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NAPNAP position statements
w NAPNAP Position Statements
T
he following statements were approved at the June 1991 meeting of the Executive Board of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP). w CHILDREN:
A PHiLOSOPHICAL
STATEMENT
The National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) believes that children are the nation’s most treasured natural resource. The nation’s prospective competency, creativity, prosperity, and leadership depends on developing the potential of all of our children. For these reasons, children merit nurturing and saGeguarding, education and investment to enable them to develop the skills, knowledge, and values necessary to fulfill their roles in our country and in the world. As a natural resource, children can be ignored, squandered, exploited,, and lost. To ensure that the outcomes for children are given maximal opportunity, NAPNAP as an organization of professional health care providers, proclaims the nation’s treasure to be its children. Furthermore, NAPNAP undertakes an advocacy role for the protection and promotion of children’s well being.
IOURNAL
OF PEDIATRIC
HEALTH
CARE
n
.
HEALTH: PHILOSOPHICAL
STATEMENT
The National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) supports the World Health Organization’s (WHO) definition of “health” as a state of complete physical, mental, and social wellbeing and not the mere absence of disease or infirmity. NAPNAI? believes that the enjoyment of the highest attainable standard of health is a fundamental right of every human being regardless of age, race, religion, political belief, social or economic status. It is not a commodity purchased only by those who can afford it. All human beings deserve the opportunity to enhance their personal health potential through access to quality health care services. Children, our most treasured natural resource, deserve universal access to quality health care services in order that they may grow and develop to their full potential as adults. NAPNAP endorses the WHO strategy and goal calling for the reorganization of health service delivery so that all those prepared for service can be used most effectively to reach the maximum number of people. NAPNAP believes that nurse practitioners can competently provide the quality, cost-effective health care our nation’s children deserve. NAPNAP is an organization of professionals dedicated to providing such quality care for children and to being an advocate for the protection, evaluation, and promotion of children’s physical, mental, emotional, and social well being.
339
Deborah Coody, MSN, RN, CPNP University of Texas kkdical School Department of Pediatrics Houston, Texas
BOARD MEMBER HlGHllCHT Patricia Bi?&iigs-Certification Chair
n
Properprof~siOmlcertification is fundamentaltociinical practice fisr pediatric nurse practitioners. As Certification Chair for NAPNAP since 1987, Pattie Billings interfaces with the National Certification Board of Pediatric Nurse Practitioners and Nurses and other certifj+ hoards. She represents NAPNAPs views and is extremely knowkzdgeable in all areas of certification. Pattie has been involved with NAPNAP since 1979, as Secretary and President of the San Diego Chapter, Policy and Position Statement Committee Member, and National Certification Chair, Pattie received her BS in nursing at Loma Linda University in 1967. She completed a Master of Public Health at Lom.a Linda University in 1971. She obtained pediatric nurse practitioner training at the University of California at San Diego in 1979. Since 1985 Pattie has been employed at Sharp Rees Steely Medical Group, a large multi-specialty private medical group in San Diego. She pe:rforms welI child examinations, assesses and treats children with acute and chronic illnesses, and serves as a preceptor to nurse practitioner students. From 1974 to 1985 she was a school nurse for the Vista School District in Vista, California, where she was responsible for the health care for 3,000 high school students. From 1967 to 1974 she worked as a public health nurse for the San Bemadino and Diego County Health Departments. Pattie has two children: Garrett (22), who is a budding science fiction writer, is studying to become a park ranger at Palomar Junior College in Escondido, and Shama (19) who is attending college in San Luis Obispo plans to become a teacher or a psychologist. Both of her children are planning to get married this year. In 1989 Pattie married Russ Billings at sundown, during a m moon, on a bridge over a pool in her back yard, on the date of her parents’ anniversary. She reports that the wedding was perhaps the most romantic in the history of mankind. She and Russ have three dogs, six cats, and a cockatoo named Margarita. They have recently named their house ‘Wild Animal Park West.” Pattie has a myriad of interests and hobbies. She and
340
Patricia
Billings
Russ recently invested in an Italian restaurant in Hillcrest, California. She swims, grows orchids and roses, raises avocados, and recently bought a pair of Rollerblade skates. When asked about !&ture goals, Pattie said that she is very comfortable where she is in her career and home life, yet would like to become more involved in speaking, writing, and research. What are her biggest concerns about children’s health care today? She is most concerned about “the lost children,” those with no health insurance or health care. She does what she can on a personal level by donating care through her practice to certain needy individuals. When asked what advice she can offer to colleagues in the field, she responded by saying, “Keep your options open. The more you give to your profession, the more you will get back.” Thanks to Pattie Billings for her unmitigated energy and interest in the we&u-e of all certified and certification-eligible pediatric nurse practitioners. n
NAPNAP OPPOSES THE GAG RUtE
Recently, the NAPNAP Executive Board adopted the following position statement regarding the “Gag Rule.” The Supreme Court on May 23, 1991, in Rust v.
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health
NAPNAP
Care
Sullivan ruled to not allow Title X projects to provide counseling concerning the use of abortion as a method of family planning. NAPNAP views this denial of freedom of speech and not an abortion issue. NAPNAP opposes this ruling. This is an issue of the fundamental denial of universal access to information and curtailment of professional counseling to clients. It is the responsibility of pediatric nurse practitioners to present all therapeutic options to clients. Background on the Issue
On May 23, 1991, the Supreme Court by a 5 to 4 decision in Rust v. Sulliv& upheld the 1988 Department of Health and Human Services (HHS) regulations to Title X, or Family Planning Clinics, otherwise known as the “Gag Rule.” At issue to the central argument in the Supreme Court ruling is that the 1988 regulations violate the Constitution’s First Amendment guarantee of free speech as they impede a health care professional from informing a pregnant woman of the various options among which she may choose. It places health care professionals in a situation where they may leave themselves open to malpractice suits if they withhold information that may be necessary for their patient’s health. Rust v. Sullivan involved regulations issued by the Department of Health and Human Services (HHS) in 1988 that have been tied up in litigation until 1991. The regulations were designed to implement a provision passed by Congress 18 years ago when the lawmakers enacted an extensive population research and planning program known as Title X of the Public Health Service Act. As part of that law, Congress said: “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” In 1971, HHS’s predecessor agency, the Department of Health, Education and Welfare, interpreted that language to mean that clinics could not use Title X money to perform abortions. Grant recipients were willing to live with that rule and generally referred patients who wanted abortions to other facilities. Others performed abortions themselves, but paid for them with money from other sources. However, in 1971, the Reagen administration decided that the 198 1 interpretation of the law was wrong. In 1988, the Reagan administration issued regulations that were called the “gag rule.” At the heart of the new Supreme Court ruling is the statement, “a Title X project may not provide counseling concerning the use of abortion as a method of family planning or provide referral for abortion as a method of family planning.”
Update
341
Under the regulation, it informs staff of family planning clinics that when a client becomes pregnant she must be referred ‘Yor appropriate prenatal and/or social services by furnishing a list of available providers that promote the welfare of the mother and the unborn child.” If a pregnant woman expressly asks how she can get an abortion, the recommended answer is: ‘The project does not consider abortion an appropriate method of family planning and therefore does not counsel or refer for abortion.” Outlook
A long-term strategy involves getting the regulations rescinded. Some believe that further litigation could overturn the regulations. Others have focused their attention on Congressional interventions that would prohibit the rules from ever going into effect. Several legislative initiatives are under current consideration that have caused the White House to decide that it will take another look at “gag rule” regulations that prohibit any form of abortion counseling at federally funded family planning clinics. The legislative initiatives as of September of 1991 are as follows: A provision that was included in the appropriations bill for the Departments of Labor, Health and Human Services and Education passed on a vote of 353 to 74. The provision would overturn the “gag rule” regulations. Because of numbers regarding the vote, there is some doubt that a Presidential veto could be sustained. Consideration of the Senate appropriations bill is anticipated in September where similar action is expected to occur. In addition, the issue will be further determined in a conference between the House and Senate on the appropriations bill. S.323 recently passed the Senate and would overturn the regulations barring abortion counseling in federally funded family planning clinics. This bill now awaits consideration by the House Energy and Commerce Committee. NAPNAP FOUNDATION FUNDS AVAILABLE
n
RESEARCH
The NAPNAP Foundation is accepting applications for research grants related to the delivery of primary health care services to children and their families or for research that demonstrates the effectiveness of the nurse practitioner. Grant applications must be postmarked by December 31, 1991. To donate to the foundation or to obtain a brochure with information on applying for a grant, contact the NAPNAP National Office.
342
Volume 5, Number 6 November-December 1991
NAPNAP Update
w CHltDREiN
THROUGH
LJTERATURE
“I am certain that children always know more than they are able to tell, and that makes the big difference between them and adults, who, at best, know only a fraction of what they say. The reason is simply that children know everything with their whole beings, while we know it only with our heads.” Jacques Lusseyran
n
MARK YOUR CALENDAR!
NAPNAP’s 13th Annual Conference will be held March ll-14, 1992, in San Antonio, Texas. Plan now to attend!
T
he following statements were approved at the June 1991 meeting of the Executive Board of the National Association of Pediatric Nurse Associates and Practitioners (NAPNAP). w CHILDREN:
A PHiLOSOPHICAL
STATEMENT
The National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) believes that children are the nation’s most treasured natural resource. The nation’s prospective competency, creativity, prosperity, and leadership depends on developing the potential of all of our children. For these reasons, children merit nurturing and saGeguarding, education and investment to enable them to develop the skills, knowledge, and values necessary to fulfill their roles in our country and in the world. As a natural resource, children can be ignored, squandered, exploited,, and lost. To ensure that the outcomes for children are given maximal opportunity, NAPNAP as an organization of professional health care providers, proclaims the nation’s treasure to be its children. Furthermore, NAPNAP undertakes an advocacy role for the protection and promotion of children’s well being.
IOURNAL
OF PEDIATRIC
HEALTH
CARE
n
.
HEALTH: PHILOSOPHICAL
STATEMENT
The National Association of Pediatric Nurse Associates and Practitioners (NAPNAP) supports the World Health Organization’s (WHO) definition of “health” as a state of complete physical, mental, and social wellbeing and not the mere absence of disease or infirmity. NAPNAI? believes that the enjoyment of the highest attainable standard of health is a fundamental right of every human being regardless of age, race, religion, political belief, social or economic status. It is not a commodity purchased only by those who can afford it. All human beings deserve the opportunity to enhance their personal health potential through access to quality health care services. Children, our most treasured natural resource, deserve universal access to quality health care services in order that they may grow and develop to their full potential as adults. NAPNAP endorses the WHO strategy and goal calling for the reorganization of health service delivery so that all those prepared for service can be used most effectively to reach the maximum number of people. NAPNAP believes that nurse practitioners can competently provide the quality, cost-effective health care our nation’s children deserve. NAPNAP is an organization of professionals dedicated to providing such quality care for children and to being an advocate for the protection, evaluation, and promotion of children’s physical, mental, emotional, and social well being.
339
Deborah Coody, MSN, RN, CPNP University of Texas kkdical School Department of Pediatrics Houston, Texas
BOARD MEMBER HlGHllCHT Patricia Bi?&iigs-Certification Chair
n
Properprof~siOmlcertification is fundamentaltociinical practice fisr pediatric nurse practitioners. As Certification Chair for NAPNAP since 1987, Pattie Billings interfaces with the National Certification Board of Pediatric Nurse Practitioners and Nurses and other certifj+ hoards. She represents NAPNAPs views and is extremely knowkzdgeable in all areas of certification. Pattie has been involved with NAPNAP since 1979, as Secretary and President of the San Diego Chapter, Policy and Position Statement Committee Member, and National Certification Chair, Pattie received her BS in nursing at Loma Linda University in 1967. She completed a Master of Public Health at Lom.a Linda University in 1971. She obtained pediatric nurse practitioner training at the University of California at San Diego in 1979. Since 1985 Pattie has been employed at Sharp Rees Steely Medical Group, a large multi-specialty private medical group in San Diego. She pe:rforms welI child examinations, assesses and treats children with acute and chronic illnesses, and serves as a preceptor to nurse practitioner students. From 1974 to 1985 she was a school nurse for the Vista School District in Vista, California, where she was responsible for the health care for 3,000 high school students. From 1967 to 1974 she worked as a public health nurse for the San Bemadino and Diego County Health Departments. Pattie has two children: Garrett (22), who is a budding science fiction writer, is studying to become a park ranger at Palomar Junior College in Escondido, and Shama (19) who is attending college in San Luis Obispo plans to become a teacher or a psychologist. Both of her children are planning to get married this year. In 1989 Pattie married Russ Billings at sundown, during a m moon, on a bridge over a pool in her back yard, on the date of her parents’ anniversary. She reports that the wedding was perhaps the most romantic in the history of mankind. She and Russ have three dogs, six cats, and a cockatoo named Margarita. They have recently named their house ‘Wild Animal Park West.” Pattie has a myriad of interests and hobbies. She and
340
Patricia
Billings
Russ recently invested in an Italian restaurant in Hillcrest, California. She swims, grows orchids and roses, raises avocados, and recently bought a pair of Rollerblade skates. When asked about !&ture goals, Pattie said that she is very comfortable where she is in her career and home life, yet would like to become more involved in speaking, writing, and research. What are her biggest concerns about children’s health care today? She is most concerned about “the lost children,” those with no health insurance or health care. She does what she can on a personal level by donating care through her practice to certain needy individuals. When asked what advice she can offer to colleagues in the field, she responded by saying, “Keep your options open. The more you give to your profession, the more you will get back.” Thanks to Pattie Billings for her unmitigated energy and interest in the we&u-e of all certified and certification-eligible pediatric nurse practitioners. n
NAPNAP OPPOSES THE GAG RUtE
Recently, the NAPNAP Executive Board adopted the following position statement regarding the “Gag Rule.” The Supreme Court on May 23, 1991, in Rust v.
JOURNAL
OF PEDIATRIC
HEALTH
CARE
Journal of Pediatric Health
NAPNAP
Care
Sullivan ruled to not allow Title X projects to provide counseling concerning the use of abortion as a method of family planning. NAPNAP views this denial of freedom of speech and not an abortion issue. NAPNAP opposes this ruling. This is an issue of the fundamental denial of universal access to information and curtailment of professional counseling to clients. It is the responsibility of pediatric nurse practitioners to present all therapeutic options to clients. Background on the Issue
On May 23, 1991, the Supreme Court by a 5 to 4 decision in Rust v. Sulliv& upheld the 1988 Department of Health and Human Services (HHS) regulations to Title X, or Family Planning Clinics, otherwise known as the “Gag Rule.” At issue to the central argument in the Supreme Court ruling is that the 1988 regulations violate the Constitution’s First Amendment guarantee of free speech as they impede a health care professional from informing a pregnant woman of the various options among which she may choose. It places health care professionals in a situation where they may leave themselves open to malpractice suits if they withhold information that may be necessary for their patient’s health. Rust v. Sullivan involved regulations issued by the Department of Health and Human Services (HHS) in 1988 that have been tied up in litigation until 1991. The regulations were designed to implement a provision passed by Congress 18 years ago when the lawmakers enacted an extensive population research and planning program known as Title X of the Public Health Service Act. As part of that law, Congress said: “None of the funds appropriated under this title shall be used in programs where abortion is a method of family planning.” In 1971, HHS’s predecessor agency, the Department of Health, Education and Welfare, interpreted that language to mean that clinics could not use Title X money to perform abortions. Grant recipients were willing to live with that rule and generally referred patients who wanted abortions to other facilities. Others performed abortions themselves, but paid for them with money from other sources. However, in 1971, the Reagen administration decided that the 198 1 interpretation of the law was wrong. In 1988, the Reagan administration issued regulations that were called the “gag rule.” At the heart of the new Supreme Court ruling is the statement, “a Title X project may not provide counseling concerning the use of abortion as a method of family planning or provide referral for abortion as a method of family planning.”
Update
341
Under the regulation, it informs staff of family planning clinics that when a client becomes pregnant she must be referred ‘Yor appropriate prenatal and/or social services by furnishing a list of available providers that promote the welfare of the mother and the unborn child.” If a pregnant woman expressly asks how she can get an abortion, the recommended answer is: ‘The project does not consider abortion an appropriate method of family planning and therefore does not counsel or refer for abortion.” Outlook
A long-term strategy involves getting the regulations rescinded. Some believe that further litigation could overturn the regulations. Others have focused their attention on Congressional interventions that would prohibit the rules from ever going into effect. Several legislative initiatives are under current consideration that have caused the White House to decide that it will take another look at “gag rule” regulations that prohibit any form of abortion counseling at federally funded family planning clinics. The legislative initiatives as of September of 1991 are as follows: A provision that was included in the appropriations bill for the Departments of Labor, Health and Human Services and Education passed on a vote of 353 to 74. The provision would overturn the “gag rule” regulations. Because of numbers regarding the vote, there is some doubt that a Presidential veto could be sustained. Consideration of the Senate appropriations bill is anticipated in September where similar action is expected to occur. In addition, the issue will be further determined in a conference between the House and Senate on the appropriations bill. S.323 recently passed the Senate and would overturn the regulations barring abortion counseling in federally funded family planning clinics. This bill now awaits consideration by the House Energy and Commerce Committee. NAPNAP FOUNDATION FUNDS AVAILABLE
n
RESEARCH
The NAPNAP Foundation is accepting applications for research grants related to the delivery of primary health care services to children and their families or for research that demonstrates the effectiveness of the nurse practitioner. Grant applications must be postmarked by December 31, 1991. To donate to the foundation or to obtain a brochure with information on applying for a grant, contact the NAPNAP National Office.
342
Volume 5, Number 6 November-December 1991
NAPNAP Update
w CHltDREiN
THROUGH
LJTERATURE
“I am certain that children always know more than they are able to tell, and that makes the big difference between them and adults, who, at best, know only a fraction of what they say. The reason is simply that children know everything with their whole beings, while we know it only with our heads.” Jacques Lusseyran
n
MARK YOUR CALENDAR!
NAPNAP’s 13th Annual Conference will be held March ll-14, 1992, in San Antonio, Texas. Plan now to attend!