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Providing Abortion Care a Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants

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Providing Abortion Care a Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants Providing Abortion Care A ProfessionAl ToolkiT for nurse-Midwives, nurse PrAcTiTioners, And PhysiciAn AssistanTs Authors Diana Taylor, RNP, PhD, University of California, San Francisco, Advancing New Standards in Reproductive Health Barbara Safriet, JD, LLM, University of California, San Francisco, Advancing New Standards in Reproductive Health Grayson Dempsey, Abortion Access Project Beth Kruse, MS, ARNP, CNM, National Abortion Federation Courtney Jackson, PhD, Abortion Access Project Organizational Sponsors Abortion Access Project, Cambridge, MA Advancing New Standards in Reproductive Health (ANSIRH) Program, University of California, San Francisco, CA National Abortion Federation, Washington, DC © Copyright 2009, regents of the University of California on behalf of the University of California, san franCisCo APC Toolkit Acknowledgments ................................................................. iii of Abortion Care by APCs .................................................. 18 About the Authors .............................................................. iii C. Barriers to Abortion Provision by APCs ..............................19 Welcome to the APC Toolkit! ...................................................1 Figure ii.3 State Advocacy Efforts to Overcome Barriers ...19 What is the APC Toolkit? ......................................................... 2 Figure ii.4 Critical Role of Professional Organizations ..... 20 Why is the APC Toolkit Needed? ............................................. 2 Summary .............................................................................. 20 Who Can Use the APC Toolkit? ................................................ 3 Section II References .............................................................21 How is the APC Toolkit Meant to Be Used? ............................. 4 Module two: advanCing sCoPe oF PraCtiCe Beyond the APC Toolkit ........................................................... 4 to inClude abortion Care References: Welcome to the APC Toolkit ................................. 5 section iii. aPC Practice regulation: roles of legislatures, licensing boards, and Professional organizations 24 Module one: understanding abortion Care a. State Abortion Laws and APCs .......................................... 24 section i. abortion in Context 6 Figure iii.1 State laws & regulations governing a. An Overview of the Abortion Care Specialty........................ 6 NP, CNM and PA practice: Where to find information ........ 25 Figure i.1 Sexual and Reproductive Health: b. Credentialing Framework for APCs.................................... 26 Comparison Among Sweden, France, Canada, C. General Legal and Regulatory Requirements ................... 26 Great Britain, and the United States ................................... 7 d. Understanding Scope of Practice ..................................... 27 Figure i.2 Number of Abortions per Defining Scope of Practice under an 1,000 Women Aged 15–44 in 2003 ...................................... 7 Authority-Based Scheme ..............................................28 Figure i.3 “Aspiration” versus “Surgical”: Defining Scope of Practice under an What’s in a Name? ..............................................................8 Evidence-Based Scheme .............................................29 b. Basic Types of Abortion Procedures ...................................8 Assessing Changes in Scope of Practice ......................30 Medication Abortion ......................................................9 e. Who Determines Scope of Practice? .................................. 30 Figure i.4 Abortion Method Terminology ........................... 9 The Common Legal Framework: Medication Abortion Regimens ......................................9 State Practice Acts and Licensing Boards ....................30 Early Aspiration Abortion in the U.S. ........................... 10 The Role of the Professions in Defining Figure i.5 from NAF (2008a): Comparison of Scope of Practice .........................................................32 FDA-Approved and Other Evidence-Based Regimens .........11 F. How Individual APCs Can Participate in Efficacy and Safety of Early Abortion ............................11 Scope of practice Determinations .................................... 33 Figure i.6 First Trimester Abortion: A Comparison What Professional Organizations Do for of Procedures ....................................................................11 Individual NPs, CNMs, and PAs ....................................33 C. Who Can Provide Abortion Care?........................................12 Getting Involved with Your Professional Organization 34 Specialist Providers of Abortion Care ........................... 12 Working with State-Based Professional Associations: Primary Care Providers of Abortion Care ...................... 12 Benefits and Challenges ..............................................34 Summary ...............................................................................13 Figure iii.2 The Importance of Membership Section I References ..............................................................13 in Professional Organizations .......................................... 36 g. Getting to Know Your Professional Community ................ 37 section ii. advanced Practice Clinicians as abortion Providers 16 Summary .............................................................................38 a. APCs within the Health Care System ..................................16 Section III References ........................................................... 39 Figure ii.1 NPs, CNMs, and PAs: Training and Clinical Roles .................................................17 section iv. advancing abortion into aPC scope b. APCs’ History of Providing Comprehensive of Practice: evidence and Methods 40 Women’s Health Care, Including Abortion ..........................17 a. Professional-Organization Position Statements Figure ii.2 Studies Documenting Safety on Abortion Care by APCs ..................................................41 © Copyright 2009, regents of the University of California ii on behalf of the University of California, san franCisCo APC Toolkit All APC professional organizations can be Scope of Practice: Politics Meddling considered pro-choice organizations. ..........................42 in Professional Norms in Arizona .................................65 APC professional organizations support CNMs, Alaska Board of Nursing Affirms One NP’s NPs, and PAs as abortion providers. ...........................42 Scope of Practice to Include Uterine Aspiration ...........66 Public health, physician, and specialty organizations Summary ..............................................................................68 support CNMs, NPs, and PAs as abortion providers. ....43 Section IV References ...........................................................69 b. Essential Elements of Professional Practice That section v. becoming Clinically Competent and Establish APCs as Qualified Providers of Abortion Care .... 43 documenting Competency in abortion Care 73 Practice Philosophies by Organization .........................44 a. Specialty Education and Training in Abortion Care: Practice and Professional Performance Standards Opportunities and Resources ........................................... 73 by Organization ............................................................44 Postgraduate Education and Training for APCs Practice Competencies by Organization .......................45 in Abortion Care and Provision ....................................74 Codes of Ethics by Organization ...................................46 Additional Training and Curricular Resources ...............76 C. Evidence of Education and Training in Abortion Care ........48 The California Health Workforce Pilot Project ..............77 Abortion Care Education and Clinical Training Figure v.1 A Question for NP, CNM, and in APC Education Programs ..........................................48 PA Educators: What Is Your Role in Advancing d.Evidence of Legislative, Legal & Regulatory Abortion Care for APCs? .................................................... 78 Environments: Provider Restrictions and Legal b. The Professional Portfolio: Proactive Documentation Strategies for Establishing Abortion as within of Professional Credentials ............................................... 78 APC Scope of Practice ...................................................... 50 Figure v.2 Professional Portfolio Template— State Legislative Changes ........................................... 51 Focus: Peri-Abortion Care ................................................ 79 State Judicial Rulings .................................................. 51 C. Case Study: Developing a Portfolio in Response State Administrative Regulations ................................52 to a Challenge ...................................................................80 State Attorney General Decisions .................................52 Summary .............................................................................. 81 Figure iv.1 Proactive Regulatory Strategy: Section V References ............................................................82 Washington State Attorney General Issues Opinion Affirming Authority of ARNPs to Prescribe appendix 84 Medication Abortion ........................................................ 54 table a.1 APC Professional Organizations—Who They Are State Administrative Body
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