The Role of the Nurse Colposcopist

1. The Role of the Nurse Colposcopist Carmel Flynn Nurse Colposcopist Royal Free Hospital

2. Topics to be considered • Background to role • Training • Implementation • Audit

3. Background: • Traditionally colposcopy has been a consultant led service • There was no formal training programme • Junior doctors were trained on an ‘ad hoc’ basis

4. Background: • In 1996 the BSCCP introduced formal training for all colposcopists. • In combination with NMC’S Code of professional Conduct(2002) this allows nurses working in an extended role within colposcopy to access colposcopy training and accreditation

5. Nursing roles in Colposcopy • Colposcopy clinic nurse • Lead nurse for colposcopy • Nurse colposcopist

6. Colposcopy Clinic Nurse: • Trained nurse, assisting the colposcopist in the day to day colposcopy clinics (D /E grade) • Care and support of the patient

7. Colposcopy Lead Nurse: • Senior nurse co-ordinating clinics and nursing staff (F/G grade) • Nurse led smear clinics • Nurse counsellor for women attending clinic • Involved in clinic audit and protocols

8. The Nurse Colposcopist • A nurse who is trained, competent and certified to perform colposcopy in accordance with the training standards laid down by the BSCCP (H/I grade) • Currently there are 74 accredited Nurse Colposcopists in the UK

9. The Nurse Colposcopist • Not entirely a new role – first pioneered in the 1970’s in America • First nurse colposcopist accredited in Birmingham in 1997.

10. The Nurse Colposcopist: • Colposcopy nurses have for many years worked closely with consultants gaining an in depth knowledge of colposcopy practice • It is logical then that training of Nurse Colposcopists should come to the fore

11. Justification: Why train nurse colposcopists?

12. Justification: Currently there are in excess of 120,000 women who require colposcopy in the UK each year

13. Advantages of the Nurse Colposcopist • Embraces a multidisciplinary approach to care • Increases patient choice • Continuity of care • Flexibility of clinic times • More skilled colposcopists • Personal satisfaction

14. Essential qualifications to train as a Nurse Colposcopist: • RGN- First level registration • Teaching and assessors course • 2 years experience in women’s health at E grade or above • Able to demonstrate an in depth knowledge of the colposcopy service .

15. Essential qualifications to train as a Nurse Colposcopist: • Evidence of good organisation, communication and leadership skills • Demonstrate a supportive, sensitive and approachable manner • Membership of a professional organisation for indemnity

16. Desirable qualifications: • Basic counselling skills • Basic knowledge of GU medicine and sexually transmitted disease

17. Local agreements: • The support of a lead consultant in the colposcopy unit • Support of the Trust and nursing management • To be trained in a unit which has been accredited for training by the BSCCP • Strict protocols

18. Training requirements • It is essential that nurses acquire the same skills and standards as their medical colleagues • To be trained by a recognised preceptor registered with the BSCCP • Access to a smear taker’s course

19. Training: • Training of the Nurse Colposcopist is identical to that of her medical colleague • However, nurses are required to spend one week in the histopathology and cytopathology modules as opposed to one day for medical staff

20. Levels of training • Level 1 Undertakes basic colposcopy assessment and diagnosis (D) • Level 2 As level 1 but undertakes treatment (T)

21. Nurses and Treatment • Some nurses wish to perform the complete role as diagnostic and theraputic colposcopist • Some nurses are reluctant to undertake treatment as it may seem one step beyond the role in which they wish to practice

22. Maintaining Registration • Nurse colposcopists undergo the same audit requirements as their medical colleagues. • All colposcopists require to see a minimum of 50 new patients each year. • All colposcopists must attend a colposcopy related postgraduate meeting every three years. (Usually BSCCP annual meeting).

23. Drawbacks • Feeling of isolation for nurses in a specialist role • Lack of support • Arranging medical cover

24. Impact of Nurse Colposcopists: • A retrospective audit was performed to assess the impact of Nurse Colposcopists on service provision in Birminghan city Hospital over the last six years (Todd 2000) • During this period 8,880 colposcopies were performed

25. Inpact of Nurse Colposcopists: • In 1993 8% of colposcopies were performed by nurses. By 1998 this had risen to 68%. • Average waiting times to be seen has fallen from 14 weeks in 1993 to 4 weeks in 1998. • Nurse Colposcopists were able to predict high grade disease in 75% of cases compared with 67% of doctors

26. Impact of Nurse Colposcopists: • Of patients referred with moderate or severe dyskaryosis and assessed by a nurse, histological diagnosis was obtained in 73% (79% doctors) • Evidence of CIN could be found in 82% of biopsies taken by nurses and 85% of those taken by doctors.

27. Current role in colposcopy • Registered as a Nurse Colposcopist in 1999 • Perform two diagnostic clinics a week • Nurse led cytology clinic • Regularly supervise trainees undergoing Colposcopy training

28. Current role in Colposcopy: • Nurse counsellor (colposcopy patients) • Clinical supervisor for the Women’s Health and Screening course (PHC3133) • Able to see women with problems post treatment

29. Patient preference in the colposcopy clinic Mrs Carmel Flynn Nurse colposcopist Mr Patrick Walker Lead colposcopist

30. STUDY OBJECTIVES • To assess the acceptance by patients of the role of the nurse colposcopist. • To see if patients have a preference as to the gender of their colposcopist

31. Women’s preference as to gender of their gynaecologist n = 169 59% preferred to see a female 7% preferred to see a male 34% expressed no preference Ivins and Kent 1993

32. CERVICAL SCREENING • When asked what improvements in the cervical screening programme would encourage more women to attend: • 25% of responders suggested the guaranteed availability of a female doctor Schwartz 1989

33. RFH STUDY - METHOD • Prospective study • Questionnaire based • July 2000- October 2000 • All new patients eligible • Two groups Group A - Before consultation Group B - After consultation

34. STUDY GROUP • Number of patients completing the questionnaire n = 169 • Randomized Group A Prior to consultation 90 Group B Post consultation 79

35. RANDOMIZATION • Group A represents the pre-conceived views of women who have never undergone colposcopy. • Group B represents the views of women who have experienced the procedure

36. Gender of Colposcopist Overall results n = 169 Female 101 ( 60%) Male 2 (1%) No preference 66 (39%)

37. Status of the colposcopist Overall results n = 169 Doctor 72 ( 42%) Nurse 13 ( 8%) No preference 84 (50%)

38. Gender of the colposcopist Group A Group B (pre) (post) Female 63% 55.5% Male 0.0% 2.5% No pref. 37.0% 42%

39. Status of the colposcopist Group A Group B (pre) (post) Doctor 47.0% 38% Nurse 11.0% 4.0% No Pref. 42.0% 58%

40. Seen by a nurse n=20 No Pref. 17 85% Doctor 3 15% Nurse 1 5%

41. Seen by a male colposcopist:n = 30 No pref : 21 (70 %) Female: 9 ( 30%)

42. CONCLUSIONS • There is an increasing acceptance of the role of the Nurse colposcopist • There is a continuing acceptance of the role of the male colposcopist

43. SUMMARY • There is a role for the nurse colposcopist • Training and assessment are essential • Audit of standards is paramount • Nurse colposcopists are not employed to replace doctors • A multidiscplinary approach will greatly enhance the service.