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ENDOSCOPY
Overcomingchallenges ingastrointestinal nursing
Laura Dwyer, chair of the British Society of Gastroenterology’s (BSG) nursing group, and Dr Helen Griffiths, advanced nurse practitioner gastroenterology, discuss endoscopy nursing workforce issues and some of the challenges in ongoing education in gastrointestinal (GI) nursing.
It was Benjamin Franklin who famously said that by failing to prepare you are preparing to fail. Financial pressures coupled with increasing demand within the NHS have changed the landscape of the nursing workforce, moving towards a skill mix consisting of vaster numbers of trained but unregistered staff. Within endoscopy these challenges coupled with the introduction of new and ever more complex technologies and quality standards leading to the accreditation of services have resulted in a maelstrom of changes both to the skill mix and culture within the nursing workforce that if not prepared for and managed appropriately risks being catastrophic both for patients and services alike.
When the British Society of Gastroenterology Nurses Association (BSGNA) as representing the endoscopy nursing workforce set about reviewing the outdated workforce guidance document it became quickly apparent that the changes in workforce over the intervening years necessitated a complete rewrite of the
document. It was at this juncture that the variances in skill mix between devolved nations and units including how staff were deployed within units was going to make this a challenging task in producing a consensus document. The resultant document was
reached after addressing issues of considerable complexity and involving many interested parties across the specialty and nations. There was however universal agreement on the basis for the guidance. Firstly that no matter where the service is delivered every patient has the right to be treated with respect and have the right procedure for the right indications that is delivered by people with the knowledge, skills and competence to make judgements that are in their best interests and secondly that there can be ‘no one size fits all’ with regard to staffing in endoscopy but rather that it is based on each individual service (environment, procedure type, patient’s health status). The latter undoubtedly was the most challenging in offering recommendations, points for consideration
and signposting service managers and providers struggling to meet both present and future service needs but without being prescriptive as to how that is achieved.
What we know about staffing endoscopy services
Those working within endoscopy services are acutely aware that how an endoscopy unit is staffed depends on a number of considerations. The type, size and layout of the endoscopy unit is the first. The number of procedure rooms, patient flow and compliance with the Department of Health (DH) privacy and dignity agenda will clearly influence the numbers of individuals needed to safely staff each area. The complexity of the endoscopic procedure, taking ERCP or the emergency GI bleed as an example, will require more staff within a room and in addition linking to the next consideration will require a higher level of skill and competence to deliver care in a safe and timely manner. The most important consideration of course is the health status of the individual and that is not always a known quantity.
What we don’t know
There is a paucity of evidenced based tools with which to calculate safe staffing levels in endoscopy and that is because in the outpatient setting of endoscopy the acuity and dependency of patients will vary on a daily basis. Although it can be broadly categorised according to age, known disability, comorbidities and procedure type (emergency, routine, diagnostic, therapeutic), this information is not always available when planning ahead unless a robust pre-assessment process ahead of the day of the procedure is employed. Hence the challenge of addressing the things that we do know about staffing endoscopy units is in guaranteeing that skills, competencies and staffing numbers can support both the routine diagnostic non dependent patient procedure and the emergency therapeutic
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