed or were close to completing postgraduate papers that would be 'creditable' to the programme (which has a prerequisite of a postgraduate diploma in nursing and at least three years specialist experience working in gastroenterology or a related specialty).

Anderson said, in late July, that meetings were scheduled over the next two months with DHBs that are either already supporting or have expressed interest in supporting the training of nurse endoscopists.

"We anticipate that subject to employer support and funding availability, nurses will be undertaking papers specifically designed for nurse endoscopy early in 2016," said Anderson.

The project website, uploaded in late June, says next steps for the project includes finalising the education framework and it was "in discussion" with the Australian and New Zealand College of Anaesthetists with "respect to conscious sedation requirements".

Associate Professor Judy Kilpatrick, the current nurse representative on the HWNZ advisory group and head of the University of Auckland nursing school, said Auckland had agreed to develop the two specialist papers required.

She says the specialty papers, focused on gastroenterology and colonoscopy (including conscious sedation) were now ready to go but work was ongoing by HWNZ and the advisory group on finalising the clinical training practicum.

"It is a training programme that requires getting agreement from the DHBs, agreement from the existing gastroenterologists to provide the training and also requires working with the anaesthetists for a satisfactory arrangement," said Kilpatrick. 

She says she was not surprised that training did not get underway at the start of 2015. "I think to be fair that's because you've got to find enough theatres, enough lists, with enough surgeon availability to be able to do the training to grow the numbers."  She understood meetings were being held in August to finalise the development of training practicums.

"But we fully expect to start offering the first paper at the start of semester one in 2016 and the second paper in the second semester. 

"We would expect the clinical hands-on (training) to commence with the second paper (i.e. second semester) as it goes hand-in-hand with the focused colonoscopy paper."

Kilpatrick say it is expected between six to ten nurses would have met the prerequisites to start the course in early 2016.  "It's not swamping the field as you just can't do that…and when you start a new programme clearly you are looking towards taking the nurses who have reasonably significant experience in the area already." 

For more background on the issue see last year's Nursing Review article, Nurse Endoscopists: the evolution of a new nursing role 

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