Advance Practice Nurses Play Key Roles on Women’s Health Team

With the growing demand in healthcare for advanced practice providers (APPs), opportunities are expanding for caregivers to develop career paths that offer greater independence and new ways to improve the patient experience.

At Cleveland Clinic’s Women’s Health Institute, advanced practice registered nurses (APRNs) serve as crucial care team members, bringing expertise to patient intake, diagnostic evaluations, pre- and post-operative counseling, and, in some cases, procedures requiring advanced or specialized training.

In the Institute’s Department of Urogynecology, advanced practice providers are full collaborators with physicians in patient care, says Katie Propst, MD. Ultimately, she says, patients benefit from the team approach.

“It’s really about sharing the work so that there’s always someone available for what our patients need,” says Dr. Propst.

According to the U.S. Bureau of Labor Statistics, the projected demand for nurse practitioners is expected to reach 322,000 by 2029 – a jump of 52% compared to the number employed in 2019. The demand is expected to grow by more than 40% for nurse anesthetists and 12% for nurse midwives.

At Cleveland Clinic, APRNs are making a difference in urogynecology, a sub-specialty that addresses pelvic organ prolapse and urinary incontinence in women.

“We know that our services are going to be needed more and more in the future because the population is aging, and these tend to be disorders that women encounter later in life,” Dr. Propst says. “Advanced practice providers play a vital role in the growing need for specialized urogynecologic care.”

The APPs in the practice see patients independently, and they may see new or follow-up patients to care for pelvic floor disorders, and to help follow up on labs and imaging results for patients. Some have a more specialized practice.

“One of our nurse practitioners works in our transgender medicine program and assists with surgical cases,” Dr. Propst says.

Abigail Anderson, MSN, CNP, was a labor and delivery nurse before pursuing her nurse practitioner credentials. While working in the Women’s Health Institute, she developed an interest in subspecializing in urogynecology. She has been mentored by physicians in the practice, but feels like a full partner among the providers.

“We’re a team model for sure. There are four nurse practitioners in our practice, and we have four to five fellows training with us each year as well,” Anderson says. “We support the surgical practice, but we also have an independent practice for medical management of our patients.”

Anderson sees patients before and after surgery, and sees non-surgical patients for ongoing management of urinary incontinence, pelvic organ prolapse, pessary fitting and management, fecal incontinence, sexual dysfunction and vaginal atrophy.

“One additional element is the postpartum care clinic, which has become a significant part of my practice,” Anderson adds. “It’s a specialty clinic for postpartum patients who have experienced obstetrical anal sphincter injuries or other pelvic floor trauma with childbirth. We see these patients throughout their postpartum course starting as soon as one or two weeks after delivery, and then we follow them until their issues are resolved.”

Anderson is grateful to Dr. Propst and former department fellow Lisa Hickman, MD, who encouraged her interest in working with the postpartum care clinic.

“When I heard about what they were doing, I reached out to them,” Anderson says. “They were happy to take me on board and provided education and training to prepare me for my role in the clinic.”

Career paths and specialization

Educational opportunities and career development are among the benefits of an APP career. In women’s health, says Dr. Propst, APPs are encouraged to partake in the same seminars and conferences that doctors attend.

“We promote education for everyone, not just for residents or fellows or physicians,” Dr. Propst says. “When our APPs identify an area of interest, we support them in pursuing it.”

This summer, Anderson will join Dr. Propst at a conference of the American Urogynecologic Society. She will participate in a presentation by physicians and a physical therapist about the postpartum care clinic, and she will give lectures independently on other topics.

“This is something new for me, and it’s definitely a little challenging, but it’s also exciting,” Anderson says. “I feel that I can have space to grow in my role as an APP.”

Across the health system, APP roles have been growing, says Maureen Schaupp, MSN, APRN-CNP, CHFN, Associate Chief Nursing Officer for Advanced Practice Nursing and Nursing Quality and Practice.

“In the 15 years that I have spent at Cleveland Clinic, the number of opportunities has just grown exponentially, and it has grown in so many different areas,” Schaupp says. “Advanced practice registered nurses are in every corner of this organization. There’s a lot of room for clinical growth, and room for professional growth as well.”

In January, an inaugural cohort of APRNs embarked on a yearlong professional pathways program developed by the APRN Council at Cleveland Clinic. Spearheaded by Pamela Combs, DNP, APRN and Anne Banas, MSN, APRN, the program established curriculum for each of four pathways for APRNs who are interested in developing expertise.

“They’ve put together four different pathways for research, leadership, quality and education,” Schaupp says. “These are all programs to help develop our caregivers even further, if one of these four things are something that they think that they are interested in developing for themselves for the future.”

For Anderson, developing an advance practice career has fulfilled two goals – to work with more autonomy and to be part of a team.

“Being able to practice to my full scope of my licensure is rewarding,” she says. “And if I get in a situation where I feel that something is beyond my scope, I can go to any of the physicians I work with and present that patient, and feel that we’re all working for the same goal: to support our patients.”