A smear taker is a registered health professional such as a medical practitioner, registered nurse, enrolled nurse or registered midwife.  The smear taker has successfully completed a course of training as a smear taker and has demonstrated competency against the national standards.

All smear takers are required to complete cervical screening training through one of the training programmes listed below:

• training as part of a medical degree
• NZQA midwifery training programmes
• NZQA accredited courses for non-medical smear takers.

Smear takers play a key role in the NCSP and are responsible for:

• identification of women for whom screening is recommended and the maintenance of appropriate call and recall systems
• educating women about the benefits of screening, the NCSP and the NCSP-Register, while at the same time ensuring the limitations of screening are understood
• educating women about the importance of regular smears
• explaining to women, that regardless of a normal smear result, any signs or symptoms suggestive of cervical cancer need to be reported to her general practitioner immediately
• providing a smear-taking service
• ensuring women are referred for specialist assessment and investigation when required and coordinating their ongoing care when investigations are complete
• sending a copy of smear results to the woman's GP, if the smear taker is not her regular GP, provided the woman has consented to this.

Responsibilities of smear takers

Smear takers have responsibilities through the NCSP Operational Policy and Quality Standards (NCSP OP&QS).  Under Chapter 4 of the NCSP OP&QS, there are general requirements that smear takers should become familiar with and incorporate in their practice.  The Standards and Polices are requirements for providers who have a contact with the National Screening Unit but are also guidelines for other organisations, such as Primary Health Organisations.

The relevant policies in Chapter 4 of the NCSP OPQS in summary are:

• smear takers are responsible for ensuring results are received for each smear taken; that women are recalled as appropriate for regular smears; and that women with abnormal smears are appropriately followed up
• that resources advising women about the National Cervical Screening Programme should be available for women having a smear and that there are educational resources available.

Informed consent

Informed consent is an important part of the relationship between the smear taker and the woman and it is important that full information about the procedure is provided.  Sufficient information includes discussing the following:

• the preventative function of having a smear and that it is a way of detecting pre-cancerous changes to cervical cells
• the difference between a screening test and a diagnostic test - explaining that the smear test is a screening test only and as such has inherent limitations
• the procedure, equipment and the anatomy involved in the detail required
• agree how all results will be provided
• where to access information about the NCSP.

In addition under Section 112L of the Health Act 1956, Part 4A there are specific duties for persons taking specimens for screening tests.

112L Duties of persons taking specimens for screening tests

1. Every person who takes a specimen from a woman for the purpose of a screening test, and who believes that it is that woman's first screening test in New Zealand, must-
   1. explain the procedure and provide information about the importance of having regular screening tests, the objectives of the NCSP, the risks and benefits of participation in the NCSP, who has access to information on the NCSP-Register, and the uses to which that information may be put; and
   2. advise the woman that she will be enrolled in the NCSP, but that she may prevent or cancel that enrolment by advising the NCSP manager under section 112G.
2. Every person who takes a specimen from a woman for the purpose of a screening test, and who believes that it is not that woman's first screening test in New Zealand, must provide that woman with information about the procedure and about the NCSP to the extent that is reasonable in the circumstances.
3. Subsections (1) and (2) do not limit any other obligation to provide information that arises under any other enactment or rule of law. 

The relevant standards in Chapter 4 in summary are:

The NCSP Operational Policy and Quality Standards require under Chapter 4 of the NCSP OP&QS the following:
Standard 401:  All smear takers will complete a recognised educational course in smear-taking practice prior to providing a smear-taking service for women.

Standard 402:  Smear takers will invite or recall women and provide a smear-taking service in accordance with the Screening Recommendations 1997.

Standard 405:  The smear taker’s practice will have appropriate infection control procedures and facilities.

Standard 406:  Smear takers including specialists will ensure women have been provided with the required information prior to taking a smear or a histology sample.

Standard 407:  Smear takers will provide the woman’s family name or surname and initials of first or given names, and date of birth or NHI on all cytology slides.

Standard 408:  Prior to sending the form and the specimen to the laboratory, smear takers must ensure that:

• the minimum information (outlined in Chapter 4 of the NCSP OP&QS) is supplied on a generic laboratory referral form, or
• all details on the NCSP Laboratory Referral form are completed.

Standard 410:  Smear takers will have processes in place to ensure that results are obtained from the laboratory within 14 working day of sending the cervical cytology to the laboratory.

Standard 411:  Smear takers will recall women in accordance with laboratory recommendations on smear results and clinical indications.

Standard 412:  Smear takers will have processes in place, which ensure all women with an abnormal smear result are appropriately followed up.

Professional development

The NCSP expects smear takers to have an up-to-date knowledge of smear-taking techniques, screening issues and the NCSP, including its benefits and limitations.

Smear takers are expected to maintain their competency by:

• taking smears on a regular basis
• reading current information from the NCSP and relevant journal articles
• attending regular clinical updates run by relevant professional bodies and NCSP regional sites
• attending regular continuing education updates on cervical screening or related topics.

Smear takers who persistently have high rates of unsatisfactory smears should seek further training in smear-taking techniques.  The accepted adequacy rates of smears is 80 percent or higher.

NCSP Competencies for Smear Taker Training

These competencies for smear taker training provide detail of the skills, knowledge and attributes expected of a cervical smear taker as well as the requirements for training entry, assessment and maintaining competence.  

The competencies have been developed by the NCSP in consultation with stakeholders to ensure nationally consistent teaching and assessment standards. Providers of training programmes are required to be registered and accredited by NZQA to deliver Unit Standard 1098: Perform cervical screening and cervical smear taking.

A copy of the NCSP Competencies for smear taker training are available for download.

This document replaces the NCSP Training Standards for Smear Takers 2002.

Smear-taker training grants

Smear-taker training courses have been designed for registered nurses and enrolled nurses who are employed within the health sector where smear taking for the NCSP is part of the service delivery, and supervised by a nominated clinical supervisor.  Enrolled nurses must only undertake nursing practice under the direction and supervision of a registered nurse or medical practitioner as required by the Nurses Act 1997.

Grants are available to nurses who meet the above criteria and:

• have their employer's support
• provide the required information
• successfully complete the course within one year from commencement.

A copy of the smear taker training grant application form is available for download. This form also contains elegibility criteria for the grant.

HPV Testing

HPV testing as per the Guidelines for Cervical Screening officially commences 1 October 2009.

HPV testing - smear taker responsibilities
This fact sheet explains and clarifies changes to smear takers’ responsibilities with the introduction of HPV testing.

HPV and HPV testing
This fact sheet for women will also be useful guide for smear takers advising women about HPV testing.

Liquid Based Cytology (LBC)

Questions and answers on LBC for smear takers and women (September 2009) are available for download. Questions and Answers on LBC.