Scope of practice issues for advanced practice nurses raise their ugly head from time to time. For NPs providing abortion care, scope of practice issues are particularly unique. Many states still have “physician only laws” that date back to the 1960s and 1970’s when they were passed to protect women from back street abortionists. Some states have used these antiquated laws to preclude advanced practice nurses from providing abortion care, particularly aspiration procedures. Other states do no have such laws in place and it is usually assumed the Nurse Practice Act encompasses the provision of abortion services among with many other women’s health care procedures. However, given the contentious nature of the abortion debate in the U.S., a variety of strategies have been used by the anti-choice movement to attempt to limit the provision of abortion, however possible.

In Arizona, a complaint was filed against an nurse practitioner (NP) who provides aspiration abortion procedures for a Planned Parenthood clinic. The complainant, who can be from the general public as well as the health care community, filed a complaint to the Board of Nursing expressing concern that the NP was acting outside of her scope of nursing practice. Once the complaint was made, the Board is obligated to investigate the situation. In this specific case, the NP began providing abortion services in 2001 to meet the needs of women in the area. The NP has an excellent safety record and provides abortion skills training to residents from a nearby medical school.

The NP stopped providing abortion services in March of 2007 while the complaint was investigated. After investigation and research, the Advance Practice Committee to the full Board of Nursing voted 10-0 to recommend that NPs with special training be permitted to perform abortions in the first trimester. The full Board of Nursing reviewed the recommendation of the Advance Practice Committee and voted, with one dissent, that NPs in Arizona can perform aspiration abortion in the first trimester of pregnancy. The Board did not penalize the NP for performing second trimester procedures since the Board did not previously have such a rule in place.

While this issue was before the Board of Nursing, a bill was introduced into the Arizona legislature. HB 2269 quickly and quietly passed the Arizona House in the spring of 2008 before nursing was notified of the proposed legislation. The bill moved slower through the Senate, allowing nurses to mobilize their opposition. The bill was defeated in the state senate on June 26th, 2008.

If the proposed legislation had become law, it would have changed the way nursing practice, not solely abortion care, is regulated. The Arizona Legislature, under HB 2269, could have usurped the expertise of the nursing board to regulate professional practice issues. The passage of the bill could have paved the way for other state legislatures to pass similar bills to make nursing regulatory boards open to control by legislative mandates for any number of health care services provided by nurses, nurse practitioners and nurse-midwives.

Thanks to the Arizona Nurses Association, the Arizona chapter of the American Academy of NPs and the many nurse practitioners and nurses in Arizona who opposed this legislation. The defeat of this bill is important to the professional practice of all nurses.