Certified nurse-midwives (CNMs), nurse practitioners (NPs), and physician assistants (PAs), collectively referred to in this document as advanced practice clinicians (APCs), are recognized and regulated providers of health care to millions of women in the United States. Some of these clinicians are enabled to provide safe, compassionate abortion care as part of their reproductive health and primary care practices. However, outdated laws, restrictive regulations, lack of clinical training opportunities, and politically-motivated challenges impede many other clinicians’ abilities to provide abortion care as a component of the full range of needed reproductive health care services. In states across the country, APCs, physicians, reproductive rights advocates, and attorneys have joined together to promote the provision of abortion by APCs, to protect both women’s access to abortion and practitioners’ rights to provide needed care for their patients.
Providing Abortion Care: A Professional Toolkit for Nurse- Midwives, Nurse Practitioners, and Physician Assistants (APC Toolkit) is for APCs who would like to advance their existing practice, as well as for those who are experienced in abortion care. The APC Toolkit presents abortion as a scope of practice issue and examines the provision of abortion care as a natural extension of the work of APCs.
Evidence that abortion care is within APC scope of practice
In Module One of the APC Toolkit, evidence is presented
regarding the safety of abortion, the need for more abortion
providers, and the role of CNMs, NPs, and PAs in providing
abortion care. In addition, it describes the multiple barriers
that APCs face in becoming abortion providers, including
lack of clinical training opportunities, politics vis-à-vis
health professionals and abortion care, isolation of abortion
care from professional credentialing or legal/regulatory
mechanisms, and the wide variation in state practice and
In Module Two, professional practice regulation for CNMs, NPs, and PAs is explained, specifically as it relates to a specialty area such as abortion care. Here the roles of state licensing boards and professional organizations in defining, enforcing, and advancing health professional practice are described, as well as how these activities apply to abortion care. Section IV of Module Two also includes an evidencebased organizing framework for demonstrating that abortion care is consistent within APC scope of practice. In this model, four categories of evidence are considered: historical, professional/clinical, education/training, and legal/regulatory environment.
The APC Toolkit moves beyond information, concepts, and statistics to “tools” — cases, strategies, and frameworks — for action. It provides guidelines for integrating the essential categories of evidence into the standards and mechanisms used by national APC organizations and state licensing boards when they consider whether abortion care (or any new practice) is within a professional’s scope of practice. It also examines case studies of APCs who successfully incorporated abortion care into their practices, in order to illustrate principles which others can apply to their own situations.
Applying the evidence—strategies and methods for advancing scope of practice
The APC Toolkit provides strategies APCs can use—with the help of their professions, educators, employers, and reproductive health advocates—to situate abortion within APC scope of practice. It also proposes approaches for documenting evidence and competencies that span professional, regulatory, political, and clinical requirements.
Documenting clinical and professional competency. Advancing scope of practice assumes clinical competency. The APC Toolkit guides APCs in developing a unique professional portfolio which documents their basic and abortion care specialty education, knowledge, and training, as well as the clinical and professional standards they use to provide safe and effective care. The portfolio is an instrument which will support APCs as they proactively advance their practice to include abortion care, and can also be a tool in responding to a professional scope of practice challenge. It will contain professional credentials, competency achievements, essential scope of expertise documents across role, population, and specialty, and examples of clinical, professional, scholarship, research, and service accomplishments.
Accessing abortion care education and training. Lack of training opportunities is the most common reason APCs give for not providing or assisting with abortion procedures. Clinical competency in abortion care knowledge and skills requires formal or postgraduate education and training. The APC Toolkit includes information on basic APC and postgraduate abortion care training programs. Resources for self-study in abortion care, as well as guidelines for training to competency, are provided.
Working together. Advancing APC scope of practice into abortion care hinges on collaboration among multiple stakeholders. The APC Toolkit includes collaborative strategies for individual APCs, their educators and employers, as well as reproductive rights advocates, professional organizations, and state regulatory groups. The APC Toolkit stresses the important balance between professional organizations and state licensing boards and legislatures in developing, maintaining, and advancing professional practice. Strategies for APC participation in professional organizations and for working with others to bring a professional voice to scope of practice conversations at the state and national levels are highlighted.
Methods for advancing scope of practice. The APC Toolkit describes a variety of effective approaches for advancing scope of practice, both in general and for abortion care. Highlighting clinicians’ successful navigation of this terrain, the APC Toolkit provides “how-to” information on the following subjects:
- Understanding how state regulatory boards decide whether abortion is within a clinician’s scope of practice;
- Submitting materials to a state licensing board to document that abortion care is within the essential scope of practice elements, including the evidence supporting abortion procedures as safe;
- Responding to a request from a state regulatory board’s practice advisory committee to explain how scope of practice has advanced for abortion care;
- Supporting abortion care as part of APC scope of practice if an APC who is performing abortions is investigated by a state regulatory board;
- Helping APC educators develop abortion care education and training programs;
- Educating legislators and policy makers, testifying before legislative committees, and drafting public statements in support of abortion care as part of APC scope of practice.
Providing women with the accessible care they deserve
CNMs, NPs, and PAs already play a vital role in providing primary care services to women. Integrating abortion into APC scope of practice will potentially foster greater continuity of care, ensure earlier diagnosis and termination of unintended pregnancy, and promote women’s health and well-being. APCs are uniquely positioned to provide women with access to quality health care. With the support of the professional and reproductive health, rights, and justice communities, APCs can improve access to abortion and provide women with the comprehensive reproductive health care they need. Providing Abortion Care: A Professional Toolkit for Nurse-Midwives, Nurse Practitioners, and Physician Assistants informs, supports, and catalyzes efforts to promote the provision of abortion by all clinically competent health care providers committed to women’s health and autonomy.