nursing roles
An Ob-Gyn Nurse Practitioner Program JUANZETTA FLOWERS, E N , BSN, SHIRLEY HIGGINS, RN, BSN, HUGH M . SHINGLETON, M D , FACOG, MILLIE PETERS, MSN, RN, and JUDY HOLCOMBE, M S N , RN An Ob-Gyn Nurse Practitioner Program, begun as a pilot project to aid in cancer detection in the state of Alabama, has become a fullfledged program to train Nurse Practitioners in all aspects of obstetrics and gynecology and has graduated 32 nurses. The program is divided into a four-month lecture and clinical experience segment and a twomonth training period with a preceptor. Twenty-eight of the graduates are employed in Alabama, either by the Health Department or by private physicians. They have been well-accepted in Alabama by peers, physicians, and patients, and cancer detection and family planning have greatly benefitted from their impact. The benefits should continue to increase. Health care in Alabama and in the South generally, lags drastically behind that of other areas of the United States. In Alabama, 41 of 67 counties are without internists, 44 lack pediatricians, 45 are without obstetricians, and 25 are without surgeons.' The American Cancer Society estimates that only 26% of the women in the United States have a pap smear test done on a yearly basis.' In Alabama, this figure is considerably lower; a 1973 study estimated that only 11% of the female population had had pap smears. The scarcity of physicians in many counties contributes in part to the small number of pap smears done. While there are no statistics available concerning family planning programs, it seems safe to assume that the physician scarcity would also affect this area. Rather than do nothing to provide an increasing patient population with adequate health care while waiting for a possible influx of physicians into rural areas of Alabama, the concept of a Nurse Practitioner has evolved. This approach deals with preparing registered nurses to function as Ob-Gyn March/April 1976 JOCN Nursing
Nurse Practitioners and locating them in those counties lacking medical personnel.
BACKGROUND Two nurses were enrolled for a 1-year training period in a pilot program consisting of didactic material and clinical experience encompassing all aspects of obstetrics and gynecology. After several months it became obvious that experienced registered nurses did not need a full year of training to function efficiently in this expanded role and the training period was cut to 6 months. The only funds available for the program came from a federal grant to train two nurse practitioners in cancer detection methods, so the concentration was on malignant pelvic disease. During the first year, the Alabama Council for Voluntary Family Planning and the Bureau of Maternal and Child Health of the State Health Department became interested in sending nurses through the program to train them to staff state-wide Family Planning clinics. To further this aim, these two 1.9
agencies provided funding for the following year. The School of Nursing of the University of Alabama in Birmingham and the Department of Obstetrics and Gynecology of the School of Medicine were asked to be cosponsors of the program for its duration. With the sponsorship of the School of Nursing during the second year, it was possible for the students to receive 25.3continuing education units for the time spent in the program. The two nurses who went through the pilot program were retained as coordinators of the program, and a formal curriculum was devised. Funds from the federal grant coupled with financial support from Family Planning grants of the State Health Department established a firm financial base for the program. Each student accepted into the program was required to have a job waiting for her in which she would use her expanded skills. This rule was made in an effort to insure that the program would fulfill its original purpose of providing health care in those rural counties with an inadequate number of practicing physicians. COURSE DESIGN AND DEVELOPMENT On March 1, 1973, the first five-member class was enrolled for the shortened program. Due to the small number of clinical facilities available, classes were limited to five or six students. The format established at that time has proven worthwhile and is still being used. Each student spends 16 weeks in Birmingham and 8 weeks with a physician preceptor in her local community. The 16 weeks in Birmingham are divided into 5 weeks (88 hours) of lectures, exams, and conferences and 11 weeks (340 hours) of clinical experience. After the 8-week preceptorship, each student is given an oral examination by the physician director of the program and, on passing, receives her certificate. The purpose of the curriculum is to acquaint the student with the many aspects of obstetrics and gynecology through academic and clinical experience, the goal being to teach the Nurse Practitioner to handle normal conditions and direct abnormal conditions to the physician’s attention. The curriculum covers general gynecology, prenatal care, and oncology (see Appendix). The Nurse Practitioner students are also encouraged to attend the weekly medical student lectures given by the Department of 0b-Gy n. During the lecture series, the students receive some limited practice in doing pelvic exams on an extremely life-like pelvic model (from Ortho Pharmaceutical Corporation) which lends itself to most gynecologic procedures. The clinical rotation begins with a week in the operating room. This en5”
ables the student to perform the first “live” pelvic exam on an anesthetized patient and seems to alleviate the initial anxiety associated with the procedure. The ever-increasing number of medical students at the University makes it very difficult to provide meaningful clinical experience for the Nurse Practitioner students, For this reason, the following clinics are being used as training grounds in the Nurse Practitioner program; all are in metropolitan Birmingham: 1) University Hospital Out-Patient Department 2) Cooper Green Hospital Out-Patient Clinics 3) Carraway Methodist Hospital Out-Patient Clinics 4) Planned Parenthood Clinics 5) Three private doctors’ offices 6) Jefferson County Health Department Family Planning, Cytology, and Prenatal Clinics After completion of the course, each student is asked to evaluate the program and give suggestions for improvements. Any aspect that is universally disapproved of is usually modified or deleted; it is hoped that these periodic evaluations will allow continual improvment of the course. Nursing School Contribution Two faculty members from the University of Alabama School of Nursing act as consultants to the Nurse Practitioner Program and conduct a series of six seminars to aid the students in adapting to their expanded nursing role. The topics discussed are revelant to their new position and are designed to stimulate thought and further study rather than to offer concrete facts. Since these students are viewed as assuming new and broader responsibilities, they are encouraged to be primarily self-directed in their learning. To promote self-study, a complete bibliography is distributed prior to each seminar. Annual Refresher Seminars As in any dynamic situation, didactic material is constantly being added and deleted. Annual refresher seminars serve to bring past graduates up to date with present students. The seminars are 10 to 12 hours long, and each Nurse Practitioner attending receives continuing education credit for them. This is very important in light of the mandatory continuing education units being required more and more by state licensing boards. The seminars are well attended, and both the Practitioners and the program benefit from the exchange of ideas. Clinical and Diagnostic Skills Following graduation, the Ob-Gyn Nurse Practitioner is prepared to give primary care in the areas March/April 1976 JOGN Nursing
of family planning, normal prenatal care, and canPEER ACCEPTANCE cer detection using basic skills such as Oddly enough, more opposition has come from 1) Obtaining and recording a complete medical the traditional nursing leaders in Alabama than history from physicians, mainly due to the fact that physi2) Complete physical examination cians are incorporated in the program as instructors 3) Speculum visualization of the vagina and in the lecture series. The theory that nurses can cervix teach other nurses anything they need to know is 4) Papanicolaou smear definitely not true in this type of program. 5 ) Goncoccal smear or culture Opposition has also arisen from nursing per6) Uterine jet washing sonnel with whom the Nurse Practitioner has pre7 ) Endometrial and cervical biopsies viously worked: Some individuals seem to think the 8) Determination of fetal size, position, and Nurse Practitioner should function in the old capacheart sounds ity as well as the new. Most Nurse Practitioners 9) Ordering of various laboratory tests have handled this situation with great poise and 10) Interpretation of wet smears for vaginitis tact, allowing time to smooth the “ruffled feathers.” 11) Insertion and removal of intrauterine con- Weekly conferences during which feelings can be traceptive devices expressed, are helpful in solving these problems. By combining these skills with basic nursing Some nursing leaders as well as auxillary nursing knowledge, the Ob-Gyn Nurse Practitioner func- personnel do not regard the expanded role of the tions as a counselor and coordinator, guiding the Nurse Practitioner as being within the realm of patient through the complexities of the health care nursing. These conflicting attitudes are slowly system. This means that the Nurse Practitioner being resoived, and in time, acceptance and a must be closely affiliated with the local medical better understanding of the Nurse Practitioner‘s societies and have complete familiarity with com- role will be reached. At all times, the Nurse Pracmunity agencies available for patient assistance. titioners are urged to use diplomacy, remembering The Nurse Practitioner is responsible for giving that they are still nurses-simply in an expanded primary care only to those patients who are termed role. normal. Any “questionable” patient is referred immediately to a physician for further evaluation. PATIENT ACCEPTANCE Patient acceptance has been very gratifying. Not only do many comment that it is nice to be examIMPACT ON ALABAMA ined by a female, especially the patients aged 55 to To date, the program has graduated 32 students, 70, but they also seem to be more relaxed and 28 of whom are employed as Ob-Gyn Nurse Prac- willing to talk about themselves to another woman. titioners either in Family Planning Clinics or in This is particularly true in the area of sexuality. private doctors’ offices across the state. Some physiThe Nurse Practitioner always stresses that she is cians were initially opposed to the idea of Nurse not a doctor, but a nurse with special skills. Some, Practitioners, but after serving as preceptors for the especially Public Health patients, appear somewhat students, most have developed favorable attitudes. confused and call the Nurse Practitioner “Doctor The preceptorship, the close relations among stuNurse,” but no complaints have been recorded dents, residents, and medical students during the from these patients. lecture series, and the clinical rotation system aids The very few patients who are offended seem to in promoting good relations with physicians who feel that they are being used as teaching models. may later want to include a Nurse Practitioner in They do not mind being interviewed by the Nurse their practice. Practitioner but they want to be examined only by The nurse with expanded skills has a unique and my own Doctor.” This issue is never forced; pervital role in the delivery of health care. The aim of mission is always obtained from the patient before this particular program is not to prepare the Nurse any examination is done by a Nurse Practitioner. In Practitioner for a totally independent practice but this area, the feeling is that the physician sets the to train her to work in close affiliation with a qual- tone. If he or she is comfortable with the concept of ified physician. This merely provides the Nurse the Nurse Practitioner, then the patient will be also. Practitioner with legal coverage, and does not mean that the potential For indepindent practice is not FUTURE POSSIBILITIES present. Due to the availability of Nurse Practitioners, family planning clinics are now serving Great possibilities exist for further expansion of approximately 24 counties in Alabama. the Ob-Gyn Nurse Practitioner role to include staff“
March/April 1976 JOCN Nursing
5’
ing gynecologic examining rooms in general hospitals, industrial complexes, women’s prisons, juvenile homes, homes for unwed mothers, and mobile pap smear units. Such facilities as the mobile units would detect many undiagnosed precancerous and cancerous conditions, as well as other serious medical problems, in patients who delay or refuse to see physicians for examinations. It is not outside the realm of possibility that Nurse Practitioners will eventually have individual practices to deliver counseling, perform diagnostic examinations, treat minor illnesses, and refer patients with pathology to physicians. This program is but one approach to alleviating the problems caused by the physician shortage. It has been successul in its present form, and it is hoped that in the future it can play an even larger role in meeting health care needs. SUMMARY AND CONCLUSIONS
the medical community and the patient population. With continued support and acceptance, the program seems to have a bright future. REFERENCES 1. State of Alabama Health Department Statistics, 1974 2. The American Cancer Society Summary Report, February, 1974
Address reprint requests to Shirley A. Higgins, RN, Coordinator and Instructor, Ob-Gyn Nurse Practitioner Program, University Hospital, Department of Obstetrics and Gynecology, University Station, Birmingham, AL 35294.
Juanzetta Flowers is an Ob-Gyn Nurse Practitioner and an instructor and coordinator in the Nurse Practitioner Program at University Hospital in Birmingham. She i s a graduate of the Birmingham Baptist School of Nursing and has a BSN f r o m the University of Alabama. Her past experience also includes student health, public health, pediatrics, and medicalsurgical, and she is a member of A N A and NAACOG.
Through the success of the Ob-Gyn Nurse Practitioner Program, health care in Alabama is being improved. The course curriculum prepares the graduate to do a variety of procedures that have proved useful in family planning, cancer detection, and public health clinics, as well as in private physicians’ offices throughout the state. Support from the University of Alabama in Birmingham Schools of Medicine and Nursing combined with federal and Shirley Higgins is a graduate of Sylacauga Hospital state funding has given the program a firmly estab- School of Nursing, Sylacauga, Alabama, and has a lished base. The program has been well accepted by BSN f r o m the University of Alabama. An Ob-Gyn Appendix: Ob-Gyn Nurse Practitioner Curriculum, University of Alabama, University Hospital Subject Orientation to Course and Building Principles of History-Taking and Review of Systems Female Anatomy Physical Diagnosis and Assessment Histology of Female Genital Tract Female Hormonal Profile Male Reproductive Role Nonmalignant Pathology of the Female Re productive System Contraception for Family Planning Human Sexuality Obstetrics-Normal and Abnormal Pathophysiology of the Female Reproductive System
Time, Instructor
Activity
2 hrs., Nurse 2 hrs., Physician
Lecture, return, demonstration
4 hrs., Physician 4 hrs., Physician & Nurse 2 hrs., Physician 7 hrs., Physician 3 hrs., Physician 4 hrs., Physician
6 hrs., Physician & Nurse 6-8 hrs. 10 hrs., Physician 14 hrs.
Lecture, slides Lecture, return, demonstration Lecture Lecture, slides Lecture, slides, film, demonstration Lecture, slides, film Lecture, films Lecture, films Lecture, slides
For further details of the curriculum and other aspects of the Ob-Gyn Nurse Practitioner Program, write to Shirley A. Higgins, RN, Coordinator and Instructor, Ob-Gyn Nurse Practitioner Program, Department of Obstetrics and Gynecology, University Hospital, University Station, Birmingham, AL 35294. 52
March/April 1976 JOCN Nursing
Nurse Practitioner, she is currently a Coordinator of Millie Peters is currently a consultant to the Obthe Nurse Practitioner Program at University Hos- Gyn Nurse Practitioner Program at University Hospital in Birmingham and a Clinical Nursing Asso- pital, Birmingham, and an Assistant Professor at the ciate at the University of Alabama School of Nurs- University of Alabama School of Nursing. She has a ing. She has previously held staff and head nurse BSN from the University of Alabama and an M N positions in Ob-Gyn and pediatrics and is a member in Maternity Nursing from the University of Pitof ANA and NAACOG. tsburgh and is a member of NLN, ANA, and NAACOG. She has had past experience as a staff Hugh Shingleton took his MD at Duke University, nurse and as a Clinical Instructor. having received his premedical AB degree from that University also. He has done cancer research under Judith Holcombe, a graduate of Carraway Methodtwo fellowships, one from the American Cancer ist Hospital School of Nursing in Birmingham, of Society and the other from the United States Public Drury College ( B S N ) in Springjield, Missouri, and Health Service, and is currently Chief of the Divi- of the University of Alabama ( M S N ) , is currently at sion of Gynecologic Oncology at the University of the University as a Coordinator of Long-Term Alabama in addition to being a Professor of Obstet- Medical-Surgical Nursing and consultant to the rics and Gynecology and an Assistant Professor of Ob-Gyn Nurse Practitioner Program. She has been Pathology at that institution. He has published active with the American Cancer Society and the widely in medical journals and is a member of American Red Cross and is a member of NLN, ANA, Oncology Nurses, and NAACOG. numerous professional organizations.
NURSING SUPERWSOR MANAGEMENT CONFERENCE The Third National Hospital Nursing Supervisor Management Conference will be held at the Marriott Hotel in Los Angeles, California on June 17-20. The conference will feature a seminar on personal development led by Joyce Brothers, PhD, and will offer other seminars and workshops on such topics as the labor union movement in health care, management effectiveness, communications skills, and coaching, counseling, and interviewing. This conference has been designed for a wide spectrum of participants including obstetrics supervisors, assistants, and head nurses. The fee is $75.00. For further information and registration materials contact Gordon M. Marshall, Hospitul Topics, 734 Siesta Key Circle, Sarasota, FL 33581.
March/April 1076 JOCN Nursing
53
An Ob-Gyn Nurse Practitioner Program JUANZETTA FLOWERS, E N , BSN, SHIRLEY HIGGINS, RN, BSN, HUGH M . SHINGLETON, M D , FACOG, MILLIE PETERS, MSN, RN, and JUDY HOLCOMBE, M S N , RN An Ob-Gyn Nurse Practitioner Program, begun as a pilot project to aid in cancer detection in the state of Alabama, has become a fullfledged program to train Nurse Practitioners in all aspects of obstetrics and gynecology and has graduated 32 nurses. The program is divided into a four-month lecture and clinical experience segment and a twomonth training period with a preceptor. Twenty-eight of the graduates are employed in Alabama, either by the Health Department or by private physicians. They have been well-accepted in Alabama by peers, physicians, and patients, and cancer detection and family planning have greatly benefitted from their impact. The benefits should continue to increase. Health care in Alabama and in the South generally, lags drastically behind that of other areas of the United States. In Alabama, 41 of 67 counties are without internists, 44 lack pediatricians, 45 are without obstetricians, and 25 are without surgeons.' The American Cancer Society estimates that only 26% of the women in the United States have a pap smear test done on a yearly basis.' In Alabama, this figure is considerably lower; a 1973 study estimated that only 11% of the female population had had pap smears. The scarcity of physicians in many counties contributes in part to the small number of pap smears done. While there are no statistics available concerning family planning programs, it seems safe to assume that the physician scarcity would also affect this area. Rather than do nothing to provide an increasing patient population with adequate health care while waiting for a possible influx of physicians into rural areas of Alabama, the concept of a Nurse Practitioner has evolved. This approach deals with preparing registered nurses to function as Ob-Gyn March/April 1976 JOCN Nursing
Nurse Practitioners and locating them in those counties lacking medical personnel.
BACKGROUND Two nurses were enrolled for a 1-year training period in a pilot program consisting of didactic material and clinical experience encompassing all aspects of obstetrics and gynecology. After several months it became obvious that experienced registered nurses did not need a full year of training to function efficiently in this expanded role and the training period was cut to 6 months. The only funds available for the program came from a federal grant to train two nurse practitioners in cancer detection methods, so the concentration was on malignant pelvic disease. During the first year, the Alabama Council for Voluntary Family Planning and the Bureau of Maternal and Child Health of the State Health Department became interested in sending nurses through the program to train them to staff state-wide Family Planning clinics. To further this aim, these two 1.9
agencies provided funding for the following year. The School of Nursing of the University of Alabama in Birmingham and the Department of Obstetrics and Gynecology of the School of Medicine were asked to be cosponsors of the program for its duration. With the sponsorship of the School of Nursing during the second year, it was possible for the students to receive 25.3continuing education units for the time spent in the program. The two nurses who went through the pilot program were retained as coordinators of the program, and a formal curriculum was devised. Funds from the federal grant coupled with financial support from Family Planning grants of the State Health Department established a firm financial base for the program. Each student accepted into the program was required to have a job waiting for her in which she would use her expanded skills. This rule was made in an effort to insure that the program would fulfill its original purpose of providing health care in those rural counties with an inadequate number of practicing physicians. COURSE DESIGN AND DEVELOPMENT On March 1, 1973, the first five-member class was enrolled for the shortened program. Due to the small number of clinical facilities available, classes were limited to five or six students. The format established at that time has proven worthwhile and is still being used. Each student spends 16 weeks in Birmingham and 8 weeks with a physician preceptor in her local community. The 16 weeks in Birmingham are divided into 5 weeks (88 hours) of lectures, exams, and conferences and 11 weeks (340 hours) of clinical experience. After the 8-week preceptorship, each student is given an oral examination by the physician director of the program and, on passing, receives her certificate. The purpose of the curriculum is to acquaint the student with the many aspects of obstetrics and gynecology through academic and clinical experience, the goal being to teach the Nurse Practitioner to handle normal conditions and direct abnormal conditions to the physician’s attention. The curriculum covers general gynecology, prenatal care, and oncology (see Appendix). The Nurse Practitioner students are also encouraged to attend the weekly medical student lectures given by the Department of 0b-Gy n. During the lecture series, the students receive some limited practice in doing pelvic exams on an extremely life-like pelvic model (from Ortho Pharmaceutical Corporation) which lends itself to most gynecologic procedures. The clinical rotation begins with a week in the operating room. This en5”
ables the student to perform the first “live” pelvic exam on an anesthetized patient and seems to alleviate the initial anxiety associated with the procedure. The ever-increasing number of medical students at the University makes it very difficult to provide meaningful clinical experience for the Nurse Practitioner students, For this reason, the following clinics are being used as training grounds in the Nurse Practitioner program; all are in metropolitan Birmingham: 1) University Hospital Out-Patient Department 2) Cooper Green Hospital Out-Patient Clinics 3) Carraway Methodist Hospital Out-Patient Clinics 4) Planned Parenthood Clinics 5) Three private doctors’ offices 6) Jefferson County Health Department Family Planning, Cytology, and Prenatal Clinics After completion of the course, each student is asked to evaluate the program and give suggestions for improvements. Any aspect that is universally disapproved of is usually modified or deleted; it is hoped that these periodic evaluations will allow continual improvment of the course. Nursing School Contribution Two faculty members from the University of Alabama School of Nursing act as consultants to the Nurse Practitioner Program and conduct a series of six seminars to aid the students in adapting to their expanded nursing role. The topics discussed are revelant to their new position and are designed to stimulate thought and further study rather than to offer concrete facts. Since these students are viewed as assuming new and broader responsibilities, they are encouraged to be primarily self-directed in their learning. To promote self-study, a complete bibliography is distributed prior to each seminar. Annual Refresher Seminars As in any dynamic situation, didactic material is constantly being added and deleted. Annual refresher seminars serve to bring past graduates up to date with present students. The seminars are 10 to 12 hours long, and each Nurse Practitioner attending receives continuing education credit for them. This is very important in light of the mandatory continuing education units being required more and more by state licensing boards. The seminars are well attended, and both the Practitioners and the program benefit from the exchange of ideas. Clinical and Diagnostic Skills Following graduation, the Ob-Gyn Nurse Practitioner is prepared to give primary care in the areas March/April 1976 JOGN Nursing
of family planning, normal prenatal care, and canPEER ACCEPTANCE cer detection using basic skills such as Oddly enough, more opposition has come from 1) Obtaining and recording a complete medical the traditional nursing leaders in Alabama than history from physicians, mainly due to the fact that physi2) Complete physical examination cians are incorporated in the program as instructors 3) Speculum visualization of the vagina and in the lecture series. The theory that nurses can cervix teach other nurses anything they need to know is 4) Papanicolaou smear definitely not true in this type of program. 5 ) Goncoccal smear or culture Opposition has also arisen from nursing per6) Uterine jet washing sonnel with whom the Nurse Practitioner has pre7 ) Endometrial and cervical biopsies viously worked: Some individuals seem to think the 8) Determination of fetal size, position, and Nurse Practitioner should function in the old capacheart sounds ity as well as the new. Most Nurse Practitioners 9) Ordering of various laboratory tests have handled this situation with great poise and 10) Interpretation of wet smears for vaginitis tact, allowing time to smooth the “ruffled feathers.” 11) Insertion and removal of intrauterine con- Weekly conferences during which feelings can be traceptive devices expressed, are helpful in solving these problems. By combining these skills with basic nursing Some nursing leaders as well as auxillary nursing knowledge, the Ob-Gyn Nurse Practitioner func- personnel do not regard the expanded role of the tions as a counselor and coordinator, guiding the Nurse Practitioner as being within the realm of patient through the complexities of the health care nursing. These conflicting attitudes are slowly system. This means that the Nurse Practitioner being resoived, and in time, acceptance and a must be closely affiliated with the local medical better understanding of the Nurse Practitioner‘s societies and have complete familiarity with com- role will be reached. At all times, the Nurse Pracmunity agencies available for patient assistance. titioners are urged to use diplomacy, remembering The Nurse Practitioner is responsible for giving that they are still nurses-simply in an expanded primary care only to those patients who are termed role. normal. Any “questionable” patient is referred immediately to a physician for further evaluation. PATIENT ACCEPTANCE Patient acceptance has been very gratifying. Not only do many comment that it is nice to be examIMPACT ON ALABAMA ined by a female, especially the patients aged 55 to To date, the program has graduated 32 students, 70, but they also seem to be more relaxed and 28 of whom are employed as Ob-Gyn Nurse Prac- willing to talk about themselves to another woman. titioners either in Family Planning Clinics or in This is particularly true in the area of sexuality. private doctors’ offices across the state. Some physiThe Nurse Practitioner always stresses that she is cians were initially opposed to the idea of Nurse not a doctor, but a nurse with special skills. Some, Practitioners, but after serving as preceptors for the especially Public Health patients, appear somewhat students, most have developed favorable attitudes. confused and call the Nurse Practitioner “Doctor The preceptorship, the close relations among stuNurse,” but no complaints have been recorded dents, residents, and medical students during the from these patients. lecture series, and the clinical rotation system aids The very few patients who are offended seem to in promoting good relations with physicians who feel that they are being used as teaching models. may later want to include a Nurse Practitioner in They do not mind being interviewed by the Nurse their practice. Practitioner but they want to be examined only by The nurse with expanded skills has a unique and my own Doctor.” This issue is never forced; pervital role in the delivery of health care. The aim of mission is always obtained from the patient before this particular program is not to prepare the Nurse any examination is done by a Nurse Practitioner. In Practitioner for a totally independent practice but this area, the feeling is that the physician sets the to train her to work in close affiliation with a qual- tone. If he or she is comfortable with the concept of ified physician. This merely provides the Nurse the Nurse Practitioner, then the patient will be also. Practitioner with legal coverage, and does not mean that the potential For indepindent practice is not FUTURE POSSIBILITIES present. Due to the availability of Nurse Practitioners, family planning clinics are now serving Great possibilities exist for further expansion of approximately 24 counties in Alabama. the Ob-Gyn Nurse Practitioner role to include staff“
March/April 1976 JOCN Nursing
5’
ing gynecologic examining rooms in general hospitals, industrial complexes, women’s prisons, juvenile homes, homes for unwed mothers, and mobile pap smear units. Such facilities as the mobile units would detect many undiagnosed precancerous and cancerous conditions, as well as other serious medical problems, in patients who delay or refuse to see physicians for examinations. It is not outside the realm of possibility that Nurse Practitioners will eventually have individual practices to deliver counseling, perform diagnostic examinations, treat minor illnesses, and refer patients with pathology to physicians. This program is but one approach to alleviating the problems caused by the physician shortage. It has been successul in its present form, and it is hoped that in the future it can play an even larger role in meeting health care needs. SUMMARY AND CONCLUSIONS
the medical community and the patient population. With continued support and acceptance, the program seems to have a bright future. REFERENCES 1. State of Alabama Health Department Statistics, 1974 2. The American Cancer Society Summary Report, February, 1974
Address reprint requests to Shirley A. Higgins, RN, Coordinator and Instructor, Ob-Gyn Nurse Practitioner Program, University Hospital, Department of Obstetrics and Gynecology, University Station, Birmingham, AL 35294.
Juanzetta Flowers is an Ob-Gyn Nurse Practitioner and an instructor and coordinator in the Nurse Practitioner Program at University Hospital in Birmingham. She i s a graduate of the Birmingham Baptist School of Nursing and has a BSN f r o m the University of Alabama. Her past experience also includes student health, public health, pediatrics, and medicalsurgical, and she is a member of A N A and NAACOG.
Through the success of the Ob-Gyn Nurse Practitioner Program, health care in Alabama is being improved. The course curriculum prepares the graduate to do a variety of procedures that have proved useful in family planning, cancer detection, and public health clinics, as well as in private physicians’ offices throughout the state. Support from the University of Alabama in Birmingham Schools of Medicine and Nursing combined with federal and Shirley Higgins is a graduate of Sylacauga Hospital state funding has given the program a firmly estab- School of Nursing, Sylacauga, Alabama, and has a lished base. The program has been well accepted by BSN f r o m the University of Alabama. An Ob-Gyn Appendix: Ob-Gyn Nurse Practitioner Curriculum, University of Alabama, University Hospital Subject Orientation to Course and Building Principles of History-Taking and Review of Systems Female Anatomy Physical Diagnosis and Assessment Histology of Female Genital Tract Female Hormonal Profile Male Reproductive Role Nonmalignant Pathology of the Female Re productive System Contraception for Family Planning Human Sexuality Obstetrics-Normal and Abnormal Pathophysiology of the Female Reproductive System
Time, Instructor
Activity
2 hrs., Nurse 2 hrs., Physician
Lecture, return, demonstration
4 hrs., Physician 4 hrs., Physician & Nurse 2 hrs., Physician 7 hrs., Physician 3 hrs., Physician 4 hrs., Physician
6 hrs., Physician & Nurse 6-8 hrs. 10 hrs., Physician 14 hrs.
Lecture, slides Lecture, return, demonstration Lecture Lecture, slides Lecture, slides, film, demonstration Lecture, slides, film Lecture, films Lecture, films Lecture, slides
For further details of the curriculum and other aspects of the Ob-Gyn Nurse Practitioner Program, write to Shirley A. Higgins, RN, Coordinator and Instructor, Ob-Gyn Nurse Practitioner Program, Department of Obstetrics and Gynecology, University Hospital, University Station, Birmingham, AL 35294. 52
March/April 1976 JOCN Nursing
Nurse Practitioner, she is currently a Coordinator of Millie Peters is currently a consultant to the Obthe Nurse Practitioner Program at University Hos- Gyn Nurse Practitioner Program at University Hospital in Birmingham and a Clinical Nursing Asso- pital, Birmingham, and an Assistant Professor at the ciate at the University of Alabama School of Nurs- University of Alabama School of Nursing. She has a ing. She has previously held staff and head nurse BSN from the University of Alabama and an M N positions in Ob-Gyn and pediatrics and is a member in Maternity Nursing from the University of Pitof ANA and NAACOG. tsburgh and is a member of NLN, ANA, and NAACOG. She has had past experience as a staff Hugh Shingleton took his MD at Duke University, nurse and as a Clinical Instructor. having received his premedical AB degree from that University also. He has done cancer research under Judith Holcombe, a graduate of Carraway Methodtwo fellowships, one from the American Cancer ist Hospital School of Nursing in Birmingham, of Society and the other from the United States Public Drury College ( B S N ) in Springjield, Missouri, and Health Service, and is currently Chief of the Divi- of the University of Alabama ( M S N ) , is currently at sion of Gynecologic Oncology at the University of the University as a Coordinator of Long-Term Alabama in addition to being a Professor of Obstet- Medical-Surgical Nursing and consultant to the rics and Gynecology and an Assistant Professor of Ob-Gyn Nurse Practitioner Program. She has been Pathology at that institution. He has published active with the American Cancer Society and the widely in medical journals and is a member of American Red Cross and is a member of NLN, ANA, Oncology Nurses, and NAACOG. numerous professional organizations.
NURSING SUPERWSOR MANAGEMENT CONFERENCE The Third National Hospital Nursing Supervisor Management Conference will be held at the Marriott Hotel in Los Angeles, California on June 17-20. The conference will feature a seminar on personal development led by Joyce Brothers, PhD, and will offer other seminars and workshops on such topics as the labor union movement in health care, management effectiveness, communications skills, and coaching, counseling, and interviewing. This conference has been designed for a wide spectrum of participants including obstetrics supervisors, assistants, and head nurses. The fee is $75.00. For further information and registration materials contact Gordon M. Marshall, Hospitul Topics, 734 Siesta Key Circle, Sarasota, FL 33581.
March/April 1076 JOCN Nursing
53
