Women's Health Nurse Practitioners, Feminism, and Women's Studies
Bernhard, Linda A., Women's Studies Quarterly
Women's health is an interdisciplinary field concerned with meeting the health needs of women across the lifespan in the context of their own lives. Women's health is a philosophical worldview and approach to working with women that evolved from the feminist women's health movement (WHM). As such, women's health has its origins in reproductive health, but it is holistic and includes other biological aspects-as well as social, psychological, emotional, spiritual, historical, and political aspects-of women's lives.
Women's health as a specialty in nursing began in the early 1980s when women's health centers suddenly appeared in hospitals across the country. The radical, alternative approach to care for women (as seen in feminist women's health centers) was being co-opted by hospitals and health care systems that needed nurses to staff these women's health centers. So, nursing created master's degree programs in women's health.1 Those early nursing programs often included feminist principles and praxis, and the emphasis was on the specialty of women's health. By the 1990s, however, most nursing graduate programs were transformed from educating nurse specialists to educating nurse practitioners, including women's health nurse practitioners.2 Nurse practitioners are more likely to emphasize general clinical nursing care than specialty practice.
Today, women's health nurse practitioners (WHNPs) are master's degree-prepared nurses who focus on the care of women. Only a small number practice in the specialty of women's health as defined above; most do not. WHNPs are registered nurses, first and foremost; they are principally traditionally educated health care professionals. Their goals are to provide good nursing care to women, not necessarily to provide feminist women's health care.
In their profession, nurses have created standards and guidelines for nursing practice to enhance quality and credibility. In 1996, two organizations that were created as nursing organizations, the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN; formerly the Nurses' Association of the American College of Obstetrics and Gynecology) and the National Association of Nurse Practitioners in Reproductive Health (NANPRH; now the National Association of Nurse Practitioners in Women's Health),3 published "clear, unified guidelines for [the] practice and education" (p. 1, NANPRH, 1996) of WHNPs, to promote similarity across nursing programs. Although the WHNP is described in the guidelines as a "specialist in the field of women's health" (p. 1), women's health is not defined in the guidelines-as feminist or in any other way, and there is nothing in the guidelines that is unique to women's health. Rather, the guidelines emphasize good nursing. Any nurse could use the six guidelines-client care, nurse-client relationship, health education and counseling, professional role, managing health care delivery, and quality of care.
After the guidelines were published, Linda Andrist, a feminist, WHNP, and WHNP educator at MGH Institute of Health Professions, in Boston, mailed a survey to 31 graduate nursing programs that were identified as educating WHNPs. What she found from the 28 programs that responded was a lack of consensus about how WHNPs should be educated, and even in how they were titled (Andrist, 1998). There were at least five different titles (women's primary care nurse practitioner, women's nurse practitioner, women's health/obstetric-gynecology nurse practitioner, women's health care nurse practitioner, and women's health nurse practitioner). The confusion in titling reflects differences in program content and focus, but it appears that rather than maintain any feminist framework that once existed, WHNPs are becoming medicalized themselves, becoming more like conventional medical doctors (particularly obstetricians and gynecologists), than like feminist women's health specialists.
But it does not have to be that way! …