Four years ago in January 2018, I was a Deputy Sister in the Endoscopy Unit and became the first Nurse from Royal Cornwall Hospitals NHS Trust (RCHT) to commence the HEE Clinical Endoscopist Training Programme to become a Clinical Endoscopist. This involved a 30-week programme where I was supported by my Trust to complete two Training Lists of Flexible Sigmoidoscopies per week, attend theory training days at King’s College London as well as allowing me time to complete the academic element of the course.
Within the 30-week HEE programme, 200 Flexible Sigmoidoscopy had to be completed before I could be assessed as competent for independent practice. As I was nearing 150 procedures the RCHT plan developed and I was asked to continue to train in Colonoscopy following completion of the programme. My training lists were converted to Colonoscopies which all counted towards the 200 procedures required for the programme.
I was accredited in Flexible Sigmoidoscopy in June ’18, my job plan was adapted to accommodate Colon training to meet the further requirement of 200 Colonoscopies prior to commencing independent practice. During this time, I completed two Colonoscopy training lists alongside two Independent Flexible Sigmoidoscopy lists which I believe assisted me in attaining accreditation in colonoscopy within one year of commencing the HEE programme.
RCHT’s plan was to diversify and establish a stable, flexible workforce as the demand for diagnostic and screening Endoscopy was set to increase. Having a nursing background offers a unique blend of nursing attributes combined with the skills and knowledge of specialised advanced practice. This was evident during the initial stages of the pandemic, when consultants were pulled to wards and Covid areas, many Endoscopy units ceased to deliver the service. At RCHT we were able to continue with a modified Endoscopy service where I continued Colonoscopy lists alongside my Clinical Endoscopist colleague delivering an essential diagnostic service for symptomatic patients at the highest risk of Bowel Cancer.
During the subsequent two years I consolidated my skills and knowledge of independent advanced practice in Colonoscopy, completing five Endoscopy Lists per week. Concurrently, I commenced training in reading small bowel capsule endoscopies and completed a Masters module in Independent Prescribing which enhanced autonomous practice, ensuring I had the ability to provide the optimal experience for all my patients.
Bowel cancer screening (BCS) age extension then highlighted the need for additional BCS accredited Endoscopists nationally. At the end of 2020, the Clinical Director of the BCS service extended an invitation to all Endoscopists who met the key performance indicators necessary to apply for accreditation in Screening Colonoscopy, as a result I was asked to apply for accreditation.
Whilst flattered, I felt overwhelmed and full of trepidation, but I was encouraged by my colleagues and Clinical Supervisor to proceed. I knew that I would regret passing up this valuable opportunity to further enhance my advanced practice and the opportunities that this qualification would present.
Over the next six months I prepared by increasing my exposure to larger, more complex polypectomies, attending weekly BCS lists and utilising the expertise of the existing BCS Consultant Endoscopists. I attended a Joint Advisory Group accredited BCS theoretical seminar and practical preparation day hosted by the Southwest Bowel Cancer Screening Hub in Gloucestershire, where it was recommended that I undertake summative assessment at the next available BCS assessment day which took place six weeks later.
Following successful completion of the multiple choice question and practical assessment, I began Independent BCS practice. My job plan was adjusted once more to accommodate five Endoscopy Lists per week inclusive of one-three BCS lists.
Whilst the Clinical Endoscopist team undertake the majority of diagnostic procedures, we are encouraged and supported by our consultant colleagues and the Trust alike to develop beyond a diagnostic level of practice. Now providing training to trainee Endoscopists and performing advanced procedures such as advanced polypectomy, chromoendoscopy, general anesthesia procedures, gastrointestinal bleed and trans nasal endoscopy.
That said, with consideration that much of our workload is diagnostic, I feel we have raised the quality and improved patient experience of diagnostic Endoscopy with improved technical skills, service improvement and shared experiences in training. This has been apparent from amazing positive patient feedback, often the phrase “that wasn’t as bad as I thought it would be” are said by patients’ as they leave the procedure room.
My professional journey over the past four years has been challenging and rewarding in equal measures, I feel fortunate to have had the opportunity but also feel proud that I have risen to the challenges that have faced me along the way. I feel that I have pushed the boundaries of advanced practice in Clinical Endoscopy at RCHT which has led to a supportive role within our growing team of Clinical Endoscopists, offering mentorship and planning with their development. Next, I plan to complete Upper GI Endoscopy training with the support of the HEE Clinical Endoscopist Training Programme in the near future and continue learning through experience every day.