Non-physician endoscopists: A systematic review

AIM: To examine the available evidence on safety, competency and cost-effectiveness of nursing staff providing gastrointestinal (GI) endoscopy services.

METHODS: The literature was searched for publications reporting nurse endoscopy using several databases and specific search terms. Studies were screened against eligibility criteria and for relevance. Initial searches yielded 74 eligible and relevant articles; 26 of these studies were primary research articles using original datasets relating to the ability of non-physician endoscopists. These publications included a total of 28883 procedures performed by non-physician endoscopists.

RESULTS: The number of publications in the field of non-specialist gastrointestinal endoscopy reached a peak between 1999 and 2001 and has decreased thereafter. 17/26 studies related to flexible sigmoidoscopies, 5 to upper GI endoscopy and 6 to colonoscopy. All studies were from metropolitan centres with nurses working under strict supervision and guidance by specialist gastroenterologists. Geographic distribution of publications showed the majority of research was conducted in the United States (43%), the United Kingdom (39%) and the Netherlands (7%). Most studies conclude that after appropriate training nurse endoscopists safely perform procedures. However, in relation to endoscopic competency, safety or patient satisfaction, all studies had major methodological limitations. Patients were often not randomized (21/26 studies) and not appropriately controlled. In relation to cost-efficiency, nurse endoscopists were less cost-effective per procedure at year 1 when compared to services provided by physicians, due largely to the increased need for subsequent endoscopies, specialist follow-up and primary care consultations.

CONCLUSION: Contrary to general beliefs, endoscopic services provided by nurse endoscopists are not more cost effective compared to standard service models and evidence suggests the opposite. Overall significant shortcomings and biases limit the validity and generalizability of studies that have explored safety and quality of services delivered by non-medical endoscopists.

The Relationship Between Registered Nurses and Nursing Home Quality: An Integrative Review (2008-2014)

Nursing home care is expensive; second only to acute hospital care for inpatient Medicare costs. The increased focus on costs of care accrued by Medicare beneficiaries in nursing homes presents a valuable opportunity for registered nurses (RNs) to further demonstrate quantitatively the value they add to the capacity of the nursing home nursing skill mix to provide cost-effective and efficient quality care. Most of the studies included in this review consistently reported that higher RN staffing and higher ratios of RNs in the nursing skill mix are related to better NH quality. Concerns about the costs of employing more highly skilled RNs and directors of nursing that have the potential to positively influence members of the nursing skill mix will continue to influence nursing home industry hiring practices. For both the advancement of nursing as an applied science and the benefit of society at large, nursing researchers are challenged to better demonstrate how the increased presence of a RN on each shift has the potential to enhance the cost effectiveness, efficiency, and quality of nursing homes.

An expensive lesson in workforce planning

The NHS is on course to spend almost £1 billion on agency nursing staff during the 2014/15 financial year in England alone, according to figures released by the RCN last week. At the same time, many trusts have despatched teams around the world to recruit from overseas in a desperate bid to maintain safe staffing levels.

The cost of temporary nurses in Wales almost doubles in a year

Spending on agency nurses by health boards in Wales jumped to £23 million in 2014, almost double the spend in 2013.

Labour draws up NHS battle lines as general election looms nearer

A Labour government would recruit 20,000 extra nurses, which would include 10,000 more newly trained nurses. Other pledges include joined up services from home to hospital and introducing measures such as tackling stress and lifting morale to boost staff wellbeing, the party's leader Ed Miliband has said.

Staff to vote on 1 per cent rise after last minute talks halt strike

Nurses and other healthcare workers in England will decide this month whether to accept a 1 per cent pay rise offered by the government, after late talks with unions averted a national strike.

Public sector workers face more misery over pay

Health service staff look set to be out of pocket for another year after it was announced that public sector pay curbs will continue.

NMC warns of registration fee hike if forced to pay for its own regulator

The Nursing and Midwifery Council has warned that registration fees could rise again if the government goes ahead with proposals to make healthcare regulators pay for the authority that oversees their work.