Early Options: Staffing

Early Options - A Provider's Guide to Medical Abortion

This page contains the following sections:

Physician-Only Laws
Staff Preparation and Training

The number and types of staff required to provide medical abortion will depend on practice size, patient volume, additional services offered at the facility, and state laws governing the scope of abortion practice. In small practices, the physician may counsel patients and perform all clinical functions. Depending on specific state laws, advanced practice clinicians (such as physician assistants, nurse practitioners, and certified nurse-midwives) or nurses may also be able to provide the entire service.

Clinics providing abortion services to a large number of women may employ a number of individuals, such as receptionists and telephone staff, counselors, ultrasonographers, and clinicians, to perform the different functions. In general, the physical examination, administration of medications, and on-call services are provided by licensed personnel; unlicensed personnel can provide screening, counseling, and initial on-call triage.

Physician-Only Laws
Many states have "physician-only" laws that prohibit anyone other than a licensed physician from providing an abortion. However, some state practice acts authorize specific health care providers, such as nurse practitioners, nurse-midwives, or physician assistants, to prescribe and/or dispense certain medications, and in most cases these state practice acts are more recent and more specific than physician-only laws.

Whether state practice acts preempt physician-only laws in the context of medical abortion will depend on how a state court or the state's health care agency interprets the laws. This issue is further complicated by the fact that there are many steps involved in providing medical abortion services and that there is enormous ambiguity regarding which steps in the process constitute "performing" the abortion and thus may be limited to the realm of physicians by physician-only laws.

In some states, there has been clarification. For example, legislation in California, administrative rule changes in Rhode Island, and an attorney general opinion in Connecticut and Washington have specifically established the role of some advanced-practice clinicians in providing medical abortions in those states. In the absence of such clarification, a physician-only law could limit the ability of nurse-midwives, nurse practitioners, and physician assistants to provide medical abortion care.

Staff Preparation and Training
Providing medical abortion requires a joint commitment from key members of the clinic or office staff. Clinicians and administrators who decide to offer medical abortion services should take into account the attitudes, feelings, and reactions of other staff members who will participate in one way or another in delivering medical abortion services, including receptionists, counselors, nurses, and office managers.

Some staff members may harbor certain prejudices about abortion in general, or medical abortion in particular. For this reason, acknowledging and exploring one's own thoughts, feelings, and attitudes is a vital component of the initial training program.

This process, often described as "values clarification," can foster greater self-awareness, better enabling staff members to present abortion information in an objective and nonjudgmental fashion.

Staff at every level of the organization should be educated about the provision of medical abortion. The overview of the medical abortion service should cover relevant clinical, administrative, and political issues.

Key staff who will be interacting with patients on-site or by telephone need copies of the clinical protocols as well as information on how to answer frequently asked questions about medical abortion. They must also learn about palliative measures and standard operating procedures for handling complications, and have ready access to emergency contact lists of 24-hour pharmacies and collaborating emergency departments.

The level of training required for the various staff members involved in providing medical abortion services will depend on the actual role each member will play. Cross-training can enhance the overall efficiency of the practice while enabling staff members to acquire new skills. All staff should learn appropriate ways to interact with a patient at each stage of the medical abortion process.

Even after the training is complete, practices should be prepared to handle the staff concerns that typically arise when any new service is introduced.

Proceed to The Medical Abortion Procedure.

References for this module