The role and function of a GI technician may vary according to the facility, system, or agency. However, one thing remains constant — the GI technician is essential to the delivery of quality patient care in any setting. These GI technicians provide much needed assistance to the endoscopist as well as the nursing staff they support.
Educational requirements for the GI technician position are dependent upon the facility, system, or agency. The American Board of Certification for Gastroenterology Nurses (ABCGN) provides education for individuals interested in advanced training and certification outside of their organization. ABCGN offers specialized training for nurses and technicians in the areas of upper and lower GI procedures as well as more in-depth training in endoscopic retrograde cholangiopancreatography (ERCP). In 1998, the ABCGN ceased certification programs for non-nurses; however, various training courses are still available for continuing education purposes. In many systems, the credentials of a GI technician range from a certified nursing technician to a licensed practical nurse. Most, if not all, GI technicians are trained on the job by qualified staff. Their orientation process may last from six months to one year, depending on their level of comprehension. During the course of this article, we will explore the role of GI technicians, look at some of their extended functions, and evaluate their educational requirements and level of competency to perform their job.
The GI Technician Role
At the Tennessee Valley Healthcare System (TVHS), the incumbent assigned to the GI technician role receives general administrative and technical supervision from the chief of gastroenterology and general directions from the clinical gastroenterology physicians and pulmonary physicians. These technicians set up and ensure that all equipment for all GI and pulmonary procedures are functional prior to each procedure. They are also responsible for high-level disinfection of ancillary equipment and supplies used during endoscopic procedures in accordance to infection control guidelines. The GI technicians function under the direct supervision of the medical director and, in most cases, the senior GI technician.
During a colonoscopy, the technician may be asked to manipulate the outer abdominal wall of a patient, a maneuver called splinting, to facilitate advancement of the video endoscope instrument through the intestine. This maneuver helps to reduce the risk of possible colonic perforation. They are also responsible for patient safety during electrocautery procedures, ensuring proper patient grounding and proper function of electrocautery equipment. The primary role of the GI technician is to assist physicians with the following procedures: colonoscopies, upper gastrointestinal endoscopies (EGDs), esophageal dilations (both pneumatic and wire-guided), percutaneous endoscopic gastrostomy (PEG), endoscopic injection sclerotherapy, heater probe treatments, argon plasma coagulation, endoscopic stent placements, endoscopic polypectomy, biopsy, and cytology specimen collections. These technicians are capable of initiating cardio-pulmonary resuscitation in times of emergency, and each of them maintains current CPR certification.
At TVHS–Nashville, the GI technicians also enter patient-related data in the endoscopic databases and into our computerized patient record system (CPRS). Of course, the GI technician must maintain annual unit-based and population-specific competencies according to the Joint Commission regulations for patient safety in hospitals. GI technicians collaborate closely with biomedical engineering and IRM within TVHS. Our GI technicians have now taken on additional responsibilities of inventory and collaborating with various outside vendors following the recent retirement of the senior GI technician. Our GI technicians also manage all endoscopy accessories in the GI lab and monitor par levels, restock endoscopy related supplies and monitor for expiration dates. In the interim, at the end of the day when inpatients are called from the units, the GI technicians also transport the patients to and from their floors. The GI technicians at TVHS are involved in the coordination of cases outside the GI lab, for instance, when cases are done in radiology, the intensive care units, triage, operating room and anesthesia; they prepare the travel GI cart. On any given day, these GI technicians may be found multi-tasking in an effort to get the job done while providing quality patient care.
The GI technician’s role may vary from facility to facility. However, one thing remains the same — GI technicians are essential to the everyday operation of the GI endoscopy laboratory whether in the federal, public, or private sector. For instance, at the Nashville Metro General Hospital in Nashville, Tenn., Lynette Oaks, RN, and SPD team leader portrays the role of their GI technicians more like the GI technicians at TVHS. The skill mix of the GI technicians in the GI endoscopy lab at the Nashville Metro General Hospital includes certified nursing assistants and medical assistants. These individuals receive on-the-job training to familiarize them with the GI technician role and requirements of the position. They assist with equipment maintenance, assisting the endoscopist, repositioning the patient, and transporting the patients back to their inpatient units. The GI technicians at the Nashville Metro General Hospital assist with colonoscopies, EGDs, and ERCPs. The one thing that differs is the location of the procedures. Unlike TVHS-Nashville, some of their procedures are done in the operating room. There are consistencies in the types of procedures that are done at both hospitals.
When I spoke with Beatriz Carcia, director of GI at Mount Sinai Medical Center in Miami Beach, Fla., she outlined the role of the GI technician much like Oaks and me. However, Carcia’s focused on the competency of the GI technicians, including their education and training. How do the GI technicians get to a state in which they are efficient enough to assist the physicians and nurses with cases? At Mount Sinai Medical Center, the GI technicians are initially required to take a battery of courses along with on-the-job training to fulfill competency requirements. GI technicians at Mount Sinai are taken through a series of online training modules provided by Cigna. The cost of this training is $160. The training includes basic anatomy and physiology of the body with emphasis on the areas specific to GI and endoscopy. A foundation is laid in these online didactic courses providing the student with background into GI and endoscopy practices. Carcia uses various tools and checklists to evaluate the competency of her GI technicians. Much like the TVHS, competency of the GI technicians is evaluated on an annual basis. These individuals must maintain current basic cardiac life support (BCLS) certification as well.
One function not mentioned by Oaks or Carcia was the sterilization of the equipment. In several facilities through out the United States, the sterilization process of the scopes and equipment fall under another department. At the TVHS, the sterilization of the scopes is handled by our SPD department. We have a technician who works on station in the GI endoscopy lab but reports to the SPD department. The general sterilization processing of the scopes is performed in designated rooms within the GI endoscopy lab. Although our GI technicians are cross-trained in the sterilization process of scopes, this is an expanded function of their job and is beneficial to us when coverage is not available by the SPD department.
Expanded Role of the GI Technician
I had the pleasure of meeting a unique man who was a pioneer in his role as a GI technician at TVHS–Nashville in the GI endoscopy lab. His name was Steven Vaughan, a certified gastroenterology technician (CGT). I met Vaughan approximately a year ago when I assumed the position of nurse manager in the GI endoscopy lab. While talking with him, I realized that I had an opportunity to learn from one of the “greats” in GI and endoscopy. Vaughan had a wealth of information and served as an excellent resource person. He was not only a GI technician, but a preceptor, mentor, and trainer. The chief of gastroenterology remarked that Vaughan was the first GI technician in the lab some 20 years ago. At that time, nurses were not used in the GI lab in Nashville, and GI technician assumed a great deal of the responsibilities that are now placed on the nurses. Vaughan expanded his role as a GI technician by specializing and providing assistance to the physicians during ERCPs. He initially took a training course years ago, which was provided by the then Society of Gastroenterology Nurses Association. During his tenure at TVHS, he trained and supervised surgical residents rotating through the GI service in certain aspects of gastrointestinal endoscopy related to equipment, instruments, computers and software. During the junior GI technician’s orientation period, Vaughan provided direct training and continued clinical supervision and remained a mentor to these individuals. He also maintained an equipment database, consolidated medical records (CMR), managing all endoscopy equipment assigned to medical service/GI. Vaughan was the go-to person for the vendors, and he was responsible for the management of the Olympus Endoworks image manager database and ordering endoscopy-related equipment and supplies. Vaughan coordinated the shared Olympus Endoworks database file server on down time and file server maintenance, endoscopic instruments and ordering supplies for the TVHS–Murfreesboro campus as well. He managed the electronic work orders for repairs of endoscopy equipment and ensured that the equipment was in working order by performing frequent maintenance checks. At the end of his career at TVHS, Vaughan arranged for the equipment, training, and supplies for electronic capsule endoscopy (ECE). After more than 20-plus years, Vaughan retired in January 2008. Our GI technicians continue to work to pick up where Vaughan left off.
Education and Training
Just from personal experience and talking with other directors and managers in this field, I have found that it is important to seek out and provide as much on-the-job training and structured training as possible. Carcia raised an important point. Competency of the GI technician is essential due to the changing technology and varying condition of patients. These competencies should be reassessed per your individual facility’s policy. There is a certain degree of motivation the GI technician should have. For instance, this individual must be willing to learn and work as a team player. The GI technician must also be willing to build a rapport with his or her team (physicians, nurses, and other GI technicians). Communication is an important factor. The physician and the nurse must be able to communicate their needs to the technician prior to, during, and after procedures. Communication among the patients, nurses, technicians, physicians, and clerks is important in moving the patient forward through procedures and to recovery.2
Online courses are available through Cigna and the SGNA Web sites. SGNA offers an eight-module course for associates.3 Below is an overview of the modules available through SGNA:
Module 1: Anatomy
Module 2: Equipment
Module 3: Reprocessing/infection control
Module 4: Patient care
Module 5: Risk management
Module 6: Roles & responsibilities/communication
Module 7: Safety
Module 8: Emergency preparedness
Competency is a must in providing safety, quality patient care, continuing education and ongoing evaluation of GI technicians.
The GI technician is an essential part of the GI endoscopy team; without their skills and assistance during procedures, the physicians’ and nurses’ jobs would be much more labor-intensive. No matter which sector the GI technician is placed, whether it is federal, public, or private, one thing remains clear: they are a vital part of the organization. Their roles may vary from facility to facility; but as managers, we must be cognizant of their educational needs and reassess their competency level often. As an educator, I would like to see more programs developed for these individuals with special emphasis on their unique skill set. I believe that they could benefit from a curriculum designed specifically for them, one more like the curriculum operating room technicians have at the community college level. GI technicians, we in the GI endoscopy field applaud you and thank you for your diligence and commitment to your job.
Phyllis Ogbode, RN, MSN, is the nurse manager of the GI and bronchoscopy labs at Tennessee Valley Healthcare System in Nashville, Tenn.
Manual of Procedures. Society of Gastroenterology Nurses and Associates, Inc. (2004): Chicago, IL
EndoNurse. Patient Flow and Other Efficiencies Affecting Patient Satisfaction (Feb. 2008)