Nurse endoscopists: the unsung Florence Nightingales

The article by van Putten et al. was read with interest [1]. Nurse endoscopists contribute enormously at their place of work on a daily basis. The British Society of Gastroenterology supports the provision of nurse endoscopists. In 2007, the Healthcare Commission reported that 85 % of acute trusts in England employed nurse endoscopists.

However, views about nurse endoscopists are variable among gastroenterologists across the globe [2] [3]. Previous studies have shown that nurse endoscopists provide a comparable service when comparing patient satisfaction in lower gastrointestinal endoscopy [4]. Studies have also shown that nurse endoscopists provide an effective and thorough examination [5]. Their flexibility ensures that all endoscopy lists are adequately covered.

All independent practising endoscopists should be able to decide whether their patients require sedation. This should be based on pre-procedure assessment and discussion. In the van Putten study, however, it appears that the nurse endoscopists had to rely on clinician input to decide on this. Independent endoscopists should also be able to titrate the level of sedation but in the study the nurse endoscopists had to take physicians’ orders for that too.

Approximately 25 % of the colonoscopies required intervention from clinicians. This appears excessive and while I agree it is important that a gastroenterologist should be available when needed, I wonder whether this intervention was higher when the gastroenterologist was in the vicinity. This study indirectly suggests that physicians should be “free” to supervise trained nurse endoscopists in about 25 % of their practice. And if you include the requirement for physicians to make a decision regarding the need for sedation, the physician intervention increases to 100 %! It is important to ensure that there is adequate training to assist non-medical endoscopists to safely and effectively carry out colonoscopy independently.

• References

• 1 van Putten PG, Ter BF, Adang RP et al. Nurse endoscopists perform colonoscopies according to the international standard and with high patient satisfaction. Endoscopy 2012; 44: 1127-1132
• 2 Khan MI, Khan R, Owen W. Doctors and the nurse endoscopist issue in New Zealand. N Z Med J 2012; 125: 88-97
• 3 van Putten PG, Van Leerdam ME, Kuipers EJ. The views of gastroenterologists about the role of nurse endoscopists, especially in colorectal cancer screening. Aliment Pharmacol Ther 2009; 29: 892-897
• 4 Maslekar S, Hughes M, Gardiner A et al. Patient satisfaction with lower gastrointestinal endoscopy: doctors, nurse and nonmedical endoscopists. Colorectal Dis 2010; 12: 1033-1038
• 5 Williams J, Russell I, Durai D et al. Effectiveness of nurse delivered endoscopy: findings from randomised multi-institution nurse endoscopy trial (MINuET). BMJ 2009; 338: b231