Nursing advocacy at the local level: An Arizona success story

Arizona Nurse, Jan 2003 by Link, Denise

Advocacy has always been a pillar of nursing practice. The Code of Ethics for Nursing charges all nurses with the responsibility to protect the health and safety of the public and to promote the nursing profession. Recently, a group of nurses put the precepts contained in the Code into action when they petitioned a local district school board to revise a policy related to sports physicals. Through their collective efforts in advocacy and public education, the nurses were successful in convincing the school board to add nurse practitioners to the list of health professionals who can confirm that a high school student is fit to participate safely in interscholastic sports.

As in other school districts, students in the Tempe Union High School District (TUHSD) are required to have an annual sports physical to verify that they are fit to participate in interscholastic sports. The original policy that addressed this requirement, adopted in 1991, stated that a physician must perform the physical examination. The following year, the Arizona Interscholastic Athletic Association (AIAA) adopted a policy that recognized physicians, nurse practitioners, and physician assistants as health care professionals who could provide this service.

Coaches and athletic directors in the TUHSD followed the AIAA policy as the TUHSD district athletic department had been accepting sports physicals done by nurse practitioners for a number of years. In the fall of 2002, however, students enrolled in schools in the TUHSD who had their sports physicals performed by nurse practitioners had their forms returned to them. The students were informed that they would need to have their sports physical done by a physician, and have the physical form signed by a physician and returned to the athletic department before they could participate in interscholastic sports. This sudden reversal in policy took the families, the high school coaches, and the nurse practitioners that did the sports physicals by surprise.

A review of the TUHSD sports physical policy revealed that while AIAA had amended their policy to include nurse practitioners, the TUHSD statement had not been revised to reflect that change and still only listed physicians as the health professional who could verify that a student was fit to participate in interscholastic sports. An informal survey of nurse practitioners on the CAZNAP listserve revealed that throughout Arizona, nurse practitioners were doing sports physicals and that their professional opinion regarding students' ability to participate in interscholastic sports was widely accepted. It was clear that the TUHSD policy was not reflective of current practice in the state and created a barrier to students receiving care from an entire group of qualified health care professionals and perhaps their primary care provider. A delegation of nurses representing a number of nursing constituencies in the Phoenix area was quickly formed to approach the TUHSD school board about the policy and ask that it be revised to include nurse practitioners.

Deborah Mammon, RN, a district school nurse at Desert Vista High School and FNP student, contacted the school board president and was able to have the petition to change the policy placed on the agenda for the next regularly scheduled board meeting. Several nurses, including Ms. Mammon, then attended the school board meeting on September 11, 2002 prepared to testify before the board. Those in attendance included Maureen Harrison, RN, FNP, a nurse practitioner who practices in a local community health clinic that provides, among other health services, sports physicals for students without health insurance; Kathy Player, RN, EdD, president of AzNA; Pamela Kidd, RN, PhD, Associate Dean ASU College of Nursing; Erich Widemark, RN, FNP, representing the Arizona Coalition of Nurse Practitioners; Agnes Oblas, RN, ANP, a nurse practitioner in private practice who cares for a number of families with adolescents for whom she does sports physicals; Denise Link, RN, DNSc, WHNP, director of the women's health nurse practitioner program at ASU and parent of a child who attends a high school in the TUHSD.

The school board members were provided with documents from the American Academy of Nurse Practitioners and the Arizona State Board of Nursing that described the role and scope of practice for nurse practitioners as well as information about nurse practitioner program and curriculum requirements. The nurses emphasized the following points in their respective three-minute statements to the board members.

1) Nurse practitioners are recognized as qualified health care providers by both federal and state health care agencies.

2) The Arizona State Board of Nursing Nurse Practice Act grants authority to nurse practitioners to perform comprehensive health assessments as well as other procedures and services included in primary health care.

3) The education and training of nurse practitioners specifically includes instruction and practical experience in performing comprehensive health assessments for clients across the lifespan.