APPENDIX

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APPENDIX A.1

APC Professional Organizations—Who They Are and Their Roles in Credentialing and Defining Scope of Practice


The history of professional organizations for advanced practice nursing (NPs and CNMs)31 began with the founding of the American Nurses Association (ANA) and the National League for Nursing Education in 1911 and 1912, respectively. These organizations established the first scope and standards for nursing practice and education.

Although the first NP scope of practice and standards documents were established within the ANA in the early 1980s, multiple organizations have emerged to represent and credential NPs, all with varying philosophies and requirements. In addition, specialty organizations such as the Association of Women’s Health, Obstetrics and Neonatal Nurses (AWHONN) and the National Association of NPs in Women’s Health (NPWH) were formed to establish standards and credentialing for nurses and NPs in women’s health practice. (More on these organizations below.)

Historically, nurse-midwives have been well-organized since the 1920s. The American College of Nurse-Midwives (ACNM), incorporated in 1955, represents both certified nursemidwives (CNMs) and certified midwives (CMs) nationally and through state chapters (ACNM, 2009b). The ACNM provides the singular voice for professional credentialing of nurse-midwives and has developed a number of foundational documents that address the scope, standards, and competencies of CNM practice. All nurse-midwifery education programs are accredited by the independent Accreditation Commission for Midwifery Education (ACME), and all CNMs are required to be certified to practice as midwifes (ACNM, 2006a, 2006b). The independent American Midwifery Certification Board (AMCB) is charged with ensuring that individual nurse-midwives are competent to enter practice as CNMs through the national certification examination.

Unlike for CNMs and PAs, no single professional organization provides sole leadership in professional credentialing and regulation of NPs. Currently, both the ANA and the American Academy of Nurse Practitioners (AANP) represent the national and state interests of practicing NPs in the professional regulation and credentialing arenas. The ANA’s unified definition, scope, and standards of nursing practice and ethics (including advanced practice nursing) linked with a broad social policy and core values provide the foundation of NP credentialing. The AANP’s contribution to professional credentialing includes an NP-focused role definition along with both scope and standards of NP practice (AANP, 2002, 2007a, 2007b). The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) and Nurse Practitioners in Women’s Health (NPWH) provide standards and competencies related to the NP role, the population focus (women’s health), as well as the specialty practice of NPs in primary care and reproductive health (AWHONN, 1998; AWHONN & NPWH, 2002). AWHONN addresses practice, research, and education issues in women’s health, obstetric, and neonatal nursing specialty practice. The National Organization of NP Faculties (NONPF) represents NP educators and is responsible for establishing entry-into-practice competencies and program reviews (NONPF & AACN, 2002).

All NP programs are required to be accredited. The National League for Nursing Accreditation Commission (NLNAC) and the Commission on Collegiate Nursing Education (CCNE) accredit the majority of NP education programs at the graduate level (CCNE, 2008). The U.S. Department of Education also recognizes the NPWH Council on Accreditation as a national accrediting agency for women’s health NP education programs. The foundation for the NP certification programs of the American Nurses Credentialing Center (ANCC), the AANP, and the National Certification Corporation (NCC) for NPs in Women’s Health is the Nurse Practitioner Primary Care Competencies in Specialty Areas: Adult, Family, Gerontological, Pediatric, and Women’s Health (NONPF & AACN, 2002).

The American Academy of Physician Assistants (AAPA), founded in 1968, is the only national organization representing PAs in all medical specialties. The Academy assures the competency of PAs through active involvement in the accreditation of PA programs, provides continuing education, and explicates scope and standards of PA practice. In all states PA licensure requires that individuals graduate from a PA program accredited by the independent Accreditation Review Commission for Education of the PA (ARC-PA) and successfully complete a certification process through the National Commission on the Certification of Physician Assistants, which certifies that individual PAs meet knowledge and skill standards (AAPA, 2008a, 2008b). In addition, the Physician Assistant Education Association (PAEA), the membership association for PA educators and program directors, develops education standards and competency criteria.

The mission of the American Academy of Physician Assistants (AAPA) is to promote quality, cost-effective, accessible health care and to promote the professional and personal development of PAs (AAPA, 2009). The AAPA has a federated structure of 57 chartered chapters representing PAs in all 50 states, the District of Columbia, Guam, and the federal services. These chapters, through committees such as government relations, political action, and professional practice, advocate for their PA members by engaging in legislative and regulatory activities that promote the profession as well as ensure patient safety.

APPENDIX A.1 REFERENCES

Accreditation Review Commission for Education of the PA (ARC-PA) (2006). Accreditation standards for PA education. Available at http://arc-pa.org/Standards/3rdeditionwithPDchangesandregionals4.24 .09a.pdf

American Academy of Nurse Practitioners. (2002). Nurse practitioners as an advanced practice nurse role [Position statement]. Austin, TX: Author.

American Academy of Nurse Practitioners. (2007a). Scope of practice for nurse practitioners. Austin, TX: Washington, DC: Author.

American Academy of Nurse Practitioners. (2007b). Standards of practice for nurse practitioners. Austin, TX: Author.

American Academy of Nurse Practitioners. (2009). AANP information. Retrieved February 16, 2009, from http://www.aanp.org/AANPCMS2/AboutAANP/AANP+Information/

American Academy of Physician Assistants. (2008a, October 1). Facts at a glance. Retrieved February 23, 2009, from http://www.aapa.org/glance.html

American Academy of Physician Assistants. (2008b). Physician assistant education: Preparation for excellence. Alexandria, VA: Author.

American Academy of Physician Assistants. (2009). Mission statement. Retrieved February 16, 2009, from http://www.aapa.org/mission.html

American College of Nurse-Midwives. (2006a). Midwifery education [Position statement]. Silver Spring, MD: Author.

American College of Nurse-Midwives. (2006b). Principles for credentialing and privileging certified nurse-midwives (CNMs) and certified midwives (CMs). Silver Spring, MD: Author.

American College of Nurse-Midwives. (2009a). About ACNM: Information about ACNM regions. Retrieved February 16, 2009, from http://www.midwife.org/regions.cfm

American College of Nurse-Midwives. (2009b). About us. Retrieved February 16, 2009, from http://www. midwife.org/about.cfm

American Nurses Association. (2009). About ANA. Retrieved February 16, 2009, from http://www. nursingworld.org/FunctionalMenuCategories/AboutANA.aspx

Association of Women’s Health, Obstetric and Neonatal Nursing. (1998). Standards and guidelines for professional nursing practice in the care of women and newborns (5th ed.). Washington, DC: Author.

Association of Women’s Health, Obstetric and Neonatal Nurses, & Nurse Practitioners in Women’s Health. (2002). The women’s health nurse practitioner: Guidelines for practice and education (5th ed.). Washington, DC: Authors.

Commission on Collegiate Nursing Education. (2008). Standards for accreditation of baccalaureate and graduate degree nursing programs: Commission on Collegiate Nursing Education. Washington, DC: Author; Available at http://www.aacn.nche.edu/Accreditation/pdf/standards.pdf

National Commission on the Certification of Physician Assistants (2009). Physician assistant national certifying exam (PANCE). Available at http://www.nccpa.net/EX_pance.aspx

National Organization of Nurse Practitioner Faculties, & American Association of Colleges of Nursing. (2002). Nurse practitioner primary care competencies in specialty areas: Adult, family, gerontological, pediatric, and women’s health. (Prepared for Department of Health and Human Services Health Resources and Services Administration, No. HRSA 00-0532(P)). Rockville, MD.

United Nations, Division for the Advancement of Women (1995). Fourth world conference on women: Beijing Declaration. Accessed June 2007, http://www.un.org/womenwatch/daw/beijing/ beijingdeclaration.html

University of Illinois-Chicago Nurse Midwifery and Women’s Health Nurse Practitioner Program (2003). Statement on reproductive rights. Chicago, IL: Author.

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TABLE A.2

Credentialing Mechanisms and Professional Organizations

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TABLE A.3

National APC Professional and Specialty Organization Websites

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TABLE A.4

Organizational Acronyms Used in the APC Toolkit

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APPENDIX A.5

Glossary

Advanced Practice Clinicians: The umbrella term advanced practice clinician (APC) is used to refer to the collected roles of nurse practitioner (NP), certified nurse-midwife (CNM), and physician assistant (PA) in this document. In the United States, CNMs, NPs and PAs have been categorically referred to as “midlevel provider” or “nonphysician provider,” which does not adequately reflect their contribution as independent and qualified primary care professionals. However, the ideal taxonomy has yet to be identified. The term, advanced practice clinician or APC is not accepted by the American Academy of PAs who have a published position on appropriate titles for PAs: “The AAPA believes that, whenever possible, PAs should be referred to as “physician assistants” and not combined with other providers in inclusive non-specific terms such as “midlevel practitioner”, “advanced practice clinician”, or “advanced practice provider” (AAPA, 2008).

Collective Bargaining: Collective bargaining is negotiation between organized workers and their employer or employers to determine wages, hours, rules, and working conditions.

Competence: Competence requires the ethical adaptation and integration of knowledge and skills into the behaviors needed in a particular context.

Credentials: Titles or degrees held by an individual, indicating the level of education, certification, or licensure.

Credentialing: Refers to regulatory mechanisms that are applied to individual professionals, educational programs, or organizations. Forms of credentialing include state licensure, national certification of practice expertise, and accreditation of generic and advanced practice education programs.

Peri-abortion Care: Peri-abortion care encompasses pregnancy options counseling through the abortion procedure (medication, aspiration) to postabortion follow-up and care.

Practice Essentials: Practice essentials are documents developed by health professional organizations (such as practice philosophy, standards, core competencies, and ethical guidelines) that are essential for competent clinical and professional practice. These “practice essentials” provide the basis for education, legal regulation, professional certification, and practice credentialing.

Scope of Practice: Scope of practice statements define what health professionals can do for/with patients, what they can delegate, and when collaboration with others is required. APC scope of practice is defined by professional organizations and codified and monitored by state regulatory agencies. Although CNMs and NPs have markedly different scopes of practice, both have their roots in nursing. And physician assistant (PA) practice which grew out of a medical model of care, shares an overlapping scope of practice with advanced practice nurses who are providing women’s primary care.

Standards of Practice: Standards of practice define safe practice, describe a competent level of care, address practice qualifications, document basic and advancing practice, and provide the yardstick for measuring practice. They reflect the values and priorities of the profession.

Standards of Professional Performance: Standards of professional performance describe a competent level of behavior in the professional role—including activities related to quality of practice, education, ethics, professional practice evaluation, collaboration, resource utilization, and leadership.

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APPENDIX A.6

Supplemental References

SECTION III SUPPLEMENTAL READINGS

Accreditation Review Commission on Education for the Physician Assistant. (2007). Accreditation standards for physician assistant education (Vol. 3). Retrieved February 8, 2009, from http://www..arcpa.org/Standards/3rdeditionwithPDchangesand regionals4.24.08a.pdf

American Academy of Nurse Practitioners (2002). Nurse practitioners as an advanced practice nurse role position statement. Retrieved February 8, 2009, from http://66.219.50.180/NR/rdonlyres/p46hom5sfqrpxhwtqcrnjmiiw54cywbruf3oe44wm3ko kmnpf5mrwithetrhcti/Position%2BStatement%2B NP%2BRole2.pdf

American Academy of Nurse Practitioners (2007a). Scope of practice for nurse practitioners. Washington, DC: Author.

American Academy of Nurse Practitioners (2007b). Standards of practice for nurse practitioners. Retrieved February 8, 2009, from http://aanp.org/NR/rdonlyres/FE00E81B-FA96-4779-972B- 6162F04C309F/0/Standards_of_Practice112907.pdf

American Academy of Physician Assistants (2005). Competencies for the physician assistant profession. Retrieved January 27, 2009, from http://www.aapa.org/manual/39-CompetenForProf.pdf

American Academy of Physician Assistants (2007). 2007 AAPA physician assistant census report for ob/gyn. Retrieved January 27, 2009, from http://www.aapa.org/research/SpecialtyReports07/ Ob_Gyn07C.pdf

American Academy of Physician Assistants (2008a). Guidelines for ethical conduct for the physician assistant profession. Retrieved January 27, 2009, from http://www.aapa.org/manual/22- EthicalConduct.pdf

American Academy of Physician Assistants (2008b). Issue brief: Physician assistant scope of practice. Alexandria, VA: Author.

American Academy of Physician Assistants (2008c). PA definition, HP-3100.2.0. In 2008-2009 AAPA policy manual. Alexandria, VA: Author.

American College of Nurse-Midwives (2008). Core competencies for basic midwifery practice. Silver Spring, MD: Author.

American Nurses Association (1985). The scope of practice of the primary health care nurse practitioner. ANA Publications, (NP-61), i-iii, 1-11.

American Nurses Association (1987). Standards of practice for the primary health care nurse practitioner. ANA Publications, (NP-71), i-iv, 1-11.

APRN Consensus Work Group & National Council of State Boards of Nursing (2008). Consensus model for APRN regulation: Licensure, accreditation, certification & education (Report). Chicago: Author.

APRN Consensus Work Group & National Council of State Boards of Nursing APRN Advisory Committee (2008). APRN model act/rules and regulations. Chicago: Author.

Ballweg, R. (1994). History of the profession. In R. Ballweg, S. Stolberg & E. Sullivan (Eds.), Physician assistant: A guide to clinical practice (Vol. 1, pp. 1-20). Philadelphia: Saunders.

Hanson, C., Hamric, A., & Spross, J. (2000). Understanding the regulatory and credentialing requirements for advanced practice nursing. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Eds.), Advanced nursing practice: An integrative approach (2nd ed., pp. 679-700). Philadelphia: W.B. Saunders.

Keeling, A., & Bigbee, J. (2005). The history of advanced practice nursing in the United States. In A. B. Hamric, J. A. Spross, & C. M. Hanson (Eds.), Advanced nursing practice: An integrative approach (3rd ed., pp. 3-45). St. Louis, MO: Elsevier Saunders.

Klein, T. A. (2005). Scope of practice and the nurse practitioner: Regulation, competency, expansion, and evolution. Advanced Practice Nursing e-Journal, 5(2). Retrieved May 8, 2006 from http://cme.medscape.com/viewarticle/506277

National Task Force on Quality Nurse Practitioner Education (2002). Criteria for evaluation of nurse practitioner programs. Washington, DC: Author.

O’Neil, E. H., & The Pew Health Professions Comission. (1998). Recreating health professional practice for a new century (Report No. 4). San Francisco: Pew Health Professions Commission.

Physician Assistant Education Association (1996). Eleventh annual report on physician assistant educational programs in the United States, 1994-95. Alexandria, VA: Author.

Physician Assistant Education Association. (2008). Twenty-third annual report on physician assistant educational programs in the United States, 2006-2007. Alexandria, VA: Author.

Reed, A., & Roberts, J. E. (2000). State regulation of midwives: issues and options. Journal of Midwifery & Women’s Health, 45(2), 130-149.

Rooks, J. P. (1997). Midwifery and childbirth in America. Philadelphia: Temple University Press.

Styles, M. M. (1998). An international perspective: APN credentialing. Advanced Practice Nursing Quarterly, 4(3), 1-5.

Taylor, D. (2001, March). Advanced practice nursing regulation: Scope, standards, competencies. Paper presented at the meeting of the California Association of Nurse Practitioners, Sacramento, California.

Taylor, D., Marion, L., Hamric, A., Spross, J., & Hanson, C. (2000). Innovative practice models: Uniting advanced nursing practice and education (Chapter 21). In A. Hamric, J. Spross, & C. Hanson (Eds.), Advanced nursing practice: An integrative approach (2nd ed., pp. 795-831). Philadelphia: W.B. Saunders.

Taylor, D., & Safriet, B. (2007, April). Professional practice regulation: Legal, professional, personal. Paper presented at the meeting of the National Abortion Federation, Boston, MA.

U.S. Congress Office of Technology Assessment. (1986). Nurse practitioners, physician assistants, and certified nurse-midwives: A policy analysis (Health technology case study 37) (Report No. OTAHCS- 37). Washington, DC: U.S. Government Printing Office.

SECTION IV SUPPLEMENTAL READINGS

Allen, R. H., Westhoff, C., De Nonno, L., Fielding, S. L., & Schaff, E. A. (2001). Curettage after mifepristone-induced abortion: frequency, timing, and indications. Obstetrics & Gynecology, 98(1), 101-106.

American Academy of Family Physicians, American College of Obstetricians and Gynecologists, Council on Residency Education in Obstetrics and Gynecology, & Association of Professors in Obstetrics and Gynecology. (1992). Recommended Core Educational Guidelines for Family Practice Residents; Obstetrics and Gynecology. Leawood, KS.

American Association of Colleges of Nursing. (1999). Women’s health in the baccalaureate nursing school curriculum: Report of a survey and recommendations. Washington, DC: U.S. Department of Health and Human Services.

Barber, D. (1997). Research into the role of fertility nurses for the development of guidelines for clinical practice. Human Reproduction, 12(11 Suppl), 195-197.

Bartlett, L. A., Berg, C. J., Shulman, H. B., Zane, S. B., Green, C. A., Whitehead, S., et al. (2004). Risk factors for legal induced abortion-related mortality in the United States. Obstetrics & Gynecology, 103(4), 729-737.

Chang, J., Elam-Evans, L. D., Berg, C. J., Herndon, J., Flowers, L., Seed, K. A., et al. (2003). Pregnancyrelated mortality surveillance, United States, 1991-1999. MMWR Surveillance Summaries, 52(2), 1-8.

Donoghue, G. D. (2000). Women’s health: A catalyst for reform of medical education. Academic Medicine, 75(11), 1056-1060.

Earl, C. E., & Penney, P. J. (2003). Rural nursing students’ knowledge, attitudes, and beliefs about HIV/ AIDS: A research brief. Journal of the Association of Nurses in AIDS Care, 14(4), 70-73.

Elam-Evans, L. D., Strauss, L. T., Herndon, J., Parker, W. Y., Whitehead, S., & Berg, C. J. (2002). Abortion surveillance, United States, 1999. MMWR Surveillance Summaries, 51(9), 1-9, 11-28.

Freedman, M., Jillson, D., Coffin, R., & Novick, L. (1986). Comparison of complication rates in first trimester abortions performed by physician assistants and physicians. American Journal of Public Health, 76(5), 550-554.

Frost, J. J., & Frohwirth, L. (2005). Family planning annual report: 2004 summary part 1. New York: Guttmacher Institute.

Gagan, M. J. (2003). Interpersonal violence issues in the nursing classroom. Journal of Psychosocial Nursing and Mental Health Services, 41(3), 44-49.

Goldman, M., Occhiuto, J., Peterson, L., Zapka, J., & Palmer, R. (2004). Physician assistants as providers of surgically induced abortion services. American Journal of Public Health, 94(8), 1352-1357.

Grimes, D. A. (2005). Risks of mifepristone abortion in context. Contraception, 71(3), 161.

Grumbach, K., Hart, L., Mertz, E., Coffman, J., & Palazzo, L. (2003). Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Annals of Family Medicine, 1(2), 97-104.

Haskell, W., Easterling, T., & Lichtenberg, E. (1999). Surgical abortion after the first trimester. In M. Paul, E. Lichtenberg, L. Borgatta, D. Grimes, & P. Stubblefield (Eds.), A clinician’s guide to medical and surgical abortion (pp. 123-128). New York: Churchill Livingstone.

Hatcher, R., Trussell, J., Stewart, F. H., Nelson, A., Cates, W., Guest, F., et al. (2004). Contraceptive Technology (18th ed.). New York: Ardent Media.

Henshaw, S. K. (1998). Unintended pregnancy in the United States. Family Planning Perspectives, 30(1), 24-29, 46.

Henshaw, S. K. (1999). Unintended pregnancy and abortion: A public health perspective. In M. Paul, E. Lichtenberg, L. Borgatta, D. A. Grimes & P. Stubblefield (Eds.), A clinician’s guide to medical and surgical abortion (pp. 11-22). New York: Churchill Livingstone.

Henshaw, S. K., & Finer, L. B. (2003). The accessibility of abortion services in the United States, 2001. Perspectives on Sexual and Reproductive Health, 35(1), 16-24.

Institute of Medicine Committee on the Future of Primary Care, & Donaldson, M. S. (1996). Primary care: America’s health in a new era. Washington, DC: National Academy Press.

Jones, R. K., Darroch, J. E., & Henshaw, S. K. (2002). Contraceptive use among U.S. women having abortions in 2000-2001. Perspectives on Sexual and Reproductive Health, 34(6), 294-303.

Kade, K., Kumar, D., Polis, C., & Schaffer, K. (2004). Effect of nurses’ attitudes on hospital-based abortion procedures in Massachusetts. Contraception, 69(1), 59-62.

Kruse, B., Gordon, R., & Tanenhaus, J. (2001, December). The role of midlevel providers in abortion care in the United States. Country profile on abortion services: USA. Paper presented at the Expanding Access: Advancing the Roles of Midlevel Providers in Menstrual Regulation and Elective Abortion Care Conference, Pilanesberg National Park, South Africa. Available at http://db.jhuccp.org/ics-wpd/ exec/icswppro.dll?Bu=http://db.jhuccp.org/ics-wpd/exec/icswppro.dll&Qf0=DocNo&Qi0= 174347&TN=Popline&Ac=QBe_uery&Mr=30%25Dl=1&&rl=1&&rf=longrecordDisplay&Df= longrecordDisplay

Luterzo, J., Mahoney, S., Armstrong, A., Parker, J., & Alvero, R. (2004). Saline infusion sonohysterography: Comparing the accuracy of NPs and OB/GYN residents’/fellows’ findings. Women’s Health Care Journal, 3(3), 27-30.

Mundinger, M. (1994). Advanced-Practice Nursing—Good Medicine for Physicians. The New England Journal of Medicine, 330(3), 211.

Nunez, A. E. (2000). Transforming cultural competence into cross-cultural efficacy in women’s health education. Academic Medicine, 75(11), 1071-1080.

Paul, M., Lichtenberg, E.S., Borgatta, L., Grimes, D.A., & Stubblefield, P.G. (1999). A clinician’s guide to medical and surgical abortion. Philadelphia: W.B. Saunders.

Pew Health Professions Commission (1993). Health professions education for the future: Schools in service to the nation—A report. San Francisco: Pew Health Professions Commission, UCSF Center for the Health Professions. Available from http://www.futurehealth.ucsf.edu

Pew Health Professions Commission (1994). Primary care workforce 2000--Federal policy paper. San Francisco: UCSF Center for the Health Professions.

Pew Health Professions Commission, Shugars, D., O’Neil, E. H., & Bader, J. D. (1991). Healthy America: Practitioners for 2005: An agenda for action for U.S. health professional schools. Durham, NC: Pew Health Professions Commission.

Policar, M., Pollack, A., Nicholas, C., & Dudley, S. (1999). Principals of abortion care: A curriculum for physician assistants and advanced practice nurses. Washington, DC: National Abortion Federation.

Safriet, B. (1992). Health care dollars and regulatory sense: The role of advanced practice nursing in a rational system. Yale Law Journal on Regulation, 9(2), 1-150.

Safriet, B. (2002). Closing the gap between can and may in healthcare providers’ scopes of practice: A primer for policymakers. Yale Journal on Regulation, 19, 301.

Saraiya, M., Green, C. A., Berg, C. J., Hopkins, F. W., Koonin, L. M., & Atrash, H. K. (1999). Spontaneous abortion-related deaths among women in the United States, 1981-1991. Obstetrics & Gynecology, 94(2), 172-176.

Schwarz, E. B., Luetkemeyer, A., Foster, D. G., Weitz, T. A., Lindes, D., & Stewart, F. H. (2005). Willing and able? Provision of medication for abortion by future internists. Women’s Health Issues, 15(1), 39-44.

Sherrod, R. A. (1998). Infertility education in baccalaureate schools of nursing. Journal of Nursing Education, 37(9), 412-414.

Shotorbani, S., Zimmerman, F., Bell, J., Ward, D., & Assefi, N. (2004). Attitudes and intentions of future health care providers toward abortion provision. Perspectives on Sexual and Reproductive Health, 36(2), 58-63.

Springhouse (2001). Procedures for nurse practitioners. Springhouse, PA: Springhouse.

Stedman, T. (2000). Stedman’s medical dictionary (27th ed.). Baltimore: Lippincott, Williams and Wilkins.

Tarrant, E. (1998). Nurse-midwives as abortion providers: Current clinical practice, facilitating factors, and barriers. Unpublished master’s thesis, Yale University, New Haven, CT.

Thompson, J. (1992). Abortion statement vote. Quickening, 23(4), 8.

Wear, D., & Keck-McNulty, C. (2003). Medical Students for Choice: Origins, current orientations, and potential impact. Teaching and Learning in Medicine, 15(1), 52-58.

Weitz, T. A., Foster, A., Ellertson, C., Grossman, D., & Stewart, F. H. (2004). “Medical” and “surgical” abortion: Rethinking the modifiers. Contraception, 69(1), 77-78.

SECTION V SUPPLEMENTAL READINGS

American Academy of Physician Assistants (2005). Competencies for the physician assistant profession. Retrieved January 27, 2009, from http://www.aapa.org/manual/39-CompetenForProf.pdf

American Academy of Physician Assistants (2008a). 2008-2009 AAPA Policy Manual. Retrieved January 27, 2009, from http://www.aapa.org/manual/profession.pdf

American Academy of Physician Assistants (2008b). Issue brief: Physician assistant scope of practice. Alexandria, VA: Author.

American College of Nurse-Midwives (2003). Standards for the practice of midwifery. Silver Spring, MD: Author.

American College of Nurse-Midwives (2004). Definition of midwifery practice (Position Statement). Silver Spring, MD: Author.

American College of Nurse-Midwives (2005a). Code of ethics with explanatory statements. Silver Spring, MD: Author.

American College of Nurse-Midwives (2005b). Philosophy of the American College of Nurse-Midwives. Retrieved 2 March, 2009, from http://www.acnm.org/display.cfm?id=480&print=2

American College of Nurse-Midwives (2008). Core competencies for basic midwifery practice. Silver Spring, MD: Author.

American Nurses Association (1996). Scope and standards of advance practice registered nursing. Silver Spring, MD: Author.

American Nurses Association (2001). Code of ethics for nurses with interpretive statements. Silver Spring, MD: Author.

American Nurses Association (2003). Nursing’s social policy statement. Silver Spring, MD: Author.

Association of Reproductive Health Professionals (2009). Professional education. Retrieved 8 March, 2009, from http://www.arhp.org/Professional-Education

31 Since the 1980s, state nursing practice acts have increasingly adopted the term advanced practice nurse (APN) or advanced practice registered nurse (APRN) to delineate the unique roles of certified registered nurse anesthetists (CRNAs), certified nurse-midwives (CNMs), clinical nurse specialists (CNSs), and nurse practitioners (NPs). The contemporary term advanced practice reflects a vertical or hierarchical movement encompassing graduate education within nursing, rather than a simple expansion of expertise through the development of knowledge and skills.