C. CASE STUDY: DEVELOPING A PORTFOLIO IN RESPONSE TO A CHALLENGE
In 2006, when the Oregon FNP was investigated by the Board of Nursing for a potential
violation of her scope of practice, the NP created a portfolio that became the foundation of the
template in Figure V.2.
Creating this portfolio involved the collation of evidence demonstrating her competence and training, as well as broader support for her work as an abortion provider. Having evidence of all essential documents—licenses, certifications, nursing/NP education, training in abortion care, practice standards, and clinical practice documents—in one easily accessible format made the investigation go much more smoothly. The portfolio demonstrated the interconnectedness of all her education, training and expertise—not just her work in reproductive health, but preparation and competency associated with primary care, mental health, and other aspects of her practice that showed abortion care to be a natural extension of her work with women and families.
In addition to these primary documents, the NP included in her portfolio detailed course outlines and clinical training materials relating to abortion care specialty training. These materials proved critical in her investigation because the investigator was largely unaware of how the abortion procedure was performed as well as of the elements of standard abortion training. The thorough review of abortion care standards, including actual procedural steps, provided in the portfolio was essential to receiving a favorable ruling. A regulatory board cannot accurately assess how abortion is situated within an APC’s scope of practice without complete and accurate information.
Finally, the NP included the following supporting evidence in her portfolio:
- national professional standards and competencies for advanced practice nursing, NP practice, and abortion care;
- statements of support from professional and practice organizations;
- empirical research demonstrating the safety of abortion care and the competency of APCs as abortion providers; and
- documentation of women’s lack of access to abortion services nationally and in her state and the NP’s role in meeting patient needs.
The NP also collected personal letters of support from respected clinician colleagues who spoke to the need for primary care providers to integrate abortion into their rural or community- based clinics. These support letters also attested to the high-quality primary care the NP was providing to women in her medically underserved part of the state. The portfolio format allowed her to refer easily to these documents during her investigation. The professional portfolio also demonstrated to the Board of Nursing this NP’s thoughtfulness and careful consideration in pursuing abortion care as a natural part of her scope of practice. In June 2006, the Board ruled that early aspiration abortion was within her scope of practice as a family NP. (To read the entire case study, see Section IV.G)