The wonderful world of endoscopy nursing

Meet Tom, who tells us about the wonderful world of endoscopy nursing.

Hi, my name is Tom and I’ve been a nurse for 1 year in the wonderful world of Endoscopy. After completing my Bachelor of Nursing at QUT, I had a really hard time finding a grad position. After many knockbacks and never hearing back from hospitals, I decided to go door-to-door and hand my resume into GP clinics, Day Surgeries and Endoscopy Clinics. Luckily, I got a call on my graduation day from an Endoscopy Clinic offering me an interview.

I went in the next day and walked out with a 6-month contract (which got extended) and I’ve been at the clinic ever since. I didn’t expect to wind up in Endoscopy, however I don’t regret my decision at all. Thankfully, I had a really supportive employer who provided full training (supernumerary days) and opportunities to attend conferences and upskill.

One thing people don’t know about me is that I’m mildly autistic. Ever since I was a child, I have been obsessed with medical stuff. I always have wanted to work in healthcare. I actually believe my autism benefits me in my career (caring personality, hyperempathy, attention to detail) and despite the struggles (sensory overload, auditory processing), I still believe it benefits my career.

It’s taken a lot of work to battle some of the issues autism poses (awkwardness, minor sensory issues etc.) however exposure to the real world has done me the power of good. Oh, and I used to have a massive home medical guide that I read back-to-back when I was a kid. While other kids were reading Diary of a Wimpy Kid, I was reading about appendicitis and what an Endoscopy was (I didn’t know it would benefit me later in life).

What is Endoscopy nursing?

Endoscopy Nursing is where nurses provide care to patients undergoing an Upper Endoscopy and/or Colonoscopy (a digital examination of either the Oesophagus, Stomach and Duodenum or the Colon and Rectum using a camera). Some clinics also complete interventional Endoscopy procedures such as an Endoscopic Ultrasound (a Doppler mounted to an endoscope to examine the mucosa) or an ERCP (Endoscopic Retrograde Cholangiopancreatography, where a specialised endoscope is combined with fluoroscopy to examine and treat issues in the bile and pancreatic ducts).

What are the main types of patients you see in your current position?   

I work in a standalone clinic (not attached to a hospital) so I generally see patients who have been referred by their GP due to either a family history of Colorectal Cancer, a positive Faecal Occult Blood Test (stool sample) as well as patients who have had previous polyps detected returning for surveillance. We also tend to see patients who have had a change in bowel habits, bleeding from the rectum as well as patients who have low iron and nausea + vomiting. These can potentially be symptoms of Colorectal Cancer so it is very important to have a colonoscopy done to rule out any sinister causes.

Describe the role & typical shift in endoscopy?

Pretty much, the Endoscopy Nurse’s job is to advocate for the patients safety at all times as well as provide a calm and safe environment for patients, relatives and staff. Because patients are sedated (cocktail of happy drugs as I like to call them), it is our job to ensure patients have a voice and their safety and comfort is upheld at all times. We’re not only responsible for patients during surgery, we’re also there to ensure patients are comfortable, free of pain and anxiety during their journey with us.

What are the different aspects/roles of an endoscopy nurse?

The Endoscopy Nurse’s role includes five areas of practice, these include Recovery, Admissions, Reprocessing of the Endoscopes and working in the Procedure room (rough equivalent to a Scrub/Scout). Some nurses are also responsible for conducting pre-assessment of colonoscopy patients and prescribe bowel preparation to them (this ensures the Gastroenterologist can see the mucosa clearly).

I start around 6:45am (one nurse starts at 6am to set up the procedure room) and we finish once the last patient is discharged (can be 6-10 hours depending on the doctor). Because my clinic isn’t attached to a hospital, we only operate Monday to Friday, and we don’t do on-call however many of my hospital colleagues are required to do on-call.

What are some complications common in endoscopy you need to identify and be able to manage?

In Endoscopy, there tends to be five roles. These include Recovery, Procedure Room, Reprocessing, Prescribing Bowel Preparation and Admissions. I started my career running the recovery room. Patients tend to spend 30 minutes in bed after their procedure so the drugs can wear off. My job is to make sure they’re not having any side effects and they are recovering well from the anaesthetic. Once the drugs wear off and the Gastroenterologist has a chat to them, we take the patient to an armchair where they’re offered a light refreshment and monitored for a further 30 minutes before discharge.

Once I gained more confidence, I started doing admissions. When a patient arrives for their procedure, the Admissions nurse will complete a set of observations and if they’re diabetic, a BGL. Patients will then be asked about their health history and the last time they ate and drank. The admissions nurse is also responsible for escalating any concerns to the Anaesthetist or Gastroenterologist.

In the procedure room, there are two nurses. One stands beside the Gastroenterologist and is responsible for operating forceps and snares as well as applying abdominal pressure to allow the endoscope to travel through the colon. The second nurse is responsible for applying monitoring equipment, operating larger equipment (diathermy machine) as well as collecting and recording specimens. Oh, and don’t forget the mounds of paperwork.

Depending on which hospital, the reprocessing of the Endoscopes might be done by a CSSD technician but at my clinic, the nurses do it. To reprocess an endoscope, we stick it in a machine that resembles a washing machine. The machine flushes the endoscope with Peracetic Acid to ensure that every part of the Endoscope is disinfected. After it’s cleaned, we stick it in a cupboard that dries the endoscope ready for the next procedure.

Some Nurses are selected to prescribe bowel preparation. Patients having a Colonoscopy attend an appointment with a nurse prior to the procedure. During this appointment, the nurse will ask about the patients’ health history and prescribe an appropriate bowel prep mixture. Factors that may cause issues down the track (BMI 40+, Cognitive Impairment) are escalated to the Anaesthetist at this point.

What are some complications common in endoscopy you need to identify and be able to manage?

There are four main complications that can happen post-procedure. While these complications don’t happen often thankfully, they still need to be addressed. These include Pain, Nausea + Vomiting, Rectal Bleeding and Narcosis (over-sedation). Abdominal pain and discomfort can occur due to the air introduced into the colon (Everyone uses CO2 now which dissipates better but our CO2 machine can break) or when specimens are collected. We tend to give patients heat packs and massage and that tends to do the trick. Sometimes we Nurse Initiate Paracetamol but thankfully not that often.

Some patients may present on the day feeling nauseous and may have vomited during the prep (3 litres of salty lemon drink isn’t that pleasant) but our anaesthetists tend to be on top of managing nausea.

Patients may have a small amount of bleeding from the rectum is very common after removing polyps however patients with a large amount of bleeding are encouraged to go straight to ED.

Especially for petite people and during long procedures, patients come out to recovery heavily sedated (more than normal) and may require extra time in bed after their procedure. We have a couple tricks of the trade to help wake patients up (light refreshments in bed, positioning patient upright) however patient safety is always maintained to prevent a side trip to ED and a fractured NOF.

What are the challenges and positives?

The main positive for working in Endoscopy is the variety of tasks you can do. One day you can be in the cleaning galley, you could be assisting the gastroenterologist the next. I like challenging myself and I love being able to do a different job every day. You’ll never get bored.

At my clinic, we only have 10 nurses and we all take care of each other. The other nurses have taken me under their wing and helped me to develop into the nurse I have become today.  Oh, and no weekends and night shifts mean I can hang out with my mates.

Thankfully there are very few challenges however there is the potential to lose skills (especially medication administration) and we don’t have the luxury of a MET call at my clinic either.

Tell us about a cool piece of equipment you use in endoscopy?

There’s lots of cool equipment in Endoscopy however my favourite would be the Argon Plasma Coagulation machine. The machine pumps a small amount of Argon gas and electrical current through a probe which helps seal blood vessels on vascular lesions. However, if not used properly it can be very dangerous and you need to be aware about the principles of electrosurgery.

What is one myth or common misconceptions that you want to debunk about your area?

One myth that I’d like to debunk is that we’re just assistants to the Gastroenterologist. We make a lot of safety decisions before and after patients enter the procedure room. We are also the ones who are tasked to find out about the patients history and determine whether they are even suitable to be seen in our clinic; and if they aren’t suitable, where they can receive their procedure in a safe environment (Tertiary Hospital).

Why should other nurses or students consider this area to work in?

If you like working with a skilled team and don’t want to be doing the same thing every single day, you should absolutely consider Endoscopy Nursing. Endoscopy Nursing has a lot of transferable skills which can potentially be applied in other procedural areas (Medical Imaging, PACU, Scrub/Scout). All I can say to other nurses/nursing students is come and join the dark side, you’ll never want to go back to the wards.

What is one thing you wish you would have known before you started your career in this field?

One thing I wish I had known was how to manage post-operative pain with non-pharmacological methods. During the procedure, the Anaesthetist and Gastroenterologist are stuck in the room and cannot leave and prescribe analgesia so I quickly had to brush up on some pretty interesting methods of reducing pain after an Endoscopy (Telling patients to pat their abdomen like a bongo drum, I often put on some bossa nova to get the patient in the groove).

What’s one of the greatest lessons you’ve learnt in your journey so far?

One of the greatest lessons I have learnt in my time is the importance of trusting your gut. I’ve had senior staff tell me it’s okay and not to bother the doctors however things can go pear shaped (and they did) so I knew I was right in escalating my concerns to the Medical Team.

Can you think of a really funny situation you’ve had while working?

In my clinic, we use a blue solution (Indigo Carmine) to help identify polyps and lesions. I forgot to clamp the bottle after the procedure and ended up spraying my face with it. Let’s just say I had a lot of people looking at me as if I was half smurf, half human. Thank heavens my scrubs were blue.

What is your top 3 pieces of advice for a nurse interested in transitioning into endoscopy nursing?

Number one would be try to do a placement/temporary contract in a Periop/Endoscopy unit. I did a Periop placement in my final year and fell in love with PACU/Day surgery work. It’s a very niche field and you need to be sure it’s right for you.

Number two would be study, study, study. Before I started, I hit the books and learnt everything Endoscopy and it really helped me settle into an alien environment.

My final piece of advice is keep an eye on clean and dirty areas and learn the importance of asepsis. You don’t want to put a sterile tube on the same table that you sort polyps on (learn from my mistake).

What is next for your career?

I actually went for an interview at a major tertiary hospital’s Endoscopy unit and I got the great news that I’ve been offered the position. This unit does a lot more advanced procedures (Endoscopic Ultrasounds, ERCP, large polyp removals and even Endoscopic Bariatric Surgery) and I am always looking to challenge myself so I think I found the right place. In the near future, I hope to commence my Graduate Certificate in Gastroenterology Nursing and potentially become credentialed with the Gastroenterology Nurses College of Australia.