Definitions

For the purpose of this document, SGNA has adopted the following definitions:

Staffing refers to the registered nurse staffing pattern in the gastrointestinal endoscopy unit.

Patient Care in the Gastrointestinal Endoscopy Unit refers to the preprocedure, intraprocedure and postprocedure care of the patient undergoing gastrointestinal endoscopy regardless of the setting.

Nurse refers to registered nurse, licensed practical nurse, or licensed vocational nurse.

Background

Trends in the healthcare industry have necessitated the reevaluation of staff numbers and skill mix. The aging population has resulted in patients who are more acutely ill upon admission to healthcare centers. While numbers of professional staff and lengths of stay in acute care facilities have been decreased, patients require more complex care to maintain and improve their health.

Another trend is the increased use of free-standing and office-based endoscopy centers. These centers may be required to comply with state and federal regulations governing their use. Patients undergoing gastrointestinal endoscopy in these centers require the same standard of care as those undergoing their procedure in the hospital setting.

Position

In consideration of the circumstances and conditions surrounding patient safety and adequate nursing staff in the gastrointestinal endoscopy setting, the Society of Gastrointestinal Nurses and Associates, Inc. supports the position that whenever a gastrointestinal endoscopy procedure is performed, the minimum registered nurse staffing pattern is as follows:

* One registered nurse in the preprocedure area to perform patient assessment prior to IV sedation and analgesia.

* One registered nurse in the postprocedure area to perform patient assessment during recovery from IV sedation and analgesia.

* One registered nurse in the procedure room to assess and monitor the patient during IV sedation and analgesia.

Because of the importance assigned to managing the patient who is receiving sedation and analgesia, a second nurse or associate is required to assist the physician with those procedures that are complicated either by the severity of the patient's illness and/or the complex technical requirements associated with advanced diagnostic and therapeutic procedures.

Procedures performed on pediatric patients often require more time and personnel than procedures performed on adults. Due to the unpredictable nature of the response of the pediatric patient to sedative and analgesic medications, all endoscopic procedures performed on pediatric patients require the availability of two staff members, including at least one registered nurse.

The establishment of registered nurse staffing patterns in the gastrointestinal endoscopy setting must include awareness of patient acuity, community needs, needs of population served, and provide for appropriate nursing staff to meet those needs, state and federal regulations, and accreditation guidelines. The economic situation of the provider organization should not serve as the primary basis for determining services offered.

SGNA believes this minimum registered nurse staffing pattern should be consistent regardless of the practice setting.

SGNA supports state and federal legislation requiring the collection and reporting of nursing quality indicators to monitor the effects of staffing.

SGNA collaborates with other professional organizations to reduce and eliminate medical errors. SGNA recognizes that adequate staffing represents an essential element in the provision of quality healthcare.

SGNA supports ongoing research to determine proper registered nurse staffing patterns in order to sustain high-quality patient outcomes.

References