Solid training essential for flexible sigmoidoscopies
June 1, 2000 2 minutes read
Solid training essential for flexible sigmoidoscopies
Any program to teach skills to nurses requires careful planning, but when you train a nurse to perform an invasive procedure that previously has been performed only by physicians, it is especially important to make sure the nurse is competent to act on his or her own after training.
If you want to use nurses to perform flexible sigmoidoscopy, start by hiring experienced gastroenterology nurses, says Jane Allaire, RN, CGRN, nurse specialist at the National Naval Medical Center in Bethesda, MD. "A gastroenterology nurse will not have to start by learning the basic anatomy, infection control, and care of the equipment," she says.
At the Naval Medical Center, nurse endoscopists who perform flexible sigmoidoscopy start their training by reviewing written articles. Subsequently, they practice on a colon model.
"The next step is observation of at least four procedures, then withdrawal of the scope on at least five procedures while the physician is with them," says Allaire. The nurse also has direct physician supervision on at least three biopsies and 50 complete procedures before he or she can perform the procedure without direct supervision, adds Allaire.
At Kaiser Permanente in Denver, nurses must perform 75 to 100 procedures under supervision before they are allowed to perform on their own, says Debbie Lantz, RN, nursing supervisor in the gastroenterology department. "We also require that a gastroenterologist be on the premises whenever nurses are performing flexible sigmoidoscopies."
Physicians review taped procedures
After training at the Naval Medical Center, nurse endoscopists are monitored by weekly physician reviews of videotaped procedures and a logbook that describes each procedure, depth of insertion, and findings of exam, says Allaire. "The logbook is important because it is used to determine competency and maintain credentials to perform the procedure." A nurse must perform at least 100 flexible sigmoidoscopy screening exams each year to maintain credentials for the procedure, she adds.
Kaiser Permanente physicians monitor findings of screenings and observe procedures to ensure nurses are following protocol and demonstrating the proper level of competency, says Lantz.
The toughest part about training a nurse to perform a flexible sigmoidoscopy is the length of time it takes to train and the investment made in the nurse, says Lantz. "We look for nurses who will stay with us for not only the three months it takes to train but for a long time afterward." While you can’t predict which employees will stay, Lantz suggests looking for someone who enjoys the autonomy of such a position so he or she will stick with it.
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