The Journey to Office Cystoscopy Privileging

Christy B. Krieg, MSN, FNP, CUNP


Urol Nurs. 2020;40(2):99-103. 

In This Article

Background and Training

During the SUNA didactic cystoscopy course in 2016, I spread my cystoscopy wings via endoscopy of freshly gutted pumpkins and foam beverage cups. Next, I approached physicians at my two practice locations about learning cystoscopy on humans, and found them to be highly supportive. One physician (A) was our department chair with whom I had worked closely since 2010, and the other was a staff physician (B) who had recently joined our practice. Having been in the group over 16 years, there was a level of confidence in my clinical judgment, but nobody, including me, knew about my motor skills.

Importantly, in our academic center with a urology residency program, my personal experience has been of a patient and gentle milieu of teaching and learning, for which I am thankful. This culture makes life better for advanced practice providers (APPs), and I know this is not the experience of all. Further, urology is often touted as the department in our organization that best utilizes APPs to the top of our scope. So there is a reputation to uphold!

Our practice administrators confirmed that my liability insurance would cover office procedures, including cystoscopy. We then reviewed our state nurse practice law. In Indiana, the language as it relates to NPs regarding procedures is somewhere between vague and absent. The nursing scope of practice does mention that unprofessional conduct occurs when a nurse performs a procedure for which they are unprepared by education or experience. But only the word "skills," not "procedure," is utilized in portions of the document pertaining to advanced practice nursing.

The two physicians and I arrived at a minimum of 50 directly observed procedures, with an option to extend that to more direct supervision if requested by any party. The quantity of 50 was chosen based on the British Association of Urologic Nurses (BAUN) (2012) training program, having no clear edict from a U.S.-based organization. My training occurred at two outpatient clinic sites from February to May 2017. I performed 55 flexible diagnostic cystourethroscopies of adults under direct supervision, 18 with Dr. A, 31 with Dr. B, and 6 with other physicians in the group. There was no tracking to ensure a balance of male and female patients.

There were no pediatric patients, and none had a history of gender reassignment surgery or complex reconstruction, such as catheterizable channel. The training did not include biopsy or complex urethral dilation. At the conclusion of my training, I was deemed competent, and each collaborating physician wrote a letter confirming completion of our agreed-upon training program and a statement of perceived competency. I reached out to the Executive Director of the Medical Staff Office who told me that since I was performing this in outpatient clinics, credentialing was not necessary.