18 December 2008

The role of nurses in abortion services

Lisa Maith, parliamentary officer of the Royal College of Nursing, discusses the background to the RCN's new guidance.

The role of nurses in abortion services has developed in response to a number of internal and external drivers. The political drive to reorganise the NHS, while modernising and developing the role of health professionals within it, provides an ideal backdrop for professional and service development.

The Royal College of Nursing has recently published guidance for its nursing members working in abortion services. As a result of changes in practice and the advancing role of nurses in providing abortion services, nurses from the RCN’s Termination of Pregnancy Network considered it appropriate to further revise the guidance, which was last reviewed in 1997.

Since the late 1960s, the authorisation and provision of abortion has been the legal responsibility of a registered medical practitioner and the strict requirements are set out in the Abortion Act 1967. The role of the nurse was historically to provide general nursing care. However, recent advances in abortion methods, particularly medical abortion (abortion stimulated by drugs rather than surgical removal), have led to the development of innovative nursing roles and a more holistic provision of nursing care. Nurses are now planning, leading and managing a significant proportion of care for women undergoing medical abortion, under the guidance of a registered medical practitioner.

In the past year there has been a considerable amount of attention on the role of nurses in abortion care. The Human Fertilisation and Embryology(HFE) Bill  and a Commons Select Committee inquiry both provided the opportunity to discuss abortion care at the highest levels and this generated debate amongst the media and public.

Ahead of the HFE Bill entering Parliament, the Commons Science and Technology Committee launched an inquiry into scientific developments relating to the Abortion Act 1967. The RCN consulted members who work in abortion services to inform its submission to the Committee in August 2007. The inquiry was completely focused on scientific developments and did not look at ethical or moral arguments. While the RCN acknowledges and respects those nurses who have a conscientious objection to providing abortion care, the organisation is committed to providing support to those nurses who do work in abortion to provide safe and quality care. We therefore thought it was important to submit evidence to this inquiry.

Following this consultation it was clear that those RCN members who worked in this clinical field felt the law on abortion required modernisation. These members saw both the requirement for two doctors to agree that a woman can have an abortion and the law that prohibits nurses and midwives from performing early surgical abortions as outdated. Both these views were adopted by the Committee in their final report.

Despite the law on abortion remaining unchanged following the passage of the Bill the nursing profession remains committed to developing more responsive, patient-centred services. Opportunities for nurses, in conjunction with medical colleagues, to take a far more proactive role in developing abortion services across England, Scotland and Wales have been created as a result of the European Working Time Directive. In addition, the increasing number of doctors ‘opting out’ of providing abortion services has resulted in gaps in service provision, which has led to further opportunities for enhanced development of nursing roles in providing medical termination of pregnancy.

The current climate of change in health care provides an ideal opportunity for clinical leaders to shape the way abortion services are provided in the future. The development of a designated resource to achieve this (for example, consultant nurse, clinical nurse specialist and nurse practitioner roles) has been successful in shaping local, regional and national nursing practice in caring for women undergoing abortion. All nurses have an opportunity to lead from a clinical perspective and can be empowered to influence change in service provision and practice development, ensuring improved services for women undergoing abortion within the legal framework.

The RCN remains committed to helping those members who work in abortion care. There have been considerable developments for nurses working in this field since the Abortion Act 1967. We hope our new guidance will provide accurate and up-to-date clinical and legal information while also empowering nurses that work in abortion care to develop their roles and promote best practice.

Abortion care: RCN guidance for nurses, midwives and specialist community public health nurses can be downloaded for free here.