With each of my patients, I am able to help a woman better understand her anatomy and her condition/diagnosis, empowering her to be more comfortable in her skin.
Dr. Nalo Hamilton, UCLA
Women’s health nurse practitioners (WHNPs) play an invaluable role in offering holistic, comprehensive, and culturally competent health services across the U.S. One of the most contentious issues in advanced practice nursing is whether or not a practitioner should be authorized to work to the full extent of his or her education and training. To many WHNPs, the misunderstanding of the NP role and subsequent limits placed on their level of practice authority can be frustrating.
The Nurse Practitioners in Women’s Health (NPWH 2017)—an organization which has provided education and advocacy for almost 40 years—summarizes the multivariate responsibilities of WHNPs, which include evaluating patients; diagnosing health conditions; creating individualized treatment plans; prescribing medications; ordering and interpreting diagnostic tests; promoting good health; and educating patients and families, among many other duties. Of course, not all WHNPs are able to carry these out in accordance with their level of knowledge and skill. In fact, NP practice authority varies widely by region; NPs in the three most populous states—California, Texas, and Florida—operate under “restricted practice” conditions which limits their ability to prescribe medications and provide some treatments, services they’re fully qualified to deliver. This assault on their professional autonomy occurs despite mounting evidence that NPs offer high-quality and resource-efficient healthcare with comparable (or better) outcomes than their physician counterparts.
By illustration, a 2015 study from Columbia University found that NPs in primary care settings performed just as well as doctors in terms of patient health outcomes and satisfaction, but they actually spent more time with patients with no increase in cost. Patients under NP care also required fewer total primary care visits. This study and dozens of others demonstrate why so many organizations support extending full practice authority NPs nationwide. In addition to virtually all nursing professional associations, the growing list of groups and policy-makers in favor of FPA includes:
Given the projected shortage of between 14,900 and 35,600 primary care providers by 2025 across the U.S., nurse practitioners—89 percent of whom are trained in primary care—are well-positioned to help meet the healthcare needs in the country, particularly in rural areas.
In interviews with three prominent professors, this article celebrates the contributions of WHNPs and aims to advance the fight for FPA nationwide, which would finally allow these advanced practitioners to offer healthcare services in accordance with their level of training regardless their state of residence.
I've been a women's health nurse practitioner for over 30 years and have seen how NPs have positively impacted our ability to increase access to care for those who are most vulnerable—especially young women and adolescent girls.
Dr. Morrison-Beedy, the University of South Florida
Women’s health NPs and practitioners across all specializations generally agree that they should be able to carry out their responsibilities independently. They note that overly restrictive practice environments can lead to decreased access to services, especially in rural areas or among vulnerable populations; less consumer choice; higher healthcare costs; problems with insurance claims; and an overall decrease in efficiency. NursePractitionerSchools (NPS) has interviewed 19 NP professors in 2017; 18 of them have been in favor of granting FPA.
As mentioned above, many organizations and policy-makers agree. In a literature review from the National Governors Association, researchers pointed out the skyrocketing demand for primary healthcare services in the U.S.—particularly in historically underserved areas—and suggested that states should reexamine their NP scope of practice laws in order to increase the pool of qualified healthcare providers. Of course, there is one segment of the American population which consistently denies NPs’ ability to function autonomously: physicians’ groups. While their powerful lobbies and advocacy efforts suggest that NPs aren’t able to provide safe, quality healthcare without significant oversight, the evidence and the growing body of pro-FPA organizations seem to suggest otherwise.
There’s still much work to be done, particularly in states such as California and Florida which have large populations and a rapidly increasing demand for healthcare services. Ultimately, it’s in the best interest of patients for NPs and doctors to come to an agreement. In a recent NPS interview, Dr. Denise Hershey of Michigan State University stated memorably: “The biggest challenge in this fight is getting the physician groups to understand that we are not in competition with them; as NPs, we are members of a healthcare team, which includes our physician colleagues and other healthcare professionals the patient may need. As a team, we need to work collaboratively in order to improve the health of our patients.” Time will tell whether WHNPs nationwide will be granted the professional autonomy for which they’ve been fighting. In the meantime, healthcare workers, policy makers, and others must come up with novel solutions to address the looming shortage of healthcare providers for women. With current proposals to eliminate funding for Planned Parenthood, slash ACA’s maternity and newborn benefits, and undermine Title X protections, empowering women’s healthcare providers is more important than ever.