OC-091 Modernising the endoscopy workforce: the development of an endoscopy assistant role

Abstract

Introduction In order to meet the demands of the 2-week rule and to satisfy the 31 and 62-day cancer targets of the NHS Cancer Plan (2004), endoscopy units need to provide an effective, high quality and, above all, timely service. The rate limiting step in endoscopy service provision had been identified by the Healthcare Commission in 2005 as a shortage of suitably trained endoscopy nurses. It estimated 20% capacity lost nationally but local experience was nearer 30% (135/400 h per week of Qualified Nurse (QN) time lost through a combination of causes in Aug 2005). This led to list cancellations, often at short notice, to the detriment of patient care and waiting times while limiting staff opportunities for further career development such as specialist roles (IBD), nurse-led clinics (polyp surveillance) and improvement initiatives such as nurse-led consent and pre-assessment clinics. Within endoscopy, there are traditionally two levels of nurse support; QN and Health Care Assistants (HCAs). The latter while having developed their roles considerably to level 3 NVQ were unable to act up within the room and adopt some of the more advanced practices of the QN such as assisting with therapeutic procedures while the former could act down. We identified a need for service improvement and experienced HCAs in whom we saw potential for career development in support of the service. Methods 5 trainees (4WTE) were selected by interview (min requirement: NVQ 3 and 2 years endoscopy experience). We developed an in-house training programme and syllabus, agreed a Scope of Practice and a Clinical Governance framework with the support of our Trust Practice Development Team and funding from Aimhigher. We commissioned a module with Teesside University to address professional issues. A competency-based job description was mapped against the NHS Knowledge and Skills Framework (DOH 2005). In-house training and assessment was completed over 10 months and supported by a programme of tutorials, workshops and mentorship under supervision of nurse trainers. The university module took place over academic year 2008–2009. Results All five successfully completed in-service training, competency-based assessments and a Teesside University Certificate: Foundations in Endoscopic Practice (60 credits at level 1). In 6 months, they have assisted a QN in 60 complex procedures such as ERCP and also 55 acute upper GI bleeders at times when a second QN was unavailable. Our QNs now have the opportunity to develop their roles such as preassessment and nurse led clinics as envisaged. Conclusion This programme broadened the range of roles within the unit, with greater opportunity for career development at all levels and greater flexibility of working practices that has benefited the service and patient care.