June | July 2002 AWHONN Lifelines 191

NP Roles in Women’sHealth Management

As an aging L & D nurse and cur-

rent FNP student, I have

become interested in women’s health

issues beyond obstetrics. Anecdotally,

I have noticed an inconsistency in

health-seeking patterns among women

my age. The tendency to regard the

gynecologist as a primary care provider

frequently exists, with augmentation of

care with specialists who manage cer-

tain chronic illnesses on a more indi-

vidual basis. Often, the outcome is that

no one seems to be at the helm of

women’s health care management.

Further, as women age beyond their

childbearing years, they may not seek

regular health care at all. Among those

who do seek care, they may not realize

that an annual Pap screening is not suf-

ficiently comprehensive for all their

health needs, particularly cardiovascular

risks, at this stage of life. Nurse practi-

tioners are in a unique position to

expand health care services more com-

prehensively for women in this country.

The AWHONN position statement

about the Cardiovascular Health for

Women Initiative (Association of

Women’s Health, Obstetric and

Neonatal Nurses, 2002) accurately

describes the rationale that women

should continue an ongoing relation-

ship with a primary care provider. Sig-

nificant cardiovascular risks among

women were well described in terms of

mortality, benefits of prevention, bar-

riers to diagnosis, patient and provider

educational needs regarding risks, and

the role of advanced-practice nursing

in addressing these problems.

Variations have been noted in the

literature regarding types of providers

seen by women. In one large study

(N = 2,447 women) Weisman,

Cassard, and Plichta (1995) found:

• 39 percent of women see family

practitioners or internists for care

• 33 percent of women see general

practitioners

• 16 percent see OB/GYN care

providers

• 3 percent see “other specialists”

• 10 percent see no regular physician

at all

Among these women are likely to be

those with significant risk factors or

health problems that are possibly going

undiagnosed. Not all obstetric and

gynecologic practices include risk pre-

vention for such long-term health prob-

lems as cardiovascular disease, osteo-

porosis, obesity or diabetes. Leading

health care organizations, such as

AWHONN and the American College

of Obstetricians and Gynecologists,

play a critical role in urging providers

to include such in their practice.

Women who seek care from

internists or family practice providers

only may not receive appropriate

gynecologic screening. Women seek-

ing care from both primary care and

OB/GYN practices tend to receive

more health screening than those who

see a primary care provider alone

(Weisman et al., 1995). Nurse practi-

tioners can play a vital role in helping

bring comprehensive women’s health

care to the OB/GYN setting. Research

demonstrates that while women are

open to seeing unfamiliar health care

providers when needing care for acute

illnesses, most women are less open to

seeing an unfamiliar provider for

what they would consider a routine

checkup (Thompson & Nussbaum,

2000). In this study, 64 percent of

women indicated that if their regular

provider were not available, they

would be willing to see a nurse prac-

titioner. Women open to receiving

care from NPs were identified as

younger, better educated and English-

speaking nonimmigrant. Women who

adamantly desired to see their

provider only were more likely to

recall past unpleasant encounters with

clinicians in this study. Women in

another inquiry were more likely to

participate in preventive screening

when a bachelor-prepared health

advocate in an OB/GYN setting was

available to provide education and

referral (Scholle, Agatisa, Krohn, John-

son, & McLaughlin, 2000).

Nurse practitioners are valuable

additions to a vibrant OB/GYN prac-

tice. Many women may be receptive to

such services, especially when provided

within a familiar office setting. Howev-

er, more public education is needed

regarding women’s health risks, appro-

priate screenings at various life stages,

and differences in services offered by

various providers. Raised public

awareness can translate into better

health services utilization by women

throughout the U.S.

Additionally, Cobb (1998) demon-

strated that clinical nurse specialists

(CNS) are instrumental in providing

health promotion and maintenance for

women in collaboration with a physi-

cian and other health care providers.

The CNS, in the OB/GYN setting, is an

important partner in the roles of clini-

cian, educator, consultant and

researcher in helping patients achieve

optimal health, and in helping the U.S.

population at large meet the goals of

Healthy People 2000, as well as imple-

ment the interventions suggested in

192 AWHONN Lifelines Volume 6 Issue 3

the Guide to Clinical Preventative Ser-

vices for Women (U.S. Preventive Ser-

vices Task Force, 1996).

Irene Strickland, RN, BSN Family Nurse Practitioner, student

University of North Carolina at Chapel Hill

References

Association of Women’s Health,

Obstetric and Neonatal Nurses.

(2002). Cardiovascular Health

for Women Initiative [online].

Retrieved February 13, 2002

from ww.awhonn.org.

Cobb, M. (1998). CNS role in women’s

health promoting and mainte-

nance in a collaborative practice.

Clinical Nurse Specialist, 12(3),

112-116.

Scholle, S., Agatisa, M., Krohn, M.,

Johnson, J., & McLaughlin, M.

(2000). Locating a health advo-

cate in a private obstetrics/gyne-

cology office increases patient’s

receipt of preventive recommen-

dations. Journal of Women’s

Health, 9(2), 161-165.

Thompson, M., & Nussbaum, R.

(2000). Asking women to see

nurses or unfamiliar physicians

as part of primary care

redesign. The American Journal

of Managed Care, 6(2), 187-

189.

U.S. Preventive Services Task Force.

(1996). Guide to clinical preven-

tative services for women.

Chicago, IL: Author.

Weisman, C., Cassard, S., & Plichta, S.

(1995). Types of physicians used

by women for regular health

care: Implications for services

received. Journal of Women’s

Health, 4(4), 407-416.