“Abortion has become an increasingly safe procedure that can be performed across a diverse range of health settings and as the ACT has shown, there is no doubt that nurses and midwives can be trained to provide comprehensive abortion care.”Professor Heather Douglas, School of Law. University of Queensland
A shortage of trained providers is a significant barrier to accessing abortion care services in Australia. When coupled with a growing global shortage of healthcare workers, the need for more innovative models of care that better utilise the skills of doctors and nurses is a critical consideration for health systems across the world.
While doctors play a leading role in abortion provision, evidence from across the world shows that nurses can and should play a greater, more autonomous role in abortion care provision, particularly early medical abortion. Evidence from the World Health Organisation (WHO) shows that nurse and midwife led abortion care models are clinically safe, effective and acceptable to pregnant people.
In Australia, access to abortion care in rural, regional, and remote settings is a challenge. Nurses, particularly Nurse Practitioners, are skilled at providing vital services and abortion care should be no exception. Our health system in Australia is built on innovations including early adoption of telehealth models, so nurse-led models of care represent another step in our health systems journey towards innovation for access.
Nursing in Australia
Nurses use a patient-centred approach to provide holistic care. Their work includes clinical care, care coordination, directing quality and safety in care, facilitating evaluation and research, and advocating for policy and legislative reforms. The importance of investment in development of nurse leadership is recognised by our international commitments and domestic policy.
Nurse-led care is often used to broadly refer to clinical practice where nurses, nurse practitioners and/or midwives have leadership roles. In the context of the paper below, the term ‘nurse-led care’ is used to refer to end to end leadership of a patient journey, whilst ‘partial nurse-led care’ to refer to a patient journey where there is partial nurse-leadership roles and doctor involvement at various points (e.g. doctors may be prescribers).
How can we advance nurse-led care?
The World Health Assembly designated 2020 as the year of the nurse and midwife. It’s timely that we expand discussions within the sector about the potential for, and benefits of nurse-led care. At MSI Australia we work with partners from across the sexual and reproductive health sector, governments and health reform advocates, to explore evidence on and opportunities for nurse-led abortion care.
In November 2020, MSI Australia published a legislative scan of nurse-led medical termination of pregnancy in Australia: The legislative scan was published in partnership with the University of Queensland (UQ) Pro Bono Centre, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) and SPHERE. In February 2022, a second edition was published — links below.
A number of systemic reforms will be required before nurse-led medical termination of pregnancy is possible across our country. The legislative considerations in this paper are a small part of a larger conversation which needs to include strategic partnerships, systems development, education and health sector capacity building, consumer advisory, evolving models of care and continuous improvement.