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 NMCS 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
  1970s 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 womens 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 takers 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.

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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 Womens 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
Womens 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

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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 n20

• No Pref. 17
  85
• Doctor 3
  15
• Nurse 1
  5

41
Seen by a male colposcopistn 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.