The appropriately prepared registered nurse who is experienced and competent in gastroenterological nursing may manipulate the endoscope as directed to facilitate an endoscopic procedure provided:

1. There is direct supervision by the physician or advanced practice registered nurse (that is, the physician or advanced practice registered nurse is physically present);
2. The registered nurse has knowledge of the techniques of endoscopic manipulation, understands the complications associated with endoscopy, is competent to identify the associated symptoms and will initiate appropriate interventions as directed by the physician or advanced practice registered nurse;
3. The nurse has full view of the lumen (via teaching adapter or video screen) throughout the entire manipulation process;
4. Another registered nurse is responsible for monitoring the patient if the patient is sedated (that is, the same registered nurse may not accept responsibility for manipulation of the endoscope and monitoring a sedated patient); and
5. The facility has policies and procedures that address all aspects of the procedure.