What Are Some of the Legal Concerns for Women’s Health / OBGYN NPs?
Women's Health Nurse Practitioners often act as a patient's primary care provider for women's health maintenance and reproductive health. As such, there are specific legal concerns that Women's Health NPs need to be cognizant of.
One of the main concerns is scope of practice. Nurse practitioners need to be aware of the specific scope of practice laws in their state. Some can practice independently, while some require physician oversight. Acting outside of scope of practice sets an NP up for litigation and can risk losing their license.
Nurse practitioners pride themselves on providing care that is equivalent to that of an MD. They also offer a great deal of patient education. Women's Health NPs must be sure to educate patients thoroughly on issues as failure to do so can affect not only the patient's health but fetal health as well. For example, an expectant mother with gestational diabetes requires education on the disease process, diet and nutrition, blood glucose monitoring, and medications. Failure to provide this education can lead to complications at birth.
Thorough documentation of education is also necessary, as well as the patient's response. Documenting that the expectant mother successfully completed a return demonstration of insulin self-injection, for example, indicates the teaching was effective.
Women's Health / OBGYN NPs may also face legal concerns when counseling patients on reproductive health, such as birth control methods and side effects. Special care must be taken when counseling teenagers. Some states have privacy laws protecting teenagers; teens can be prescribed birth control without their parents' knowledge. Women's Health NPs should be aware of the privacy laws in their state.
Additionally, abortion counseling should be thorough and well documented as well. Many facilities have specific requirements for patients seeking abortions, for example, pregnancy options should be discussed along with future birth control counseling. Procedure and medication side effects need to be addressed and with response documented.
Childbirth itself also presents legal concerns. Fetal demise, unexpected C-Sections, perineal tears, and injury during delivery can occur. Parents are distraught when a birth has an adverse outcome, and many families need answers for emotional closure. Women's Health NPs should carefully monitor patients, document treatments along with the response to treatment, and educate the patient and family along the way. Calling in a colleague or MD may be necessary. Any necessary procedure should have a documented informed consent indicating the patient was educated on the procedure and potential risks and has agreed to move forward.
Women's Health nurse practitioners have an enriching career. Unfortunately, in the world of healthcare, legal action is widespread. NPs can avoid this risk by educating, practicing within their scope, maintaining ethical decorum, knowing limitations, and documenting thoroughly.
Amanda Bucceri Androus RN, BSN
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