Chapter 20: Diagnostic investigations
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Legal and professional issues
Flexible cystoscopy is the most commonly performed urological procedure. Nurses with specialist training have been performing this advanced role for several years. In 2000, the British Association of Urological Surgeons set up a working party and first published recommendations in support of nurse cystoscopy for surveillance of bladder cancer (Ellis et al. [43]). In the late 1990s nurse specialists began training to undertake flexible cystoscopy. The role of nurse cystoscopy has developed to encompass surveillance of superficial bladder cancer, diagnostic bladder biopsy, cytodiathermy and the removal of stents (>(BAUS and BAUN [16], [17], Skills for Health [151], [152], [153], [154]).
Patients should expect that a nurse performing a flexible cystoscopy should be performing at a level of competence equivalent to that of a competent urologist (Cox [30]). Evidence from several UK studies suggests that nurse‐led flexible cystoscopy is as effective as doctor‐led services in correctly reporting abnormalities (Smith et al. [157], Taylor et al. [161]). Although some studies suggest that nurse‐led services have a greater tendency to over‐report abnormalities, other studies suggest that doctors and nurses equally over‐report abnormalities (Smith et al. [157]). However it is accepted that experience improves both abnormalities detected and over‐reporting of abnormalities (Radhakrishnan et al. [125]).
The nurse cystoscopist
Nurse cystoscopy is increasingly common and several training courses are available in the UK. Training has also been extended to include diagnostic procedures such as biopsy, treatment with cystodiathermy and ureteric stent removal, as well as surveillance. Services are also being developed overseas following the UK model (Osborne [118]). The joint British Association of Urological Surgeons and British Association of Urology Nurses (BAUS and BAUN) guidelines were published in 2012 to guide training and practice.
Training should include all elements of practice as agreed by senior management and consultants and should always include consent training. Continuing professional development for the nurse cystoscopist should include regular updates on this element of practice. The nurse cystoscopist should also participate in regular clinical audit including comparison of accuracy of findings, patient satisfaction and service capacity/waiting times (BAUN and BAUS [16], [17]) to ensure the highest standards of clinical care are being met. It is also important for the nurse to perform regular audit. The audit data are required to reflect on the nurse's own practice and maintenance of competence in accordance with national and local policies and guidelines (BAUS and BAUN [16], [17], Skills for Health [151], [152], [153], [154]).
Consent
Written consent must be obtained prior to the procedure (NMC 2013). The patient must be informed of the procedure, its risks and potential side‐effects. Accurate and legible documentation should be recorded immediately after the procedure, including all the observations and decisions made before, during and after the procedure (NMC [114]).
