Women’s health nurse practitioners (WHNPs) care for women of all ages, from early adolescence to menopause and beyond. Their typical responsibilities include conducting women’s health assessments, screening for reproductive health issues such as breast and cervical cancers, and helping patients manage health problems such as endometriosis, polycystic ovarian syndrome, ectopic pregnancies, sexually transmitted diseases, and hormonal imbalances. WHNPs also provide family planning services, including birth control and guidance around contraception and fertility. Women’s health nurse practitioners typically work in primary care settings such as women’s health clinics, obstetrics and gynecology (ob/gyn) departments in larger medical centers, women’s care private practices, and community health centers. Through the preventive care and educational services they provide, WHNPs help women lead healthier lives and take more control over their reproductive health, which leads to better health outcomes, not only for their patients, but also for patients’ children and families.
Registered nurses who are interested in becoming women’s health nurse practitioners must complete a graduate nursing program with a concentration in women’s health (nurse midwifery is a related field of advanced practice nursing that also focuses on the care of women before, during, and after pregnancy, including labor and delivery) from an institution that has been accredited by the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). They must also complete a minimum of 500 hours of clinical practicum in relevant settings, such as women’s health clinics, ob/gyn departments of hospitals, private practices, and family planning clinics. After graduating, prospective WHNPs must pass a certification examination administered by the National Certification Corporation (NCC), and also research and fulfill any licensure or certification requirements outlined by the state board of nursing for their state of residence.
Where Women’s Health Nurse Practitioners Work
Women’s health nurse practitioners typically work in primary care settings that serve women at various stages in their lives, from adolescence to pregnancy to menopause and post-menopause. Examples of such settings include ob/gyn departments of hospitals and medical centers, individual and group women’s health private practices, and community health clinics.
Obstetric/Gynecology Departments of Hospitals
A common setting for women’s health nurse practitioners is ob/gyn departments of hospitals and medical centers. WHNPs do not typically attend deliveries or support women in labor, but they provide support to pregnant women before, during, and after pregnancy in collaboration with a larger team of providers. In addition, WHNPs in ob/gyn departments provide essential primary and reproductive care services to girls and women who are not pregnant. Depending on the patient population(s) they serve and the resources available to the hospital, ob/gyn departments may have different clinics that support different health needs and specific reproductive conditions. For example, a given Obstetrics and Gynecology Department may have several or all of the following specialized services or clinics:
- General Obstetrics and Gynecology: Obstetrics is defined as the branch of medicine that concerns the medical care of women during pregnancy and childbirth, while gynecology is the branch of medicine that concerns the health of women and girls, specifically the health of their reproductive system and organs. General ob/gyn clinics attend to patients who need routine reproductive health consultations, checkups, and/or procedures.
- Gynecologic Oncology: Gynecologic oncology is defined as the medical and surgical care that is provided to women experiencing cancers of their reproductive organs, including cervical cancer, ovarian cancer, and uterine cancers. WHNPs who work in gynecologic oncology clinics provide health support to patients who have undergone gynecologic surgery.
- Maternal and Fetal Medicine: Maternal and fetal medicine departments provide expert care to pregnant women with higher risk pregnancies or whose babies have fetal abnormalities.
- Fertility and Endocrinology: Some ob/gyn departments have a designated fertility and endocrinology clinic and lab devoted to fertility issues in both women and men. This type of clinic may run tests and diagnose reproductive issues such as endometriosis, amenorrhea, uterine fibroids, tubal diseases, and ovulatory abnormalities.
WHNPs in these settings typically collaborate with gynecologists, obstetricians, endocrinologists, nurse practitioners, nurse midwives, nurses, and medical assistants to provide care.
WHNPs can also provide primary care and reproductive health services to girls and women in private practice settings, which can be either a single physician’s practice or a group private practice. Women’s health private practices generally provide primary care and reproductive health services, including routine physical checkups, birth control options, screenings for reproductive health problems, minor procedures such as IUD insertions and Nexplanon implantations, and health support and guidance before, during, and after pregnancy to girls and women across the lifespan.
Women’s health private practices that provide labor and delivery services typically partner with a nearby hospital so that their patients have a designated medical center for giving birth. However, some private practices also give women non-hospital options for their labor and delivery, including natural births (a delivery without the typical medical equipment and anesthesia), at-home midwifery services, and/or water birth options. As women’s health nurse practitioners are not generally trained in nurse midwifery, unless they are dually certified as a CNM, they do not typically attend deliveries, but they can provide medical support to mothers before and after the delivery of their child.
Community Health Clinics
Community women’s health clinics often work with underserved and vulnerable populations of women to help them receive the primary care services they need to prevent and address reproductive health issues. Services that community women’s health clinics provide include birth control and emergency contraception, HIV screenings and tests for other sexually transmitted infections, family planning consultations, prenatal and post-partum care, mental and emotional health counseling, and patient education around safe sexual practices and caring for one’s sexual health. Community women’s health clinics are typically nonprofit organizations that offer medical services on a sliding scale for people who are not able to afford health insurance and who cannot pay out of pocket for health care services.
International Programs for Women’s Health
Women’s health nurse practitioners can also work for organizations that travel to countries to treat, educate, and support vulnerable female populations that do not have access to adequate reproductive health services. Alexandra Sherman, MSN, WHNP-BC is a women’s health nurse practitioner who volunteered for the nonprofit Prevention International: No Cervical Cancer (PINCC), which is now known as Preventing Cervical Cancer (PCC), after she passed her National Certification Corporation Women’s Health Nurse Practitioner board examination. “In 2011 I volunteered with Prevention International: No Cervical Cancer (PINCC) as an instructor. I have taken two trips with PINCC to Nicaragua to teach local health care providers how to screen for and treat cervical cancer,” she told OnlineFNPPrograms.com.
In addition to working in person with women in need of gynecological care, WHNPs can also work for telemedicine companies to provide remote consultations to patients via phone and online video chats. Loryn Ashton, MSN, WHNP-BC is a Women’s Health Nurse Practitioner at Southwest Obstetrics and Gynecology. In addition to her in-person work with patients in clinic, Ms. Ashton also works as a consultant for Maven, which is a mobile app for women that provides prescriptions and medical advice around reproductive and primary health concerns. In an interview with OnlineFNPPrograms.com, she explained how Maven helps women in need of timely and convenient medical advice and prescriptions. “Women can use this app to book video appointments to see a multitude of providers pending their complaint. I started with Maven working on an as needed basis seeing patients,” she said, “I see a multitude of problems: urinary tract infections, yeast, bacterial infections, need for birth control, issues with anxiety/depression, pregnancy complaints, and occasionally common colds/flu to name a few. I am allowed to prescribe medications (if necessary) to those patients in the states in which I am licensed (I am licensed in 7 states).”
Telemedicine does have some limitations due to the remote nature of the patient-provider relationship. “This app does not allow you to order labs or diagnostic tests. It also does not provide routine gynecologic care such as pap smears. As Maven is a virtual office, I cannot physically touch a patient and diagnosing some illnesses can be difficult,” Ms. Ashton noted, “However, [… the] app provides a woman with care at any time, which is extremely convenient. I have used this app myself when I wanted to speak with a pediatrician about an issue with my daughter. I can also receive texts through the app from a patient with a basic question. […] Although this is not my full time position, it truly is a great job and shows the versatility of nursing.”
What Women’s Health Nurse Practitioners Do
Women’s health nurse practitioners help adolescent girls and women across the lifespan to lead healthy lives and safely manage the reproductive milestones and challenges they encounter from menarche to menopause and beyond, including but not limited to navigating sexual health risks, having a healthy pregnancy, and managing hormonal issues. Through primary care services such as regular checkups, gynecological screenings, patient education, immunizations, and other primary care services, WHNPs support their patients in building a strong foundation of reproductive health.
WHNPs also help patients prevent and/or manage such health issues as sexually transmitted diseases (STDs), endometriosis, polycystic ovarian syndrome, gynecologic cancers (such as breast cancer, cervical cancer, uterine cancer, and ovarian cancer), pelvic inflammatory disease, uterine fibroids, amenorrhea, and anemia. Furthermore, while they do not typically attend women in labor, WHNPs help women plan for and have healthy pregnancies through education around family planning, and routine prenatal care. Below is a more detailed description of some of the core responsibilities that WHNPs fulfill.
Well Woman Exams and Reproductive Health Consultations
One of the main responsibilities that WHNPs have in clinical settings is to conduct well women examinations, including any related gynecological screenings needed in order to detect, prevent, and/or treat reproductive conditions. Many reproductive health problems that women encounter are preventable or are easier to address when detected early, and therefore well women examinations are a crucial part of female patients’ overall primary care.
Well women examinations are typically comprised of a pelvic examination, a pap smear, and a breast examination. During the exam, WHNPs also generally discuss reproductive health considerations with their patients, such as upcoming immunizations they should receive, how to conduct breast self-examinations, and birth control options.
In her interview with OnlineFNPPrograms.com, Ms. Ashton explained her core responsibilities as a WHNP at Southwest Obstetrics and Gynecology. “I strictly see gynecology patients with a variety of complications. My responsibilities include but are not limited to: obtaining a thorough medical, social, and mental history, performing an exam (if needed), obtaining pap smears, ordering labs and diagnostic imaging, inserting IUDs (birth control device), birth control counseling, providing consults, discussing and treating menopause, interpreting results, and informing patients of those results,” she said.
Specialized Medical Screenings and Support
If they discover reproductive health abnormalities during a well woman examination, WHNPs are also responsible for conducting additional tests to diagnose the problem. Upon diagnosis, WHNPs also provide guidance, treatment, referrals to specialists, and other support to ensure that patients receive the appropriate care for their reproductive health issue. In her interview with OnlineFNPPrograms.com, Ms. Sherman explained how, in addition to well woman examinations, she also connects with specialized clinics in the event of an abnormal screening, and also helps patients who have serious reproductive health complications. “I also participate in our colposcopy clinic, where I follow up on any abnormal pap smears. My visits generally involve physical assessment, collecting samples or taking biopsies, and writing prescriptions,” she said.
Though they are trained in primary care, WHNPs can support patients suffering from acute and/or critical health conditions through a combination of care coordination and patient education around the management of their condition. In her current work as a Women’s Health Nurse Practitioner at Alameda Health System, Ms. Sherman assists patients who are experiencing high-risk reproductive problems. “I see both new patients with acute high-risk problems such an ectopic pregnancy, and manage women with chronic illnesses such as polycystic ovarian syndrome (PCOS) or lichens sclerosus,” she explained to OnlineFNPPrograms.com.
Ms. Sherman also works as a Gynecological Oncology Nurse Practitioner for BASS Medical Group in Walnut Creek, California. In this role, she supports patients who have undergone or are undergoing treatment for gynecological cancers. “My role as a Gynecological Oncology Nurse Practitioner is to see patients once they have completed their treatment for endometrial, cervical, or ovarian cancer. At these visits we do the recommended surveillance, which can be something as basic as education about symptoms of recurrence or involve ordering labs and imaging,” she told OnlineFNPPrograms.com, “A lot of our visits are protocol driven, working off of the guidelines of the National Comprehensive Cancer Network (NCCN). Occasionally I see a newly diagnosed patient and get them ready for the visit with the gynecologic oncology surgeon by ordering labs, imaging, and collecting histories. As each type and subtype of cancer can dictate different follow up, I work very closely with my supervising physician. Our team at BASS is very small and is composed of myself, the surgeon, and a medical assistant. Our patient population is very varied, we see women of all ages and from all walks of life.”
Family Planning and Pregnancy Support
Women’s health nurse practitioners also provide birth control consultations and prescriptions to women, as well as advice on planning for and having a healthy pregnancy. In her interview with OnlineFNPPrograms.com, Ms. Sherman explained her responsibilities around family planning, “As a Nurse Practitioner in the Women’s Clinic at Highland Hospital, […] I do a lot of teaching and counseling regarding family planning. If a patient is interested in contraception, I explain each method to help her make her choice. If she is not interested in contraception, we talk about how to optimize her chances of conception, such as well lifestyle modifications that can help her have a healthier pregnancy.”
While they do not typically attend deliveries, WHNPs conduct medical checkups and provide counseling and other support to pregnant women throughout the term of their pregnancy. “At Highland Hospital, most pregnancies are managed by our wonderful midwives, so it is quite rare for me to see women during their pregnancy unless they are experiencing an acute problem such as bleeding in the first trimester, vaginitis, or an upper respiratory infection and see me in our walk in clinic,” Ms. Sherman said.
Depending on their work setting and interests, WHNPs can also participate in academic research. Nancy Riffle, MSN, WHNP-BC is a Women’s Health Nurse Practitioner who worked at Stanford University School of Medicine. In an interview with OnlineFNPPrograms.com, she described how she supplemented her clinical work at Stanford with research on in utero health conditions, and also published her findings in an academic journal. “When I was not in the clinic I did research on women exposed to diethlstibestrol in utero. We examined these women semiannually and recorded, then categorized the genitourinary changes we observed,” she said, “Our team was among the first to delineate and later publish the cervicovaginal changes apparent in young women exposed to diethylstilbestrol. Later, we gave talks around California about the research. Knowing as much as a handful of experts in the world about in utero diethylstilbestrol remains one of my career highlights.”
WHNPs do not have to work at academic medical centers in order to participate in research. Organizations such as The March of Dimes, The Mayo Clinic, and The National Institutes of Health (NIH) may provide nurse practitioners with research opportunities through grant funding or programs that focus on women’s health research. Nurse practitioners can also reach out to universities and academic medical centers in order to see what research initiatives are in progress and how they may be able to contribute.
While patient education is an inherent part of WHNPs’ clinical work, they can also participate in patient education programs that focus on empowering women to take care of their reproductive health. Responsibilities that WHNPs may fulfill when contributing to such patient education programs include conducting seminars and workshops on sexual health, effective prenatal care, post-partum depression, breast cancer awareness and detection, and other important topics within women’s health care.
When she worked at Stanford University Medical Center, Ms. Riffle participated in a prenatal education program for women from underserved communities. “During my time at Stanford, I also set up prenatal classes for low income patients who came to the clinic and hired a nurse midwife to offer the classes while patients were waiting to see a health care provider in the clinic,” Ms. Riffle told OnlineFNPPrograms.com. She also created a patient education pamphlet that elaborated on the important components of prenatal self-care. “Initially, my position was partially funded by the March of Dimes and it was a condition of their grant that I write a soft cover prenatal self care manual for our patients.”
Staff Education and Training
WHNPs can also educate and train other women’s health practitioners in their work setting and at medical facilities both nationally and internationally that would benefit from additional training in reproductive health services. In the hospital setting, WHNPs can help to develop and implement staff training programs in order to improve overall systems of care within their work environment.
As mentioned previously, WHNPs can also participate in international programs that teach health care practitioners abroad about important topics within women’s health, and essential methods for addressing specific women’s health conditions. During her work with PINCC, Ms. Sherman taught medical practitioners in several different countries how to detect and address cervical cancer. “PINCC is an organization whose members travel to parts of the world where women do not have access to cervical cancer screening and teaches medical professionals in those countries how to screen for and treat precancerous lesions,” she said, “It has been so inspiring to see how something as simple as a cup of acetic acid can literally save lives.”
The Rewards and Challenges of Advanced Practice Women’s Health Nursing
Advanced practice women’s health nursing is a challenging field in that women often face numerous social, political, familial, and financial obstacles to receiving sufficient reproductive health care. In her interview, Ms. Ashton outlined the numerous reasons why women’s health nursing is a challenging field. “There are so many barriers to face [in women’s health],” she said, “(1) Women typically put themselves last when it comes to healthcare; I see women everyday that have not seen a provider for many years because they were busy with their kids or parents. (2) Women work high demand jobs–they cannot take off work for routine care. (3) Birth control is not always covered by insurance. (4) We typically do not have every test available in one place such as a mammogram machine, lab, or mental health specialist.”
Ms. Sherman also noted how some of the severe challenges and traumas that her patients face affect her emotionally. “I think one of the most challenging aspects of the job for me, and something I continue to work on every day, is staying optimistic in the face of some really difficult truths you face every day,” she said, “Seeing women for very sensitive services can sometimes expose a lot of ugliness that is in the world around us such as rape, domestic abuse, and perpetual cycles of poverty. It can be heart wrenching at times to see what women around the world have to endure. I’ve learned to try to focus on the small things we can do, and to listen for women to tell you what it is they need rather than making assumptions.”
These challenges, though complex, pervasive, and difficult to overcome, also make the field of women’s health nursing rewarding for the impact that WHNPs can make on their patients and their families. Providing women with the space and time to properly care for themselves is a central and rewarding part of the work that WHNPs do. “My job is to provide the most comprehensive care to women yet take the time to listen to their needs and desires,” Ms. Ashton said.
Flexibility and creativity when trying to surmount the barriers that patients encounter to receiving the medical services they need can also be rewarding when one succeeds. “The most common problems affecting our patients are socioeconomic,” Ms. Sherman said of her work at the Alameda Health System, “Our hospital sees some of the most impoverished folks, some of whom have significant barriers in accessing care and perhaps have not accessed care in a number of years. It’s very challenging to provide care to people who may struggle with things that many of us take for granted, such as simply getting to the hospital for an appointment. I often have to be creative in the way I deliver care to my patient by doing follow-ups by phone, or trying to schedule multiple visits all in one day. Luckily our hospital consists of a great number of specialty providers.”
Due to the central role that many women play in the health and well-being of their families, WHNPs may also find gratification in having a far reaching impact on their community. When describing her motivations for becoming a women’s health nurse practitioner, Ms. Riffle said, “While I was in college I noted that women not only cared for their own health but for that of the family as well. In fact, sometimes they cared for their family’s health at the expense of their own. Given that big responsibility that so many mothers assumed, I believed that by dedicating my career goals to empowering women in the health care system I could have the biggest impact on the health of the family.”
Ms. Sherman similarly cited the opportunity to empower women to take care of their reproductive health in ways that had positive ripple effects on their familial and social situations as a particularly rewarding part of her work. In her interview with OnlineFNPPrograms.com, she described how learning about women’s health in nursing school propelled her into a specialization in the field. “I realized that there was a huge knowledge deficit for many women. It often stemmed from the fact that we were not empowered and comfortable asking questions when we saw our health care providers,” she said, “I realized how powerful educating a woman about her body could be in transforming so many other aspects of her life. For example, family planning can be a tremendous force in interrupting the cycle of poverty. Additionally, women who are about to have a child are on a precipice of a massive life change.”
The relationships that WHNPs form with patients through their work can also be immensely fulfilling. “Some of the most satisfying parts of my career have come about from relationships forged,” Ms. Riffle told OnlineFNPPrograms.com, and recalled patients whom she assisted at Stanford University Medical Center and during her time in private practice. “I met a young, single, pregnant junior in high school in the clinic at Stanford. I followed her through to her successful delivery of a healthy son,” she recalled, “Several years later, she had joined the Postal Service as a mail carrier and greeted me as she delivered the mail to our office! More recently, the first student I met when I started work at the high school was a young man whose mother I’d assisted through three pregnancies in the private practice.”
Advice for Registered Nurses Interested in Becoming WHNPs
Registered nurses who are interested in becoming women’s health nurse practitioners must complete a graduate nursing program in women’s health nursing that has been accredited by either the Commission on Collegiate Nursing Education (CCNE) or the Accreditation Commission for Education in Nursing (ACEN). They must also complete at least 500 hours of clinical practicum through their program, and take and pass a certification examination administered by the National Certification Corporation. Prospective WHNPs must also complete and maintain any state-specific licenses in order to practice in their state of residence.
On top of the minimum academic and examination requirements and fulfilling state-based requirements for licensure to practice, prospective WHNPs should try to seek additional ways of obtaining experience in women’s health care settings. “I would suggest trying to get a job as a nurse in women’s health: labor and delivery, mother baby, outpatient obstetrics and gynecology offices. It is truly helpful to be in your specialty area early on if you can,” Ms. Ashton advised. She also recommended that nursing students interested in women’s health nursing volunteer at community women’s health clinics and similar environments. “If you can volunteer for a family shelter service or help with teaching prenatal classes as a volunteer, I would,” she said, “While I was a student, I volunteered for a few different community outreaches and it really helps on the resume.”
Ms. Sherman recommended that students prioritize building essential skills such as effective patient interviewing, flexibility in the face of barriers to medical care, and the foundational knowledge that is essential to women’s health care over memorizing smaller details that can be easily accessed and referred to on the job. “I know it is completely overwhelming to try to learn everything. Don’t worry about memorizing treatment guidelines or algorithms. When you are in the field you can look these things up,” she said, “Practice active listening as much as you can. Try to have contact with as many patients from as many walks of life as you can.”
Once they have become certified and begun working with women in clinical settings, WHNPs should take care to develop and maintain a strong self-care plan. “[R]emember to take time for yourself,” Ms. Ashton said, “Remember that you must take care of you first before you can help anyone else: sometimes this is forgotten when you are so busy with school, work, and family.”
Through careful academic and professional preparation, attentiveness and commitment to their patients, a solid self-care plan, and vigilant maintenance of their certifications and licenses to practice, WHNPs can build a rewarding career that affords them autonomy in their work and the opportunity to have a significant impact on the women and families in their community and beyond.