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Nurse Practitioners Abortions - Permission to Perform
Nurse Practitioners Performing Abortions, and scope of practice
In June of 2008, an important ruling by the Arizona state Senate gave the go ahead to licensed nurse practitioners to perform vacuum or suction aspiration abortions. A handful of nurse practitioners in Arizona have been performing abortions for a number of years, citing that nothing in the state law unequivocally states that only medical doctors can perform this procedure. According to the Arizona Daily Star, (June 27, 2008) the subject came to light when a nurse practitioner Mary Andrews had a complaint filed against her with the Arizona State Board of Nursing for performing aspiration abortions at the Tucson Planned Parenthood clinic. A bill was introduced shortly thereafter that would make abortions performed by nurse practitioners illegal in the state of Arizona. The bill was defeated in the state Senate and shortly thereafter the Arizona Board of Nursing ruled, that a nurse with advanced training is able to perform this particular procedure up to and including the 13th week of pregnancy.
Referenced in the National Abortion Federation’s web site (http://www.prochoice.org/cfc/legal_practice.html), there are currently seven states that do not place abortion procedures specifically within the realm of licensed medical physicians: Arizona, Kansas, Kentucky, New Hampshire,
Oregon and Vermont. An important landmark act for nurse practitioners in California occurred in 2003, when the state passed the Reproductive Privacy Act (SB 1301, Kuehl, Chapter 385, 2003), which now allows certified nurse practitioners and nurse midwives to perform medical abortions.
The case could be made to train and educate advanced practice nurses to perform abortions, solely based on the fact that abortion-providing physicians have become a scarcity in the United States. Issues such as anti-abortion protests and violence and vandalism, combined with unfavorable professional and financial benefits have led to a decreasing number of licensed physicians willing to take on the task of providing abortion procedures.
According to Hollander (2006), only half of the respondents to a 2004 survey of Obstetrics and Gynecological medical residency programs were routinely training physicians to perform abortions. Although this represents a significant increase from an earlier survey completed in 1998, the lack of trained professionals combined with an increasing reluctance to provide abortion services is leaving many women with few options for pregnancy termination.
In 2008, Jones, Zolna, Henshaw and Finer, presented the results of a survey on access to abortion services in the United States. They found that there were no abortion providers in 87 percent of counties surveyed. The report also shows that approximately 1 in 5 pregnancies end in abortion.
Most women in search of abortion services will have to travel over 100 miles to have access to services. A lack of providers along with a 20% abortion rate and limited access is a situation that the mid-level practitioner could easily fulfill.
Abortion procedure training and education along with state nursing boards that would be willing to place this procedure within the scope of practice for advanced practice nurses would allow women more options and better access when seeking to terminate a pregnancy.
A question to be considered in determining the feasibility of nurse practitioners performing surgical abortions would be the willingness to perform this procedure by the nurse. A study published by Hwang, Koyama, Taylor, Henderson and Miller (2005), put that question to 1,176 advanced licensed practitioners in 2003. Over 41.85 percent of midwives and 23.6 percent of nurse practitioners when asked if they wanted abortion training responded yes.
Advanced practice nurses are uniquely qualified to deliver total care to the client wishing to terminate a pregnancy. They are involved in most aspects of care prior to the procedure, such as reproductive and termination counseling and education, performing histories and physicals. They are also very involved in follow up care providing medical care, prescribing and ongoing psychological care when necessary.
There are many established precedents to show that nurse practitioners are competent and safe to perform this procedure. According to Taylor, Hwang and Stewart, physicians assistants have been performing surgical abortions in the state of Vermont for well over thirty years. Rates of complications encountered from these mid level practitioners run concurrent with the rates of complications for physician-performed abortions. Nurse practitioners and other advanced level providers have shown that with adequate training they are capable of performing basic surgical procedures that fall within the scope of the nurse practice acts of most states.
The right of a woman to choose to terminate a pregnancy is diminished, when access to providers who are able to provide abortion services is diminished. With the obvious need for abortion services combined with the decrease in physicians willing or able to provide this service, and the willingness of nurse practitioners to train for abortion procedures, a natural conclusion would be to train and educate advanced practice nurses to perform these procedures. Appropriate training would include didactic instruction that encompasses matters related to social and historical framework of abortion, surgical techniques, management of abortion patients in the pre-operative and post-operative period and information on counseling related to reproductive choices. Nurse practitioners have the ability to provide all pre and post procedure care and with the adequate training would be quite capable of performing this surgical procedure.
References
You can get expert help with your essays right now. Find out more...Hollander D. (2006). U.S. Abortion Training.Perspectives on Sexual and Reproductive Health,38(4), 181. Retrieved July 27, 2008, from Pro Quest Nursing & Allied Health Source database. (Document ID: 1321730681).
Hwang A.C., Koyama A., Taylor, D., Henderson J.T.& Miller S. (2005). Advanced Practice Clinicians' Interest in Providing Medical Abortion: Results of a California Survey.Perspectives on Sexual and Reproductive Health,37(2), 92-7. Retrieved July 27, 2008, from Pro Quest Nursing & Allied Health Source database. (Document ID: 857214031).
Jones R. K., Zolna, M. R. S., Henshaw, S. K., Finer, L. B. (2008). Abortion in the United States: Incidence and Access to Services, 2005. Perspectives on Sexual and Reproductive Health, 40(1), 6-16. Retrieved July 27, 2008, from Pro Quest Nursing & Allied Health Source database. (Document ID: 1460772671).
(June 27, 2008). Tucson nurse practitioner prevails in abortion vote. Arizona Daily Star,The (Tucson, AZ) B1. Retrieved July 27, 2008 from NewsBank on-line database (America's Newspapers) on the World Wide Web:<http://infoweb.newsbank.com>.
Legal Practice Issues (n.d.). In National Abortion Federation. Retrieved July 26, 2008,from http://www.prochoice.org/cfc/legal_practice.html
Taylor D., Hwang A.C. & Stewart F.H. (2004, October). Care for Women Choosing Medication Abortion.Nurse Practitioner, 29(10), 65-70. Retrieved July 27, 2008, from Pro Quest Nursing & Allied Health Source database.(Document ID: 734528431).
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