Copyright 2021 Society of Urologic Nurses and Associates (SUNA) All rights reserved. No part of this document may be reproduced or
transmitted in any form without the written permission of the Society of Urologic Nurses and Associates.
Defining uRologIC NuRSINg
Defining the Role of the Urogynecology Nurse
Practitioner: A Call to Contemporary Distinction
through Subspecialty Certification
Jennifer L. Cera, DNP, APRN-NP, WHNP-BC; Melanie Schlittenhardt, DNP, APRN, FNP-BC,
CUNP; Amy Hull, DNP, WHNP-BC; and Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP,
FAUNA, FAANP
Research
1.4 contact hours
Urogynecology is emerging as a subspecialty role
© 2021 Society of Urologic Nurses and Associates for nurse practitioners (NPs) whose focus is on pre-
Cera, J.L., Schlittenhardt, M., Hull, A., & Quallich, S.A. (2021). vention and treatment of female urinary and fecal
Defining the role of the urogynecology nurse practitioner: incontinence (also known as dual incontinence) and
A call to contemporary distinction through subspecialty pelvic floor disorders (PFDs). An increased demand
certification. Urologic Nursing, 41(3), 141-152. https:// for NPs with knowledge and expertise in this sub-
doi.org/10.7257/1053-816X.2021.41.3.141
specialty is projected to grow considering the preva-
lence of these conditions, the aging population, and
This is the first survey conducted to examine the role of
the current shortage of physicians who provide care
the urogynecology nurse practitioner (NP) and highlights
the need for the development of a current, distinct for this population. According to the U.S. Census
description of the sub-specialty role. Descriptive statis- Bureau, by 2030, there will be a 35% increased
tics were used to report the characteristics of the sam- demand in care for women with incontinence and
ple group (N = 55). This article reports on the urogyne- PFD, which is only expected to rise (Kirby et al.,
cology subspecialty NP role, creates a basis that can be 2013). Physician specialists, such as urologists,
used when negotiating a new position or promotion, and gynecologists, and female pelvic medicine and
provides insight into whether NPs who practice in this reconstructive surgeons (FPMRS), provide most of
subspecialty are interested in a national certification the care for these conditions. However, there is a
examination to distinguish their expertise. Proposing a
new designation that aligns with current female pelvic
medicine and reconstructive surgery (FPMRS) physi-
Jennifer L. Cera, DNP, APRN-NP, WHNP-BC, is an Assistant
cians to replace urogynecology NP is discussed as a Professor and Co-Coordinator, Women’s Health Specialty Program,
possible natural progression to define the specific University of Nebraska Medical Center College of Nursing – Omaha
knowledge, clinical competence, and aptitude needed Division, College of Nursing Science; and a Women’s Health Nurse
to practice in this field. Practitioner, Female Pelvic Medicine & Urogynecology, Olson Center
for Women’s Health, Nebraska Medicine, Omaha, NE; and is a mem-
Key Words ber of the Urologic Nursing Editorial Board.
Clinical competence, advanced practice provider, Melanie Schlittenhardt, DNP, APRN, FNP-BC, CUNP, is a Family
workforce, specialty practice, urology, women’s health, Nurse Practitioner and Co-Owner of an independent continence clin-
urodynamics, ambulatory care, urogynecology. ic, Pelican Health, Bismarck, ND.
Amy Hull, DNP, WHNP-BC, is an Assistant Professor of Clinical
Obstetrics and Gynecology, Vanderbilt University Medical Center,
Nashville, TN.
Susanne A. Quallich, PhD, ANP-BC, NPC, CUNP, FAUNA,
FAANP, is an Assistant Professor of Urology and Andrology Nurse
Practitioner, Division of Andrology, General and Community Health,
Department of Urology, University of Michigan Health System, Ann
Arbor, MI; Fellows Taskforce Chair, Fellows of the Academy of
Instructions for NCPD Contact Hours Urologic Nurses and Associates (FAUNA); and Editor, Urologic
UNJ 2104 Nursing.
Nursing continuing professional development (NCPD) contact
Editor’s Note: Findings of the study do not necessarily reflect the
hours can be earned for completing the learning activity
opinions of SUNA. The views expressed herein are those of the
associated with this article. Instructions are available at
authors, and no official endorsement by SUNA is intended or should
suna.org/library
be inferred. This article was vetted through the journal’s standard,
Deadline for submission: June 30, 2023 blinded peer review process.
UROLOGIC NURSING / May-June 2021 / Volume 41 Number 3 141
, Copyright 2021 Society of Urologic Nurses and Associates (SUNA) All rights reserved. No part of this document may be reproduced or
transmitted in any form without the written permission of the Society of Urologic Nurses and Associates.
Research
Research Summary
Introduction participants (79.9%) support subspecialized certification,
There is little discussion of nurse practitioner (NP) sub- and the importance of a national certification examination
specialty roles in the literature and very minimal specific to was deemed as moderately, very, or extremely important by
urogynecology. This article presents data relative to the 70% of respondents. Most respondents work collaboratively
urogynecology NP position, including interest in a national with physician colleagues. Results also detail an initial
certification to define and clarify its unique role. overview of general women’s health and role-specific urog-
ynecology responsibilities and procedures needed to pro-
Methods vide competent, comprehensive care.
A convenience sample was obtained via five online
platforms, along with encouraging respondents to forward Conclusion
the survey link to colleagues (snowball sampling), to attempt This is the first survey to be completed that reports
to access as wide a sample as possible. exclusively on the subspecialty role of the urogynecology
NP. This provides additional support for the ongoing evolu-
Sample tion and viability of a national certification examination that
Only NPs working in urogynecology environments were can provide an avenue for a contemporary distinction and
eligible, regardless of years of experience. title. An additional study with a larger, more representative
sample is warranted to develop curricula and move toward
Results implementing a national certification examination.
A total of 55 NPs completed the survey, representing a
Level of Evidence: III-A
range of states and practice experience, as well as experi-
enced and recent graduate NPs. Sample demographics Source: Johns Hopkins Hospital/Johns Hopkins University,
were similar to national and women’s health NP results, 2016.
although our sample was slightly younger. The majority of
deficit of urologists (American Urological Associa- the years changed names as the subspecialty
tion [AUA], 2018) and gynecologists (Vetter et al., evolved into what is now known as the American
2019) in the United States. Even though the projec- Urogynecologic Society (AUGS). Expertise within
tion of FPMRS physicians is anticipated to increase, this field has grown exponentially over 50-plus
the physician/patient ratio will remain steady at its years, and several other organizations have originat-
current level (Brueseke et al., 2016). ed for the common goal to promote education,
A hallmark of the NP profession is health pro- research, and collaboration within this subspecialty,
motion and disease prevention, along with serving such as the Society of Urodynamics, Female Pelvic
as primary care providers in the assessment, diagno- Medicine and Urogenital Reconstruction (SUFU);
sis, and management of health care conditions. the International Continence Society (ICS); and the
Recent research in urogynecology emphasizes the International Urogynecological Association (IUGA),
need for prevention. Numerous medical entities, to name a few. The establishment of these organiza-
such as the National Institute of Diabetes and tions only validates the significance of this niche of
Digestive and Kidney Diseases (NIDDK) initiation of medical exigence and expertise. Finally, a collabora-
the Prevention of Lower Urinary Tract Symptoms tion between the Board of Obstetrics and Gyne-
(PLUS) network in 2015 (Harlow et al., 2018), the cology and the Board of Urology enabled the devel-
National Institutes of Health (NIH) in 2011, the 5th opment of a physician certification examination;
International Consultation on Incontinence in 2012 competency in this subspecialty now requires a fel-
(Dumoulin et al., 2016), and the Agency for lowship and board certification in FPMRS.
Healthcare Research and Quality (AHRQ) (2013) Advanced practice registered nurses (APRNs),
recommend pelvic floor health promotion by which include NPs, have long held a pivotal role in
addressing modifiable risk factors to prevent the providing health care within the urogynecology sub-
onset of urinary incontinence. specialty; however, to date, a certification examina-
tion that ascertains the advanced didactic and clini-
cal expertise has not been developed. Instead, NP
Background: History of Urogynecology core curriculum requirements and standardization
and Female Pelvic Medicine have been used as a springboard for the subspecialty
The creation of urogynecology began in the field education that the urogynecology NP has had to
of medicine with a few founding surgeons who seek independently and informally.
believed strongly that treatment of female inconti- Nurse practitioners begin with a Bachelor of
nence and PFDs become a subspecialty of obstetrics Science in Nursing (BSN) degree that provides a
and gynecology. A small gathering of founders at foundation of patient care assessment, pathophysi-
first, they formed a non-profit organization that over ology, and pharmacology, and focuses on the art of
142 UROLOGIC NURSING / May-June 2021 / Volume 41 Number 3
